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Commons Chamber

Volume 726: debated on Tuesday 24 January 2023

 House of Commons

Tuesday 24 January 2023

The House met at half-past Eleven o’clock


[Mr Speaker in the Chair]

Oral Answers to Questions

Health and Social Care

The Secretary of State was asked—

Ambulance Services: Strikes

We have introduced a range of contingency measures, such as the provision of military personnel, who are available to assist with the driving of ambulances, and community first responders, who can help before ambulances arrive on the scene.

Will my right hon. Friend join me in thanking call handlers at the South Western Ambulance Service NHS Foundation Trust—and the public—for halving the number of 999 calls to the trust over the last month, and reducing average call answering times by 95%, to just three seconds? Will he also join me in expressing dismay at the approach taken by the Leader of the Opposition during the most recent session of Prime Minister’s Question Time in seeking to sow fear in the hearts of my constituents and others for his own narrow political gain?

I am happy to join my hon. Friend in paying tribute to the work of call handlers at the South Western Ambulance Service, and to the staff there as a whole. He is right to draw attention to the improved performance that we have seen in recent weeks, and also right to point out that all parts of the United Kingdom have faced considerable challenges, particularly over the Christmas period when we saw a significant spike in flu levels.

We have just heard in the Health and Social Care Committee that on strike days there was a drop in service demand, but also value added by the increased clinical support, resulting in better and more cost-effective decisions. Why does that happen on strike days rather than on every single day of the year?

We are taking a number of steps to improve performance, and not just on strike days—but I thought the hon. Lady was going to refer to the comment that she made about those on her own Front Bench, when she said:

“I think what our health team need to do is really spend more time in that environment with clinicians to really understand what drives them.”

We on this side of the House are spending a significant amount of time with clinicians, and it is important that those on the hon. Lady’s Front Bench do so as well.

NHS Workforce: Retention and Recruitment

The long-term workforce plan that is being developed by NHS England will help to ensure that we have the right staff numbers with the right skills to deliver high-quality services in the future.

Is the Secretary of State fully aware that under this Government every part of the NHS is in crisis? Are the Government satisfied with the fact that, as medical students in their second year told me recently, the shortage of staff on hospital wards and the pressures on those wards are affecting their training? The students also told me that they had little aspiration to work as junior doctors in the UK after qualifying, because of the acute strain on the NHS and because they felt undervalued. Does the Secretary of State know about this, and what is he going to do about it?

We see a considerable number of applications for medical undergraduate places, far in excess of the number of places available. We have boosted the number of places—[Interruption.] The hon. Member for Ilford North (Wes Streeting) chunters from the Opposition Front Bench, but when I was last in the Department and the Chancellor had my role, we increased the number of medical undergraduate places by 25%. Indeed, we have more doctors and nurses than we had last year, and 3.5% more full-time equivalent staff: we have over 42,000 more people working in the NHS than we had last year.

The British Heart Foundation has reported that by the end of August 2022 a record 346,000 people were waiting for heart care. Despite the best efforts of NHS staff, workforce shortages are affecting primary and secondary care services. Can the Secretary of State explain how the Government’s comprehensive NHS workforce plan will address specific gaps in the workforce, especially those in cardiology services?

The hon. Gentleman has raised an important issue. I think that, in particular, we should look at our approach to major conditions, and I will say more about our thinking in that regard at the start of topical questions. I also think that we need to look at the issue of heart conditions in the context of the wider debate about excess deaths; we know that there is a particular issue in the 50 to 64-year-old cohort. As well as providing those extra doctors and clinicians—and from next autumn we will also have the additional medical doctor degree apprenticeship route—we need to look at methods of upstream testing, particularly in respect of heart conditions.

In reference to my right hon. Friend’s earlier answers, we are keen to see the success of the new Lincoln medical school leading to more locally trained NHS professionals working across Lincolnshire. What more can the Government do to remove barriers to entry to ensure that anyone who can do so is able to train to become a doctor, nurse, dentist or dental nurse in our NHS, specifically in Lincoln and Lincolnshire?

My hon. Friend raises an important point on two levels. The first relates to how we boost recruitment in areas such as Lincolnshire, and the new medical school in Lincoln will play a key part in that. The second relates to how we increase the retainability of staff in those parts of the country, and having more on-the-job training and apprenticeships is a key way of doing that. That is why things like the new medical doctor degree apprenticeship will be particularly relevant to cohorts of the population in areas such as Lincoln.

One of the biggest issues my local hospitals raise with me in outer London is the impact of Sadiq Khan’s ultra-low emission zone expansion, with nurses and other staff facing charges of £12.50 per shift or £25 if they are working nights. Given that 50% of London’s emergency service workers live outside the capital, does the Minister agree that the Mayor and the Labour party should stop ignoring Londoners and drop their ULEZ tax rate?

My hon. Friend raises an important point about the additional costs that the London Mayor is imposing not just on NHS staff but on all staff working in the capital, in contrast to the approach the Chancellor has taken to energy support to help staff across the workforce, including in the NHS, with the cost of living.

Most of the GP practices in South West Devon report to me that their biggest challenge is recruiting new doctors. Does my right hon. Friend have an estimate of the number of young doctors finishing their training this year who are likely to want to become GPs, and can he reassure us that that is a greater number than the number who are likely to retire in the next 12 months?

My hon. Friend raises two important themes. The first relates to how many are in training, and I think it is around 4,000. We have boosted the number of GP training places and we have looked at medical schools as a specific issue. Also, he will have seen some of the changes being made around pensions in order to better retain staff, mindful of those clinicians who are leaving the profession, and further discussions are taking place with Treasury colleagues in that regard.

In Shropshire there are 14% fewer GPs and 29% fewer GP partners than in 2019, yet in the period from April to November 2022, they provided 6% more appointments. It is this additional workload that is causing burnout in GP practices and a flight from the profession. What is the Secretary of State doing to improve the retention of GPs as well as recruitment?

It is important to look at the number of doctors in general practice, and those numbers are up. There are 2,298 more than there were in September 2019, so we are increasing the number of doctors. What is also important is getting the right care at the right time within primary care, which is about the wider workforce—the paramedics, the mental health support and others working in primary care—and there are an extra 21,000 there. This is enabling GPs to see more patients a day and allowing more patients to get the right primary care, perhaps not from a doctor but from others who can offer specialised support.

One of the best ways to improve recruitment and retention is to make sure that staff have an excellent working environment, which is why I campaigned for a new urgent and emergency care department at Walsall Manor Hospital. I was successful, and it is opening in March. Will one of the ministerial team join me to celebrate this success?

I welcome my hon. Friend’s drawing attention to the investment that has been made, which is in no small part due to his campaigning and championing his constituents, as he does so assiduously. I think the Minister of State, Department of Health and Social Care, my hon. Friend the Member for Colchester (Will Quince) has plans to join him to mark the opening of that important facility, which shows our investment in the estate within the NHS.

One way to improve retention and recruitment of NHS staff at Northwick Park Hospital, which serves my constituency and which I believe the Secretary of State visited last Thursday, would be to invest in doubling its intensive care beds. Did the Secretary of State discuss that issue with the chief executive of Northwick Park when he visited last week? Will he tell us when he might be able to announce funding for the new 60-bed unit that Northwick Park needs?

The hon. Gentleman is right to highlight the importance of bed capacity at Northwick Park, but my discussions with the chief executive were more in the context of how step-down capacity will relieve pressure on A&E. The hon. Gentleman will know that Northwick Park has one of the busiest, if not the busiest, A&Es in London on many days, and the chief executive spoke to me about the value of adding extra bed capacity from a step-down perspective, much more so than from an intensive-care perspective. If there are specific issues for intensive care, I am happy to follow them up with the hon. Gentleman.

In mental health we rely on staff, not shiny machinery, so why is the Secretary of State rehashing old announcements and scrapping plans? It is because the Government have run out of ideas. Labour has a plan. We will recruit 8,500 more mental health professionals, ensuring a million more patients get treated every year. We will double the number of medical school places. We will train 10,000 extra nurses and midwives every year, and we will focus on retaining the fantastic staff we already have. Where is the Government’s plan? We have had our plan for two years, but they are binning theirs.

It is slightly odd for the hon. Lady to talk about a plan when she does not agree with the plan of the shadow Health Secretary, the hon. Member for Ilford North (Wes Streeting). He plans to use the private sector, which he describes as “effective and popular,” whereas the hon. Lady said:

“In my own brief in mental health we have use of the private sector, which ultimately often lets patients down.”

First, the hon. Lady does not agree with the shadow Secretary of State. [Interruption.] The hon. Lady chunters, but she asked about a plan when she does not agree with her own Secretary of State.

Secondly, the hon. Lady talked about shiny new equipment. I am delighted that she allows me to draw the House’s attention to yesterday’s announcement of a fleet of 100 new mental health ambulances, which will relieve pressure on A&E. I am delighted that she gave me an open door to highlight that investment, which is part of our £2.3 billion investment in mental health.

Women’s Health Strategy for England

Last summer we published the first Government-led women’s health strategy for England, which sets out our 10-year ambition to boost the health and wellbeing of women and girls and to improve how the health and care system listens to them. I am pleased that we have set out the first eight priorities for the first year of the women’s health strategy, and that we are already delivering on many of them.

After 13 years of Conservative Government, more than half of maternity units now consistently fail to meet safety standards. Almost 40,000 women now wait over a year for gynaecological treatment, up from just 15 women 10 years ago. Women in the poorest areas are dying earlier than the average female in almost every comparable country. At every stage of a woman’s life, her health is being compromised. When will these failures be reversed, and when will we see real investment in the NHS workforce and in women’s health?

I am sorry that the hon. Lady does not welcome our announcement of this country’s first women’s health strategy, which is putting women as a priority at the heart of the health service.

We have eight priorities for this year. We are rolling out women’s health hubs around the country as a one-stop shop to make healthcare more accessible to women. We are improving women’s health provision by setting out a women’s health area, with reliable information, on the NHS website. We are working with the Department for Work and Pensions to support women’s health in the workplace. We are recognising pregnancy loss by developing the first ever pregnancy loss certificate for babies who are born and lost before 24 weeks. We are improving and standardising access to in vitro fertilisation for same-sex couples around the country. And we are launching the first ever hormone replacement therapy prepayment certificate in April. That is some of the work we are doing, and I am disappointed the hon. Lady does not recognise that effort.

A stated intention of the women’s health strategy is to explore mechanisms to publish national data on the provision and availability of IVF, on which there has since been no Government progress. This issue affects families and would-be parents across the country. We know all too well that a postcode lottery exists, and it is just not good enough. Will the Minister support my private Member’s Bill to address this issue, which is due to have its Second Reading on 24 March?

I pay tribute to the hon. Lady for the work she is doing in this space. I was in the Chamber when she presented her Bill last week and I can reassure her that, as part of the work we are doing with integrated care boards, we are collating and publishing data on the commissioning of fertility services, so that women in each part of the country can not only see what services are available to them, but compare what is being offered locally. That is happening in England; I cannot comment about what is being done in Wales. Let me also say that the Human Fertilisation and Embryology Authority is publishing data about add-ons, which I know is a particular interest of hers. We want to make sure that that information is available on the NHS, so that women can make an informed decision.

I welcome that update, and the tone and, as always, the calm confidence with which the Minister provides it. Does she agree with me and with the Chancellor that the NHS has to help people back into work?

I thank my right hon. Friend for her kind words. I absolutely agree on that, which is why helping women back into work and dealing with their health issues in the workplace is one of the first eight priorities of the women’s health strategy. We are working with colleagues in the Department for Work and Pensions on that. Last night, I had a roundtable with tech and STEM— science, technology, engineering and maths—employers, and they were desperate to keep their women in the workforce and to recruit more. Whether we are talking about young women who need support as they go through endometriosis or IVF treatment, or older women who are dealing with the menopause, we are absolutely committed to supporting women’s health needs in the workplace.

I welcome the recent announcement of enhanced breast cancer facilities at Kettering General Hospital. Is that not just the sort of extra investment we need to improve the delivery of women’s health services?

I thank my hon. Friend, who has always been campaigning for better health services in Kettering. Let me reiterate what he has just said: that announcement followed the announcement last week of £10 million for NHS breast screening services, to provide 29 new mobile units and static breast care units across England.

The women’s health strategy was an opportunity to fundamentally change the inequalities women face. Women were promised a clinical women’s health lead in the NHS, yet a former Health Minister, the hon. Member for Sleaford and North Hykeham (Dr Johnson), admitted that there has not even been a discussion about establishing the role. Women in east Kent were promised change after the damning review of local maternity services, yet the Care Quality Commission is now threatening the trust there with enforcement action. Time after time, women’s voices are at best being ignored and at worst being silenced. So I ask the Minister: when will this Government stop letting women down with empty promises? Is the women’s health strategy worth the paper it was written on?

Perhaps the shadow Minister will reflect on her comments when she receives the “Dear colleague” letter later today outlining the eight priorities areas for our first year of the strategy, with work such as the prepayment certificate for hormone replace treatment being done already; it is launching in April and saving women hundreds of pounds on the cost of HRT. May I say that I am gobsmacked by the Labour party’s position on this? Not only does it struggle most days to define what a woman actually is—for reference, it is a female adult human—but it cannot stand up for women either. There was no greater example of that than what we saw in this Chamber last week, when Labour Members were heckling the hon. Member for Canterbury (Rosie Duffield) and intimidating my hon. Friend the Member for Penistone and Stocksbridge (Miriam Cates). Come back to us when the Labour party is reflecting on the behaviour of its own MPs before dictating to us.

Access to GPs

We recognise that increased demand has had an impact on GP services. That is why we are investing at least £1.5 billion to create an additional 50 million GP appointments by 2024.

There is a clear failure to invest in critical infrastructure across the primary care estate, for example, in modernising in-patient mental health services and GP hubs. To make matters worse, Government bureaucracy is holding up capital funding allocations. My constituents deserve better community care and hospitals need relief, so when will the Government finally release the funding to build the facilities desperately needed in Bedford and Kempston?

We have literally just heard in this questions session from my hon. Friend the Member for Walsall North (Eddie Hughes) about the investment the Government are making in infrastructure across the NHS. That is why we have also, alongside the investment we are making in primary care, invested in the new hospitals programme, as part of this Government’s commitment to the NHS estate.

Since the beginning of January, Gosport patients have learnt that one of our GP practices is threatened with closure, while another is about to merge with an already very subscribed group of practices. Partners are retiring, with no replacements. Will the Secretary of State confirm what he is doing to ensure that my constituents can access a GP? Will he please meet me to discuss this issue?

My hon. Friend raises an important point, and we are investing over a fifth more than in 2016, as part of our wider investment programme. I am very keen to work with her on the role of her ICB. It was set up operationally last summer, and its role is to commission primary care services for the community and to assess the needs of her Gosport constituents. I am very happy to work with her and her ICB on the issues she raises.

Hull has the second highest ratio of GPs to patients in the country. Even though GPs see 46 people a day on average, it is clear that demand for their services outstrips supply. Of course the Labour Government will have a plan to resolve this, but in the meantime will the Secretary of State look at giving women direct access to specialist nurses and services, such as endometriosis or menopause specialists, to prevent them from having to go via their GP each time they need renewed treatment and updated medication?

First, that is exactly what the women’s health strategy is doing through designing women’s health hubs. It is exactly why we are appointing a wider portfolio of roles into primary care. The hon. Lady says that Labour has a plan, but Labour’s plan is to divert £7 billion out of primary care property, which will not improve services for women and will actually impede the ability to deliver exactly the sort of services she is calling for.

Thornton Cleveleys will see a 17% increase in new patients registering for primary care in the next five years, exceeding the physical capacity. Cost-effective solutions have been found, but the obstacle is the integrated care board, which keeps changing its mind as to whether money is or is not available. The clock is ticking on the need for this new capacity. Will the primary care Minister meet me to resolve this impasse and get the ICB to sort its act out?

My hon. Friend brings welcome transparency to the issue. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien) was listening intently, and is nodding his head about meeting him to discuss it.

Access to NHS Dentistry

The Government are working to improve access. We have made initial reforms to the contract and created more unit of dental activity bands to better reflect the fair cost of work and to incentivise NHS work. We have introduced a new minimum UDA value to help sustain practices where they are low, and we are allowing dentists to deliver 110% of their UDAs for the first time to deliver more activity. Those are just the first steps; we are planning wider reforms.

On 20 October, the House passed a motion highlighting the continuing crisis in NHS dentistry and calling on the Government to report to the House in three months’ time on their progress in addressing this crisis. That time has now elapsed. I am grateful to the Minister for that update, but can he confirm that the Government will be producing a comprehensive strategy for the future of NHS dentistry, and can he inform the House when it will be published?

It was very useful to meet my hon. Friend the other day, who is a great expert on this issue. As he knows, we are working at pace on our plans for dentistry. As well as improving the incentives to do NHS work, we are working on the workforce to make it easier for dentists to come to the UK. We laid draft secondary legislation in October to help the General Dental Council with that. We are working on our plans for a centre for dental development in Ipswich and elsewhere in the east of England, as he knows. Although we have not yet set a date to set out the next phase of our plans, my hon. Friend knows from our meeting that this is a high priority area for us and that we are working on it at pace.

I was contacted recently by my constituent Helen, who said:

“I don’t know what to do. I have phoned 25 dental practices today and been told the same thing each time: all we can do is put you on a 3 year waiting list.”

What does the Minister say to Helen and the thousands who, like her, cannot access an NHS dentist? When will he get a grip on this crisis?

We are the first to say that the current situation is not satisfactory. That is why we invested an extra £50 million in the last quarter of last year, and it is why we are working at pace. Let us be clear: dentistry has not been right since Labour’s 2006 contract, and until we fix the fundamentals of that and the problems set up by the Opposition, we will not tackle the underlying problem.

NHS Beds: Alexandra Hospital

7. What steps his Department is taking to increase the number of NHS beds available in the Alexandra Hospital in Redditch. (903223)

Right now, we are putting an extra £750 million into our health and social care system to free up beds in hospitals. Looking ahead, we will shift the dial on the decades-old problem of delayed discharge by properly planning for discharge, making more care available at home, and joining up health and social care in a way that has never been done before. That is how we are freeing up beds in hospitals such as the Alexandra in Redditch.

I thank the Minister for that answer. In Worcestershire, we warmly welcome the £2.6 million that has been allocated as our share of the discharge fund. Will the Minister set out when my constituents who use the Alexandra will start to see these changes flowing through? What practical changes will they see and what impact will there be on waiting times and waiting lists?

I thank my hon. Friend for her excellent and important question about her local share of the £750 million of extra funding for discharge this winter. I can tell her that, in Worcestershire, money is already going into extra placements in homecare, community care and care homes, and into providing practical support to help people when they get home from hospital, in partnership with the voluntary sector. I assure her that we will publish the spending plans for her area and the rest of the country shortly.

Excess Deaths: Policy Implications

13. What assessment he has made of the implications for his policies of the number of excess deaths in 2022. (903229)

Excess deaths data are published on the website, which was most recently updated on 12 January. They show that causes of death from conditions such as ischemic heart disease contributed to excess deaths in England in the past year.

The UK’s all-cause mortality for working-age people was 8.3% above the average for the previous five years and the fifth highest in Europe. On top of that, excess deaths are disproportionately experienced by the most deprived and by people of African, Caribbean and Asian descent. Given that these figures are driven by structural inequalities, and that those inequalities are getting worse—the richest 1% have bagged nearly twice as much wealth as the remaining 99% in the past two years—does the Minister think that it is appropriate to recommend that people pay for their GPs?

The Government are not recommending that people pay for their GPs. In fact, we are investing more in primary care than ever before, unlike the shadow Secretary of State who wants to dismantle the GP system and privatise the healthcare system as well. I think the hon. Lady needs to have a conversation with those on her own Front Bench. Not only did the shadow Secretary of State insult primary care teams for running up their vaccination programme, calling it “money for old rope”, but we are the ones who are investing in primary care services and making them more accessible to people.

According to Cancer Research and Action on Smoking and Health, smoking costs the NHS in Stockton £9 million a year and social care £5 million a year, and it costs some £47 million in lost productivity, unemployment and premature deaths. Assuming that one day soon we will get the Government to back a control plan, will Ministers ensure that it includes the desperately needed funding for local smoking cessation services?

Local decisions on public health are taken by local commissioning groups and local authorities, and it is for each local area to decide how it spends the money on public health.

The chief medical officer recently warned that non-covid excess deaths are being driven in part by patients not getting statins or blood pressure medicines during the pandemic. However, when looking at the data on statins on, which is based on monthly NHS prescribing, there appears not to be a drop, so where is the evidence? If there is none, what is causing these excess deaths? Will the Minister commit to an urgent and thorough investigation on the matter?

We are seeing an increase in excess deaths in this country, but we are also seeing that in Wales, in Scotland, in Northern Ireland and across Europe. There is a range of factors. As we saw, there was an increase in December in the number of people being admitted with flu, covid and other healthcare conditions. That was seen not just in this country, but across Europe.

The Office for National Statistics has not issued mortality data by vaccination status since 31 May last year. Will the Minister confirm that her Department has collected that data for the rest of 2022 and inform the House when it will be published?

I am happy to write to the hon. Gentleman with that information. However, I must be clear that we planned for an increase in admissions this winter. That is why we got on and delivered on our plans for 7,000 extra beds, and why we brought forward our flu and covid vaccination programme and lowered the age of eligibility. There are a number of factors, and they are the same factors that have driven excess deaths across the United Kingdom and across Europe.

There were 50,000 more deaths than we would otherwise have expected in 2022. Excluding the pandemic, that is the worst figure since 1951. The Health Secretary—part man, part ostrich—says he does not accept those figures, but as many as 500 people are dying every week waiting for essential care, and we are still getting the same old Tory denial and buck-passing. In her answer, will the Minister finally take some responsibility, accept the ONS excess deaths figure, and recognise the damage that she and her Government are doing to our NHS?

I prefer to deal with facts rather than—[Interruption.] The BMJ has ranked the UK mid-table in Europe for mortality figures, which makes it comparable with Italy. In fact, Germany has higher excess deaths, at 15.6%, as do Finland, at 20.5%, and Poland, at 13.3%. However, if the hon. Gentleman wants to hear about what is happening in Labour-run Wales, the statistics available on the website show that Wales, in December, had the highest number of red calls ever and that only 39.5% received a response within eight minutes—the lowest figure on record. Those are clinical reasons for excess deaths, not political ones. Perhaps the hon. Gentleman needs to recognise that fact.

Impact of Brexit: Recruitment

9. What recent assessment he has made of the potential impact of the UK’s departure from the EU on recruitment in the health and social care sector. (903225)

15. What recent assessment he has made of the potential impact of the UK’s departure from the EU on recruitment in the health and social care sector. (903231)

We have record numbers of staff in the NHS in England. We are on track to hit our target of 50,000 more nurses since 2019. Speaking of 50,000, there are more than 50,000 more people working in social care since 2016. We are boosting the home-grown workforce, recruiting from the EU and welcoming health and social care workers from all around the world.

It is undeniable that EU-trained medics and social care staff face extra bureaucracy and higher costs as a direct result of Brexit, making working and staying in the UK a much less attractive option. Given the pressures on all four NHSs and the social care sector, we cannot afford to turn anybody away right now, so what discussions has the Minister had with the Scottish Government about removing the barriers that the hostile environment places on people who want to come here, work and contribute to our NHS and social care sector in Scotland?

Of course the hon. Lady would like to make everything about either Brexit or the Union—or, most often, both—but the fact is that a doctor, nurse or care worker from the EU who wants to work here can do so. We are also welcoming people from the rest of the world, and there are 12,000 more staff in the NHS in England from EU and European economic area countries since the referendum.

In the Baillieston area of my constituency, one of the biggest issues people raise with me is the difficulty in accessing GPs. Part of the problem is that we do not have enough GPs. The Royal College of General Practitioners shows that 49% of EU-trained medics experienced issues with their visas, which led 17% of them to think of leaving the UK altogether. When will the Minister grasp this issue, speak to the Home Office and get rid of the hostile environment that means many of my constituents do not get access to the GPs they need?

If the hon. Gentleman had been listening to earlier questions, he would have heard about the increased number of GPs in England, with more than 2,000 more GPs now working in England. Coming to the question of the NHS in Scotland, which is of course run by the SNP-led Scottish Government, I have heard that NHS Scotland is “haemorrhaging” staff, in the words of the chair of the British Medical Association in Scotland.

With more than 4,000 fewer specialist doctors from the EU or the European Free Trade Association in the UK than in pre-EU referendum trends, there is clear evidence that shutting off free movement is a totally unnecessary barrier to recruitment for our care and health services. Have the Minister and Secretary of State made representations to the Cabinet to discuss the disastrous effects of Brexit on the UK?

Yet again, an hon. Member from the SNP thinks it is all to do with Brexit, when the facts show that that is simply not the case. As I said a moment ago, 12,000 more staff from EU and EEA countries are working in the NHS in England since the referendum. However, I point the hon. Gentleman yet again towards his own party’s record in government in Scotland and the problem of the NHS in Scotland haemorrhaging staff.

Covid-19 Backlog: Elective Care

Since the publication of the elective recovery delivery plan, the NHS has virtually eliminated two-year waits for treatments and is making progress on tackling the next ambition of ending waits of over 18 months by April. To support those efforts, NHS England recently wrote to providers mandating action on 18-month waits. We agreed that appointments must be scheduled as soon as possible to enable that target to be met.

The people of Peterborough are looking forward to their new NHS community diagnostic centre supplying an extra 67,000 tests, scans and checks each and every year, but that will shine a light on the need to power through our covid elective backlog. At the Royal Free Hospital, many cases that were previously treated as elective overnight stays are now treated as day cases, improving patient experience and increasing capacity. How will the Minister ensure that such innovation is spread across the NHS?

My hon. Friend is absolutely right to raise this issue, and to highlight the difference being made by the 89 community diagnostic centres that have already been rolled out and the importance of getting up to 160 centres as quickly as possible. He is right that such innovations, including CDCs, surgical hubs, telemedicine and, of course, using spare capacity in the private sector, are helping us to tackle the longest waits and reduce the covid backlogs, and I very much thank him for his support in that endeavour.

There are almost 20,000 people on the waiting list for treatment at Barnsley Hospital, but at the beginning of this month, 98% of the hospital’s beds were occupied. How does the Government expect that hospital to solve the treatment backlog when it simply does not have the resources?

We are increasing capacity by introducing an additional 7,000 beds and the £500-million discharge fund. In addition to that, an extra £250 million was announced in January. Over and above that, alternative capacity is being created through the independent sector, we are engaging with patients on choice, and we are working with the most challenged trusts. Of course, I understand the impact that this has on patients, and we are working hard to address the backlog.

Ministers will never deal with the record waits for NHS treatment until they stop older people being stuck in hospital because they cannot get decent social care in the community or at home. Does the Minister understand that this is not just about getting people out of hospital, but about preventing them from being there in the first place? Is he aware that more than half a million people now require social care but have not even had their needs assessed or reviewed? Where on earth is the Government’s plan to deal with this crisis, which is bad for older people, bad for the patients waiting for operations and bad for taxpayers?

As I said, we are creating 7,000 additional general and acute beds. We are investing £500 million in adult social care specifically for discharge, and that goes up to £600 million next year and £1 billion the year after. There is also an extra £250 million. The hon. Lady asks specifically about adult social care. That is exactly why the Chancellor announced £7.5 billion in the autumn statement—the largest investment in social care ever.

GP Appointments: Chesterfield, Derbyshire and England

11. If he will make an assessment of the adequacy of GP appointment availability in (a) Chesterfield constituency, (b) Derbyshire and (c) England. (903227)

In November, there were 13.9% more appointments in general practice across England as a whole than in the same month before the pandemic. In Derby and Derbyshire, there were 16.6% more appointments. Our GPs are doing more than ever, and, compared with 2015-16, we are investing a fifth more in real terms. But we know that demand is unprecedented, and we are working to further support our hard-working GPs.

I thank the Minister for that answer. We know that there are GP appointment difficulties everywhere, but we also know that it is much more difficult in more deprived communities. Social Market Foundation research shows that GPs in more deprived communities have twice as many patients on their books than those in more affluent areas. This means that, in addition to the greater health inequalities in those communities, people are finding it very difficult to get appointments, including at the Royal Primary Care practice in Staveley. Why should patients in more deprived communities be expected to tolerate far greater difficulties in getting GP appointments than those in more affluent areas?

In Derby and Derbyshire, for example, there are 495 more doctors and other patient-facing staff than in 2019. Step 1 is to have more clinicians, which we are doing through that investment. The hon. Member raises a point about Carr-Hill and the funding formula underlying general practice. There is actually heavy weighting for deprivation, and the point he raises is partly driven by the fact that older people tend not to live in the most deprived areas, and younger people tend to live in high IMD—index of multiple deprivation—areas. That is the reason for the statistic he used. Funding is rightly driven by health need, which is also heavily driven by age. We are looking at this issue, but the interpretation he is putting on it—that there is not a large weighting for deprivation—is not quite right.

In south Derbyshire there are now 133 more full-time equivalent clinical staff in general practice than in 2015. That includes nurses, physios and clinical pharmacists. What more is my hon. Friend doing to encourage more people to book an appointment with the most appropriate healthcare professional, rather than simply defaulting to booking a GP appointment?

That is an excellent question. As well as having an extra 495 staff across Derby and Derbyshire, it is crucial that we use them effectively by having good triage. That is why we are getting NHS England to financially support GPs to move over to better appointment systems. That is not just better phone systems, but better triage.

Topical Questions

I am pleased to announce that we will be developing and publishing a major conditions strategy. Around 60% of disability-adjusted life years in England are accounted for by just six conditions: cancer, cardiovascular disease, chronic respiratory disease, dementia, musculoskeletal disease and mental health. An increasing number of us live with one or more of these conditions. Tackling them is a significant opportunity to improve the lives of millions of people and to support our goal to improve healthy life expectancy.

This work will bring together our existing commitments to develop plans for mental health, cancer, dementia and health disparities, and our new strategy will shift our focus on to integrated, whole-person care, with a focus on prevention, early detection and the use of innovative technology to improve patient outcomes. It will also improve how the NHS functions, relieving pressure on hospitals, promoting integration and putting us on a sustainable long-term footing.

We look forward to involving partners in the NHS, the charitable and voluntary sector and industry in developing this important work. Further detail about the strategy is included in my written statement published today. The statement also confirms that we will publish a suicide prevention plan this year, building on the important work of my predecessor, my right hon. Friend the Member for Bromsgrove (Sajid Javid), and I look forward to updating the House in due course.

During the passage of the Health and Care Bill in 2021, safe staffing levels in the NHS came up, and the Government told us then that they

“do not believe that there is a single ratio or formula that could calculate what represents safe staffing.”––[Official Report, Health and Care Public Bill Committee, 27 October 2021; c. 773.]

Is the truth not that the Strikes (Minimum Service Levels) Bill is not about safe staffing levels, but about preventing nurses, doctors and paramedics from exercising their fundamental right to withdraw their labour, because they have lost all confidence in this Government?

The hon. Gentleman is right to say that it is a fundamental right that people are able to strike, and the legislation will balance that right, in the same way that other countries in Europe do, with minimum safe staffing levels. That is something that the French, the Italians and many other European countries have, and the Bill is simply bringing the NHS into line with other health systems.

T3. Wrexham Maelor Hospital was built in 1934 and is no longer fit for purpose. It has been divided and sub-divided with modular add-ons. It is a labyrinth of rooms, ageing departments and corridors. I trained there as a nurse in 1990 and returned during covid, and there has been little improvement. It is no longer fit for a new city. Healthcare is devolved in Wales. The Welsh Labour Government have received the largest funding settlement since devolution began, so will the Minister agree that Welsh Labour needs to listen to the people of Wrexham and build us a new hospital? (903244)

My hon. Friend makes an extremely powerful point. I hope the Labour-run NHS in Wales takes heed of her comments. She brings professional experience to this issue and is absolutely right that there needs to be investment in the NHS estate in Wales.

Labour founded the NHS to be free at the point of use, and we want to keep it that way. Given that the Prime Minister has advocated charging for GP appointments, and one of the Secretary of State’s predecessors has urged him to charge for A&E visits, will he take this opportunity to rule out any extension to user charging in the NHS?

I can see from your reaction, Mr Speaker, and the reaction of colleagues in the House, that that is a misrepresentation of the Prime Minister’s position. For the majority of its existence, the NHS has been run by Conservative Governments. We remain committed to treatment free at the point of use. That is the Prime Minister’s position and the Government’s position.

I note that the Secretary of State did not rule out any future extension of user charging, and I am sure that patients will have noticed too. Given that the chief executive of NHS England has said that the NHS needs to expand training; that many of the Secretary of State’s own Back Benchers are echoing Labour’s calls to double the number of medical school places; and that he has no plan whatsoever to expand NHS medical school training places, nursing and midwifery clinical training places, to double the number of district nurses qualifying, or to provide 5,000 more health visitors, is it not time for the Conservatives to swallow their pride, admit that they have no plan and adopt Labour’s workforce plan instead?

I am not surprised that the hon. Gentleman wants to misrepresent the Government’s plan, not least because his own plan is disintegrating before his own Front Bench. The hon. Member for York Central (Rachael Maskell), who spoke earlier, contradicted his point. Not only have the hon. Gentleman’s Front-Bench colleagues contradicted it; even the deputy chair of the British Medical Association has said that Labour’s plan would create higher demand and longer waiting times. I am not surprised that the hon. Gentleman does not want to talk about his own plans anymore; that is why he has taken to distorting ours.

Eastleigh, Hedge End and the villages have many vibrant pharmacies, but it is disappointing that Lloyds has closed two branches in my constituency. I welcome the additional £100 million that this Government are investing in community pharmacies, but can my right hon. Friend confirm how that funding will cut NHS waiting times and, more importantly, reverse the trend of closures?

My hon. Friend is right. Although pharmacies are private businesses, we invest £2.5 billion in the clinical services they provide. We put in another £100 million in September so that they can provide more services. The number of community pharmacists is up by 18% since 2017, and we have introduced the pharmacy access scheme to ensure that we support pharmacies in areas where there are fewer of them. Clearly, the solution is for pharmacies to do more clinical work, take the burden off GPs and provide accessible services. That is exactly what we will keep growing.

When I brought up pension tax rules in November, the Secretary of State agreed that pensions were an important issue and said that he would meet the Chancellor later that day. Can he give an update on the progress that his Cabinet colleagues are making to provide a permanent solution that will help retain NHS staff?

Those discussions are ongoing with my right hon. Friend the Chancellor. The hon. Gentleman will know that we made progress in the summer on a couple of areas in relation to pensions, and my right hon. Friend is having further discussions with us in that context.

I declare an interest as a GP and the immediate family of a GP and doctors. GPs are working incredibly hard in tough times. It is true that supply has gone up, but so too has demand. Change needs to happen in primary care, but one of the bedrocks is the GP partnership model. Does this Government agree?

Unlike the Opposition, we do not regard GPs’ finances as murky and we do not want to go back to Labour’s policy of 1934 by trying to finish off the business that even Nye Bevan thought was too left-wing. We do not believe in nationalising GPs; we believe in the current model. [Interruption.] We do not believe that people with a problem should immediately go to hospital, driving up costs and undoing the good work of cross-party consensus in the last 30 years. A plan that was supposed to cause a splash has belly-flopped.

Mr O’Brien, when I move on, I expect you to move on with me. I have all these Back Benchers to get in. I do not need the rhetoric; I want to get Members in—I want to hear them, not you.

T2. The UK has the sixth largest and richest economy in the world, yet data from the Food Foundation shows that in September 2022, 9.7 million people on these islands lived in food insecurity. That kind of malnutrition does not have a good impact on the health service. When will Ministers pick up the phone or nip along the corridor to the Department for Work and Pensions and tell it to drop its punitive sanctions regime, which pushes so many people into poverty and so many problems on to the NHS? (903243)

We are concerned about the exact same issues. The £900 cost of living payment for 8 million households is how we are trying to address this. It is also why we are bringing in the largest ever increase in the national living wage for 2 million workers.

The Secretary of State is well aware of the challenges facing Essex mental health care and the independent inquiry there into so many patients who have died. Can he tell the House and my constituents what steps he is taking to make this a statutory inquiry?

My right hon. Friend raises an extremely grave and serious issue that I know is of concern to a number of colleagues. Following representations from parliamentary colleagues, I had discussions with the chair of the inquiry, and I then with the chief executive and leadership team, in terms of the level of engagement with the inquiry. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), and I are closely involved in that issue, and I am happy to have further discussions with my right hon. Friend.

T4. While the Government have slashed medical school places by a third, Labour is committed to doubling the number of places in order to train a new generation of NHS staff. Will the Minister support me in backing the University of Portsmouth’s bid for a much-needed medical school for my city? (903245)

The hon. Gentleman is just factually wrong. We have increased medical undergraduate places by a quarter—I was in the Department at the time the decision was taken—so he is wrong on the facts. We also need to look at new ways of getting medics in and having more diverse recruitment in relation to social profile. That is why the apprenticeship route is an extremely important one that I am keen to expand.

The Select Committee looks forward to hearing about the major conditions strategy and engaging with it, as I hope Ministers will engage with our major prevention inquiry, launched last week. One of our national newspapers has contacted 125 acute trusts and asked them about visiting rights. Some 70% of them still have some form of restrictions in place, most commonly limiting the time that people can spend with their loved ones and the number of people who can sit by the bedside. On 19 May last year, the chief of NHS England said that we should return to pre-pandemic levels—

Order. The hon. Gentleman may be the Chair of the Select Committee, but I have to get other people in—it is not just his show.

I thank my hon. Friend for his question. National NHS guidance is absolutely clear: providers are expected to facilitate visiting for patients in hospital wherever possible and to do so in a risk-managed way. It is up to individual providers—they do have discretion—but I understand the benefit that this brings to patients. It is a very important factor, and I will meet NHS England to discuss this further.

T5. According to a recent Care Quality Commission report, black people experiencing mental health crisis are 11 times more likely to be sectioned and to receive restrictive and violent community treatment orders. How will the Minister tackle these inequalities and implement the recommendations in the report? (903246)

I thank the hon. Lady for her question. She is right that black and ethnic minority groups are more likely to be detained under the Mental Health Act 1983. We are planning to reform the Mental Health Act. There has been pre-legislative scrutiny, and I hope that when we reform that Act there will be an improvement in those figures.

The Kent and Medway integrated care board reported that we had an increase of over 230,000 in the number of GP appointments offered to patients between September 2020 and September 2022. However, Medway has some of the lowest numbers of GPs per head in the country, and demand has increased. What support is the Department giving to the ICB to further increase access to GP appointments in Medway?

I welcome the increase in appointments and the numbers that my hon. Friend has drawn to the House’s attention. There is targeted funding of up to £20,000 for areas that are having difficulty recruiting; I am happy to discuss with her how we ensure that Medway can adequately access that fund.

T6.   Why are the Government continuing to delay their consultation on the regulation of physician associates? Constituents who are physician associates point out that they could be doing much more to perform vital duties and relieve pressure in our hospitals, which, I am sure the Secretary of State would agree, we desperately need. (903247)

I agree that that is an important issue and I am keen to expedite it; we are having urgent discussions about how we maximise the use of physician associates. The hon. Lady raises an important point that we are discussing with the devolved Administrations, because it applies across the United Kingdom. I am keen to move quickly on that important area.

“The Future of Pharmacy” report was published yesterday and highlighted again the funding pressures on the sector, including for the brilliant Belfairs Pharmacy in Leigh-on-Sea, which asks whether the Minister will urgently consider writing off the £370 million of covid loans given to pharmacies during covid-19.

We are working to increase the amount of funding going into pharmacies so that they can do more clinical services. I will look closely at the issue that my hon. Friend raises.

T7. Last week, the Government decided to mothball the covid-19 testing facility in Leamington, which will leave up to 670 people without a job. The lab reputedly cost more than £1 billion—perhaps the Minister could confirm—and when the investment was made, I was promised that it would be used for other purposes, such as pathological testing and other diagnostics. Why is that not happening? (903248)

As the hon. Gentleman knows—we discussed the issue over the telephone last week—the decision was taken to wind down the Rosalind Franklin Laboratory because the number of PCR tests has reduced significantly and NHS laboratories can take that capacity. There is a residual service and additional use of the laboratory is being considered.

I recently met a dentist in my constituency whose practice group operates over 19 sites where the rate for units of dental activity ranges from £25 to £36. He is convinced that there needs to be a uniform UDA rate to attract NHS dentists to areas such as Cleethorpes. Can the Minister consider that?

Absolutely; we are looking at that issue. We have already brought in a new minimum UDA value, and we would like to deliver more. We will look at measures to encourage people to work in areas with the greatest shortages.

T8.   On World Cancer Day 2022, the then Secretary of State for Health and Social Care, the right hon. Member for Bromsgrove (Sajid Javid), announced a 10-year cancer plan to make us a world leader. Today, cancer services are buckling under immense pressure. Can the Minister confirm that the strategy will be fully resourced and will she commit to working with cancer charities to ensure that it is delivered? (903249)

Right now, we are seeing more people come forward for cancer diagnosis or to be given the all-clear. We are supporting services with an extra £8 billion for elective recovery. Cancer is an important part of our major conditions strategy, which the Secretary of State just announced, because we are determined to include patients’ cancer outcomes.

In today’s Shropshire Star, my local paper, there is an eight-page spread on what is happening to healthcare in Shropshire, which is described as a war zone. Will the Secretary of State meet me and other Shropshire MPs to discuss the challenges we face?

I am happy to meet my hon. Friend to discuss the issues in Shropshire. I draw her attention to the fact that we have more doctors, more nurses and more funding going into the NHS, and more people are being treated.

T9. In the light of the Government’s welcome announcement of the Strathdee rapid review of in-patient mental health services, can we revisit West London NHS Trust’s decision to make the covid closure of the Wolsey wing permanent, which leaves Ealing, the third biggest borough in London, with no acute mental health beds for under-65s? (903250)

Local healthcare decisions are made by local commissioning groups, but I am happy to raise that on behalf of the hon. Lady. We are putting an additional £2.3 billion a year into expanding and transforming mental health services in the community and patient services.

Although I welcome the new investment in emergency mental health services that was announced this week, does the Secretary of State agree that we must not lose sight of the fact that we need a long-term plan for the transformation of mental health services so that we achieve parity of esteem between mental and physical health in the NHS?

I do agree. That is why the long-term plan signalled the importance of mental health and the parity of which my hon. Friend speaks. It is also why, as the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), has said, additional funding is being targeted at mental health—the extra £2.3 billion a year from 2024—signalling this Government’s commitment to mental health, as he will have seen with the announcement on mental health ambulances this week.

T10. Suicide rates in England are as high now as they were 20 years ago, yet the written ministerial statement today simply says that a strategy will be published later this year. Saving deaths by suicide cannot wait. When exactly will the suicide prevention strategy be produced? (903251)

What we have signalled, and I agree with the hon. Member on this, is the importance of the suicide prevention plan. It is something my predecessor, my right hon. Friend the Member for Bromsgrove (Sajid Javid), highlighted. I am keen to work with him and Members across the House on that. I set out in the written ministerial statement today not a specific date, but our commitment to a bespoke plan, and I am very happy to work with her and other Members on that.

Current plans for community diagnostic hubs in North Staffordshire would see only a single facility, which is meant to serve over half a million people. That is totally insufficient, so will the Secretary of State look at my suggestion that there should be two of these facilities in North Staffordshire?

Will the Secretary of State for Health—today, on the record—condemn the call from his predecessor to impose charges on visits to the GP or to A&E?

I am not sure how many times one needs to say the same point. The Government’s position on this is clear: we are committed to treatment free at the point of use. That is the Government’s position, and it has been throughout the NHS’s history, the majority of which has been under Conservative Governments.

The most recent figures published by the UK Health Security Agency show that, last year, the rate of syphilis cases reached its highest since 1991 and the total number of cases hit its highest since 1948. That shocking increase in syphilis transmission is just one reason why we need the Government to set out their vision for sexual and reproductive health in their long-overdue sexual and reproductive health action plan. Can I therefore ask the Minister to set out when the plan will be published and what she is doing to stop the spread of syphilis?

Can I just reassure the hon. Lady that we take sexual health services very seriously? Local authorities in England have received more than £3 billion from Government to support those services. We have produced a number of plans to improve sexual and reproductive health, from the HIV action plan in 2021 to the women’s health strategy, which focuses on sexual health as well.

The all-party group for diagnostics will hold its inaugural meeting on 8 February, and plans to conduct a short inquiry with the aim of providing a blueprint for how community diagnostic centres should operate in the longer term. As part of the inquiry, will my right hon. Friend commit to meeting members of the group to discuss what more the Government can do to maximise the role of diagnostics in addressing the pressures on the NHS?

I am very happy to give my hon. Friend that commitment. She is absolutely right to highlight the centrality of diagnostics and its importance in our overall plan to get elective numbers down.

Unaccompanied Asylum-seeking Children

(Urgent Question): To ask the Home Secretary if she will make a statement on what steps she is taking to find missing unaccompanied asylum-seeking children and to keep them safe.

The rise in small boat crossings has placed a severe strain on the asylum accommodation system. We have had no alternative but to temporarily use specialist hotels to give some unaccompanied minors a roof over their heads while local authority accommodation is found. We take our safeguarding responsibilities extremely seriously and we have procedures in place to ensure all children are accommodated as safely as possible while in those hotels. This work is led on site by personnel providing 24/7 supervision, with support from teams of social workers and nurses. Staff, including contractors, receive briefings and guidance on how to safeguard minors, while all children receive a welfare interview, which includes questions designed to identify potential indicators of trafficking or safeguarding risks. The movements of under-18s in and out of hotels are monitored and recorded, and they are accompanied by social workers when attending organised activities.

We have no power to detain unaccompanied asylum-seeking children in these settings and we know some do go missing. Over 4,600 unaccompanied children have been accommodated in hotels since July 2021. There have been 440 missing occurrences and 200 children remain missing, 13 of whom are under 16 years of age and only one of whom is female.

When any child goes missing, a multi-agency missing persons protocol is mobilised alongside the police and the relevant local authority to establish their whereabouts and to ensure they are safe. Many of those who have gone missing are subsequently traced and located. Of the unaccompanied asylum-seeking children still missing, 88% are Albanian nationals, with the remaining 12% from Afghanistan, Egypt, India, Vietnam, Pakistan and Turkey.

As I have made clear repeatedly, we must end the use of hotels as soon as possible. We are providing local authorities with children’s services with £15,000 for eligible young people they take into their care from a dedicated UASC—unaccompanied asylum-seeking children—hotel, or the reception and safe care service in Kent.

I fully understand the interest of the hon. Member for Brighton, Pavilion (Caroline Lucas), and indeed the whole House, in this issue and I am grateful for the opportunity to address it. I assure the House that safeguarding concerns are, and will remain, a priority for me and for my Department as we deliver the broader reforms that are so desperately needed to ensure we have a fair and effective asylum system that works in the interests of the British people.

This is horrific. Vulnerable children are being dumped by the Home Office, scores of them are going missing, and I can tell the Minister that there is nothing “specialist” about these hotels. We are not asking him to detain children; we are asking the Home Office to apply some basic safeguarding so that we can keep them safe. Does he know how many have been kidnapped, trafficked, put into forced labour—where are they living, are they allowed to leave, are they in school? He should know because the Home Office is running these hotels. It has told me it is commissioning everything from social work to security, but it is still unclear whether it is prepared to take legal as well as practical responsibility.

Meanwhile, these children are in legal limbo. I was told before Christmas that Government lawyers were deliberating over their ultimate legal responsibility. We need to know the outcome today: what is it? We need to know why successive Home Secretaries have played into the hands of criminal gangs.

The Minister will talk of new money being given to local authorities, but where will they get the foster care capacity, which he knows is in seriously short supply? Brighton and Hove City Council has been raising concerns about the dangerous practice of using these hotels for 18 months, and as the hon. Member for Hove (Peter Kyle) has made clear on many occasions—I pay credit to him for his tireless work on this—it was entirely foreseeable that children were at risk of being snatched, abducted and coerced by criminals.

Has the Minister taken up offers of help from charities working with children? What is the response to the migration watchdog’s finding that some staff in these hotels were not DBS—disclosure and barring service—checked? What role is the Children’s Commissioner playing? Why is not Ofsted inspecting these hotels regularly? Will he commit to publishing regular data on missing children—how long they have been missing, whether they are still missing, when they went missing? Where is the special operation to find the missing children? This feels like the plight of the girls in Rotherham who were treated like they did not matter and, frankly, it is sickening. Lastly, the use of these hotels must stop—when will that actually happen?

The staggering complacency and incompetence from the Home Office are shameful. We need immediate answers and an urgent investigation, and we need to ask how many more children are going to go missing before we see some action.

If the hon. Lady has not visited the hotel in her constituency, or indeed in her neighbouring constituency, I would be happy to organise that. I spoke with the chief executive and director of children’s services of Brighton and Hove City Council yesterday to ask for their reflections on the relationship with the Home Office and the management of the hotel. We have a good relationship with that council and I want to ensure that that continues.

As regards the level of support provided in that hotel, and indeed others elsewhere in the country, it is significant. On any given day, there will be a significant security presence at the hotel. Those security guards are there to protect the staff and the minors and to raise any suspicious activity immediately with the local police. I have been assured that that does happen in Sussex. A number of social workers are on site 24/7. There are also nurses on site and team leaders to manage the site appropriately. So there is a significant specialist team provided in each of these hotels to ensure that the young people present are properly looked after.

The report by the independent chief inspector of borders and immigration in October last year—I believe that Ofsted was involved in the inspection—did find unanimously that the young people reported that they felt safe, happy and treated with respect. Now, that does not mean that we have any cause to be complacent, because it is extremely concerning if young people are leaving these accommodation settings and not being found. I have been told that any young person leaving one of these hotels and not returning is treated in exactly the same way as any young person of any nationality or immigration status who goes missing anywhere else in the country and that the police follow up as robustly as they would in any other circumstances. That is quite right, because we have a responsibility to any minor, regardless of why they are here in the United Kingdom.

Working with police forces and local authorities, we have created a new protocol, known as “missing after reasonable steps”, in which further action is taken to find missing young people. That has had significant success: I am told that it has led to a 36% reduction in the number of missing people occurrences. We will take further steps, as required, to ensure that young people are safe in these hotels and not unduly preyed on by the evil people smuggling gangs that perpetuate the trade.

The key task ahead of us—other than deterring people from making dangerous crossings in the first place, of course—is to ensure that these young people are swiftly moved out of hotels, as the hon. Lady rightly said, and into more appropriate settings in local authorities. Since being in position I have reviewed the offer that we have for local authorities and significantly enhanced it. From next month—this has already been announced—any local authority will receive a one-off initial £15,000 payment for taking a young person from one of these hotels into their care in addition to the annual payment of about £50,000 per person. That is a significant increase in the amount of financial support available to local authorities.

The hon. Lady is right to say that money is not the only barrier to local authorities, because there are significant capacity issues including a lack of foster carers, a lack of trained social workers and a lack of local authority children’s home places. Those are issues that the Department for Education is seeking to address through its care review. The best thing that any of us can do as constituency Members of Parliament who care about this issue is speak to our local authorities and ask them whether they can find extra capacity to take more young people through the national transfer scheme so that we can close these hotels or, at least, reduce reliance on them as quickly as possible.

I share the concern about the story, but it is not new news. Last year, the Home Office came in front of the Home Affairs Committee to be interrogated about this, and there was a particular problem with the hotel in Hove, which instigated the story in The Observer at the weekend, because the Home Office did not tell the local council when it was putting children there in the first place. However, there have not been any reports to Sussex police of children being snatched and abducted by gangs outside.

There are two questions that the Minister may like to clear up. First, there is a grey area over who is responsible as the safeguarding body for children in hotels. Is it the Home Office or the local authority? There seem to be different stories. Secondly, is he using specialist refugee children’s charities, which have welfare and safeguarding training, to look after children in the hotels and ensure that they are not being taken advantage of, as he has done at Dover and other ports of entry? Those children are not criminals, and we cannot put them in a secure facility. They are free to come and go, but we need people keeping a special eye on them.

I am grateful to my hon. Friend for those questions. He is right to make the final point, which is that these are not secure locations. Young people are not detained in them. We do not have the legal powers to do that and I do not think any right hon. or hon. Member from across the House would wish us to do that. It is inevitable that some young people will choose to leave these settings, as, very sadly, they do from local authority care homes, but that is not to diminish or renege on our responsibility to reduce that as far as we possibly can.

We have relationships with charities and the voluntary sector. I will happily take up with the Department whether there is more we can do there. We have made good use of those relationships in other settings, such as hotels for adults and Manston. As I said earlier, there is a very significant amount of specialist support in the hotels. I specifically asked the officials running them what we would find on any given day. It is several security guards, a number of nurses and a number of social workers, as well as team leaders running the operation. So they are well staffed by well-trained and professional individuals who are drawn from other settings where they are used to looking after vulnerable young people.

Lastly, on the first point my hon. Friend made, there is a challenge around the legal status of a local authority with respect to these hotels. Our objective is to reduce demand for hotels as fast as possible, so that young people are in this accommodation for a very short period of time while we get them to local authorities where they can be cared for properly in accordance with the law.

The report from Sussex police is that one in four unaccompanied children in a Home Office hotel have gone missing—one in four—and that around half of them are still missing. It would appear from the figures the Minister has given that that means one hotel accounts for 40% of the missing children.

A whistleblower is reported as saying:

“Children are literally being picked up from outside the building, disappearing and not being found. They’re being taken from the street by traffickers”.

Greater Manchester police warned that asylum hotels and children’s homes are being targeted by organised criminals. There is a pattern here. The gangs know where to come to get the children—often, likely because they trafficked them here in the first place. There is a criminal network involved and the Government are completely failing to stop it. They are letting gangs run amok. Last year, there was only one—just one—conviction for child trafficking, even though it is now believed to involve potentially thousands of British children, as well as the children targeted here.

Where is the single co-ordinated unit involving the National Crime Agency, the Border Force, the south-east regional organised crime unit and local police forces to hit the gang networks operating around this hotel and across the channel? Why are the Government still refusing to boost the National Crime Agency? Why have they repeatedly ignored the warnings about this hotel and unregulated accommodation for 16 and 17-year-olds being targeted by criminal gangs?

It is unbelievable that there is still no clarity on whether the Home Office or the council is legally responsible for these children. Will the Home Office now agree to immediately end the contract with this hotel and move the children out to safer accommodation? Will it set up a proper inquiry and team to pursue the links between organised crime, trafficking and the children in these hotels? This is a total dereliction of duty that is putting children at risk. We need urgent and serious action to crack down on these gangs, and to keep children and young people safe.

I gave the figures the Home Office has at the start of this urgent question. Of the 4,600 unaccompanied children who have been accommodated in hotels since July 2021, 440 have gone missing at one point and 200 remain missing, so I am afraid the statistics the right hon. Lady quotes are not those that I have been given by the Home Office.

On press reports that individuals have been abducted outside the hotel, those are very serious allegations. I specifically asked the officials who run the hotel whether they have seen evidence of that, and I also asked the senior leadership of Brighton and Hove Council. I have not been presented with evidence that that has happened, but I will continue to make inquiries. Senior officials from my Department are meeting the Mitie security team in the coming days to ask them whether they have seen any occurrences, whether the individual quoted in the press as a whistleblower raised issues with Mitie, and, if they did, why those issues were not subsequently passed on to the Home Office. The right hon. Lady has my assurance that I will not let the matter drop. I am also going to meet a number of staff who work at the site in the coming days to take their opinions and reflections.

On the broader point the right hon. Lady makes about our policy, she is incorrect when she says the NCA is insufficiently financed. The Prime Minister announced at the end of last year that we would step up NCA funding. In fact, I visited the NCA just last week to be briefed on the work it is doing upstream throughout Europe and into Turkey, Iraq and a number of other countries. There is very significant activity happening to tackle the evil people-smuggling gangs.

The problem the right hon. Lady has is that she does not support any of the measures the Government bring forward to stop the trade. She votes against every Bill we bring forward to try to address this challenge. There is nothing compassionate about allowing unsecure borders and allowing growing numbers of people, including young people, to cross the channel. She will have an opportunity to put her money where mouth is when we bring forward further legislation in the weeks ahead.

What assessment has my right hon. Friend’s Department made of the availability of specialist foster carers able to accommodate unaccompanied asylum-seeking children? In light of the Abdulrahimzai case reported today, can he reassure the House that foster carers are provided with the information and support they need to keep both themselves and any young person in their care safe?

My hon. and learned Friend raises a very important issue. There is, as he knows as well as almost anyone in this House, a lack of capacity in relation to specialist foster carers. That is why the Department for Education conducted its care review, is considering the findings, and will be bringing forward recommendations in due course. Most young people in the hotels we are discussing today are older—predominantly 16 and 17-year-olds—so it is about a national lack not only of foster care capacity, but of supported accommodation and the kind of settings that a 17-year-old, for example, might be placed in for a relatively short period of time before they move forward with their life. Those issues are very important to us, which is why, for my part, I have made available significantly increased funding for local authorities so they can, for example, use that money to procure more supported accommodation.

On the case my hon. and learned Friend referred to, that is a truly shocking case. We are reviewing how it has happened and how the individual was able to enter the UK posing as a minor. We will learn the lessons and set out more in due course.

It is completely unacceptable that vulnerable young people who need care and support continue to vanish under the Home Office’s watch. The Children’s Commissioner for England made her concerns clear on the safeguarding of these young people. Has the Minister met the Children’s Commissioner for England? Has he considered an equivalent to the Scottish Guardianship Service, which provides personalised and sustained support to unaccompanied refugee children? Would that be a useful model to keep young people safe?

Sussex police say 76 children are unaccounted for in this case. The Minister said that 440 children had gone missing and that 200 remained unaccounted for across the UK. Is he certain of those figures, and will he provide regular updates to the House on the number of children missing and still unaccounted for? Will he end the practice of putting children in hotels, a practice that many stakeholders and whistleblowers have repeatedly flagged as dangerous and putting children at risk?

I want to end the practice of putting children in hotels, but the key to that is stopping people crossing the channel in the first place. If we continue to have tens of thousands of people, including very significant numbers of minors, crossing the channel every year, I am afraid that there is no choice but to accommodate people for a short period of time in hotels before they can flow into better accommodation within local authorities.

The hon. Lady and others across the House should appreciate that this is a national emergency. It is part of a global migration crisis, and we need to take the most robust action we can to deter people from making the journey, or I am afraid that we will find this problem magnified in the years to come. That is why we have taken the steps that we have in the recent past; that is why the Prime Minister set out his plan at the end of last year; and that is why we will shortly be bringing forward legislation, which I hope the hon. Lady and her colleagues will support.

I will certainly look into the Scottish guardianship model that the hon. Lady raises, but as I have said many times, it remains true that as a proportion of its population Scotland takes far fewer unaccompanied asylum-seeking children than England. One practical step that she could take would be to encourage the SNP Government and local authorities in Scotland to play a fuller part in ensuring that these young people are given the care and attention they deserve.

I know that the Minister cares profoundly about the fate of these children, and it is reassuring to hear of the assertive action taken by local authorities and police when they go missing. However, if dozens of children had been going missing from, say, boarding schools across the country, I have no doubt that there would be a national mobilisation involving the NCA and indeed the National Police Chiefs’ Council. Could the Minister enlighten us as to what the national response in British policing looks like at the moment? Does he feel that more could be done to address this systemic problem, not least given the possible links to serious and organised crime?

My right hon. Friend is absolutely right that, as I made clear earlier, we should treat any child who goes missing with the same focus and intensity of effort, regardless of their background, nationality and immigration status. That is exactly what happens in this case. If a young person leaves a hotel—for example, the one that we are discussing this afternoon—and does not return within four hours, they are immediately recognised as a missing person. The local police—in this case, Sussex—are contacted, and the case is treated with all the same effort as it would be for any other individual.

That is why a significant proportion of these young people have, fortunately, been found and returned to care. But too many have not, so I think my right hon. Friend makes a valid point that we should be working with local police forces and others to see whether the procedures that we have in place are sufficient or whether we need to go further. That work was done last year, and it led to the new protocol that I described earlier. From the numbers that I have received, that has made an impact: occurrences have reduced by about a third, but if there are further steps that we should be taking, we will do so.

This is a broader challenge, because the numbers going missing from these settings are, sadly, not dissimilar from the numbers going missing from local authority children’s homes. We should be applying all our learnings from this to local authority settings as well.

In July last year, the Home Affairs Committee raised our serious concerns about unaccompanied asylum-seeking children going missing from hotels. I can assist the Minister: the Home Office’s permanent secretary, Sir Matthew Rycroft, told the Committee that

“broadly speaking…it is the Home Office”

that acts as the safeguarding authority for a child placed in a hotel.

We called on the Government to

“provide a clear timeline for ending the accommodation of unaccompanied children in hotels.”

May I press the Minister on that today, because it has not been forthcoming so far? Given the Home Office’s clear child safeguarding responsibilities, can we have a clear commitment today from the Minister as to the date by which it will end the clearly unsafe and unsatisfactory placement of unaccompanied asylum-seeking children in hotels?

I respect the right hon. Lady and her Committee, but it is not as simple as my being able to set a date by which these hotels will close, because we have to be honest with ourselves about the challenge that we face as a country. There are hundreds, if not thousands, of young people crossing the channel on small boats every year. What we need to do is flow those young people as swiftly as possible into local authority care, but if local authorities do not have the capacity to take them immediately, we have to bear in mind that we can detain somebody for only 24 hours—or now 96 hours, with the recent legal change that we have made. In a relatively short timeframe, we have to have a short period of bridging accommodation. For as long as the challenge remains as pronounced as it is today, we will need that.

The task for us is twofold. The first part is to work with local authorities and provide the incentives for them to boost their own capacity. The other is to deter people from making the crossing in the first place. We are trying to do everything within our power to do so, including by making further legislative changes, but until we beat this trade, there will be young people placed in this position.

The particular vulnerability of children in distress touches our hearts and must move us to further action, as my right hon. Friend says. Will he tell the House when the legislation that he has described will come before us? Will he implore all those who share my compassion and concern for these desperate children to support that legislation without equivocation? Unless we deal with this problem at root, the sheer scale of it will overwhelm our capacity nationally or locally to protect these children. It is as simple as that.

My right hon. Friend is absolutely right. This is a symptom—a very serious and disturbing symptom—of the problem, which is the people-smuggling gangs luring tens of thousands of people, a significant proportion of whom are minors, across the channel. We have to do everything we can to deter those people and break the business model of the people smugglers. That is what we are determined to do, and that is the purpose of the legislation that we will bring forward very shortly. My right hon. Friend and others have only a short period to wait until we present it to the House. I hope it will have broad support, because if we do not address the problem, all the evidence suggests that in the years to come we will find it magnified, with tens of thousands of people, if not hundreds of thousands, attempting to make the crossing.

The Minister says that safeguarding these children is a priority for him. He will know that since October last year, I have been asking to see the safeguarding requirements that he has placed on the private companies involved in running these hotels for both unaccompanied and accompanied children. I understand now why he was so reluctant to give that information: when I finally used a freedom of information request to get it, there was no mention at all of requiring these private companies, which are making millions of pounds running these places, to do anything about modern slavery or human trafficking—not one word.

Let us be clear. It does not matter whether these children are Albanian, Syrian, Pakistani or Iranian. It does not matter whether they are boys or girls. They are children. Will the right hon. Member now use his authority as the Minister responsible to require these companies to have a duty to prevent human trafficking and modern slavery? Will he finally make sure that, for all the money they are making out of this, they do something to protect these children? It is on his watch that these children are going missing, and it was on his watch that he missed out that requirement from the contract.

The hon. Lady and I have met to discuss the issue on a number of occasions. We take this very seriously. We have asked all our providers, of course, to take their responsibilities for safeguarding seriously. We have a safeguarding hub in the Home Office and we work closely with the local authorities, which also have a duty to support people in their care.

The hotels that we are discussing today are not run by private providers. There are providers that support us in terms of security arrangements, but these hotels are run by the Home Office, so the hon. Lady is not correct to say that they are run by external providers. But that does not change the reality that, as I have said on a number of occasions, we should take the care of these minors as seriously as we would take that of our own children. I hope that I have given her the assurance that we do.

Does my right hon. Friend agree that to place vulnerable asylum-seeking children in the care of local authorities whose Ofsted rating is inadequate is a dereliction of not only our international but our moral obligations?

That is an important point. We want to place these minors in the care of local authorities, and, of course, we want to place them in the care of local authorities with good track records of looking after young people. I presume that my hon. Friend is referring to his own local authority, Sefton Council. If there are concerns about its performance, he should bring them to my attention and, in particular, to the attention of my right hon. Friend the Secretary of State for Education.

Thank you for allowing me to contribute, Mr Speaker; I appreciate it.

The community that I represent was given just a couple of hours’ notice that 96 unaccompanied children were to be placed in a hotel in that community. I visited the hotel within days and have visited it many times since, so I am able to say that it is ignorant to suggest that these are specialist facilities.

In those ensuing days, I saw for myself, having met the children who were there, that some of them were extremely vulnerable—vulnerable emotionally and vulnerable, should they leave the premises, to being coerced into crime—so I contacted the council, the police, social services and the Minister’s Department, the Home Office. The only organisation that responded effectively, in my view, and with the kind of seriousness that one would expect, was Sussex police, but it lacked the facilities, the resources and the powers to do the job that needed to be done. It is incorrect to say that these children are not being coerced into crime, because just last year Sussex police pursued a car that had collected two of them from outside the hotel. When the officers managed to get the car to safety, they released the two children and arrested one of the drivers, a gang leader who was there to coerce the children into crime.

The uncomfortable truth for us is that if one child related to one of us in this room went missing, the world would stop, but in the community that I represent, a child did go missing; then five went missing, then a dozen went missing, then 50 went missing, and currently 76 are missing—and nothing is happening. My question to the Minister is this: the next time I visit the hotel, in the coming days, what will be different there from what went before? If nothing is different, children will continue to go missing.

Perhaps the hon. Gentleman and I should visit the hotel and see its facilities together, as I am due to visit it in the coming days. According to the assurances that I have had, when we visit the hotel—if the hon. Gentleman does visit it— he will see that there are several security guards who immediately raise with the police any suspicious activity that they find, and also a number of nurses and social workers, so there is a strong set of support staff on site. He will also see that there are robust procedures for signing in and out when young people want to leave the facility, and that as soon as any concern is raised that someone has not returned within the agreed time, Sussex police are alerted and the usual procedures are followed.

However, I take the hon. Gentleman’s remarks very seriously, and will continue to listen to him. If he would like to meet me and discuss this, I should be happy to do so, because it is in all our interests to ensure that this never happens again.

The Minister is demonstrating a great deal of seriousness and compassion in gripping this very concerning situation, but does he agree that the best way in which to safeguard these children is to prevent them from crossing in the first place? Does he also agree that it is both concerning and shameful that Opposition Members are standing up to speak having failed to back legislation that will do that, and will, furthermore, enable us to test the age of these children? Does he agree that it is vital for us to know that they are in fact children, and not dangerous criminals? Does he, like me, hope that the next time he introduces legislation, we will strengthen our sovereign borders, as we as a country have a right to do?

My hon. Friend is entirely right. This is a serious issue, but it is also a symptom of the problem of people smugglers bringing very large numbers of people across the channel, and we must tackle that with the most robust response possible. However, the Opposition continually oppose any effort by us to strengthen our borders.

We will be introducing further legislation, and, as my hon. Friend knows, we are reviewing whether we can adopt a more scientific approach to the verification of ages, as is being done by a number of our European counterparts. It is right for us to do that, because any adult who poses as a child coming into this country poses a serious risk to the young people alongside whom they then live, whether in these hotels or in any other setting.

Locally, I am afraid, my council also does not have a grip on this serious situation. It is out of its depth and, unfortunately, it is in a legal limbo. Past child protection scandals have shown us that all agencies must take both joint and separate responsibility for the protection and safeguarding of children, so this process cannot continue—the process of the Home Office pointing at the council, the council pointing at the Home Office, and nothing being done.

At the centre of this is the fact that Home Office is moving children into our local authority in a way that is wholly outside the law. The Home Secretary’s failure to enforce mandatory requirements to transfer children into foster care is creating an unregistered children’s home in our area, and that is counter to law. The children’s home, by the way, is owned by a man called Hoogstraten who changed his name to Adolf, so we can guess where his sympathies lie. May I ask this Home Office Minister what statutory powers he is using to transfer children into an unregistered children’s home in Hove?

Let me say first that there is no pitting of the Home Office against the local authority. The Home Office is working closely with Brighton & Hove City Council, and we have a good working relationship. My officials speak regularly to those at the council, and, having spoken to the chief executive and the director of children’s services, I can say that they too feel that the relationship is working. We also work closely with other partners, including Sussex police. Can we do more to strengthen those relationships? Perhaps we can, and that is exactly what we intend to do in order to prevent any of these instances from happening again in the future.

As for the hon. Gentleman’s ideal solution, we are in agreement. We both want to see the number of hotels of this kind reduced and, ultimately, to see them closed, through better use of the national transfer scheme. However, that does require local authorities to come forward and offer places. We have therefore provided significant financial support, so there should be no financial barrier to local authorities’ investment in more accommodation and, indeed, more social workers and supporters.

Order. We need to speed up both questions and answers, because a great many Members still need to get in.

As my right hon. Friend has said, effective co-ordination between police, local authorities and healthcare providers within communities where hotels are being used to provide asylum accommodation is very important. A meeting of that kind in Folkestone and Hythe has been organised for this coming Friday. If the Minister cannot attend the meeting through virtual participation, can he at least ensure that relevant Home Office officials are there to answer questions about policy and also to co-ordinate with the local authorities?

I will certainly arrange that. As my hon. Friend knows, Kent has borne a particular burden in this regard, so it is right for us to do everything we can to support it and his constituents.

The only surprising aspect of this whole sorry affair is the fact that anyone is surprised by it. Young people are placed in totally unsuitable accommodation, and are then left there while the Home Office fails to process applications for them and, indeed, for all asylum seekers. This was always going to happen. On 16 December the Minister announced a £15,000 extra funding package for local authorities, which is due to expire at the end of February. Is he telling us today that that additional money—not the standard money—will continue after 28 February?

Before I arrived at the Department in the summer there was already an initial payment to local authorities, which I believe was £6,000 or thereabouts. That did ensure that more local authorities came forward, but, given the scale of the challenge that we have been discussing today, I took the view that it needed to be more, which is why we made this more generous offer available. We have operated it as a pilot to establish whether it encourages more local authorities to come forward. I am receiving advice in respect of the number of local authorities that have taken up that offer, and before it is closed we will decide whether it was successful enough to warrant its continuation. However, I am open to continuing it further into the future.

Given some of the horrors of war that asylum seekers can witness, they can become desensitised to the difference between right and wrong and, without intervention, could pose a threat to society. Can I ask for a formal Home Office investigation into the Afghan asylum seeker Abdulrahimzai, who murdered Tom Roberts in Bournemouth last year? Abdulrahimzai had a criminal record for murder in Serbia and a criminal record for drugs in Italy. He then threatened his foster carer here in the UK and bluffed his way into our asylum system, posing as a minor. So many red flags were missed that could have revealed what a threat to society this individual was, and there are lessons to be learned. Please will the Minister launch an investigation?

My right hon. Friend is right to say that this is a terrible case, and our thoughts are with the family and friends of Thomas Roberts. As he will know, sentencing has yet to take place but we will be investigating the full circumstances surrounding the case so that we can ensure that we learn all the lessons. One that we will certainly take forward is, as I said earlier, a more robust method for assessing the age of those coming into the country, taking advantage of modern scientific methods.

One child missing is one child too many. It is horrendous that these children have left their home country seeking safety in the UK, only to be put at serious risk because of the incompetence of the Home Office and its failure to ensure basic safety in hostels. Can the Minister explain to the House what measures are in place to safeguard children and adult asylum seekers to ensure that no refugee needs to face such preventable dangers?

These young people are not being put at risk primarily by the Home Office; they are being put at risk by dangerous people smugglers and criminals—those who smuggle them into the country and those who might exploit them when they are here. Our efforts are focused on protecting the young people in the hotels, as I described earlier, and we are also doing everything we can to fight the people smugglers, whether upstream or here in the United Kingdom, through working with the National Crime Agency and the security services and police forces.

Does my right hon. Friend concede that unaccompanied minors in our asylum seeker system are being targeted by criminal gangs and does he agree that we need more resources to tackle the organised criminals who are causing this problem, in order to resolve it?

It is wrong to generalise about where all the missing young people go. Some leave hotels to meet up with familial contacts, but my hon. Friend is right to say that others are drawn into criminality at the behest of people smugglers and trafficking gangs. We are working with the NCA, with police forces and with immigration enforcement to bear down on those gangs. One element of that is the work we are now doing to significantly increase the amount of immigration enforcement activity occurring in the UK, including raids on illegal employers such as construction sites, car washes and care homes, so that we can find the illegal employers, issue them with penalties and deter them from taking this kind of activity.

I am a bit troubled, listening to the Minister, because how can he claim that this is a robust vetting procedure when there are still 76 young people missing? This story is yet another failure and a stain on the Home Office. This was entirely avoidable. We have heard stories about the security and safety failings at the hotels. Many of those who are missing are teenagers—young people who are at the prime age to be groomed by the criminals who target 16 and 17-year-olds. Does the Minister accept that it was a mistake not to ban the placement of 16 and 17-year-old children in unregulated accommodation? What will he do to end this practice?

I am not sure what the hon. Lady is suggesting. If we did not use these hotels, which have a range of security and support staff available to them, is she suggesting that we put them in hotels with adults? [Interruption.] She says, from a sedentary position, regular hotels—

No one would want to do that. The only alternative to using these settings is for young people to go into good quality, permanent local authority support, and I have already said that we have made available substantial financial incentives for local authorities to do that. The best thing that we can do is to encourage our own local authorities to take part in the national transfer scheme and ensure that there is a better solution.