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House of Commons

Tuesday 7 September 2010

The House met at half-past Two o'clock

Prayers

[Mr Speaker in the Chair]

Oral Answers to Questions

Health

The Secretary of State was asked-

Cancer Drugs Fund

1. Neil Carmichael (Stroud) (Con): What steps he is taking to work with clinicians and patient groups in the design of the cancer drugs fund. [13147]

The Secretary of State for Health (Mr Andrew Lansley): We are committed to ensuring that the cancer drugs fund, which is to be introduced in April next year, will enable NHS patients to have greater access to new cancer drugs. We will soon consult the public and clinicians on our plans for this. From 1 October this year, as an interim measure, regional panels led by expert clinicians will respond to requests to fund cancer drugs that have not been funded locally.

Neil Carmichael: I am delighted with the answer from the Secretary of State. Some people are concerned about the possibility of a postcode lottery. Has the Department thought about that, and what actions does it plan to avoid the fund being subject to that?

Mr Lansley: I am grateful to my hon. Friend. Many people are concerned about their experience of a postcode lottery and access to new cancer drugs. Indeed, there is not just a postcode lottery but an international lottery, with patients in this country not getting access through the NHS to new cancer drugs while patients in other countries do get access to those drugs in the same clinical circumstances. That is why we will not only establish the cancer drugs fund next year, but, this year, we have found £50 million by making savings on management and marketing costs to enable new cancer drugs to be made available, at a regional level across England, where they are not funded locally.

Valerie Vaz (Walsall South) (Lab): Has the Secretary of State had any discussions with the National Institute for Health and Clinical Excellence about the fund, and is it cash-limited?

Mr Lansley: Yes, I did have discussions with NICE. The interim measure this year is indeed cash-limited-£50 million is available between October and the end of March.


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Anne Marie Morris (Newton Abbot) (Con): Will the Secretary of State consider seriously the situation with regard to Avastin-a drug that particularly relates to bowel cancer? I have a constituent who is dying of that complaint, and their primary care trust has refused treatment under current NICE guidance. NICE is currently reviewing the situation. I would be grateful if the Secretary of State will say that he will support positive findings.

Mr Lansley: My colleagues and I are very well aware of the issues relating to Avastin, and I am grateful to my hon. Friend for her question. In terms of the interim measure that starts on 1 October, patients should go through all the normal procedures of seeking treatment through their hospital with the consent of their PCT. However, if that fails, a regional panel of expert clinicians will be able to look at their circumstances, with a special fund to enable patients to have access to cancer drugs which previously they would not have received.

Diana R. Johnson (Kingston upon Hull North) (Lab): Of course we support efforts to ensure that those with rarer cancers get access to the drugs that they need, but there are serious concerns about the cancer drugs fund. Professor Alan Maynard says that

The Lancet has called the fund a product of political opportunism and intellectual incoherence leading to the potential for a postcode lottery between strategic health authorities. Where does this leave NICE-an organisation that the Secretary of State said that he wants to strengthen?

Mr Lansley: It in no way undermines the role of NICE, which continues to play a very important role in giving advice to the NHS on the relative clinical effectiveness and cost-effectiveness of drugs. However, there are many circumstances at the moment whereby patients are not getting access to medicines. NICE, through its thresholds, is setting limitations on access to new cancer medicines. The hon. Lady should know, because the research was commissioned under her Government, that we need to look at international variations in drug use across health economies. Her Government did not publish that information; we have published it. It demonstrates that in this country we have relatively poor access to new cancer medicines, often before the point at which NICE has undertaken a full cost-effectiveness appraisal. We are going to ensure that patients in this country do not lose out as a consequence of those delays.

David Tredinnick (Bosworth) (Con): When considering the drugs fund, will the Secretary of State bear it in mind that many patients who have had chemotherapy find relief from using herbal medicine and acupuncture? When will he come forward with proposals to interface with next year's European directive so that herbal and acupuncture practitioners can conform to the law?

Mr Speaker: I know that the Secretary of State's response will relate to the cancer drugs fund.

Mr Lansley: The answer to my hon. Friend's question is soon.

Mr Speaker: We are grateful.


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GP Commissioning

2. Emma Reynolds (Wolverhampton North East) (Lab): What account he took of arrangements for the provision of mental health services in developing his proposals for GP commissioning. [13148]

The Minister of State, Department of Health (Mr Paul Burstow): GPs play a crucial role in co-ordinating patient care and committing NHS resources through daily clinical decisions. Our new model of commissioning builds on the regular contact that GPs have with patients and their understanding of patients' wider health care needs. Our proposals will create an effective dialogue across all health and social care, with professionals putting in place the conditions for a more integrated and personalised approach to both physical and mental health.

Emma Reynolds: I thank the Minister for his answer. According to a recent survey by the leading mental health charity Rethink, 58% of GPs questioned said that they did not feel they had the level of expertise required to commission mental health services. Given that, what specific measures will the Government take to ensure that GPs have the skills and expertise needed to commission those highly specialised services?

Mr Burstow: I do not accept that that is the case, and from the consultation and engagement that the Department and I have already had with GPs and others, it is quite clear that there is huge enthusiasm for the reforms that we propose in the White Paper and a real desire both to see patients put at the heart of the NHS and for GPs to have real control over commissioning again, to ensure that services really meet patients' needs. When it comes to specialist commissioning, we have said in the White Paper that there will be opportunities for charities, other providers and local authorities to access support to harness those skills.

Mr Stewart Jackson (Peterborough) (Con): Parnwell, in the east of Peterborough, which has specific health needs, faces the loss of its current single general practitioner upon his retirement at the end of October. Can the Minister confirm that there is no necessity to remove single practitioner GP facilities, and that they can be incorporated into the new GP commissioning system as we go forward?

Mr Burstow: I am very happy to give that confirmation.

Barbara Keeley (Worsley and Eccles South) (Lab): It is of great concern that medical charities such as Rethink tell us that most GPs that they have surveyed feel that they lack the expertise needed to commission mental health services, and also that campaigning groups such as the Muscular Dystrophy Campaign feel that GPs have too little knowledge of muscle wasting conditions to commission services for their patients. Given Government plans to hand commissioning over to GPs, to abolish primary care trusts and, according to the White Paper, to reduce the role of the Department of Health in training, can the Minister say more to the House about how the considerable shortfall in expertise in commissioning services will be tackled over the next year or two?


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Mr Burstow: It is perhaps worth noting that the Select Committee on Health, when there was a Labour majority on it before the election, back in March, identified significant weaknesses in PCT commissioning. In particular, it identified the lack of clinical input. Our White Paper puts that clinical input back into commissioning. When one considers that one in four of all consultations involve mental health problems and that 90% of all mental health care is delivered in primary care settings, one sees that putting the GP right at the centre is critical to better outcomes.

Dr John Pugh (Southport) (LD): On the subject of consultation, what consultations have taken place with the mental health charities, either prior or subsequent to the proposals?

Mr Burstow: In July, I and the Secretary of State had a successful and long engagement with all the mental health charities, and we are continuing to have a dialogue with them.

Health Service Redundancies

3. Mr Jim Cunningham (Coventry South) (Lab): What estimate he has made of the number of redundancies which would result from the abolition of strategic health authorities and primary care trusts? [13149]

The Secretary of State for Health (Mr Andrew Lansley): Our White Paper set out proposals for greater devolution to clinical leadership in the NHS and an enhanced role for local authorities in setting health strategies and improving public health. That means that we will abolish primary care trusts and strategic health authorities. General practice-led consortiums will make decisions about their requirements for management support, as will the new NHS commissioning board and local authorities. However, the requirement to cut management costs and protect the front line will mean reduced numbers of administrative posts. The extent of that will depend on local plans, and we will publish an impact assessment in due course.

Mr Cunningham: The coalition agreement stated that PCTs would be a strong voice for the public. How will the Government achieve that if they are going to abolish them?

Mr Lansley: We set out clearly in the White Paper how we will increase accountability to the public, including by establishing Health Watch. Before the election, the hon. Gentleman's party's Government demolished the patient representative voice in community health councils and patients' forums and created nothing effective in its place. Health Watch will be an effective voice for patients, and democratic accountability through local authorities will be far stronger because Health Watch will enable NHS services, public health services and social care to be joined together through co-ordination in a local authority's health and well-being partnership.

Mark Pawsey (Rugby) (Con): On the question of redundancies, the hon. Member for Coventry South (Mr Cunningham) and I represent adjacent constituencies covered by the same NHS trust, in which there is
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currently a review of urgent care provision at the hospital of St Cross in my constituency. Candidates for the Labour leadership recently visited the area, and one spoke to the Rugby Advertiser about his concern that the review was an example of the

Does the Secretary of State share my outrage at the choice of language by the likely Leader of the Opposition, and will he confirm that since this Government have committed themselves to real-terms increases in NHS funding, any reforms considered for Rugby will have nothing to do with the amount of funding for the local NHS?

Mr Lansley: I am grateful to my hon. Friend. We visited St Cross hospital together, so he knows the importance that we both attach to the service that is provided there for his constituents locally, but that happens in the context of the resources that we provide to enable the NHS to do its job. The Government have made an historic commitment to increase resources for the NHS in real terms each year, notwithstanding the appalling financial circumstances that we inherited from the Labour party.

The policy of the right hon. Member for Leigh (Andy Burnham) is to cut the NHS budget. Under those circumstances and under the policies of the Labour party, the number of redundancies in the NHS would proliferate.

Andy Burnham (Leigh) (Lab): The right hon. Gentleman is planning the biggest reorganisation in the history of the NHS, and yet he is unable to give basic information on it, such as how many people may lose their jobs, to my hon. Friend the Member for Coventry South (Mr Cunningham). Tens of thousands of people who work for primary care trusts and strategic health authorities are at risk of losing their jobs, so it is no wonder that after a just a few short weeks in his job, the Secretary of State has brought morale in the NHS to rock bottom.

In his letter to the NHS, the NHS chief executive says that £1.7 billion should be set aside to pay for the Secretary of State's reorganisation. Others have said that the cost of his reform could be up to £3 billion. At a time when the NHS needs every penny to maintain standards of patient care, it is scandalous for money to be diverted in that way. He may be ignoring the human cost, but can he tell the House today his latest estimate from the Department of how much his ideological reorganisation will cost?

Mr Lansley: I do wish the right hon. Gentleman would at least remember what he was responsible for before the election. He said that the NHS in this financial year should set aside 2%-£1.7 billion-for the cost of reorganisation. I have not changed that figure by one penny. However, I have taken his policies, which led to a proliferation in management costs-an 80% increase in the cost of management consultants in the NHS in two years and a doubling of management costs in PCTs and SHAs in eight years-and reversed them. We are cutting management costs in the NHS this year by more than £220 million and by up to £1 billion over four years. I make no apology for that, because if we are to protect front-line services and improve health outcomes, that is exactly what we need to do.


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Andy Burnham rose-

Mr Speaker: Order. The remainder of this exchange-on both sides- needs to be shorter.

Andy Burnham: Let us first get some facts straight. I asked PCTs to set aside money to invest in patient care, changing patient pathways and better services. I did not say that a Labour Government would cut the NHS budget; I said that we would maintain it in real terms, not increase it, as the Secretary of State proposes. The effect of his increase will mean severe cuts to councils, which need to provide care support to older people to get people out of hospital.

However, the Secretary of State would not today tell us what his proposals would cost. Is it not the case that the plans were not in the Conservative or Liberal Democrat manifestos, and that there is no democratic mandate for the break-up of the NHS? Given that there is now a chorus of protest at his plans, will he step back, listen to patients and staff and consult on those reforms before taking them forward further?

Mr Lansley: I and my colleagues are engaging right across the country with patients, the public, local authorities, PCTs and general practitioners, and we are meeting enthusiasm for our proposals. Why? Because we are focusing on delivering improving outcomes for patients, and doing so in the context of an historic commitment by this coalition Government to increase resources for the NHS in real terms each year. The right hon. Gentleman's policy would be to cut the NHS budget.

Andy Burnham: The Secretary of State thinks he can behave any way he likes with the NHS, the most beloved institution in this country, but we will not let him-we will give him a fight every inch of the way. The latest example of his high-handed and arrogant behaviour came on the eve of a bank holiday weekend, when he casually let slip that NHS Direct would be scrapped. NHS Direct is a valued service that receives 27,000 calls every day and saves millions of pounds for the NHS, and that has more than 3,000 staff working for it. Will he today apologise for making that statement in such an outrageous manner? Will he listen to the 14,000 people who signed a petition to save NHS Direct, and going forward, stop acting in such a cavalier manner with our NHS?

Mr Speaker: Order. A question should be a question-it should not really be three questions.

Mr Lansley: Once again, the right hon. Gentleman should remember what he did before the election. A press release from his Department on 18 December 2009, when he was Secretary of State, said that he would establish a new 111 national number for non-emergency health care, and that this could become the single number to access non-emergency care services, including NHS Direct. I did not announce anything: I simply said that we were going to get on with that-he never did.

National Capitation Formula

4. Mr Peter Bone (Wellingborough) (Con): What plans he has for the future of the national capitation formula. [13150]


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The Minister of State, Department of Health (Mr Simon Burns): Revenue allocations post 2010-11 will be set following the spending review. From 2013-14, the NHS Commissioning Board will allocate the majority of NHS resources to GP consortiums on the basis of seeking to secure equivalent access to NHS services relative to the burden of disease and disability. Public health resources will be separately allocated to reflect relative population health need and to seek to reduce health inequalities.

Mr Bone: Under the Labour Government, Northamptonshire was the worst funded primary care trust in the country. That was because the Government never met the national capitation formula in full, denying Wellingborough a hospital, for instance. Will the Minister's new proposals be fairer and encourage my constituents in the belief that they will get a better deal?

Mr Burns: I am grateful to my hon. Friend for that question, because he is right-under the Labour Government, Northamptonshire Teaching PCT was underfunded and is currently receiving 1.4% below its target allocation. That is why my right hon. Friend the Secretary of State and I are seeking, under the vision outlined in the White Paper, to free the NHS from day-to-day political interference so that the allocation of resources will be the responsibility of the NHS Commissioning Board which can seek to address the problems highlighted by my hon. Friend.

Cross-Border Health Services

5. Mr David Hanson (Delyn) (Lab): What recent discussions he has had with the Welsh Assembly Government on the effects of proposed changes to health services in England on patients living in Wales who use those services. [13151]

The Parliamentary Under-Secretary of State for Health (Anne Milton): Since the election, there have been informal, but no formal, discussions between my right hon. Friend the Secretary of State for Health and the Welsh Assembly Government. However, I understand that a meeting is planned for later this year. Clearly, there have been discussions between officials about the impact of the White Paper and the changes.

Mr Hanson: May I respectfully suggest that someone in the Government gets on and talks to the Welsh Assembly Government? A third of my constituents, who live in Wales, use the Countess of Chester hospital in England, and they use hospitals in Manchester, including the Christie and the Clatterbridge for cancer services, as well as the Robert Jones and Agnes Hunt hospital in Shropshire for orthopaedic services. They are as appalled as I am by the changes being proposed by the Conservatives to destroy the NHS. Get on and talk to someone please.

Anne Milton: May I thank the right hon. Gentleman for his question and assure him that officials have got on with it and do it constantly? It is important that we ensure that any changes are synchronised across the two areas, and I know that he will continue to raise cross-border issues. I can reassure him that we have already got on with it and he need not remind us to do so.


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David T. C. Davies (Monmouth) (Con): Given that patients in Wales, served by the Welsh Assembly, have to wait far longer for routine operations and ambulance responses, is it not the case that the only problem that the Department will face is that the people of Wales will be galvanised by the excellent policies of this Government into suggesting that the Welsh Assembly Government ditch their failed health policies and copy those of the coalition Government?

Anne Milton: I thank my hon. Friend for that wonderful advertisement for the changes that we are bringing in. I agree with him and I am sure that the people of Wales will see the changes that we are bringing in and contact the right hon. Member for Delyn (Mr Hanson) to urge him to ensure that the changes are also introduced in Wales.

Hywel Williams (Arfon) (PC): Fourteen thousand people from Wales are registered with GPs in England, and 19,000 people from England are registered with GPs in Wales. Will the Under-Secretary ensure that the changes that she brings in do not lead to any dangers to the services provided for both sets of people travelling across the border, and that adequate financial recompense is made as well?

Anne Milton: It is extremely important that people receive similar and safe passage and continuity of care across the borders, and we will continue to have conversations, both at ministerial level and between officials, to ensure that any hitches that arise are smoothed out as soon as possible.

GP Consortiums

7. Caroline Flint (Don Valley) (Lab): How many GPs in Doncaster have expressed an interest in establishing GP consortiums. [13153]

The Minister of State, Department of Health (Mr Simon Burns): The Yorkshire and Humber strategic health authority has informed me that two existing practice-based commissioning consortiums are currently working on behalf of all Doncaster's 45 GP practices. GPs in Doncaster are enthusiastic about the agenda and, in partnership with Doncaster primary care trust, have established a transition team meeting to oversee the process.

Caroline Flint: Yes, there is something called the "Doncaster commissioning consortium" in Doncaster, which provides clinical leadership to Doncaster PCT when it comes to commissioning. From what I understand from the Government's proposals, as a result of these changes the Doncaster commissioning consortium, made up of the majority of GPs, will have to employ people, either from the PCT or other sectors, to do the budget and management of commissioning. Is this restructuring not just a rebranding to make the Government look as if they are being innovative in health care when in fact they are pouring money down the drain and conducting a restructuring that we just do not need?

Mr Burns: May I recommend that the right hon. Lady, who from her past ministerial career is familiar with health issues, study not only the White Paper that we have published, but the documents, particularly on
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commissioning, that flowed from that, because I am afraid that her interpretation of the situation is wrong? This is a great change from the PCT system, because it will basically ensure that commissioning will no longer be remote but be carried out by GPs at the forefront of dealing with patients' needs and care, who know best how to ensure that patients get the finest and best health care possible.

GP Commissioning

8. Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con): What plans he has to assist GP commissioning in rural areas. [13154]

The Parliamentary Under-Secretary of State for Health (Anne Milton): Our proposals in the White Paper will enable general practices to structure commissioning to reflect the character of the area they serve. Practices in rural areas, such as Cumbria and Cambridgeshire for instance, are exploring commissioning models. To support GP consortiums, we will create a statutory NHS commissioning board.

Dr Poulter: The Minister will be aware that many women make the choice to have a home birth and delivery, but unfortunately, in many rural areas, maternity services have historically been under-resourced. What steps does the Minister envisage better to support home delivery in rural areas, and to support GPs in their commissioning of these services in the future?

Anne Milton: I congratulate my hon. Friend on taking up the chairmanship of the all-party group on maternity. I know that his work with it will be very valuable, particularly in the light of his previous experience in the health service. Contrary to what Labour Members believe, this is an important opportunity to put general practices-in all their shapes and forms within all the professions-at the very heart of shaping services. As he said, home births and choice in maternity services are crucial for women.

Ann Coffey (Stockport) (Lab): I have concerns about the effect of the Secretary of State's proposals for GP commissioning on services in rural areas and urban areas such as mine. Greater Manchester PCT provided strategic leadership in the recent reconfiguration of children's services, which was very contentious. Can the Minister clarify how that strategic leadership will be provided in the future reconfiguration of cancer, maternity and ambulance services in Greater Manchester, as GP commissioning will be focused on local health needs and national commissioning on national specialities?

Anne Milton: The hon. Lady made the point that urban and rural areas have very different needs. What is vital are the people on the front line, making decisions and offering the leadership and vision to shape those services. I do not think that she will find many people lining up to save PCTs, whose commissioning has not always been as successful as she would like to believe.

Dr Thérèse Coffey (Suffolk Coastal) (Con): I should like to suggest to the Minister that it might help GPs who are commissioning in rural areas if the formula for capitation were to include the information that their
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patients live in sparsely populated areas, as well as information about their age, especially in constituencies such as mine and that of my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter).

Anne Milton: My hon. Friend is right to raise the issue of the distances covered in rural areas. I believe that only ambulance trusts currently have the opportunity to reflect that. This is why it is so important that local commissioners will shape the services for their patients. It is they, not the pen-pushers in the PCT, who know best what is right for their patients.

Diabetes

9. Keith Vaz (Leicester East) (Lab): What steps his Department is taking to inform young people about diabetes prevention. [13155]

The Minister of State, Department of Health (Mr Paul Burstow): I thank the right hon. Gentleman for his question, and for his tireless campaigning to raise awareness of diabetes. We know that being physically active and maintaining a healthy weight can reduce an individual's risk of developing type 2 diabetes and cardiovascular disease. Our approach is to support families and young people to eat healthily and be physically active.

Keith Vaz: I thank the Minister for his comments. I declare an interest as one who has type 2 diabetes. As he knows, we spend £1 million an hour treating diabetes-related illnesses, and more and more people are now being diagnosed at a much younger age. What steps are the Government taking to alert parents and young people to the perils of diabetes?

Mr Burstow: The right hon. Gentleman is absolutely right to draw our attention to the rising rate of diabetes in our country. When it comes to diabetes in children, we have to bear in mind that the diagnosis for type 1 diabetes-which affects about 23,000 children in this country-is a genetically predisposed condition that cannot easily be prevented. We need to do more about type 2 diabetes, however, by tackling the obesity problems in this country. We need to deliver physical and healthy eating programmes through schools and other partners, and those things are much better done in the context of the local authorities, which will now have a new responsibility for public health that the last Government never gave them.

Mr Adrian Sanders (Torbay) (LD): Information and education are also important for people with the condition of diabetes, to help them to get the maximum benefit from their prescribed course of treatment. May I urge the Minister to make an assessment of the improvements to health that education and information can contribute?

Mr Burstow: My hon. Friend makes a good point about the value of information in empowering patients, and about the value of education. That is why we want to do more with NHS information prescriptions, which is an important tool, and to ensure that the care planning process that delivers tailored care plans also includes structured education. There is no doubt that providing education really does make a difference to the outcomes for people with diabetes.


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Jim Shannon (Strangford) (DUP): I thank the Minister for his response to the question. I also wish to declare an interest as a type 2 diabetic. The junk food culture of the moment is a serious problem, so what steps is the Minister taking to address that in his effort to reduce the number of people being diagnosed as diabetic over the next year?

Mr Burstow: The best way of responding to the hon. Gentleman's very appropriate question is to say that we are taking a four-pronged approach to diabetes. First, we need to tackle the causes of the condition through a renewed impetus on public health. We shall announce more of our plans in our White Paper later this autumn. Secondly, we need earlier identification and diagnosis so that we can help people to manage their condition at an earlier stage so that it does not progress. Thirdly, we need effective management and self-directed care. Finally, we need world-class research so that we can better understand the condition and deliver better treatments.

Accident and Emergency Departments

10. Mr Barry Sheerman (Huddersfield) (Lab/Co-op): What steps he is taking to ensure the adequacy of resources allocated to hospital accident and emergency departments. [13156]

The Minister of State, Department of Health (Mr Simon Burns): It is the responsibility of local NHS commissioners to plan and arrange adequate A and E health services according to the needs of their local populations. Attendances at hospital A and E departments are reimbursed through mandatory national tariffs.

Mr Sheerman: Is the Minister aware that my constituents in Huddersfield are very pleased with the improvements to their A and E services over recent years? They put that down to fewer people going to A and E because they have NHS Direct to take the pressure off A and E, and to the guarantee of being seen within four hours, and having the right to complain pretty vigorously-as we do in Huddersfield-if that does not happen. Are not the measures that the Government are introducing simply going to make A and E impossible again?

Mr Burns: May I reassure the hon. Gentleman's constituents that they will be just as pleased with the responses that they receive from a 111 line, where professional advice and help will be given to people who need to contact it about their health needs? May I also reassure his constituents on the question of four-hour targets? The target that was introduced caused distortions; it was a political target. We are relying on clinical decisions and activity to ensure that people are seen as quickly and relevantly as possible.

Mr Stephen Dorrell (Charnwood) (Con): Does my hon. Friend agree that in addition to the proper funding of A and E departments, it is also important to take steps to manage the demand on those departments? In particular in urban areas, that means that commissioners should accept the responsibility to look for improvements in the delivery of primary care so that patients have more easy access to less urgent care in the primary care context, thus reducing the demand on A and E departments.


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Mr Burns: My right hon. Friend is absolutely right. It is, of course, not only a question of correctly identifying those people who should use A and E; the other assistance given through the health service is also important. We need a first-class and relevant out-of-hours service as well.

Facet Joint Injections

11. Hugh Bayley (York Central) (Lab): What recent assessment his Department has made of the clinical effectiveness of facet joint injections; and if he will make a statement. [13157]

The Parliamentary Under-Secretary of State for Health (Anne Milton): Recommendations on facet joint injections were made by the National Institute for Health and Clinical Excellence in its 2009 clinical guidelines on low back pain. NICE did not find sufficient research evidence that strongly supported the effectiveness of facet joint injections and recommended that more research should be done. I understand that the National Institute for Health Research is looking at whether it will commission further research.

Hugh Bayley: Access to these injections is restricted in North Yorkshire and York PCT, although it is widely available on the NHS in other areas. The consultant in charge of York's pain clinic believes that the PCT is not following the most recent NICE guidelines. What are the Government doing to reduce this kind of postcode lottery? Will the Minister contact the PCT and arrange for it to meet me and the consultant to discuss how these guidelines ought to be applied in North Yorkshire and York?

Anne Milton: I thank the hon. Gentleman for his remarks and point out that it is precisely because of the situation that he describes that we are bringing in some of our reforms. It is important that decisions about treatment and care are made by clinicians-GPs and a large number of other people, including some voluntary and charitable organisations-and that they are clinically led, evidence-based and also include patient choice.

NICE (Cost-effective Drugs)

12. Mr Charles Kennedy (Ross, Skye and Lochaber) (LD): What recent discussions he has had on the effectiveness of the National Institute for Health and Clinical Excellence's procedures to review the cost-effectiveness of drugs; and if he will make a statement. [13158]

The Minister of State, Department of Health (Mr Simon Burns): Ministers discuss NICE's work from time to time as part of routine business. We attach great importance to the work NICE does in giving advice to commissioners and clinicians on the relative clinical and cost-effectiveness of treatments. The right hon. Gentleman will know that we also propose reforms that will better reflect the value of new drugs in the relevant prices paid by the NHS.

Mr Kennedy: In thanking the Minister for that helpful reply, I note that my question rather overlaps with the pertinent question just asked by the hon. Member for York Central (Hugh Bayley). Can the Minister give us
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any indication of where the Government, at this stage of their Administration, are on the proposed cancer drugs fund, particularly with reference to the drugs used for kidney cancer treatment, which NICE is still evaluating? Can these drugs be issued under the interim cancer drugs fund, not least given the terrible delays some patients face with the local PCTs, when by the time things are resolved it is sometimes, sadly, too late?

Mr Burns: May I reassure the right hon. Gentleman that we will shortly consult on the cancer drugs fund. On the question of Afinitor, in which I know he has a particular interest, I appreciate that there has been some concern expressed by families and patients about the issuing of the interim guidance. I would like to emphasise that the guidance is only interim, that the appraisal is ongoing and that we await the final guidance from NICE. I hope that he will be reassured that, since the publication of the draft guidance, the manufacturer of Afinitor has proposed a revised patient access scheme for the drug, which is now being considered as part of the NICE appraisal. In the light of that, we will have to await the announcement of the final decision.

Cancer Survival Measurement

13. Mr John Baron (Basildon and Billericay) (Con): What recent representations he has received on the proposed one-year cancer survival measure. [13159]

The Minister of State, Department of Health (Mr Paul Burstow): I have received many helpful representations on the proposed one-year survival measure, including his own when I met him along with a number of leading cancer charities in July. We have launched a full public consultation to shape the first ever outcomes framework for the NHS, and I urge all interested parties to contribute. The consultation document has put forward a range of possible outcome measures, including a one-year cancer survival rate that could be included in the framework. A full response to the consultation will be provided when it closes on 11 October.

Mr Baron: The one-year cancer survival measure is welcome, because it will encourage earlier diagnosis. As the Minister will know, however, under-treatment of the elderly in the NHS remains a pressing problem, which was highlighted in a recent report on cancer inequalities by the all-party parliamentary group on cancer. Can he assure us that the over-75s will not be excluded from the one-year or the five-year cancer survival measures once they are constructed?

Mr Burstow: The hon. Gentleman makes an important point. It is essential for us to ensure that the NHS delivers treatments that are both based on evidence and age-appropriate, which means ensuring that older people receive treatments that will enable them to survive cancers. His representations will need to be taken fully into account as we consider the results of the consultation on the outcomes framework.

Chris Leslie (Nottingham East) (Lab/Co-op): Has the Minister seen today's report from Cancer Research UK? It suggests that many primary care trusts and hospitals focus on drug therapy, and that radiotherapy-particularly targeted and image-guided radiotherapy-is
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often not given enough priority. Can the Minister assure us that, when considering cancer drugs expenditure, he will give equal priority to radiotherapy treatment?

Mr Burstow: The hon. Gentleman's question is also relevant to surgery, but Cancer Research UK was right to produce this snapshot of the lamentable record of the last Government on access to radiotherapy. Spending on the NHS has now reached European levels, but we have not seen an equivalent achievement in terms of outcomes. That is why the present Government have been consulting on outcomes, and why we have asked Mike Richards, clinical director for cancer services, to examine these very issues in his review of the cancer reform strategy.

Hospital Facility Transfers

14. Gordon Birtwistle (Burnley) (LD): What steps his Department takes to ensure that local NHS trusts observe its guidelines on reconfigurations involving transfer of facilities from one hospital to another. [13160]

The Secretary of State for Health (Mr Andrew Lansley): Commissioners should ensure that current and future reconfigurations demonstrate evidence of compliance with the four criteria that I announced in May. That should be a rigorous process, involving GPs and other local clinicians, local authorities, patients and the public, as set out in guidance. For current schemes, the local assessment should be concluded by 31 October this year.

Gordon Birtwistle: Is my right hon. Friend aware that East Lancashire Hospitals NHS Trust is breaching his guidelines by transferring a children's ward from Burnley to Blackburn without the approval of local GPs and the local council or the support of the local population? Will he please intervene?

Mr Lansley: My hon. Friend and I have had a conversation in Burnley about emergency and children's services at Burnley hospital. I was not aware of the position that he has just described, but I will ensure that any reconfigurations that have taken place in the past and are still being reviewed, or that are currently being proposed or acted on, comply with the criteria that I set out in May, and I will write to him.

Mental Illness Care

15. Anna Soubry (Broxtowe) (Con): What mechanisms are in place to assess the effectiveness of assertive outreach teams in providing support for people with severe mental illness; and if he will make a statement. [13161]

The Minister of State, Department of Health (Mr Paul Burstow): The Department of Health has issued guidance on the key components of an effective assertive outreach team. It is for each local trust to put in place robust quality assurance arrangements to ensure that it delivers the high-quality and effective service that the public expect. That is further underpinned by the work of the Care Quality Commission.


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Anna Soubry: I am grateful to the Minister for his response. One of my constituents, William Barnard, who was profoundly mentally ill, went on to kill his grandfather as a result of the poor system that was operating in relation to his care. What progress has been made in ensuring that other teams do not suffer from the same failings in their systems?

Mr Burstow: The hon. Lady and I debated this issue in the Chamber back in July. One of the most concerning aspects of the case of William Barnard was a singular failure to listen to the concerns expressed by family members and carers on the part of those who could have taken the necessary action to improve matters. I continue to take a close interest in the investigations being undertaken by the local NHS. We want to ensure that when lessons can be learned nationally, they are reflected in the Government's forthcoming mental health policies.

Miss Anne Begg (Aberdeen South) (Lab): Have the Minister or others in his Department had any discussions with the Department for Work and Pensions, because in the coming months a large number of people with mental health problems will be called in for interview to be reassessed from incapacity benefit on to employment and support allowance? This is already causing a great deal of anxiety among my constituents because Aberdeen is one of the trial areas. I wonder whether any of the mental health professionals have been informed and are ready for the influx that might result from that change in policy.

Mr Burstow: There are several parts to that question. First, we have already made commitments to invest in talking therapies, which are improving hugely the quality of lives of many people with mental health conditions. Secondly, I and departmental officials have had meetings with colleagues in the DWP, and I will have further meetings shortly, particularly to discuss the DWP input into a cross-Government mental health strategy.

Death Certificates

16. Andrea Leadsom (South Northamptonshire) (Con): What recent representations he has received on requirements for doctors to record the primary cause of death on a death certificate. [13162]

The Parliamentary Under-Secretary of State for Health (Anne Milton): I am not aware of any such representations. Doctors are required under the Births and Deaths Registration Act 1953 to complete the medical certificate of cause of death "to the best" of their "knowledge and belief". They receive information on this as part of their medical training. The Office for National Statistics produces reference material from time to time, including a video and training pack to assist doctors in completing the medical certificate on cause of death.

Andrea Leadsom: I thank the Minister for that answer. We have in my constituency of South Northamptonshire the Progressive Supranuclear Palsy Association headquarters. That is a neuro-degenerative disease with some similarities to motor neurone disease, although the big difference is that I doubt that many Members will have heard of it before now. Many people suffer
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from it, however, yet it is often not recorded on the death certificate. It is always fatal, giving a life expectancy of about two years. Might the Minister be prepared to review the situation and give some consideration to requiring doctors to put the primary cause of death on the death certificate so that we can properly assess the magnitude of this awful degenerative disease?

Anne Milton: I thank my hon. Friend for raising this issue. As a result of inquiries from the Progressive Supranuclear Palsy Association and others, the ONS is carrying out a special exercise to attempt to identify the true number of deaths involving PSP. However, it is extremely difficult to diagnose. I should just point out that medical examiners, when appointed, will be confirming the cause of death in all cases not investigated by the coroner. I think that that will make a difference to the information recorded on death certificates.

Topical Questions

T1. [13172] Caroline Flint (Don Valley) (Lab): If he will make a statement on his departmental responsibilities.

The Secretary of State for Health (Mr Andrew Lansley): My responsibility is to lead the national health service in delivering improved heath outcomes in England, to lead a public health service that improves the health of the nation and reduces health inequalities, and to lead the reform of adult social care that supports and protects vulnerable people.

Caroline Flint: In recent years more research and evidence has demonstrated that the trans fats present in our food are a major heath hazard. That is how the National Institute for Health and Clinical Excellence has described them, and the World Health Organisation has described them as toxic, but many people do not even know they are in our foods because they are not listed on the front of our food packaging. Is the Secretary of State prepared to consider banning trans fats in our food, as is happening in other countries around the world, or at the very least consider making sure they are labelled on the products we buy so that we can make an informed choice?

Mr Lansley: The right hon. Lady will know that we have made progress in this country in reducing the amount of trans fats in foods. My personal view is that we should seek to eliminate them, rather than have them in foods and have them labelled. It is important that we have front-of-pack food labelling that identifies the extent to which there are saturated fats, and I am looking forward to making greater progress in getting a more consistent front-of-pack food labelling than we have achieved in the past.

T2. [13173] Tony Baldry (Banbury) (Con): GPs and GP practice managers in my constituency are keen to get on with GP commissioning because they see that that can lead to better outcomes for local people but, unsurprisingly, they have a number of detailed questions as to how GP commissioning will work. Who will best answer those questions, and when will that happen?


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Mr Lansley: My ministerial colleagues, and many other leadership colleagues across the NHS, are engaged in meeting staff and potential commissioners, and existing commissioners and patients and public across the country. I had a meeting of that kind in Hampshire just last week, which illustrated precisely the point my hon. Friend makes: people came from general practices across Hampshire, and they fully endorse the principle of this change and they just want to get on with it. They did not want to wait for the full transition, and they now wanted to go through some of the detailed questions. We issued a consultation document following the White Paper, which was focused on general practice commissioning. I urge my hon. Friend's constituents and others to respond to that before 11 October, which will enable us then to proceed to set out the full details of how general practice-led commissioning will work.

Mary Creagh (Wakefield) (Lab): The Secretary of State had a difficult summer, with his plans to scrap free milk for the under-fives being attacked across the spectrum and eventually vetoed by the Prime Minister, but he met the new chair of Unilever, Amanda Sourry, on 21 July. On the following day, Ms Sourry wrote him a letter, some of which is blanked out. She wrote that

The Department has tried to black out that sentence, perhaps because it shows an unhealthy closeness between the Secretary of State and Unilever. Does the Secretary of State have an opinion on how food should be labelled, and, if so, will he tell the House what it is? Will he tell the House what other areas of food policy he plans to subcontract out to multinational food giants?

Mr Lansley: I hardly know where to begin due to the absurdity of some of the assertions in that question. How does the hon. Lady imagine that we are going to make progress on front-of-pack food labelling, on which her Government never made sufficient progress-there is no consistency on front-of-pack food labelling? This Government and this Parliament have no unilateral power to mandate what front-of-pack food labelling should look like and we have to achieve consensus in Europe and consensus in this country. We must do that with the manufacturers, the retailers, the charities and the health experts. That is precisely why our public health commission, when we were in opposition, brought together all those people around a table for the first time. I intend to create a realistic and effective partnership to deliver improving public health in this country, where her Government failed.

T5. [13177] Mr Philip Hollobone (Kettering) (Con): Kettering general is a wonderful hospital but recently its paperwork has got out of control. Some 30 occasional chaplaincy visitors from the local Catholic Church, many of whom are retired, have recently had to complete Criminal Records Bureau checks, employer references and an intrusive personal health questionnaire. Does the Minister agree that if we are to create the big society that the Prime Minister would like us to create, such bureaucracy must be minimised?

The Minister of State, Department of Health (Mr Simon Burns): I have considerable sympathy with the problems that my hon. Friend's constituents had. Although they are necessary, I would like to think that vital checks
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could happen through a process that is easy to manage for those who have to go through them. My view is that hospitals must ensure that checks on volunteers are proportionate and do not discourage good and well-meaning people from becoming involved in local care. I hope that my hon. Friend is reassured by the fact that my right hon. Friend the Home Secretary announced on 15 June that the CRB regime would be scaled back to common-sense levels. The Government will announce the terms of reference of the review shortly.

T3. [13175] Keith Vaz (Leicester East) (Lab): Some 1,800 patients in the Belgrave area of my constituency have been left without their local surgery because it has closed. Will the Minister assure me that despite the scrapping of the primary care trust, the new Belgrave health centre will be built? If he cannot tell me now, it would be very helpful if he could write to me.

Mr Lansley: I am grateful to the right hon. Gentleman, but in the absence of notice of that question, I fear that I shall have to tell him that I shall certainly look into that and write to him.

T6. [13178] Miss Anne McIntosh (Thirsk and Malton) (Con): The Minister of State wrote to me on 25 August to say that all future service changes must be led by clinicians and patients. How can it be that, although all the clinicians and patients oppose the downgrading and possible closure of the Ryedale ward of Malton hospital, that can proceed? Will he please use his good offices to block any such change?

Mr Burns: I am very grateful to my hon. Friend and would like to tell her that I have been informed by NHS Yorkshire and the Humber that NHS North Yorkshire and York has proposed incrementally to alter the balance between resources in the community and the in-patient areas by slowly reducing the number of beds open for admission and slowly transferring staff into the community. We understand that that forms part of the PCT's ongoing strategic plan for Malton. However, given my hon. Friend's concerns, I would be more than happy to meet her to discuss the issue further.

T4. [13176] Gloria De Piero (Ashfield) (Lab): When the Government say that the NHS budget will be ring-fenced, people might assume that whatever cash a hospital gets in this financial year will be matched next financial year. So could the Health Secretary explain why the King's Mill hospital in my constituency has been told to expect its budget to treat patients next year to fall by 8.2% or £14.9 million?

Mr Lansley: The answer to the hon. Lady's question is probably because that is what the Labour Government's spending intentions implied. All over the country primary care trusts are telling their hospitals that they can expect a zero increase in tariff and a reduction in activity, and hence a reduction in budget. I am making it clear that we are intending an historic commitment by this coalition Government to increase the resources for the NHS in real terms. That does not mean an increase in real terms for every part of the NHS all the time. It does mean, however, that resources will be realised through efficiency savings and that increase to enable us to improve the service we provide through the NHS and to meet rising demand.


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T8. [13180] Mr John Baron (Basildon and Billericay) (Con): Is any flexibility available to allow the interim cancer drug fund to review earlier and more speedily adverse National Institute for Health and Clinical Excellence decisions-because in certain cases, as we know with Avastin for late-stage bowel cancer, a few months, or even a few weeks, can make a big difference to patients.

Mr Lansley: My hon. Friend will be aware that we have proceeded as rapidly as we possibly can in finding savings this year, so that from 1 October the regional panels of expert clinicians can look at individual cases. It is not a matter of their reviewing NICE decisions; it is a matter of their looking at individual cases that cannot be funded under existing guidance or local decisions, but being able to apply clinical criteria to individual cases using an additional fund.

T7. [13179] Emma Reynolds (Wolverhampton North East) (Lab): Wolverhampton is the 28th most deprived local authority area in the country, resulting in major health inequalities. Can the Secretary of State reassure me that in future funding allocations, levels of deprivation will be taken into account?

Mr Lansley: Yes and more than that. I could make it clear that in the future, we will be moving-not for next year necessarily, but in years beyond, as we will make clear in the public health White Paper-to an explicit allocation of public health resources taking account of relative health outcomes and health inequalities, and those funds will be used to deliver improving public health. At the moment the formula to the NHS may take account of relative deprivation as measured by, for example, access to income support, but the money does not get spent on reducing those health inequalities and on an effective public health strategy. That is why we shall be very clear about separate, ring-fenced, public health resources used, together with local authorities, to deliver an effective public health strategy locally.

Andrew Selous (South West Bedfordshire) (Con): Leighton Buzzard is one of the larger towns in the country not to have a community hospital. What reassurance can my hon. Friend give me that the wishes of local GPs will be respected in deciding what services the proposed community hospital will have?

Mr Burns: I think I am in the fortunate position of being able to give my hon. Friend considerable reassurance. NHS Bedfordshire has the full support of local GPs, and they continue to develop a business case for the primary health care facility in Leighton Buzzard. They will go to full public consultation on the proposals. The centre is planned to open in 2012 and would be funded by NHS Bedfordshire.

John Mann (Bassetlaw) (Lab): Some 36,000 of my constituents, who voted by ballot, and every single GP in both local authorities, all believe that Bassetlaw accident and emergency department should remain a full 24-hour service. Can the Secretary of State conceive of any reason why that might not be the case during this Parliament?

Mr Lansley: The hon. Gentleman will be reassured to recognise that one of the commitments of the coalition Government in our programme was to stop the forced
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closure of accident and emergency departments. I am sure he will take comfort from the commitment of this Government, and from our commitment to increasing resources for the NHS in real terms each year, to enable the services that his constituents and others' require to continue to be provided and improved.

Jo Swinson (East Dunbartonshire) (LD): Information in a parliamentary answer given on 19 July showed that the cost to the NHS of emergency admissions in cases of anaphylaxis has risen by 45% in four years. Will the Minister look at how allergy support services could be enhanced in primary care to reverse the rising trend in emergency cases and in doing so save money and, crucially, lives?

Mr Lansley: Yes I will gladly do that. I have had the privilege and pleasure of visiting the specialist allergy service at my local hospital, Addenbrooke's, one of a small number across the country. I think it was the House of Lords Select Committee that produced an excellent report on allergy services, and I hope that this is one of those areas where clinical relationships between GPs and hospital specialists will enable both community and specialist services to be improved to meet this need.

Mr Kevin Barron (Rother Valley) (Lab): Given that 50% of health inequalities are created by tobacco use, will the Secretary of State give us an assurance that the targeted smoking cessation programmes in the national health service will survive?

Mr Lansley: We are going to improve the effectiveness of our public health services. As the right hon. Gentleman will know from past debates, I entirely recognise the extreme importance of reducing tobacco use. After the introduction of legislation on smoking in public places, there was a reduction in prevalence, but at the moment there is no continuing further reduction, especially among manual workers and young people; we need to achieve that reduction, and we will continue to look at measures to do that. We will say more about the issue in our public health White Paper.

Mr Steve Brine (Winchester) (Con): Many of my constituents, and indeed many practitioners, have grave concerns about the pending closure of Winchester ambulance station. Will the Minister assure the House that no changes to static ambulance bases will take place until local consortiums, when they are formed, are happy that a suitable alternative is in place?

Mr Burns: I am extremely pleased to be able to give my hon. Friend some reassurance. South Central strategic health authority has informed me that the service to the people of Winchester will not be affected, as there will be static provision for Winchester; ambulances will be deployed via a control centre in Otterbourne, 2 miles from Winchester. Those changes are set to take place in December, and the existing station will not be closed until there is new provision.

Mr David Lammy (Tottenham) (Lab): A decision has been taken in the past few days, without any consultation at all, to transfer the out-of-hours service for 950,000 north Londoners from the GP-run co-operative to a private provider. Will the Secretary of State intervene to ensure that local people and GPs make that determination?


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Mr Lansley: I am aware of the matter. The right hon. Gentleman will be perfectly well aware of my view: we want to involve general practitioners much more in commissioning out-of-hours services. I will undertake to look at what is proposed by the primary care trusts in north London and see whether it is consistent with the development that we are looking for in the White Paper.

Mrs Helen Grant (Maidstone and The Weald) (Con): If local GPs fail to support reconfiguration plans en masse-if, say, 97% fail to do so-what would be the Secretary of State's response?

Mr Lansley: As I said in response to a previous question, one of the four criteria that I set out on 21 May was that reconfigurations must have the support of local general practitioners as the future commissioners of services. To that extent, a reconfiguration that did not have the support of local general practices would not be able to meet that test.

Ian Paisley (North Antrim) (DUP): What discussions, if any, has the Secretary of State had with the Minister for Health, Social Services and Public Safety in Northern Ireland about making Avastin and other specialist cancer drugs available on the same terms and conditions under which they are available to people who suffer from cancer here on the mainland? Will those drugs be made available in Northern Ireland under the same terms and conditions?


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Mr Lansley: I have had very helpful and productive conversations with the Health Minister in Northern Ireland, but I have to say that they did not include that particular subject. Of course, decisions on the availability of medicines in Northern Ireland are a devolved matter, but I should be perfectly happy to take account of those issues when we next talk.

Dr Sarah Wollaston (Totnes) (Con): One year on from the implementation of the European working time directive, there is evidence that patient care is suffering. Handovers have been inadequate in some cases, and junior doctors' training time has been reduced. Will my right hon. Friend reassure me that he will take action to allow some acute specialities to opt out of the European working time directive?

Mr Lansley: Yes. I am very clear that, together with my right hon. Friend the Secretary of State for Business, Innovation and Skills, we need to take the European working time directive back to the European Union. We need to discuss it again. We need to go to the European Union with the intention of maintaining the opt-out and of giving ourselves, not least in the health context, the flexibility that we lack, so that junior doctors, in particular, have the capacity to undertake the training that they need. It is not that we want to go back to the past, when there were excessive hours-100-hour weeks and so on-but we want junior doctors to be confident that they will get the training that they require in the period allocated for training.


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Audit Commission

3.34 pm

Mr Clive Betts (Sheffield South East) (Lab) (Urgent Question): To ask the Secretary of State for Communities and Local Government if he will make a statement on his intention to abolish the Audit Commission.

The Secretary of State for Communities and Local Government (Mr Eric Pickles): On 13 August, I announced plans to disband the Audit Commission and to refocus audit on helping local people to hold councils and local public bodies to account for local spending decisions. Those changes will pass power down to people, replace bureaucratic accountability with democratic accountability and save the taxpayer £50 million a year.

Earlier that day, I spoke to the commission's chairman, Michael O'Higgins, informing him of my decision. I also informed him that I intended to invite Lord Adebowale of Thornes and Bharat Shah to serve a second term as members of the commission. As we have announced today, I am pleased to confirm that they have agreed to continue to serve, with Bharat Shah as deputy chairman. As I have also announced today, further commissioners will be recruited to the board through open competition to bring in new private sector expertise, as the commission focuses on the changes that I have announced.

These changes mean that the commission's responsibilities for overseeing and delivering local audits stop. Its research activities will end. Its in-house audit practice will be moved to the private sector, and we will consider a range of options for doing that. Councils will be free to appoint their own independent external auditors from a more competitive and open market. There will be new audit arrangements for local health bodies. All local audits will be regulated within a statutory framework, overseen by the National Audit Office and the profession.

With the ending of the inspection regime of comprehensive area assessment, many of the Audit Commission's functions have disappeared. While its corporate centre may have lost its way, the well-respected in-house audit practice has consistently done a good job, and it is to protect the future and to increase competition in auditing that we seek to put it into the private sector. The Government are happy to see a mutual set up by existing staff. My intention is that those arrangements will be in place from 2012-13, which involves introducing legislation this Session.

We will now work closely with local government, the health sector, the commission, the accounting profession and other partners to complete the detailed design of the new arrangements, and to take forward, in the most effective way, the transfer of the commission's in-house audit practice to the private sector.

Mr Betts: I thank the Secretary of State for his response, but I am not sure that I am any clearer about the precise reasons for his decision. First, may I ask why it was necessary to announce this decision in the middle of the recess, rather than coming to the House and making a statement? There did not seem to be any particular time imperative. Will he place in the Library of the House all the detailed papers that he must have gone through showing how he came to his decision? Presumably it was not a rushed one, or a knee-jerk reaction.


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As for the annual audit function, does the Secretary of State believe that the private sector has the capacity to carry it out at the same cost as the district audit service? If business is transferred to the private sector, will there be a return to the public purse? Value-for-money studies are not, as he tried to make out, some attempt to dictate to local authorities, but an important way of making comparisons between authorities, which are useful to the authorities and to the electorate in holding them to account. Who will undertake those studies in future? Finally, if the Secretary of State really believes in localism, why did he not consult local councils and the Local Government Association before announcing his decision?

Mr Pickles: I am grateful for the hon. Gentleman's questions and, indeed, I look forward eagerly to meeting him and his Committee next Monday to go through this in a more discursive way.

Of course I think there is plenty of capacity to deal with this. After all, the Audit Commission is the fifth-largest accounting practice in the country. The hon. Gentleman will readily understand that the Audit Commission was thinking along identical lines, and had already begun to engage in discussions with some of the larger practices regarding a potential sale, long before I talked to the chairman.

Do I think that going to private practice will operate at the same level of audit fees as currently? The answer is no. I expect it to be a lot cheaper. After all, audit fees have doubled in the past 13 years. With regard to the value-for-money practices and services, in the past the Audit Commission performed a very useful function. When it started out, it was virtually alone in doing that, but now there are many organisations providing those services, not least the National Audit Office. We should not be duplicating such reports.

Mr Edward Leigh (Gainsborough) (Con): I welcome the announcement. One of the problems with the Audit Commission, as opposed to the National Audit Office, is that it did not have a dedicated Committee in this place to which it could report-namely, the Public Accounts Committee. Presumably, this will now change. Can my right hon. Friend reassure me that with regard to local government and other matters covered by the Audit Commission, such as what goes on in hospital wards, the value-for-money work can now be taken up by the National Audit Office through the Public Accounts Committee and reported to the House?

Mr Pickles: The short answer is yes, and I thank my hon. Friend for that contribution. The House should celebrate the rigour that the National Audit Office has brought to the study of value for money, the work that it has done to offer good practice, and its accountability to the House. What the coalition Government have done will increase accountability to the House.

Margaret Hodge (Barking) (Lab): I share with others the concern that the Minister felt he could make such an extremely important announcement in the middle of recess, without making it to the House. I understand that he wishes the National Audit Office to have a new role, but does he understand that the National Audit Office is not a Department of Government but is accountable to Parliament, and that it is staffed not by civil servants but by officers of the Crown? In that
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context, is he aware that he cannot instruct the National Audit Office to play any particular role in this instance? Will he undertake to have proper consultations-I do not think my Committee has even had a letter from him-both with the Public Accounts Commission and with my Committee before he makes any other proposals, to ensure that these proposals are workable and bring to proper public account the massive expenditure and many programmes from local government?

Mr Pickles: I am sure it was a slip of the tongue by the right hon. Lady when she said that she had received no communication from me. She was one of the first people to whom I wrote-

Margaret Hodge: I have not had a letter.

Mr Pickles: I am amazed at that. I will send the right hon. Lady a copy. I assure her that I was at great pains to write to her, and I spoke to her principal officer to ensure that she would be briefed on the matter, so I am very surprised at that and will seek to speak to her immediately after this urgent question.

I apologise to the hon. Member for Sheffield South East (Mr Betts) for not dealing with why the announcement had to be made during recess. The simple truth is that we needed to appoint a number of commissioners. Had I appointed a commissioner on a short-term basis, it would have been obvious what was happening and that would have led to all kinds of speculation. I appointed just a sufficient number of commissioners at the end of August to ensure that the commission would remain quorate and that we would have an opportunity of appointing some commissioners with experience of transferring such a valuable asset to the private sector.

Margot James (Stourbridge) (Con): As the Secretary of State knows, the Audit Commission appointed ConnectPR to lobby parliamentary candidates, MPs and Ministers in the last Parliament. What is his Department doing to end the scandal of Government agencies that are supposed to be independent using public money to lobby other arms of Government in that way?

Mr Pickles: I share my hon. Friend's concerns about that. At a time when money and resources are short, it is clearly inappropriate for public bodies to use public money to lobby other public bodies. Indeed, my Department has issued instructions to all our bodies, including arm's length bodies, to cancel all existing contracts with lobbyists, and we will shortly issue guidance to public bodies on the use of lobbyists.

Mr John Denham (Southampton, Itchen) (Lab): Over the past 15 years, is it not true that the efficiency and effectiveness of local government improved significantly? By 2008, four out of five top-tier councils were rated in the top two performance categories. Councils were making £5.5 billion of efficiency savings in the current spending period, and the Commonwealth Fund recently judged the national health service to be the most efficient health care system among industrialised countries.

Is it not the case that the independent Audit Commission played a significant role in achieving those improvements? Why was the decision to abolish the commission taken
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in secrecy? It was not in the coalition agreement or in the published work plan of the right hon. Gentleman's Department. Why did it have to be rushed out without consultation? Will the Secretary of State apologise for briefing that the commission was spending money on trips to the races, when he knew that it hired a meeting room on a non-race day? Why did he hide behind tabloid headlines that he knew were wrong?

When the noble Lord Heseltine set up the Audit Commission, he said that

Was not the noble Lord right? Are not the Government recreating between local councils and auditors the cosy, incestuous relationships that also failed Enron and, more recently, the banking system?

The Audit Commission was increasingly looking at whether local services as a whole were working together to provide quality and cost-effective services, and letting the public compare the value for money that taxpayers receive from area to area. Is it not true that the Secretary of State stopped that work because he wants to see unjustified variations in service quality and an unfair postcode lottery?

The Conservatives said at the election that the independent Audit Commission would judge whether changes to local government finance were fair. Has not the right hon. Gentleman now abolished that body so that he can make changes without any effective scrutiny?

The Audit Commission was not perfect. I too blocked the appointment of an unduly highly paid chief executive, but is the Secretary of State not destroying one of the tools for challenge and improvement? It was the Audit Commission to which I could turn to investigate the boomerang bosses who walk out with big pay-offs and go into new jobs. It was the Audit Commission that advised first me and then him on the action to be taken with Doncaster city council. The House might share my fears that this move will end up costing local taxpayers far more than it will save.

Mr Pickles: The right hon. Gentleman seems to have changed his tune slightly, because at the time of the announcement he said:

The right hon. Gentleman refers to the use of Newmarket race course. I am not concerned that the Audit Commission spent £40,000 on pot plants, £8,000 on a conference at that race course or £4,600 on bagels. Nor am I worried that it spent £6,000 to celebrate its 25th( )anniversary at the Reform club, £3,000 on fine dining at Shepherd's or £170,000 on role-playing and training for its staff. The commission might have made a number of mistakes and errors of judgment, but this measure is about saving the audit function.

The Audit Commission itself recognised that it was working on identical sets of proposals, because it recognised that the future of audit was in the private sector. John Seddon, a visiting professor at Cardiff university business school, recently described the commission as


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It was once a great organisation, and it did make a change to local government. However, local government has changed itself and it is time to move on. No doubt the right hon. Gentleman will spend some considerable time living on past glories, but the Audit Commission cannot do that. It is time to pass the baton to the National Audit Office for the supervision of the process, and it is massively important to ensure that audit remains rigorous.

Simon Hughes (Bermondsey and Old Southwark) (LD): I hold no brief for the present regime, but will the Secretary of State explain the mechanism under the new arrangements whereby local communities will be able to tell on an annual basis whether their council is good value for money? If an individual or company wants to bring a particular query to the attention of auditors and get a quick reply, will they be able to do that, so that there is relevance both politically and economically?

Mr Pickles: The hon. Gentleman has a long and distinguished record of supporting localism. What we are doing passes the power to local people. We will ensure that a rigorous auditor is appointed and that there is rotation of auditors so that no cosy relations are built up. Auditors will have a responsibility for public probity and if a member of the public is unhappy about how their council is operating and has reason to believe that what it is doing is financially inappropriate, they will be able to report that directly. In addition to that, we will ensure that the ombudsman's powers are increased and made legally binding.

Barry Gardiner (Brent North) (Lab): The Secretary of State has said that he expects the costs to the public purse to go down as a result of abolition. Will he undertake to publish each year the actual costs of the arrangements with the private sector? Will he also ensure that there is a method whereby constituents can see comparability across the audits conducted for each area?

Mr Pickles: I am delighted to tell the hon. Gentleman that I can do better than that. We will ensure that all local authorities-and, indeed, my Department-will publish every single item of expenditure over and above £500. Members of the public will have a very clear idea where their money is being spent. That is not in any way meant to replace the auditing function. The cost of the auditing function will be made available to the public. There will be no hiding place for the Government; £50 million a year-at a Conservative estimate, if you'll pardon the pun-will be saved for the public.

Brandon Lewis (Great Yarmouth) (Con): I welcome this decision and, like councillors across the country, I suspect, I am looking forward to one of the benefits. We are all here to represent residents, and councils are there to serve them. Am I right in thinking that one of the key benefits for residents, thanks to this measure, is that councils will be able to move forward and make decisions based on what their residents want and need, rather than just ticking a box for the Audit Commission, which leads to unpopular decisions such as fortnightly waste collections?


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Mr Pickles: My hon. Friend makes a valid point about fortnightly waste collections. He is not alone in this; he will be delighted to know that he is in the company of the former Mayor of London, Ken Livingstone, who has welcomed the abolition of the Audit Commission. He said:

I am sure that we are all with him on that-although it is, of course, a coalition cut, not a Tory cut.

My hon. Friend has mentioned a prime example of the Audit Commission being keen to please the Government rather than perform its functions. When the Government were clear that they wanted fortnightly collections, it went out of its way to push local authorities in that direction. My hon. Friend is right: this measure means more power to local people.

Fiona Mactaggart (Slough) (Lab): After the implementation of this decision, what will happen to the rigorous but usually free audit support that the Audit Commission gives to small parish councils?

Mr Pickles: Given that 30% of all audit functions in public bodies are now in the private sector, I suspect that it will make no difference.

Bob Blackman (Harrow East) (Con): I am very pleased to hear the Secretary of State's announcement. I am also pleased to hear that these contracts will be rotated. However, one of the things we will all want to see is vigour in the process and expertise built up. What regulation or guidance will be issued on the length of contracts to ensure not only that a cosy arrangement does not grow up between auditors, but that expertise can be built up to speed up the process and reduce costs?

Mr Pickles: My hon. Friend is quite right to wish to ensure that there is a rigorous regime. He is also right to warn about the consequences of auditors remaining within a particular local authority for too long; it is always important to have a fresh eye. We will be looking to the National Audit Office and the professions to build up a very rigorous regime that will last and will pass the test of time.

Jon Trickett (Hemsworth) (Lab): The guarantee of probity is one of the central functions of the audit, and achieving that requires independence. One remembers very clearly the role of the Audit Commission in the political corruption at Westminster council, which revealed millions of pounds effectively being taken away from the public-the ratepayers-there.

May I draw to the House's attention the remarkable coincidence that the day on which this announcement was made-13 August-was the same day that Sir Philip Green was appointed the Government's efficiency tsar? Was there any connection between the two announcements? Can the Secretary of State give the House an assurance that Sir Philip Green, given his tax arrangements, will play no role whatsoever in guaranteeing probity in public expenditure?

Mr Pickles: I have known the hon. Gentleman for a long time, so I am genuinely sorry to do this to him, but may I politely remind him that the auditor in Westminster
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was a private sector auditor working for KPMG? It was not a district auditor-it was somebody in the private sector.

With regard to any outside organisations dealing with these matters, we are looking to the National Audit Office and the professions.

Dr Andrew Murrison (South West Wiltshire) (Con): May I congratulate my right hon. Friend on doing this and on the speed with which he is carrying it out? I think it will be welcome right across the public sector. Does he agree that the problem with the Audit Commission has been one of function, structure and, I am afraid, on occasion, questionable leadership? Will he distinguish that from the excellent audit function that many who work at the coal face in the commission carry out and will presumably continue to carry out under different managerial structures?

Mr Pickles: I am very glad to make that distinction. There was an element within a part of the Audit Commission that was about press releases, sucking up to Government and being part of the latest fad. That never percolated to the audit function, which has always upheld a very high standard. While we will pursue all options, I certainly hope that the workers within the Audit Commission get the opportunity to be able to set up a co-operative. We are keen to see that it is not the bosses of the Audit Commission who benefit from this but the workers.

Sir Peter Soulsby (Leicester South) (Lab): May I remind the Secretary of State that the auditor for Westminster was appointed and supported by the Audit
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Commission? What assurance can he give us that the rigour that was shown by that auditor will be repeated in future when auditors are appointed and chosen by local authorities themselves, inevitably leading to cosy relationships?

Mr Pickles: I note that the hon. Gentleman has conceded the point, although a little reluctantly and perhaps not with the greatest grace, that the auditor was a private sector auditor. That clearly demonstrates that the private sector can be trusted as auditors. The majority of those dealing with industry are private sector auditors, and that is the best guarantee of probity. We will ensure that the National Audit Office and the professions oversee this. There is a distinction, and it is this: we trust local authorities; Labour Members clearly do not.

James Morris (Halesowen and Rowley Regis) (Con): Does the Secretary of State agree that under the previous Government, the Audit Commission became increasingly an agent of central control? The decision that he has rightly made sends a very important signal that this coalition Government have confidence in local government and in driving through a decentralisation agenda. That is why I welcome his decision-it is the beginning of a decentralisation path that I wholly support.

Mr Pickles: I am most grateful to my hon. Friend for his support, and he is quite right. That is one reason why I believe the Audit Commission, despite all its defects, recognised that the time had come to acknowledge that the fifth-largest auditing function in the country would be better, safer and regulated more safely in the private sector.


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Pakistan Floods

4.1 pm

The Secretary of State for International Development (Mr Andrew Mitchell): With permission, Mr Speaker, I would like to make a statement about the floods in Pakistan. I am sure that Members of all parties will wish to express their profound sadness at the terrible suffering and devastation that the catastrophe has caused. Our thoughts are with all those families, both in Pakistan and here, whose lives have been touched by this terrible natural disaster.

It is now nearly a month since the devastating floods hit Pakistan, and it is almost impossible to describe the magnitude of what has happened. Ten years' equivalent of rainfall fell in one week, and subsequently a wall of water has travelled 1,200 miles down the country. Some 12.5 million people are in need of immediate assistance and 1.2 million homes have been damaged or destroyed. More than 1 million head of livestock have been lost and 3.5 million hectares of standing crops damaged or lost. The estimated cost to Pakistan's economy this year alone is $4 billion.

Britain will continue to do everything we can to help. I am particularly concerned about the potential for a secondary humanitarian public health crisis due to the slow draining of waters from Sindh province and parts of Punjab, the lack of access to clean water and sanitation facilities, and inadequate health facilities to treat the outbreak of water-borne disease. I have discussed all those concerns on a number of occasions with the United Nations Secretary-General, and he has assured me that the UN, working with partners on the ground, will do all it can to respond to the threat.

I am pleased to be able to say that the UK has been at the forefront of the international community's response to the disaster and was the first major country to come to Pakistan's support in significant scale in its hour of need. The Department for International Development has sent 3,500 all-weather tents to provide shelter for up to 10,000 people. More plane loads of aid quickly followed, providing tents, shelter kits, water containers and blankets to help many thousands more affected by the floods. We have drawn upon all resources available to the Government. The Royal Air Force has flown in five plane loads of relief, and I am sure that the whole House will join me in paying tribute to the contribution of our armed forces in this crisis.

Our assistance to date includes help for 500,000 malnourished children and pregnant or breastfeeding women through the provision of high-energy food supplements, treatment for severely malnourished children and the training of health workers. We are providing safe drinking water, sanitation and hygiene for 800,000 people, and have prioritised clean water and health interventions in Punjab and Sindh. Our support is helping to provide hygiene kits for more than 500,000 people and is being channelled through Save the Children, Concern and Oxfam. We are also providing shelter for up to 40,000 households through the Pakistan Red Crescent movement and working closely with Islamic Relief.

In addition, I am pleased to announce the overnight arrival in Karachi, in Pakistan, of the first of three new flights delivering DFID relief goods. It will bring much
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needed water purification units, pumps and water tanks to assist those in desperate need of clean drinking water. The other two flights will carry a range of items, including water carriers and shelter kits. We are also starting emergency production lines in two factories in Pakistan to produce hygiene kits and water containers that will help stop the spread of water-borne diseases in southern Pakistan, and are helping to set up an emergency field operation and co-ordination base camp near Sukkur to provide a base for relief workers in the middle of the worst flood-affected area.

My Department has also brought forward a bridge rehabilitation programme as part of the recovery effort. The first 10 bridges left Tilbury docks last week and will arrive in Karachi later this month. That assistance will help to open access routes and reduce the pressure on much-needed air assets.

Soon after the flooding started, I travelled to Pakistan with my noble Friend Baroness Warsi to see for myself the devastation. I visited the town of Pir Sabaq in Khyber Pakhtunkhwa province and saw the 12 foot-high watermarks on the remaining walls of the houses. It is not easy to imagine the terror and panic that must have affected particularly older, less mobile people and children as the mountain of water swept through the town. I know that the Deputy Prime Minister's visit to Pakistan last week made a similarly deep impression on him. During our visits, the Deputy Prime Minister and I discussed the situation with President Zardari and Prime Minister Gilani, as well as with representatives of UN agencies, non-governmental organisations and donors.

Following my visit to Pakistan, I went immediately to attend the UN General Assembly special session on the Pakistan floods, to support the UN Secretary-General's appeal. The initial response of the international community was woefully inadequate. I used that meeting to encourage other nations to contribute more and announced the doubling of the UK's contribution to the relief effort to £64 million. We have consistently worked to co-ordinate the effort of the donor community and on the ground with Pakistan's National Disaster Management Authority, under the experienced leadership of General Nadeem. The Pakistan authorities, the Pakistan Red Crescent Society and local and international agencies, including many brilliant British non-governmental organisations, have worked tirelessly throughout. We will continue to work closely with all partners to ensure that the response is as effective as it can be.

I should like to assure the House that my Department has throughout been committed to transparency and achieving value for money. We have not simply signed a cheque and handed it over. Our contributions to this humanitarian crisis have been based on detailed and rigorous assessments of needs on the ground. We are working night and day to ensure that every penny spent achieves a meaningful output that alleviates the suffering of the victims of this disaster. We have recently put a floods monitor on DFID's website to enable everyone to see where and how British aid is being spent to help those affected by the floods in Pakistan. All the UK's humanitarian assistance is provided through impartial agencies or through goods in kind.

I should also like to express my profound gratitude and respect for the unstinting hard work and skill shown by all British Government officials-both in DFID and from across Whitehall-throughout this emergency.


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In addition to the UK taxpayer's contribution, the British people have once again demonstrated their compassion and generosity. I am sure all hon. Members will wish to join me in commending the magnificent response from the British public, who have committed more than £47 million to the Disasters Emergency Committee appeal. We continue to urge people to give, and to give generously, to that appeal.

Our commitment is not just for the current emergency relief phase but also for the long haul. We will remain at Pakistan's side to help people to rebuild their lives and livelihoods. We will also support the longer-term reconstruction needs, such as schools, health clinics and other essential infrastructure, which are being considered as part of the bilateral aid review of our development programme.

Although the floods have been a terrible tragedy, their aftermath offers a genuine opportunity for Pakistan. It is an opportunity for the international community to come together and provide exceptional support to Pakistan in its hour of need, but equally, the situation offers an unprecedented opportunity for the Government of Pakistan to drive forward a radical economic reform agenda that could make a real difference to the future of the country.

The UK and Pakistan are bound together by bonds of history and family, which underline our support for Pakistan in good times and in bad. The Pakistani diaspora living in Britain ensures that our two countries remain closely linked. This bond will remain strong over the coming months and years, as we work together to help Pakistan to recover from this unprecedented catastrophe.

Mr Douglas Alexander (Paisley and Renfrewshire South) (Lab): May I thank the Secretary of State for his statement and for the early sight of it? I join him in expressing my deep sympathy for and solidarity with the people of Pakistan in the wake of this terrible flooding. The thoughts of all us are undoubtedly with all those families in Pakistan and their relatives here in the United Kingdom who have been affected by these unprecedented events.

May I, on behalf of the Opposition, also join the right hon. Gentleman in paying tribute to the work of the officials in the Department for International Development, as well, of course, to our armed forces, especially the Royal Air Force, and many other officials across Whitehall, in responding so effectively to this emergency? There is also common ground across this Chamber in paying tribute once again to the incredible generosity of the British people. As the Secretary of State mentioned, the DEC appeal has now raised upwards of £47 million and many outstanding British charities are contributing to the relief effort.

It is nevertheless incumbent on me to ask a number of questions. First, the Secretary of State and the Deputy Prime Minister were right to criticise the response of the international community to this disaster as "woefully inadequate" and far too slow. Will he therefore give us more detail on which specific donors and international organisations he and the Deputy Prime Minister have spoken with over the past few weeks to encourage them to make more generous contributions? Will he also tell us what meetings have taken place at the EU level, and what meetings in particular he has had with Commissioner Georgieva?


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Secondly, I thank the Secretary of State for providing us with a detailed list of what the Government aim to fund in the relief effort. He has indicated that he decided to bring forward some projects, including bridge building. That strikes me as a sensible approach, but could he clarify how much of the funding announced comes from sums already earmarked for Pakistan in the DFID budget, and how much of it is new and additional financing?

Thirdly, I join the Secretary of State in expressing concern about the secondary health crisis now emerging. According to the most recent reports, more than 200,000 cases of acute diarrhoea, 260,000 cases of skin disease and more than 200,000 cases of acute respiratory infection have already been reported. Does he believe that the health situation is under control? What further steps will he be taking to help to improve access to clean water and sanitation?

I wish to conclude by raising two final issues. As many in the House will know, there has been a series of concerning revelations over the summer about the Government's policies on international development. However, I do not think it appropriate to raise those in the context of today's statement, and I hope that the Secretary of State will do us the courtesy of coming to the House again soon to clarify his position on those matters. Nevertheless, there are two particular matters on which I seek further clarification today, relating specifically to this disaster.

First, as the poor initial response by donors showed, there is a clear need for greater pooled and co-ordinated funding able to be easily and quickly disbursed in disasters such as this-one of the main reasons why we championed the expansion of the UN central emergency response fund. Can the Secretary of State therefore tell us what role CERF has played in responding to this disaster, whether adequate funds were available, and whether or not he intends to increase Britain's contributions to the fund in future?

Secondly, it is clear that there is a need for continued reform of the global humanitarian system, including the UN, to increase its efficiency and effectiveness in responding to disasters such as the Pakistan floods. Can the Secretary of State therefore tell us whether or not he intends to continue the drive of the previous Government in pushing for global humanitarian reform and investing in a reformed international system, what lessons he believes need to be learned from this particular crisis, and what discussions he plans with the new UN Secretary-General?

The Secretary of State was of course right to point out the common bonds of history, culture and family that unite the UK and Pakistan. We must continue to be resolute in our support for the poor and vulnerable in Pakistan, particularly at this troubling time. Be assured, Mr Speaker, that the Government will have our support on this side of the House in their continued efforts to do so.

Mr Mitchell: I thank the right hon. Gentleman for his welcome for the statement and I will try to answer his questions.

First, may I thank him for his comments about the hard work of officials across Whitehall and the brilliant work that is being done by British charities throughout
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the flooded area? He asked me about the meetings that have taken place. Off the top of my head, I cannot speak for all the meetings that the Deputy Prime Minister has had, but I can tell the right hon. Gentleman that I had a raft of meetings when I was in Pakistan and New York, as well as having numerous phone calls since I got back. I talked to the Finance Minister and the Prime Minister in Pakistan, to all the leading non-governmental organisations, and to the head of the Office for the Co-ordination of Humanitarian Affairs in Islamabad, who has responsibility on the ground for the cluster system. I also had bilateral meetings with Canada, Norway, the United Arab Emirates, Japan, Australia, and with the World Bank, the International Monetary Fund and the European Union while I was in Pakistan. In New York, I had meetings with the UN Secretary-General and John Holmes, and I lobbied hard with the UAE Minister for Foreign Affairs. I also spoke to my opposite number in the United States, Raj Shah, the Pakistani Foreign Minister, the Swedish Development Minister, the Irish Development Minister and Lord Malloch-Brown. I hope, therefore, that the right hon. Gentleman feels that the British Government have used this opportunity to lobby hard and to get across the points on which he and I are agreed.

The right hon. Gentleman asked how much of the funding is new money and how much is coming from existing programmes. I cannot tell him that at the moment. Obviously, we first ensured that we found the money required, and in due course we will see what budget line it will come from.

The right hon. Gentleman next asked whether I am satisfied with the preparations made to tackle the secondary health crisis. He will be aware that the water is draining from Sindh extremely slowly because it is built on clay, and it might be many months before that drainage takes place. He is right to identify water-borne diseases and the dangers from them spreading rapidly through the vulnerable community, particularly among children and older people. All I can say is that we are on the case. I have spoken personally to the Secretary-General about that specific point, and all the money announced by the Deputy Prime Minister when he was in Pakistan last week will go directly to confronting that issue, which the right hon. Gentleman rightly raised.

Finally, the right hon. Gentleman mentioned leaks. I have seen these leaks, and I think that he will understand, having held this office, that there is probably less to them than meets the eye. However, he made two specific points. On the central emergency response fund-this proves my point-when his predecessor, the right hon. Member for Leeds Central (Hilary Benn), announced the setting up of CERF, we gave it strong support in opposition. I pressed in New York for additional amounts from that fund to be made available, and as part of our review, we will certainly see whether we can build on the substantial benefits accrued from that decision.

The right hon. Member for Paisley and Renfrewshire South (Mr Alexander) made another point about the lessons to be learned from this disaster. I am sure that there will be lessons-although obviously at the moment we are focused on confronting the emergency phase of this disaster-and I hope very much that they will be
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picked up and learned by the emergency humanitarian review that we have set up and is being chaired by Lord Ashdown.

Malcolm Bruce (Gordon) (LD): I welcome the Secretary of State's statement and agree with him that the UK's response, from his Department, across Whitehall and the private sector, and from private citizens, has been a leadership to the world, and also cements the relationship between the United Kingdom and Pakistan, which is very close and important. In the reconstruction effort, will he ensure that there is co-ordination between the World Bank, the United Nations, the IMF and the European Commission so that reconstruction is done to a standard that will ensure that, even if floods like this never happen again, future floods will not result in the same scale of devastation, because the standards will be higher and able to withstand the pressures? Finally, Pakistan has suffered from earthquakes and these devastating floods, and is tackling a very difficult insurgency. In those circumstances, would it not be appropriate for Pakistan to be promoted probably to the top of our bilateral aid list?

Mr Mitchell: On the last point raised by the Chairman of the International Development Committee, I said before these floods hit Pakistan that I thought it likely that, as a result of the bilateral aid review, Pakistan, within a comparatively short period, would become Britain's most significant bilateral aid programme-so I underline the point that he made in his third question.

On his first point, I thank him for what he said about British leadership. It is encouraging to note that there has been a significant increase in support for the Secretary-General's appeal fund. On his second point, about the reconstruction effort, he is clearly right that there needs to be strong co-ordination between all those taking part, and I hope that it will be provided by the pledging conference, which undoubtedly will take place before too long, and which I hope will take place in Islamabad.

Stephen Timms (East Ham) (Lab): The Secretary of State will know that concern has been expressed about the effectiveness of Pakistan Government agencies in responding to the terrible crisis that has engulfed that country, perhaps with the exception of the Pakistan army. However, he has rightly drawn attention to the contribution of NGOs-he mentioned Save the Children, Oxfam and Islamic Relief. What is his judgment of the right balance for the deployment of his Department's funding to, on the one hand, agencies of the Pakistan Government and, on the other hand, the NGOs that he has mentioned and others?

Mr Mitchell: The right hon. Gentleman is right to focus on those points. It is fair to say that no Government in the world would have been able to handle a catastrophe of this scale, and there are many who believe that the Government of Pakistan have done rather better than might have been expected. Despite the experience from the earthquake gained by General Nadeem, who is in charge of the disaster authority on behalf of the Government, and whom I met during my visit, there has clearly been a struggle. However, the Government have done better than many people expected.

The right hon. Gentleman asked how British taxpayers' money and the money so generously donated to the Disasters Emergency Committee by the British people
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is being allocated. None of it goes through the Government of Pakistan; it all goes through the United Nations or through the NGOs that he mentioned, which are doing such good work in very difficult circumstances.

Mr James Clappison (Hertsmere) (Con): I join the welcome for the Secretary of State's statement. There will be widespread public support for the international lead that this country has taken in responding to this immense disaster. Does it follow from what he just said to the right hon. Member for East Ham (Stephen Timms) that British aid is being administered through his Department and through NGOs and charities directly and promptly, so that the public can have confidence that the money being spent by the Department and the money that they are generously donating is getting through directly and promptly to those in need?

Mr Mitchell: My hon. Friend is absolutely right to say that the money that is going from the British taxpayer and from people's generous donations to the Disasters Emergency Committee does not go through the Government of Pakistan. It goes through the UN cluster system, with which he will be familiar, and through the NGOs that have been mentioned. If he cares to visit the DFID website, he will see an easily accessible monitor that enables people to track where British aid is going and what it is buying.

Anas Sarwar (Glasgow Central) (Lab): I join the Secretary of State's tribute to the British people. Every time there is a disaster, they put out their hands in friendship and donate generously. They have done so again now, and we must pay tribute to them for that. I also agree with his comments about the woeful response of the international community, and I understand the answer that he gave to the shadow Secretary of State about the discussions that he has had. It is always easy to get a response and donations when people can see the sad scenes and the high waters on their television screens, but what will happen when the waters subside and the cameras are switched off? The communities and the people of Pakistan will not overcome this tragedy in a matter of days; it will take months, if not years. The message that we need to get across to the international community is that, yes, Pakistan needs its support now, but it will also need it in the months and years to come. On that last point, what work is DFID doing alongside the NGOs and other international organisations on the ground to ensure that there is a co-ordinated response through the Disasters Emergency Committee?

Mr Mitchell: The hon. Gentleman speaks eloquently about the needs that will continue for many years as a result of this crisis and of the development needs of Pakistan. Three phases are involved. The first is the emergency phase, which I hope can be brought to a conclusion as swiftly as possible. The second is the rehabilitation and rebuilding phase, which will involve the pledging conference, to which I referred, in order to co-ordinate the international effort. The third will involve the long-term development programme. We are currently reviewing Britain's contribution to that through the bilateral aid review. There will need to be great co-ordination between all members of the donor community and the Government of Pakistan to ensure that the programme
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addresses the long-term needs of the country and offers hope to the people who are in a pretty desperate position today.

Sajid Javid (Bromsgrove) (Con): I welcome my right hon. Friend's statement and commend the swift action that he and his Department have taken. He will know, however, that the Pakistani state is unfortunately riddled with corruption on many different levels of bureaucracy and politics. Will he reassure us that his Department is taking whatever action it can to ensure that British taxpayers' money is being spent wisely and used to provide relief and humanitarian aid?

Mr Mitchell: My hon. Friend is right to focus on the importance of bearing down on corruption, but I have made it clear that, in regard to all the emergency relief work that is being done through my Department on behalf of the British taxpayer, and through the Disasters Emergency Committee, none of the money goes through the Government of Pakistan.

Mr Gregory Campbell (East Londonderry) (DUP): Understandably, the emphasis at the moment is on the immediate assistance required, and tributes have rightly been paid to the magnificent response of the people of the United Kingdom in that regard. Towards the conclusion of his statement, the Secretary of State referred to the need to drive forward a radical economic reform agenda. How does he envisage that panning out over the next few months as the Government and people of Pakistan prepare for the future?

Mr Mitchell: The hon. Gentleman will be aware that discussions are ongoing between the IMF and the World Bank and the whole of the donor community. A number of plans, particularly for macro-economic reform in Pakistan, are already in train. The point I sought to make in my statement was that an unprecedentedly strong offer of support from the international community also merits an unprecedentedly strong focus by the Government of Pakistan on implementing the reforms that everyone is agreed need to be made, but which perhaps seem to be taking quite a long time to get through.

Paul Uppal (Wolverhampton South West) (Con): I thank the Secretary of State for delivering this ministerial statement. I am glad to see that he is conscious of the developing problem in Sindh province and also, as he mentioned, in parts of Punjab. Does he share with me the general concern he highlighted about the lack of a proper response and the poor response from the international community? It is crucial in this politically sensitive area to address this issue because it affects hearts and minds. He may be aware of initial media reports showing that Taliban-inclined elements were helping with the very initial relief. If it were ever the case that people remember who their friends are in times of need, it applies now.

Mr Mitchell: I thank my hon. Friend for his contribution. On his first point, all the money announced in New York-the second tranche, which is the doubling of our funding-is now being spent in Sindh and Punjab, for reasons that a number of hon. Members on both sides of the House have underlined.


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My hon. Friend is right to identify the poor response, although while I was in New York there was a big increase in support from Saudi Arabia, Canada and Australia, and a number of other countries have followed since. I very much hope that at the European Union meetings taking place in the next fortnight, there will be a strong focus on ensuring that all the countries that can come to the assistance of Pakistan in its hour of need do what they can to help.

Geraint Davies (Swansea West) (Lab/Co-op): In respect of flood risk management in the future, to what extent will the UK Government support sustained investment in the adaptation of Pakistan to climate change, therefore making the country's infrastructure and communities more resilient to future flooding?

Mr Mitchell: The hon. Gentleman is absolutely right to talk about the importance of ensuring that there is effective investment in flood defences. It is something that the international community and the Government of Pakistan will want to look at in all three of the phases I described.

Dr Julian Lewis (New Forest East) (Con): May I ask my right hon. Friend to focus a little more closely on the second point raised by my hon. Friend the Member for Wolverhampton South West (Paul Uppal)? Was the Secretary of State as appalled and disgusted as I was to hear of the threats being issued by the Pakistani Taliban to murder "infidel" aid workers who presume to try and help their fellow countrymen? I know that his emphasis must be on the relief of suffering at the moment, but when that issue has moved further forward, will he have conversations with Foreign Office Ministers on how best to make it clear to the Pakistani people in future what sort of atrocious attitude and immorality is rife among those who say that people who want to help the people of Pakistan ought to be murdered?

Mr Mitchell: My hon. Friend makes an eloquent contribution and I can assure him that we discuss on a regular basis these and every other matter related to the emergency in Pakistan with colleagues right across Whitehall. It seems to me that in confronting the specific issue he raised, it must be right to try to ensure that the international community and the Government of Pakistan get the relief as effectively as possible to the people who are earnestly waiting for it because they have been cut off from it. In a sense, that is the answer to his question about what the international community can do to combat the malign influences that he described.

Sir Gerald Kaufman (Manchester, Gorton) (Lab): In comparing the inadequate and belated response of the international community with the heartwarming and generous response of the British public, may I draw the right hon. Gentleman's attention to the numerous fundraising activities that are taking place in my constituency? Many of my constituents have relatives in the afflicted area. Will he enable his Department to work closely with Manchester airport to ensure that goods sent as a result of those fundraising activities are conveyed from Manchester to Pakistan as soon as possible?


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Mr Mitchell: I thank the right hon. Gentleman for the encouragement that he has rightly given to communities in and around his constituency. I will certainly refer his point about Manchester airport to my officials, who will write to him shortly with an answer.

The right hon. Gentleman is also right to pay tribute to the extraordinary generosity of the diaspora communities in raising funds. I am thinking particularly of Islamic Relief, which is doing incredible work, but it is not the only organisation involved. Last Friday I had a chance to spend time with the Pakistani diaspora community in Birmingham, where I experienced a thought process very similar to the right hon. Gentleman's.

Dan Byles (North Warwickshire) (Con): I echo the Secretary of State's thanks to our overstretched armed forces for their assistance to people who have been devastated by the flood. Does he agree that their logistic capabilities represent a uniquely effective resource for conveying aid to where it is needed, quickly and flexibly, at such times of crisis? Will his Department be making a submission to the Ministry of Defence as part of the strategic defence review, urging it to preserve that capability?

Mr Mitchell: My hon. Friend is right to draw attention to the strong support that has been provided across Whitehall throughout the weeks of the emergency. I have already mentioned the work of the Royal Air Force and the assistance that has been given with the supply of bridges. MOD officials in Islamabad are working more than 18 hours a day with officials from the Foreign Office and from my Department. Moreover, NATO has offered to provide 300 hours of flying time in support of the United Nations and others involved in the relief effort, and I know that they are considering how and when to take up that offer.

Joan Walley (Stoke-on-Trent North) (Lab): My constituents with families in Pakistan will welcome the statement; they will also welcome the web monitor enabling them to track progress. Given the scale of the emerging public health problems and the need to consider long-term reconstruction, will the Secretary of State tell us a little more about his discussions with the World Bank about debt cancellation?

Mr Mitchell: I thank the hon. Lady for her comments. I know that she is heavily engaged with the community in her constituency on these matters. As I have said, we are doing everything we can to support all who are involved in combating the public health crisis, especially in Sindh, where the problem of water-borne diseases is so dangerous and prevalent. As for public debt, it amounts to only about 3% of Pakistan's budget, so it should be seen in context. However, all those issues will be considered during the ongoing discussions with the International Monetary Fund and the World Bank.

Greg Mulholland (Leeds North West) (LD): Like other Members, I have received an incredible response from people in my constituency. I am sorry that I cannot attend this evening, with the lord mayor of Leeds, a late breakfast at the Makkah mosque, where there has been some wonderful activity.

May I take the point made by the hon. Member for Stoke-on-Trent North (Joan Walley) a little further and refer the Secretary of State to the ONE International Pakistan debt campaign? Surely, as happened in the
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case of Haiti, we should consider diverting some of Pakistan's debt payments over the next couple of years to people who need the money so desperately now.

Mr Mitchell: I agree with the hon. Gentleman's final point, and I know that the IMF and the World Bank will show great sensitivity in that regard. As I said in my previous answer, we are dealing with relatively small interest payments, but he is right to suggest that we should be sensitive about the matter at this time. I also refer him to my earlier remarks about the importance of macro-economic reform. That will undoubtedly be one of the issues dealt with in the discussions on that subject.

Barry Gardiner (Brent North) (Lab): The Secretary of State spoke of the devastation caused when a wall of water travelled 1,200 miles down the country. A question that his officials will, of course, have considered is why it was able to do that, and no doubt the answer that they will have given the Secretary of State is that there was demand for wood from the forests to provide cooking fuel and enable construction to take place in Pakistan. Once the immediate need no longer exists and reconstruction is under way, will the Secretary of State consider the need for reconstruction of green infrastructure and the forests that would, in the past, have stopped that wall of water from travelling those 1,200 miles?

Mr Mitchell: I am grateful to the hon. Gentleman for both asking and answering his question. He is right to talk about the importance of developing green infrastructure as part of the recovery phase, and I can assure him that that will be considered, but the truth is that a flood of such a completely unprecedented scale would have swept away almost everything in its path.

Mr David Nuttall (Bury North) (Con): I thank the Secretary of State for his statement. I also thank him on behalf of my constituents, many of whom have family in Pakistan, for the work his Department has done. While declaring an interest as a member of the Rotary club of Bury, may I ask the Secretary of State to join me in paying tribute to the work of Rotary International for the work it has done in helping to relieve the suffering of those in Pakistan who have been affected by the floods, particularly through the work of its ShelterBox scheme?

Mr Mitchell: I thank my hon. Friend for his comments, and he is of course right to say that the 1 million or so members of the Pakistani diaspora, many of whom have relations directly affected by the flooding, have been extremely concerned and worried. We have been able through a number of mechanisms to give both information and reassurance. I pay tribute to my noble Friend Baroness Warsi, who has been very heavily involved with all the diaspora community and who came with me to Pakistan. I also join my hon. Friend in paying tribute to the work of Rotary, which makes such a tremendous contribution in this and so many other areas of development.

Rushanara Ali (Bethnal Green and Bow) (Lab): I welcome the Secretary of State's statement. I remind the House that the community in my constituency has, with the rest of the British public, been working hard to raise money. A third of my constituents are of Bangladeshi origin and they are no strangers to floods causing such devastation as has happened in Pakistan.


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I urge the Secretary of State to work with the EU countries to focus on what steps can be taken to tackle the long-term challenges of climate-related disasters. What additional funding, on top of what has already been committed and Government aid funding and emergency aid, is he committing to climate change adaptation?

Mr Mitchell: On that final point, the hon. Lady must wait for the outcome of the spending review, which will be announced on 20 October, but I assure her that the points she made so eloquently are being actively considered. This morning, I discussed with the Foreign Secretary the point she made about ensuring that we work closely with EU members to take forward our common endeavours. Her comment about closer EU co-ordination is very well made.

Jeremy Lefroy (Stafford) (Con): I thank the Secretary of State for his statement and join him in thanking all those across the country who have given so generously. This weekend, Staffordshire county council will host a dinner involving members of the local community to raise funds for disaster relief.

The Secretary of State will be aware that there are great concerns about the effect of the floods on agricultural land. Will he keep under review the long-term effect on agriculture, particularly the effect on upcoming planting, and how the UK can assist in relieving the problems that Pakistan is likely to suffer?

Mr Mitchell: My hon. Friend is absolutely right about the devastation that has struck both livestock and crops, upon which people in Pakistan are absolutely reliant. I set out in my statement the scale and extent of that devastation. We are already providing funding for seeds for the forthcoming planting season and we will keep under close review the important aspect my hon. Friend highlights, which will directly affect the extent of food security in Pakistan in the forthcoming year.

John Cryer (Leyton and Wanstead) (Lab): I, too, welcome the Secretary of State's statement, as will many of my constituents in Leyton and Wanstead. On the question of economic reform, in his discussions with the IMF and other international bodies, will he guard carefully against any suggestion of anything that resembles structural adjustment programmes? They might not be called that any more, but the fact is that elements in many international bodies are still keen on such programmes, which in the past have wrought the kind of devastation that we have seen in many countries, including environmental devastation.

Mr Mitchell: The hon. Gentleman makes a good point. After my discussions not only with the IMF but with the Minister of Finance, who is working so hard in Pakistan on these reforms, I can assure the hon. Gentleman that a measured approach is being taken on those matters.


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