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House of Commons

Tuesday 26 April 2011

The House met at half-past Two o’clock


[Mr Speakerin the Chair]

Oral Answers to Questions


The Secretary of State was asked—

Neuromuscular Services (North-West)

1. Barbara Keeley (Worsley and Eccles South) (Lab): What progress the NHS North West Specialised Commissioning Group has made in reviewing neuromuscular services in the region; and if he will make a statement. [52548]

14. Mr John Leech (Manchester, Withington) (LD): What progress the NHS North West Specialised Commissioning Group has made in reviewing neuromuscular services in the region; and if he will make a statement. [52562]

The Parliamentary Under-Secretary of State for Health (Anne Milton): I understand that the North West Specialist Commissioning Group received a report from its neuromuscular services review group at the end of March, and that it has since circulated it to all primary care trust chief executives with a request that it is shared with board members and GP commissioning consortia leads.

Barbara Keeley: The north-west has not seen the investment in extra services, such as transitional care and extra care advisers, that the report recommends, and now the Government’s proposed reforms are causing turmoil in specialised commissioning and real worries about how the commissioning of tertiary services will work in future, so will Health Ministers issue guidance to commissioners to ensure that the investment is made to cover those critical gaps in the north-west, and that emergency admissions are avoided?

Anne Milton: I thank the hon. Lady for her question, but I reject her assertion that the changes to the NHS—the modernisation of the NHS—have thrown the process into difficulty. Clearly, she feels that there is a problem in the first place. As I am sure she will agree, however, it will be down to the commissioning of the GP consortia and the primary care trusts to decide the best way to provide services in the light of all the information that they have. I understand that the commissioners will feed back to the specialised commissioning group on how they will deal with the recommendations.

Mr Leech: The report highlighted that, for an investment of less than £30,000, Manchester primary care trust could ensure that all muscular dystrophy sufferers, including my constituent Ben Dale, have access to specialist care adviser support, saving an estimated £5 million in hospital admissions costs. Does the Minister agree that that investment would be excellent value for money, given that it would help my constituent Ben to live a more fulfilling life and save money for the NHS?

Anne Milton: The hon. Gentleman specifically mentions a constituent of his, and I have every sympathy with people coping with muscle-wasting diseases, and indeed with their families. The burden can be quite considerable. The multidisciplinary group that examined services throughout the north-west deserves our thanks for its

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work, but the fact is that it is for NHS commissioners, PCTs and the emerging GP-led consortia to consider the evidence that they have. Indeed, if money can be saved by commissioning services in a different way, so they should be, but that decision should be taken locally.

Acute Services (Trafford)

2. Kate Green (Stretford and Urmston) (Lab): What steps he is taking to ensure the provision of acute services in Trafford district. [52549]

The Minister of State, Department of Health (Mr Simon Burns): This is a matter for the local NHS. Every NHS trust has a duty to provide the best quality care for its patients. The Government believe that the delivery of health services should be led locally, with clinicians working with GPs and patients to ensure that their needs are met.

Kate Green: I am grateful for that answer and for the Minister’s letter to me last week, but, having already lost paediatric and maternity services recently, and with the decision not to provide trauma services in Trafford, local people are understandably anxious about further services being lost. Is the Minister confident that sufficient independent oversight is in place to ensure that the needs and wishes of local people are adequately met?

Mr Burns: I hope that I can reassure the hon. Lady, because if there were to be any reconfigurations in the future—I put that in the conditional tense because the relevant trust is confident that there will not need to be any—quite clearly the four tests that my right hon. Friend the Secretary of State introduced last May would have to apply. There would have to be full consultation with local people and with clinicians, GPs and others in the health economy.

NHS Reform

3. Simon Hughes (Bermondsey and Old Southwark) (LD): What processes he has put in place to allow lay members of the public and elected public representatives to contribute to discussions on the reform of the NHS. [52550]

The Secretary of State for Health (Mr Andrew Lansley): Following formal consultation last year, and as I told the House on 4 April, we are taking this opportunity to pause, listen, reflect and improve the Health and Social Care Bill. A total of 119 events have already been organised centrally, and the regional and local NHS will organise many more. Those events will allow us to hear a full range of views from professionals, the public and patients.

Simon Hughes: The Health Secretary knows that colleagues welcome the pause and the opportunity to reflect on what changes might be beneficially made to the legislation. Will he assure us that lay people and elected representatives, such as councillors and others, will be fully engaged in the process? The professionals have had their say, and they have very strong views, but the patients and elected people need to have their say, too.

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Mr Lansley: Yes. I am grateful to my right hon. Friend, and I can give him that assurance. Indeed, one reason why it is important to pause and to listen now is not least that shadow health and wellbeing boards have been put forward by 90% of relevant local authorities in England, and it is an opportunity for them to be very clear about how we can improve patient and public accountability. I hope that they and others will take that opportunity. As my right hon. Friend knows, the Bill already substantially improves both the public and the patient voice in the NHS, and we have to ensure that we take every opportunity now further to improve it.

Mr Kevin Barron (Rother Valley) (Lab): If the Government do come back with some major changes to the Bill, will those changes go out to public consultation, and will this House have the opportunity to oversee and to look in detail at any further proposals they may make?

Mr Lansley: I think I made it clear to the right hon. Gentleman in the House on 4 April that we were looking to pause, to listen, to reflect and to improve the Bill, and we are taking the opportunity to do so now, before Report and Third Reading.

Mr Stephen Dorrell (Charnwood) (Con): Can my right hon. Friend confirm that in the listening exercise it is his intention, in addition to listening to representatives of local authorities and the public, to ensure that we fully take account of the views of representatives of the full range of clinical opinion within the health service—nurses, hospital doctors and community-based clinicians as well as GPs?

Mr Lansley: Yes. My right hon. Friend will know that we have done that in the past, and we continue to do so. Just as early implementers of health and wellbeing boards have an important voice in how local authorities will strengthen public accountability and democratic accountability, we also now have an opportunity that we did not have in the consultation last year for the new pathfinder consortia, as they come together—88% of the country is already represented by them—to have their voices heard. I hope that the public generally will exercise this opportunity too. I know that groups representative of patients are doing so and very much want to get involved in these discussions.

Ms Diane Abbott (Hackney North and Stoke Newington) (Lab): The Secretary of State will be aware that if Lib Dem MPs were seriously opposed to this reorganisation, they could have voted against it on Second Reading—so how can he expect the public to take these discussions and the listening exercise seriously? Are they not just a device to get the coalition through the May elections, and is he not determined to get away with as little substantive change as he can manage?

Mr Lansley: On the contrary—the hon. Lady should know, because I made it clear on 4 April, that my objective, and that of the Prime Minister, the Deputy Prime Minister and all of the Government, is further to strengthen the NHS, and we will use this opportunity to ensure that the Bill is right for that purpose. The reason Government Members supported the Bill on Second Reading, and Labour Members should have done so, is

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that, as the right hon. Member for Wentworth and Dearne (John Healey) said, the general aims of reform are sound.

Mark Pritchard (The Wrekin) (Con): As part of the listening exercise, will the Secretary of State confirm that the public, patients and medical professionals will be listened to? Many of them want to see root-and-branch reform of the NHS in order to improve its effectiveness and efficiency and improve patient outcomes.

Mr Lansley: Yes, my hon. Friend is right. We have an opportunity, which we want to realise to its fullest potential, to improve many of the ways in which patients and the public are involved. For example, we want to arrive at a point where patients feel that the invariable response of the NHS to their need is that there is no decision about them without them. We are proposing in the Bill to strengthen the scrutiny powers of local authorities. We are also proposing to bring in a patient voice through HealthWatch and HealthWatch England that has not existed since the Labour Government abolished community health councils, and we are going to strengthen substantially democratic accountability through health and wellbeing boards.


4. Keith Vaz (Leicester East) (Lab): What his policy is on funding for a national framework and quality of service guidelines for diabetes patients. [52551]

The Minister of State, Department of Health (Paul Burstow): To support the NHS in improving outcomes, the National Institute for Health and Clinical Excellence has published a quality standard for diabetes building on the existing national service framework, which provides an authoritative definition of good-quality care. Under proposals in the Health and Social Care Bill, quality standards will have a central role within the new system’s architecture.

Keith Vaz: May I declare my interest as someone who has type 2 diabetes, and remind the Minister that we currently spend 10% of the NHS budget—£1 million an hour—on diabetes-related illnesses? Does he agree that what is central to this framework is providing funding for prevention? If we can prevent and assess diabetes, we will save a great deal of money in the long run.

Paul Burstow: I certainly agree with the right hon. Gentleman that prevention is undoubtedly the right way forward, but earlier diagnosis is also very important. That is why we continue, as a Government, to support the roll-out of NHS heath checks for people aged 40 to 65 as a way of ensuring that we detect more readily and earlier so that we can provide the appropriate support.

John Pugh (Southport) (LD): Just 10 minutes ago, I met representatives of Diabetes UK, who want to see greater emphasis on integration and co-operation between and within services in the NHS Bill. Can I assume that they will not be disappointed?

Paul Burstow: As my right hon. Friend the Secretary of State has already indicated in today’s exchanges in this House, we are committed to listening and reflecting

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during this pause, and to ensuring that we come back with substantive improvements to the Bill to deliver its central purpose of improving health care for the people of this country.

Out-of-Hours Surgeries

5. Mr Jim Cunningham (Coventry South) (Lab): How much his Department allocated to the provision of out-of-hours surgeries in the last 12 months for which figures are available; and if he will make a statement. [52552]

The Minister of State, Department of Health (Mr Simon Burns): The Government do not allocate centrally how much money is spent by local NHS providers on out-of-hours services. However, in 2009-10, the last year for which figures are available, £403.8 million was spent on out-of-hours GP services in England and £1.6 million was spent on out-of-hours services in Coventry. We plan to give GPs and other health professionals greater powers to commission out-of-hours care to achieve high quality, integrated services that are focused on the needs of patients.

Mr Cunningham: Given that waiting times in emergency units are increasing, what will the Minister do to protect out-of-hours clinics?

Mr Burns: It was, of course, the hon. Gentleman’s Government who did so much to undermine the provision of out-of-hours services. We propose not only to review the existing framework, but to ensure that there are the real improvements that benefit patient care, which are so badly needed.

Sir Peter Bottomley (Worthing West) (Con): Will my right hon. Friend ensure that there are no artificial constraints so that GPs, even though they may be commissioners, can ensure that they provide out-of-hours services in combination with clinics and ambulance services?

Mr Burns: I am grateful to my hon. Friend for raising that important issue. I assure him that there are mechanisms in the Health and Social Care Bill to provide protection so that there are not the problems that he anticipates.

Health and Social Care Bill (Cross-border Implications)

6. Mr David Hanson (Delyn) (Lab): What discussions he has had with Ministers in the Welsh Assembly Government on the cross-border implications of the Health and Social Care Bill. [52553]

The Parliamentary Under-Secretary of State for Health (Anne Milton): The Secretary of State for Health met Ministers of the Welsh Assembly Government on 1 December last year to discuss the future of the cross-border commissioning protocol, and I am meeting the Under-Secretary of State for Wales in the next few weeks. It was agreed that until the forthcoming changes in the Health and Social Care Bill are finalised, no substantial changes to the cross-border protocol should be introduced, as is right. The protocol, which expired on the 31 March this year, has therefore been renewed for one year with minimal changes.

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Mr Hanson: More than 200,000 people from Wales, including people from my constituency, access services in England at the Countess of Chester hospital, Clatterbridge, the Christie, and the Walton in Liverpool. More than 50,000 people from England access health services in Wales. What guarantees can the Minister give me that the proposed changes in the Health and Social Care Bill will not wreck those arrangements?

Anne Milton: There is absolutely no reason why they should. I thank the right hon. Gentleman for raising this issue. It is worth pointing out that there are many areas of commonality between the health services in England and Wales. Of course, it is up to the Welsh Assembly Government to decide what scale of finance and resource they provide. I am aware that there are some cross-border issues that clearly need to be resolved.

Richard Drax (South Dorset) (Con): Will the Minister confirm whether funds will be held by the consortia or the GPs in the practices, because there is confusion among GPs in my constituency of South Dorset on that point?

Mr Speaker: With reference to the discussions that have been held with the Welsh Assembly Government.

Anne Milton: I am grateful, Mr Speaker. I was going to make that point. Although Dorset is a long way from Wales, I assure the hon. Gentleman that GPs will not have the money in their personal bank accounts.

Hywel Williams (Arfon) (PC): The Minister will know from the Welsh Affairs Committee report that there is considerable traffic of people accessing GP services across the border in both directions, with the net benefit going to England. Will she reassure me that the interests of people on both sides of the border will be served when the Health and Social Care Bill is finally enacted?

Anne Milton: Yes, I assure the hon. Gentleman that the Health and Social Care Bill aims to resolve as many of the problems that we know about on the border as possible.

Social Care (Eligibility Criteria)

7. Mrs Linda Riordan (Halifax) (Lab/Co-op): What estimate he has made of the number of local authorities which changed their eligibility criteria for social care in the last 12 months. [52554]

The Minister of State, Department of Health (Paul Burstow): Decisions about eligibility criteria are a matter for local councils. As part of last year’s spending review, the Government committed an additional £530 million through the local government formula grant, and £648 million in direct support from the NHS, to support social care, as well as £150 million for re-ablement. By 2014, that will rise to £2 billion of additional support for social care.

Mrs Riordan: Is the Minister aware that according to a recent survey by the Association of Directors of Adult Social Services, 19 local authorities including my own, Calderdale, have had to raise the eligibility criteria

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for social care because of the cuts that they have received from the Government? Does he stand by his statement of 21 October that there is

“no justification for local authorities to slash and burn or for local authorities to tighten eligibility”?

Paul Burstow: I certainly stand by the idea that the Government provided adequate resources in the financial settlement last year, alongside efficiency savings, to ensure that every local authority could choose to maintain the current levels of eligibility and services in its area if it so wished.

Miss Anne McIntosh (Thirsk and Malton) (Con): Will the Minister examine situations in which domiciliary care contracts are awarded under the EU public procurement directives, to ensure that especially when they are awarded on price, they are not dumbed down and the level of service reduced?

Paul Burstow: My hon. Friend makes an important point about ensuring that competition is always based on quality, not just price. If she would like to write to me with more details about the matter, I would certainly be happy to follow it up with her.

Emily Thornberry (Islington South and Finsbury) (Lab): Since the Government are no longer doing an assessment of the provision of social care by local authorities, I have done it for the Minister. My survey has found that not only have eligibility criteria been tightened, but 88% of councils are increasing their charges, 63% are closing care homes and day centres and 54% are cutting funding to the voluntary sector. Now that I have told the Minister the facts, will he take back his comment that

“no councils need to reduce access to social care”?

Would he like to start being straight with the public?

Paul Burstow: I will take Labour facts with a pinch of salt. Under Labour, social care was always very much the poor relation. Under this coalition, social care has received a £2 billion spending boost and an unprecedented transfer of resources from the NHS—something that the hon. Lady’s party, if it had been in power, would not have been able to do, because it would have been busy cutting the NHS.

NHS (Rochdale)

8. Simon Danczuk (Rochdale) (Lab): What plans he has to visit NHS services in Rochdale; and if he will make a statement. [52555]

The Parliamentary Under-Secretary of State for Health (Anne Milton): My right hon. Friend the Secretary of State for Health visited the Pennine Acute Hospitals NHS Trust, which delivers services to the people of Rochdale, in June last year. There are no immediate plans to repeat the visit.

Simon Danczuk: The reason I asked the question is that the people of Rochdale are extremely concerned about how Rochdale infirmary is being run and believe

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that the Pennine acute trust is not accountable. The Minister and the Secretary of State will be aware of the recent Channel 4 “Dispatches” programme, which showed the trust and its chief executive in a very poor light. The reconfiguration of services there has been handled very badly. May I ask the Minister, as a matter of urgency, to act upon all the concerns and investigate the management of the Pennine acute trust?

Anne Milton: I thank the hon. Gentleman for his question. I am aware of the recent “Dispatches” programme and the fact that the Pennine Acute Hospitals NHS Trust is implementing a number of service changes in a number of areas, including Rochdale. Those changes are part of the “Healthy Futures” and “Making it Better” programmes, both of which have been subject to full consultation with local people. NHS North West has confirmed that both programmes meet the four tests for service change, but if the hon. Gentleman continues to have concerns, I am sure one of the ministerial team will deal with them personally.

Front-line Services

9. Chris White (Warwick and Leamington) (Con): What steps he is taking to maintain front-line services in the NHS. [52556]

The Secretary of State for Health (Mr Andrew Lansley): We are increasing funding for the NHS in each year of this Parliament, amounting to an increase of £11.5 billion over its course. Over the next few years, planned improvements in the efficiency of use of NHS resources, increasingly led by front-line staff, will support modernisation of the NHS to respond to rising demand and new technologies. Not least, we are cutting administration costs across the system by one third, saving £1.7 billion a year, every penny of which will be available for reinvestment in front-line services.

Chris White: Will the Secretary of State join me in praising the work of chief executive, Glen Burley, and the excellent team of health professionals at Warwick hospital, who are improving community care while seeking to reduce management costs? Will the Secretary of State also take the opportunity to visit Warwick hospital to discuss how those things can be done at local level?

Mr Lansley: I am glad to endorse my hon. Friend’s congratulations to the staff and team at Warwick hospital. I hope to have an opportunity to visit that hospital at some future date. Across the NHS, we are setting out not least to increase productivity and efficiency, stimulate innovation, reduce administration costs and put more decision-making responsibility into the hands of those who care for patients, which the Labour party failed to do.

Clive Efford (Eltham) (Lab): How can the Secretary of State convince people that he is protecting front-line services when a flagship Bill such as the Health and Social Care Bill is in such disarray? While he is pausing and listening and reflecting on that Bill, will he also consider whether the House will have a further opportunity to consider his reflections, because we are through the Committee stage? Will there be another Committee?

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Mr Lansley: The hon. Gentleman misses the point that what matters to the public is the quality of services that are provided to them. When he asked his question, he might have reflected on the simple fact that the Labour party told us before the spending review to cut the budget of the NHS. We refused to do that, which means that this financial year, £2.9 billion more will be available for the NHS to spend than it spent last year.

Harriett Baldwin (West Worcestershire) (Con): A crucial front-line service is the provision of stroke care. Can the Secretary of State confirm that under his proposed reforms, local clinical practitioners will have much more influence over the location of those stroke services than in the current situation, when management can make somewhat arbitrary changes?

Mr Lansley: Yes, I can confirm that. We are looking for commissioning consortia not only to lead from a primary care perspective on behalf of patients, but to work on commissioning services with their specialist colleagues. Of course, the stroke research network has formed a strong basis upon which such commissioning activity can take place.

There have been many improvements in stroke care. Over the last year, we have seen a significant improvement in performance in relation to responses to transient ischaemic attack, and I hope we continue to see improvements in future.

Liz Kendall (Leicester West) (Lab): Last year, the Prime Minister made a very clear pledge to protect front-line NHS services. Will the Secretary of State confirm that in the run-up to next year’s Olympics, which will bring around 1 million extra people to the capital, the London ambulance service is cutting 560 front-line staff? Will the Secretary of State also confirm that nationally, A and E waits of more than four hours are up 65%, that the number of patients waiting more than six weeks for their cancer test has doubled, and that more patients are waiting for longer than 18 weeks than at any time in the last two years? Will he now admit that the Prime Minister’s pledge to protect front-line care is unravelling even faster than the Secretary of State’s chaotic Health and Social Care Bill?

Mr Speaker: There were three questions there, but I know that the Secretary of State will provide a characteristically succinct reply.

Mr Lansley: Thank you, Mr Speaker. None of those questions reminded the House that the Labour party wanted to cut the budget of the NHS, nor that in Wales, a Labour-led Welsh Assembly Government are cutting the NHS budget in real terms—there is no increase at all.

Let me tell the hon. Lady that waiting times in the NHS are, on average, nine weeks for patients who are admitted and three and a half weeks for those who are not admitted. That is broadly stable.

The hon. Lady will know that the chief executive of the London ambulance service, Peter Bradley, has made it clear that the ambulance service, like the NHS, needs to maintain front-line services while continually improving efficiency. That will happen in the ambulance service and it will happen right across the NHS.

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Health and Wellbeing Boards

10. Karen Lumley (Redditch) (Con): What progress he has made on the establishment of local health and wellbeing boards. [52557]

The Minister of State, Department of Health (Paul Burstow): Almost nine out of 10 local authorities have signed up as early implementers to press ahead with the setting up of health and wellbeing boards. Councillors, clinicians and local communities have told us that by working together through those boards, they can and will improve health and care outcomes for local people.

Karen Lumley: Does my hon. Friend agree that giving greater public health powers to the health and wellbeing boards will allow more targeted help in our local communities?

Paul Burstow: Absolutely. By bringing public health home to local government we will have the opportunity to ensure that many of the underlying causes of ill health can be tackled more effectively, and that is why we are making the reform in this way. By having a health and wellbeing board that brings together all the interested parties we can also ensure a far more integrated approach.

Mr Barry Sheerman (Huddersfield) (Lab/Co-op): Will the hon. Gentleman persuade the Secretary of State to come to Yorkshire and perhaps speak to a small group of people—no more than 60—in a quiet room about what these boards are supposed to do? Who will be on them, how accountable and transparent will they be, and will they have any teeth?

Paul Burstow: My right hon. Friend of course is more than happy to go to all sorts of places to talk to people about the health reforms. However, local government fully supports this particular proposal and sees it as a vital innovation for the involvement of local government in the health service. It will be transparent because it will be part of the local authority and will meet in open.

GP Pathfinder Consortia

11. Neil Parish (Tiverton and Honiton) (Con): What recent assessment he has made of progress by GP pathfinder consortia in delivering improvements in NHS services. [52559]

The Secretary of State for Health (Mr Andrew Lansley): I am delighted that nearly 90% of the country is now covered by pathfinder consortia, including my hon. Friend’s constituency, where the eastern Devon consortia chairs board pathfinder is up and running. I know that one area on which these emerging consortia are focusing is providing better, more flexible services for patients in community settings. We are supporting all the pathfinders through the pathfinder learning network, which is already showing a wide range of examples of where clinician-led commissioning is delivering benefits for patients.

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Neil Parish: I welcome the Secretary of State saying that the consortium in my constituency is up and running. Will he also take this opportunity to ensure that through these consortia patients can get better access to their doctors? Labour paid doctors a great deal more money, but patients actually got less access to their doctors.

Mr Lansley: That, indeed, will be one of the areas on which the quality and outcomes framework for individual GP practices will focus. In addition, however, through the commissioning outcomes framework for the NHS as a whole, one area in which we want to see continuing improvement in quality is patient experience and outcomes as reported by patients. GPs and their clinical colleagues will therefore be incentivised continuously to improve quality.

Valerie Vaz (Walsall South) (Lab): Can the Secretary of State tell us how much this consultation exercise is costing the public purse?

Mr Lansley: No, I cannot, but I will write to the hon. Lady.

Mr Rob Wilson (Reading East) (Con): The Secretary of State knows that many of us have received e-mails from constituents, the majority of which have been cut and pasted from a left-wing website. The impression given of the role of the GP consortia bears little relationship to that of GP leaders in my constituency such as Elizabeth Johnston. Will he confirm that he will listen very carefully to the experience and expertise of my local GP leaders, and not a left-wing motivated campaign?

Mr Lansley: My hon. Friend will know, like I do, that his GPs in Reading have already commissioned a new care pathway for people with lower back pain, which means that instead of having to go to hospital appointments, patients can be seen in their own homes by physiotherapists or occupational therapists offering practical advice and assistance in managing pain. Those are practical steps led by front-line staff, the purpose of which is to improve care for patients.

Hospital Services

12. Luciana Berger (Liverpool, Wavertree) (Lab/Co-op): What arrangements he has made for continuity of provision of existing hospital services under his proposed reforms of the NHS; and if he will make a statement. [52560]

The Minister of State, Department of Health (Mr Simon Burns): Commissioners would remain responsible for securing continued provision of NHS services to meet the needs of their local populations. We are proposing to support commissioners in this by introducing a comprehensive system of regulation at national level and additional regulation for designated services.

Luciana Berger: The Minister told the Bill Committee that some accident and emergency services might be undercut by private providers, which could force them to close. Will the Government bring forward amendments to the Bill to safeguard existing A and E services in all areas, including Merseyside?

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Mr Burns: I know that the hon. Lady does not want to mislead the House, but she is totally, factually incorrect in how she paraphrased what I said in the Health and Social Care Bill Committee. As any hon. Member who was there will know, I tried to be helpful to the hon. Member for Leicester West (Liz Kendall)—it is the last time I will—and gave her an illustrative example of how designated services would work. However, I did not say what the hon. Member for Liverpool, Wavertree (Luciana Berger) attributed to me.

Mr David Ruffley (Bury St Edmunds) (Con): Clinicians at the West Suffolk hospital in Bury St Edmunds are concerned that they will get the same tariff for an operation as a private sector provider, even though the NHS has to carry the cost of training whereas, on the whole, the private sector does not. What steps will the Minister take to address this perceived unfairness?

Mr Burns: I should like to reassure my hon. Friend. As he will know, we do not propose to introduce price competition into the NHS; rather, we propose to introduce competition based on quality. His clinicians are correct that the price will be the same. However, they must remember that we are going to stop the practice of the last Government, who, with independent sector treatment centres, paid the private sector over 11% more per operation than they were prepared to pay the national health service.

Mr Speaker: I call Mr Derek Twigg.

Derek Twigg (Halton) (Lab) indicated dissent.

Mr Speaker: I thought that the hon. Gentleman wanted to come in on this question. That is what I have been told, but never mind: we will wait to hear his dulcet tones in due course.

Non-Emergency Phone Number

15. Helen Goodman (Bishop Auckland) (Lab): Whether he has made an assessment of the effectiveness of the 111 non-emergency number; and if he will make a statement. [52563]

The Minister of State, Department of Health (Mr Simon Burns): NHS 111 is currently being piloted in County Durham and Darlington, Nottingham city, Lincolnshire and Luton, and a full independent evaluation of these pilots will be available in spring 2012.

Helen Goodman: In Durham, 111 calls are being answered by telephone receptionists without any medical training. They run through a list of pre-scripted questions and frequently divert ambulance paramedics away from 999 calls. Clearly that is risky. Will the Minister look into that before the number goes nationwide?

Mr Burns: I am sorry, but the hon. Lady is a little bit confused. She says, rather dismissively, that the calls are being answered by telephonists. These are non-medically trained people who have nurses and GPs available to give them help and advice as and when the callers demand it, because of the complaint or problem that they are raising. The beauty of the 111 service is that people do not have to wait to be called back, as they do

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with NHS Direct. Instead, the people trained to help callers will point them towards the appropriate care—which in some cases will be the emergency services—and they are right to do so when this has been clinically determined.

Andrew Bridgen (North West Leicestershire) (Con): Can my right hon. Friend assure the House that 111 telephone operators will be trained to the same level as 999 telephone operators?

Mr Burns: Yes, absolutely.

Health and Social Care Bill

16. Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op): What amendments he plans to table to the Health and Social Care Bill. [52564]

The Secretary of State for Health (Mr Andrew Lansley): As I told the House on 4 April, we are taking the opportunity presented by a natural break in the legislative process to pause, listen, reflect and improve our plans for modernisation of the health service. We will consider what amendments are required in the light of this.

Jonathan Reynolds: The Health and Social Care Bill is undoubtedly one of the most controversial pieces of legislation being proposed by the coalition. May I push the Secretary of State a little further on some of the answers that he has given my hon. Friends and ask him exactly how he will ensure adequate parliamentary time to scrutinise the amendments that he will bring forward?

Mr Lansley: I am not sure that I necessarily subscribe to the hon. Gentleman’s premise. This issue is important and it warrants the kind of attention that we are giving to it, and there is an opportunity to listen, reflect and improve the Bill because we want to ensure that we can thereby strengthen the NHS. On strengthening the NHS, I am surprised that the hon. Gentleman did not take the opportunity to refer to the £12.9 million increase in the budget for Tameside and Glossop PCT this year—something that Labour would not have offered. The truth is that we are going to strengthen the NHS through the Health and Social Care Bill, as we are strengthening it through our commitment to the priorities of the NHS.

David Tredinnick (Bosworth) (Con): Has my right hon. Friend had any further thoughts on the effect of HealthWatch England’s representatives being included in local health and wellbeing boards? Does he think that the provisions are sufficiently robust to ensure that they have an impact on commissioning?

Mr Lansley: As my hon. Friend knows, we intend health and wellbeing boards to bring together HealthWatch, plus councillors, commissioning bodies and providers, as part of the process of local representation, so that we can link up NHS commissioning with public health and social care, to see how they collectively meet the joint strategic needs assessment led by the local authority.

Mr Speaker: I call Diana Johnson.

Derek Twigg (Halton) (Lab) rose—

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Mr Speaker: I apologise to the hon. Member for Kingston upon Hull North (Diana Johnson). The change of mind on the part of the Opposition Front Bench fazed me, for which I apologise. The hon. Member for Halton (Derek Twigg) wants his opportunity to ask a question, and he should have it.

Derek Twigg: Thank you, Mr Speaker. I think there was some confusion between questions 13 and 16.

We obviously want to see important improvements to the Bill, including the deletion of part 3, which drives competition to the heart of the NHS, and of clause 150, which removes the private patients’ income cap. I also want to ask the Secretary of State a specific question. On 16 March, during the Bill’s passage through the House, the Prime Minister said to the Leader of the Opposition:

“Perhaps he would like to…support our anti-cherry-picking amendment.”—[Official Report, 16 March 2011; Vol. 525, c. 292.]

Will the Secretary of State tell us whether it is still the Government’s policy to table such an amendment in this House, or whether they intend to do so at a later stage?

Mr Lansley: As I said earlier, when we have completed this process of listening and reflecting, we will table amendments to the Bill. I will tell the House about them then, just as I told them on 4 April that we were going to go through this process. Let me make it clear that we are intending not to allow cherry-picking. We intend to make it absolutely clear to the private sector or anybody else that they must not be able to compete with the NHS on uneven terms because, actually, that is what the last Labour Government did. Under that Government, we ended up with £250 million being spent on operations in private hospitals that never took place because of the poor nature of the private sector provision that they put in place. We are not introducing competition into the NHS through this Bill. Why does the hon. Gentleman suppose that the last Labour Government set up the competition and co-operation panel, if not—

Mr Speaker: Order. I am grateful to the Secretary of State. I call Diana Johnson.

Local Authorities (Public Health Duties)

17. Diana Johnson (Kingston upon Hull North) (Lab): How much funding he plans to allocate to local authorities in order to perform their new public health duties in each of the next three years. [52565]

The Parliamentary Under-Secretary of State for Health (Anne Milton): We want local authorities to have the powers and the resources that they need in order to make a real difference to the health and well-being of their local populations. Shadow allocations for the local ring-fenced public health budget will be announced later this year.

Diana Johnson: Hull’s Lib Dem council does not have a very good record on public health. It is currently slashing services delivered to children through its children’s centres and early years services. We all know that public health can be improved by that early investment. What is the Minister going to do to ensure that councils take their wider public health responsibilities seriously?

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Anne Milton: I thank the hon. Lady for her question. With resources come responsibilities. I am pleased that the hon. Member for Hackney North and Stoke Newington (Ms Abbott) has welcomed the shift in public health. There is no doubt about it: local authorities have a long history of delivering public health improvements, and this will give them the opportunity to see again some of the improvements that were long awaited under the last Government.

Children with Disabilities

20. Helen Jones (Warrington North) (Lab): What assessment he has made of progress in providing co-ordinated medical assessments for children with disabilities. [52568]

The Parliamentary Under-Secretary of State for Health (Anne Milton): The Department for Education Green Paper, “Support and aspiration: a new approach to special educational needs and disability—a consultation”, was published in March and includes a proposal to develop a single new co-ordinated assessment for education, health and care plans by 2014. The consultation on the Green Paper continues until June 2011, and I hope that the hon. Lady will respond to it.

Helen Jones: That was a very interesting answer, particularly as the Prime Minister told me on 30 March that this

“idea is rapidly becoming Government policy.”—[Official Report, 30 March 2011; Vol. 526, c. 340.]

Can the Minister tell us whether she intends to table an amendment to the Health and Social Care Bill to ensure that those crack teams of medical experts that the Prime Minister promised would be set up will be set up by GP consortia?

Anne Milton: Families of children with disabilities and special needs will welcome the single, co-ordinated assessment. We have to see health and social care working more closely together, because those families bear a considerable burden of care. I would point the hon. Lady towards the consultation, and I suggest that she points her constituents towards it as well, as it is extremely important that we get their feedback.

Patient Choice

22. Mr David Evennett (Bexleyheath and Crayford) (Con): What steps he is taking to extend the choice that patients have over the treatment they receive from the NHS. [52570]

The Minister of State, Department of Health (Mr Simon Burns): The Government have consulted on proposals to give patients greater choice and control over their care and treatment. We have deferred publication of our response to take into account the results of the listening exercise.

Mr Evennett: I thank my right hon. Friend for that answer and refer him to the King’s Fund paper, “Patient choice”, which was published in March 2010. Does he agree that people value being able to choose and that

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the exercise of choice raises standards and encourages NHS providers to design services around patients and their needs?

Mr Burns: My hon. Friend is absolutely right. I am certainly aware of the King’s Fund publication. The report was cited as a key source of evidence in the consultation document, “Liberating the NHS”. The Department of Health welcomes this significant contribution to the evidence base, which will inform how we implement the choice commitments set out in the White Paper, “Equity and excellence: Liberating the NHS”.

Fiona Mactaggart (Slough) (Lab): When I was first elected, I regularly received letters from constituents who were concerned about how long they had to wait for treatment. During the years of the Labour Government, those letters went away, but they are coming back again. What I know from my constituents is that their main choice is not to have to wait. Is that a choice that this Government are going to offer them or will waiting times increase?

Mr Burns: The choice this Government will offer them will make sure that they get the finest quality health care, where they can exercise their choice of which hospital to go to, which consultant to see, which GP to see, without having to wait unduly for that treatment.

Topical Questions

T1. [52573] James Morris (Halesowen and Rowley Regis) (Con): 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 NHS in delivering improved health 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, which supports and protects vulnerable people.

James Morris: The Alzheimer’s Society predicts that by 2021, there will be a million sufferers from dementia in this country. Will the Secretary of State reassure my constituents that those people suffering from it will get the support they need—now and in the future?

Mr Lansley: Yes, I can tell my hon. Friend that the response to dementia is a key priority for this coalition Government. I think we have already demonstrated it in our commitment to dementia research. We need to improve both earlier diagnosis of dementia and the possibilities for treatment. We have demonstrated our commitment to improving standards in dementia care, both in hospitals and in care homes, and, indeed, in the further work we have done on reducing the use of anti-psychotic medicines.

John Healey (Wentworth and Dearne) (Lab): How does the Health Secretary square the Prime Minister’s promise to pause in his changes to the NHS with the NHS chief executive saying a week later:

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“I want to stress very firmly that we need…to maintain momentum on the ground.”

With the Government’s health Bill, are we not seeing both rushed pre-legislative implementation and confused post-legislative policy making? If the Prime Minister really gets cold feet about his NHS changes, let me ask the Health Secretary for a fourth time whether the Government will guarantee the extra time needed for this House to examine the changes fully?

Mr Lansley: Let me be clear about the right hon. Gentleman’s point. Both things are entirely compatible because there are 220 GP-led consortia that have come together as pathfinders to demonstrate how they can improve commissioning and the service to their patients; 90% of local authorities have come together in health and wellbeing boards; while at the same time, we have to deliver the challenge of improving productivity, quality and efficiency. All of that requires us, on the ground, to continue the momentum of improvement for patients. At the same time, we are listening not least to all those clinicians and members of the public who want to be sure that the Bill will provide them with the opportunities for involvement and the safeguards they are looking for in the NHS in the future.

John Healey: The Health Secretary ducked for the fourth time this afternoon the question of whether he will do right by this House in allowing sufficient time for proper scrutiny of any changes to the Bill that come forward. While he is listening, will he consider the risks he is running with the NHS? The Prime Minister promised a real rise in NHS funding, yet this year more than nine out of 10 hospitals are faced with cutting costs by more than 4%; one in seven by more than 8%; while nearly £2 billion for patient care is being held back to cover the costs of the internal NHS reorganisation. Will he admit that this reorganisation is now piling extra pressure on NHS funding and services so that patients are seeing waiting times rise, operations cancelled and front-line staff jobs cut as the NHS starts to go backwards again under the Tories?

Mr Lansley: I find the hon. Gentleman’s cheek astonishing. It was his party which, before the election, announced its intention of making up to £20 billion of efficiency savings, it was his party which told us after the election that the NHS should be cut, and it is his party which is actually cutting the NHS in Wales. It is the coalition Government who have made decisions that will give the NHS £2.9 billion—a 3% cash increase—and, because of the way in which we are tackling the costs of management, will put more people on the front line. Following the election, there are 3,500 fewer managers and 2,500 more doctors and nurses.

T2. [52574] Greg Mulholland (Leeds North West) (LD): The Secretary of State is well aware of concern in the Yorkshire area about the review of children’s heart units, and I thank him for his recent letter, but does he accept that there is a contradiction between the logic applied to the south of England and that applied to the north, where 14 million people rely on the fact that the children’s heart unit in Leeds is only a two-hour drive away?

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Mr Lansley: I should make it clear that the review is being led by the Joint Committee of Primary Care Trusts, not by the Department of Health, and that it is being conducted by an independent team who are employing an independent consultative process. My colleagues and I have made no decisions so far, but we will expect all the points made by the hon. Gentleman and others throughout the country about paediatric cardiac surgery to be taken fully into account in the consultation.

T4. [52576] Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op): The Secretary of State will be aware that, according to the quarterly monitoring report from the King’s Fund, waiting times have hit a three-year high. Does he accept that that is a direct result of his actions, particularly the abolition of the centrally managed target in June last year?

Mr Lansley: I can tell the hon. Gentleman that waiting times in the NHS are stable. The average waiting time for patients who are admitted to hospital is nine weeks, and the average waiting time for out-patients is three and a half weeks. I think that people in the NHS might reasonably say that it is not fair to cite February 2011, when patients waiting for elective operations could not be admitted because critical care beds were occupied in the immediate wake of a severe winter and the largest flu outbreak since 1999.

T3. [52575] David Morris (Morecambe and Lunesdale) (Con): According to recent press reports, hospitals have used money earmarked for front-line NHS services to pay salaries to trade union officials. Does my right hon. Friend consider it acceptable to spend taxpayers’ money on paying union hatchet people, and will he order an investigation?

The Minister of State, Department of Health (Mr Simon Burns): The Government consider it right for NHS staff to have access to trade union representatives at work, but that should not be abused. Arrangements for reimbursing staff for trade union activities should be agreed locally between trusts and unions. There are no current plans to review union facility time.

T6. [52578] Diana Johnson (Kingston upon Hull North) (Lab): Given that, according to the King’s Fund, waiting times are increasing as a result of the reorganisation, does the Minister expect things to improve now that the financial squeeze is starting to bite?

Mr Lansley: As I have already explained, I do not accept the premise; but would the hon. Lady apply the same logic to the fact that the number of cases of hospital-acquired and health care-acquired infection has fallen substantially over the past year, the fact that access to services for strokes and transient ischaemic attacks has improved, and the fact that diabetic retinopathy and bowel cancer screening are improving? Would she argue that those developments are a result of our reforms? No, because our reforms have not been implemented., but we are making the investment in the NHS that the Labour party would not make, and we are giving the NHS the credit, which the Labour party would not do.

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T5. [52577] Mr John Baron (Basildon and Billericay) (Con): There is some concern about whether GP consortia will be given enough specialist support when commissioning integrated cancer services. Will my right hon. Friend use the pause in the passage of the Health and Social Care Bill to consider extending the guarantee for cancer network funding from 2012 to 2014, when the transition period ends and GP commissioning comes fully into effect?

The Minister of State, Department of Health (Paul Burstow): I am grateful to the hon. Gentleman for his question. The listening exercise is a genuine one, and we intend to bring forward appropriate changes as a result. I can certainly give the commitment that we will want to take on board such representations. We are, and consistently have been, committed to such clinical networks for the valuable contribution they make.

T7. [52579] John Mann (Bassetlaw) (Lab): If Bassetlaw council refers the reconfiguration of accident and emergency, paediatric and maternity services at Bassetlaw district general hospital to the Secretary of State, what criteria will he use to make a decision?

Mr Lansley: Under those circumstances, if a referral is made to me, I will wish to apply the kind of criteria that I set out last year for reconfigurations across the country for the first time: that they must meet the tests of being consistent with the result of any public consultation and with the public’s view, with the views of prospective future commissioners—such as the commissioning consortia that are coming together as a pathfinder in the hon. Gentleman’s constituency—and with the future choices made by patients about where and how they want services to be provided to them, and that they must meet clinical criteria for safety and quality.

Philip Davies (Shipley) (Con): May I join my hon. Friend the Member for Leeds North West (Greg Mulholland) in urging the Secretary of State to protect the children’s heart unit at Leeds hospital as it is a very worthwhile facility for people in Yorkshire, and does my right hon. Friend the Secretary of State agree with me that doctors should go to where the patients are, rather than the other way around by expecting patients to travel for many hours to get to such an important service?

Mr Lansley: I am grateful to my hon. Friend for his question, but in response I will simply reiterate what I said to our hon. Friend the Member for Leeds North West: that these matters are currently the subject of consultation by an independent group representing the primary care trusts collectively, and not by the Department of Health at this stage.

T8. [52580] Yvonne Fovargue (Makerfield) (Lab): Given the concerns of researchers and medical research charities and their belief that the research provisions in the Health and Social Care Bill should be strengthened, what discussions has the Secretary of State had with the medical research community during this pause?

Mr Lansley: The hon. Lady will know that the Health and Social Care Bill does make specific provision for

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NHS organisations to have regard to the needs for research. She will, I hope, also be very well aware that, by virtue of decisions made by this Government in the spending review, we have been able to sustain the level of research in the NHS. In particular, I was recently able to announce a new 30% increase in funding for translational research funded through the NHS.

Dr Julian Lewis (New Forest East) (Con): When the consultation on the future of children’s heart surgery units is complete, will the Secretary of State bear it in mind that it would be a preposterous and perverse conclusion that the unit in Southampton, which is one of the two best in the country, should be threatened with closure?

Mr Lansley: I am, of course, aware of these issues, which have been raised by colleagues on both sides of the House. At this stage, may I simply reiterate that the consultation team should consider the points that I know my hon. Friend and others are making to it? After the consultation team has fully reflected on all the points, I hope Members will be able to see that it has fully taken them into account in whatever proposals it brings forward.

T9. [52582] Gavin Shuker (Luton South) (Lab/Co-op): The Secretary of State has just appeared to blame the rise in waiting times on, as it were, the wrong kind of snow. Can we infer from that that if waiting times continue to rise over the coming months, he will reinstate the targets that brought waiting times down and kept them low?

Mr Lansley: The point I made was that average waiting times are stable. Maximum waiting times continue to be a right of patients under the NHS constitution. I recommend that the hon. Gentleman should go to Luton and Dunstable hospital and discuss with the staff there how they dealt with a combination of circumstances that led to there being unprecedented pressure on critical care beds. He must know that if hospitals do not have critical care beds immediately available, it is not in the patients’ interests for the hospitals to bring some patients in for elective surgery. That had an inevitable consequence on waiting times for a small minority of patients.

Annette Brooke (Mid Dorset and North Poole) (LD): I have received representations from constituents regarding the reclassification by the primary care trust of elderly relatives for continuing health care funding, with severe needs apparently becoming moderate over time. Does the Secretary of State share my concern about this, and how widespread is this practice in the current climate?

Paul Burstow: My hon. Friend’s point is important and I regularly receive correspondence about this from hon. Members from all parts of this House. If she wishes to write to me, I will be happy to discuss the matter with her further, once I have had a chance to look at the details.

Mr Dave Watts (St Helens North) (Lab): Given that Department of Health officials are actively discussing the privatisation of my local trust behind closed doors and are signing secret documents, will the Minister

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publish all those documents and will he make a statement in the House about the Government’s plans to privatise some of our NHS hospitals?

Mr Burns: I am afraid that I do not accept the premise of the question. May I tell the hon. Gentleman that this Government are not seeking and will not ever seek to privatise either the whole of the NHS or an individual trust? St Helens and Knowsley Teaching Hospitals NHS Trust is, like all other health trusts, currently agreeing plans to achieve foundation trust status by April 2014. That involves ongoing discussions with the North West strategic health authority and the Department of Health to determine the issues the trust faces and the actions needed to address them.

Stuart Andrew (Pudsey) (Con): May I join my hon. Friends the Members for Leeds North West (Greg Mulholland) and for Shipley (Philip Davies) in supporting the children’s heart unit in Leeds? If the review fails to take full account of, and reflect on, the issues raised, what steps will the Secretary of State take to ensure that that is done so that we can fully understand the problems that would face families in Yorkshire?

Mr Lansley: I understand my hon. Friend’s concern and that of colleagues in other locations across the country. If—I repeat the “if”—the consultation were not to arrive at what he or others in any specific location regarded as justified conclusions, it would be open to them, as this is a service reconfiguration of the NHS, to seek a referral of the proposal to me as Secretary of State.

Jim Shannon (Strangford) (DUP): Diabetes UK has a strategy to reduce the number of people with diabetes across the whole UK. Will the Minister tell the House what discussions he has had with the Northern Ireland Assembly—the matter is devolved in Northern Ireland—to ensure that the strategy of prevention, awareness and education is followed across the whole of the UK?

Paul Burstow: The hon. Gentleman is absolutely right, because this strategy must contain four elements; it must be about prevention, earlier diagnosis and appropriate self care, and we also have to have world-class research. Discussions with the Northern Ireland Assembly are ongoing.

Duncan Hames (Chippenham) (LD): Professional autonomy need not come at the expense of transparency in the provision of public services. Given that the Department for Education was able to extend the Freedom of Information Act to academy schools, does the Minister agree that it would be healthy for the Act to apply also to GP consortia in the NHS?

Mr Lansley: I am grateful to my hon. Friend for that. The Health and Social Care Bill establishes the commissioning consortia as public statutory bodies and, as such, that Act will apply to them.

Stephen Twigg (Liverpool, West Derby) (Lab/Co-op): As part of his consultation exercise on NHS reform, the Secretary of State recently visited Liverpool, where

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he met nurses. When he was listening to the nurses at the Royal College of Nursing conference, what did he hear?

Mr Lansley: I heard many things, including the nurses’ concerns about front-line services, which I share; Dr Peter Carter has said time and again that he is very worried that the NHS might go through a process of trying to salami-slice services to the detriment of patients when it is actually possible to deliver greater efficiency through cutting out waste, administration and bureaucracy. I agree with many of the things I heard and I want to make sure, as a matter of urgency, that right across the country that efficiency is achieved and we do not act to the detriment of front-line services.

Richard Graham (Gloucester) (Con): Will the Secretary of State join me in congratulating GP practices in Gloucestershire, all of which have decided to participate in the single consortium taking forward the commissioning of health services? Will he reassure those of my constituents

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who still have concerns that this whole process is about protecting front-line services and that it is absolutely not about the back-door privatisation of the NHS?

Mr Lansley: Yes. My hon. Friend makes an extremely important point and his pathfinder consortium in Gloucestershire is focused on how it can deliver more integrated services. One of the things that we are looking for is the integration of services, which has not happened sufficiently in the past. In Gloucestershire, both in the commissioning consortium as it comes together and in the work done by the local authority, we can see how, on the ground, there is determination and enthusiasm to make the modernisation of the NHS work for patients. We must ensure that the legislation supports it.

Several hon. Members rose

Mr Speaker: Order. I am sorry to disappoint colleagues but as is so often the case, demand has exceeded supply and we must now move on.

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Escape of Taliban Prisoners

3.35 pm

Paul Flynn (Newport West) (Lab) (Urgent Question): To ask what repercussions the escape of Taliban prisoners will have on United Kingdom soldiers.

The Parliamentary Under-Secretary of State for Foreign and Commonwealth Affairs (Alistair Burt): I am grateful to the hon. Member for Newport West (Paul Flynn) for raising the subject of this serious incident. It might help the House if I give some of the background to it.

At 4 o’clock in the morning on 25 April, 476 prisoners escaped from the national security unit in Sarposa prison, Kandahar. This prison is under the control of the central prisons directorate of the Afghan Ministry of Justice. A number of prisoners have been recaptured by Afghan security forces, and they continue to search for escaped prisoners. The Afghan Ministry of Justice will conduct a joint investigation into the escape with the national directorate of security. The head of the CPD, General Jamshid, is travelling to Kandahar and General Tahir, of the detention and investigation section of the NDS, is already there. In the meantime, all prisons in Afghanistan have been put on alert and have reviewed their security accordingly.

The UK has had no involvement with infrastructure builds, training, mentoring or any other support to Sarposa prison. We continue to support the development of the Afghan prison sector by assisting the Afghan Ministry of Justice’s central prisons directorate in developing prison infrastructure, policies and working practices; supporting and structurally maintaining the high security unit within Policharkhi prison in Kabul; providing training and mentoring to improve prison officer standards; and funding the construction of a prison in Lashkar Gah.

In answer to the hon. Gentleman’s specific question, this is a serious event that vividly underlines the importance of building a secure prisons sector in Afghanistan. We urge the Afghan Government to put every effort into recapturing those who have escaped in order to minimise the danger and damage to anyone—be they UK forces and personnel or anyone else—and to apply lessons learned from the planned investigation to ensure that this does not happen again.

Paul Flynn: The valiant professionalism of our soldiers in Afghanistan is as distinguished as that of any in our proud military history. They deserve our gratitude and they also deserve our vigilance to protect them against avoidable risks. This was not just a small incident—it was a disaster. Many of those who escaped were captured originally at grievous cost in blood and treasure. Now hundreds are liberated to attack our soldiers again.

The Government have been accused of being optimistic in their faith in the reliability and loyalty of the Afghan police and army. This is the second major escape from Kandahar. Three British soldiers were murdered by an Afghan soldier. This month, the Afghan police stood aside as United Nations peacekeepers were lynched. The Afghan security services have proved themselves, to a large extent, to be endemically corrupt, inept and probably, in this case, infiltrated by the Taliban. Their loyalty is often for sale. When will the Government realise that they cannot build an ethical reliable army

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and police force on rotten corrupt foundations? Will they now concentrate on a political solution in Afghanistan and abandon our misplaced trust in the Afghan army and police, which is now a deadly threat to the lives of our British soldiers? Optimism and trust become naivety when we do not know who to trust.

Alistair Burt: I understand, and go along with, a certain amount of what the hon. Gentleman has said. This is a significant event—a disaster, to use his term. It is a disaster in security terms; of course it is. Were those held in the prison detained at great cost? Yes, they must have been, to all who were involved. I understand that only three or five of them were originally UK detainees who were passed into the Afghan system, but that does not mean that others who were involved in capturing and holding them were not upholding the very standards that he was talking about, or that they have not been let down by the security situation. That is why there must be an investigation, and why we must find out what happened.

In answer to the hon. Gentleman’s other points, it is of huge importance to us all that there be a transfer of power and responsibility to allow Afghanis to be responsible for their security, because there is no other answer. Security cannot be held indefinitely by those outside Afghanistan. I am sure that he is well aware of the political process that is going on in parallel with the transition process and everything else. I do not think that those members of the Afghan national security force who, along with the international security assistance force, were involved so much in Helmand last year in clearing out the Taliban and working so hard to create a safe space for their fellow Afghanis would quite recognise his description of them. Of course, maximum effort must be given to the training of new security forces—both police and army. Loyalty must be an absolute basic and training must be rigorous, but it is not correct to dismiss them all because of individual incidents.

That this matter is serious there is no doubt. We must get to the bottom of it and there must be tightening regarding those responsible and the security system. The future for Afghanistan is, as the hon. Gentleman makes out, a political solution, but the military and tactical support we are providing to the Afghanis, who must ultimately be responsible for their own security and safety, must continue despite the setbacks.

Patrick Mercer (Newark) (Con): Having been involved with several such prisons around the world, I know that reinforced floors and listening microphones were customarily fitted in them to prevent the digging of tunnels. Was such equipment fitted—and if not, why not?

Alistair Burt: Clearly, at this stage, not having the same experience as my hon. Friend, I am not able to go into detail about what equipment was available to protect security. The basic point is that if people have expended effort in detaining people to pass them into a secure system, the responsibility we owe to all those to whom those people might be a threat is to make sure that they are secure. It will be part of the investigation to look not only at what has been done to ensure security previously, but at what might be done in future to reinforce that and to make sure that in future, secure places are indeed secure.

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Mr John Spellar (Warley) (Lab): May I express our admiration and support for the work of our troops in countering the Taliban and inflicting heavy losses on them? Understandably, our troops will be concerned at the escape of some of those whom they risked their lives to capture. We fully recognise that these are early days in collecting information and framing a considered response. In that context, can the Minister give us an early assessment of the seniority, importance and capabilities of those who have escaped, especially as we approach the fighting season? We should be frank that this is a setback, but we also need to be clear about its significance.

Secondly, what assessment has been made about the—clearly failed—level of security at the prison, and what steps are being taken across Afghanistan to check on security arrangements at other prisons? Indeed, given the previous breakout, what had been done to make the prison more secure, and to vet the staff? Can the Minister give any assessment of those who have been recaptured—what level they are, and what level of co-operation has been given by the Afghan police and the local population in relation to their recapture?

Thirdly, has the Minister also asked for an assessment of recent intelligence gathering? Had any indication of an impending escape been picked up, and if so, was that information conveyed to the right level?

Fourthly, what discussions has the Minister had with our NATO allies, especially the US, about our immediate response and our assessment of the broader impact on progress in Afghanistan?

Finally, moving closer to home, has the Minister made, or will he be making, an assessment of the impact of the escape on the threat to our security in the United Kingdom?

Alistair Burt: I am grateful for the tone and the nature of the right hon. Gentleman’s questions, which mirror almost exactly the questions that we in the Department are asking. It is barely a day after the event, and the answers to his questions lie a little way in the future, but in fairness I must deal with them.

It is indeed crucial to find out who has escaped. Record keeping is not such that we can be supplied with a list immediately. It is a matter of huge concern to us to find out exactly who escaped, and their positions in the seniority of the Taliban. Estimates of who has been recaptured already vary. There are some estimates as low as 25 and others as high as 60, but we do not know. Again, it is just too early to find out, but we need to do that. The investigation into what happened will cover not only what has changed as a result of events but, as I indicated to my hon. Friend the Member for Newark (Patrick Mercer), what might be done in the future to make these places more secure.

The right hon. Member for Warley (Mr Spellar) made extremely good points about intelligence gathering. Again, we have not yet had the reports on what might have been picked up, but plainly it was not accurate enough to enable the escape to be prevented, or on threat levels to us, but those are at the top of our agenda.

What the incident demonstrates clearly is that in the process of working with Afghan authorities in the essential job that they do—taking responsibility for their own country, its security, its prison system and its

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justice system—it is vital for our engagement and the engagement of others to continue. Kandahar, the area concerned, is not the direct responsibility of the United Kingdom. Another nation is responsible for the provincial reconstruction team working with the authorities there, including the prison authorities.

Of course the incident is a huge setback, but it demonstrates why we continue to need to be engaged as much as any reason to say no, there should be no further engagement. I am sure that the right hon. Gentleman will join me, and the rest of the House, in saying that the work must continue and lessons must be learned every time there is an incident in order to prevent it from happening again, but ultimately Afghanistan must be responsible for its own security under a proper political process initiated by the Afghans themselves and supported by the international community.

Mr John Baron (Basildon and Billericay) (Con): This event will come as a heavy blow to our armed forces just as the fighting season begins. The handover of operations to Afghan security forces is integral to our exit strategy, yet it seems that they are incapable of even guarding the Taliban, let alone taking them on in the field. Although it is early, what lessons can be learned from this in terms of our eventual exit strategy?

Alistair Burt: I am grateful to my hon. Friend for understanding the essential nature of Afghanistan’s involvement in its own security. The lessons are blindingly obvious to all of us. Whatever security was in place there was inappropriate. The methods to detect what might be going on in terms of any potential escape were clearly inadequate, but we need to know a lot more before we can make definitive judgments and, more importantly, work out what needs to be done in the future. It is essential for the process to continue.

The Afghan security authorities and the Afghan Ministry of Justice are responsible for other installations elsewhere in Afghanistan that have not been subject to similar incidents. To draw from one incident the conclusion that none of them are working anywhere in the country would therefore not be appropriate or correct, which is why some provinces are moving towards transition, as was announced by the President just over a month ago.

David Miliband (South Shields) (Lab): I very much welcome the sober and serious remarks of the Minister today, which stand in sharp contrast to the claim of the Defence Secretary in the House last July, when he said:

“In Kandahar, and under the direct oversight of President Karzai, Afghan security forces are leading operations as part of a rising tide of security”.—[Official Report, 7 July 2010; Vol. 511, c. 373.]

May I ask the Minister to respond to two points? First, there should be an absolute ban on that kind of happy talk. Secondly, is it not time for the United Nations to appoint a mediator to take forward precisely the political settlement that he and I agree is so essential to our exit from Afghanistan and its development as some kind of secure and stable society?

Alistair Burt: On the right hon. Gentleman’s second point, I do not necessarily make the same link as he does between this incident and the political process. That is continuing. There are further conferences this

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year on the peace process, which was authorised and supported at the Kabul conference earlier this year. There are processes in place, which are being followed by the international community and led by President Karzai. The UN is closely involved, but I am not certain that a call for a mediator is either enhanced or diminished by the events of the past 36 hours. I recognise what the right hon. Gentleman says, but that process is continuing apace.

As for remarks about optimism or otherwise, it is entirely appropriate that, as they have done in the past, colleagues make statements honestly as they see the circumstances and as they see security situations improving, or not improving. I am here to talk about an incident that has clearly set back the process, but there are other things to talk about in relation to Afghanistan that clearly show the process moving in a different direction. I think that it is right that colleagues should be able both to report honestly the optimistic aspects of what is happening in Afghanistan and, as the right hon. Gentleman suggests, to assess things soberly if they go wrong.

Dr Julian Lewis (New Forest East) (Con): Can the Minister at least confirm the early report that suggests that instead of prisoners tunnelling out, accomplices tunnelled in to reach them? What does it indicate about the internal security of a prison if people are able to tunnel in and it proves possible to go from cell to cell assembling hundreds of prisoners so that they can take advantage of that outside help?

Alistair Burt: I am grateful to my hon. Friend for such a detailed question. However, I am sure that although he will be disappointed, he will not be surprised to learn that the Foreign and Commonwealth Office does not yet have sufficient detail to confirm the veracity or otherwise of that report. It is such reports that lead, understandably, to our great concern about this case, and the need to find out exactly what has happened—and, of course, how we can ensure that such circumstances do not arise in future.

Mr Bob Ainsworth (Coventry North East) (Lab): The Minister is right that this is a blow of whose significance we cannot at this stage be certain, but surely it points to the fact that we cannot rely on the security sector alone to provide a stable situation in Afghanistan within the time frame that the Government have set—by 2014-15. We must now, as the Foreign Affairs Committee has called for, redouble out efforts on the political front, in conjunction with our allies. Will he ensure that the Government do precisely that without delay?

Alistair Burt: The right hon. Gentleman is entirely correct. He will not hear any voices from the Government side of the House, or indeed from his colleagues, indicating that the events of the past 36 hours or so suggest any lessening in the determination to find a political answer. Ultimately, the future of Afghanistan will be in the hands of Afghanis themselves. They will be responsible for security, whether through policing, justice or the army, and the work of training goes on apace. I read with great interest the Foreign Affairs Committee’s report about its concerns and how it wishes to see people proceed in future. The political process is an absolutely key and integral part of that, and the United Kingdom will continue to support it, while at the same

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time supporting the work being done to ensure that the transition to Afghan security control is as good as possible, but that work will continue beyond 2015. The House should remember that although 2015 is the date when combat troops will be withdrawn, it is not the date when the United Kingdom will finish its commitment to the people of Afghanistan and their future.

Andrew Bridgen (North West Leicestershire) (Con): Does my hon. Friend agree that the news of 476 dangerous Taliban fighters escaping from detention risks seriously damaging the morale of our troops serving in Afghanistan, and that it is therefore essential not only to improve the security at the detention centres immediately, but to tell our troops on the ground what measures are being taken to improve security, in order to shore up their morale and give them the confidence to know that that will not happen again?

Alistair Burt: My hon. Friend makes a very good point. Armed forces from whatever background, whether Afghanis, other elements of ISAF forces or UK forces, must be absolutely reassured that when they have done their job, at great cost to themselves, by securing the detention of those who have caused harm or danger to others, the system at that stage is able to pick those people up and make them secure. It is certainly my intention to ensure that once we have a full report and the Afghan authorities have completed their investigation, that information is transmitted to forces so that they know that if they do their jobs, other people will do theirs.

Chris Bryant (Rhondda) (Lab): I wholeheartedly support the calls that have been made this afternoon for redoubling the political effort in Afghanistan, but is not one of the most depressing facts about this event that in many cases it will have been British special forces who captured those people in the first place, and it may well be British special forces that have to capture them all over again? I do not expect the Minister to comment on operational matters, but is it not depressing that at this stage we are cutting 650 troops from the Royal Marines—precisely where those special forces are largely drawn from?

Alistair Burt: May I repeat something that I said earlier? Of the 476 detainees who escaped from the prison, as far as we are aware between three and five of them were captured and transferred into the system by United Kingdom forces: as the hon. Gentleman makes his distinction, I have to make that distinction back. A very small number of the total were involved with and detained by British security forces—but that does not avoid the main point, which is that of course there are 476 detainees who should be inside the prison today, not outside. The situation affects all the forces that have been engaged, and we do not draw a distinction as to who detained the prisoners.

Mr Denis MacShane (Rotherham) (Lab): The Minister has made a very clear and good statement, but is the situation not proof again that events in Afghanistan are controlling us, rather than the other way around? I wonder whether, on the subject of Afghanistan, a lot more people in this House and in the country may be

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recognising the salience of Pitt the elder’s remark that we should retract while we can, rather than retract when we must.

Alistair Burt: The right hon. Gentleman—[ Laughter. ] Clearly, we understand the point that he makes.

Mr MacShane: You could ask somebody about Pitt.

Alistair Burt: Yes, I am very comfortable knowing a great deal more about Pitt than I did when I first took this role, having read some excellent books about him over the past few months. [Hon Members: “Wrong Pitt!”] All the Pitts.

In answer to the question, however, I must say no. This is an example—whatever the effort being made on military operations in Afghanistan and on the political process—of an immensely complex and difficult process in which there will be progress and setbacks, and it is no more fair to suggest that policy is run by all the setbacks than it is to say that progress can continue in an absolutely linear direction without any setbacks whatever.

It is perfectly proper to advance the process on the basis that the work that so many people are doing will increase and improve security month after month as time goes on. That is what everyone is working towards, but of course it is absolutely inevitable that there will be setbacks and difficulties. The responsibility of the Government, and my responsibility, to the House is to make sure that anything that can be done to prevent those setbacks is done, and that if things occur to which there was no opportunity to make any change or difference, lessons are learned from them in order to make improvements for the future.

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Ms Gisela Stuart (Birmingham, Edgbaston) (Lab): I think the record will show that I have spent the best part of the past five years asking Ministers in successive Governments how many secure prison places they think exist in Afghanistan. So far I have not had a decent answer, but, given that the Minister said he thought that this was an isolated incident, can he give us an assessment of how many secure prison places he thinks currently exist in Afghanistan?

Alistair Burt: The short answer to the hon. Lady is that I do not know, and she must forgive me for that. I will endeavour to get a written answer—to the best of our knowledge—to her as quickly as possible, so that it is public. The picture is more flexible, depending on what one sees as detention, official prison places and the like, but if the hon. Lady has asked successively we must get the best answer that we can for her, and I undertake to do that as quickly as I can.

Jim Shannon (Strangford) (DUP): That was a very sober statement to the House. The indications are that it took eight months to dig the tunnels and 450 prisoners on their hands and knees probably upwards of 12 hours to escape—but nobody saw anything. We in the United Kingdom have many governors and prison people with experience and knowledge, so will the Minister offer that knowledge to the Afghan authorities to ensure that they can improve on what has happened?

Alistair Burt: Yes, indeed. I have already had that discussion with officials. The inquiry and investigation must be carried out by the Afghans as the sovereign power, but we do indeed have great expertise in all aspects relevant to the escape, and it is absolutely clear that it should be made available to the Afghan authorities. We will certainly be doing that.

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Middle East and North Africa

3.59 pm

The Secretary of State for Foreign and Commonwealth Affairs (Mr William Hague): With permission, Mr Speaker, I will update the House on recent developments in the middle east and north Africa.

Britain has continued to take a leading role in international efforts to protect civilians in Libya, and the case for action remains compelling: Gaddafi’s regime persists in attacking its own people, wilfully killing its own civilian population. Our strategy is to intensify the diplomatic, economic and military pressure on Gaddafi’s regime, and since the House last met we have made progress on all those fronts.

On the diplomatic front, I co-chaired the first meeting of the Libya contact group in Doha on 13 April. The 21 states and seven international organisations represented demonstrated clear unity, with participation from across the Arab world and the African Union in attendance. The group agreed that Gaddafi’s regime had lost all legitimacy, that the national transitional council should be offered further support, and that the UN special envoy should take forward an inclusive political process. I will attend the next contact group meeting in Rome on 5 May.

At the NATO Foreign Ministers meeting in Berlin on 14 and 15 April, I joined colleagues in showing our determination to increase the pace of military operations to enforce UN Security Council resolution 1973. The 28 NATO member states and six Arab countries that attended, 16 of which out of the 34 are engaged in military action, agreed a common strategy. That is an important milestone in world affairs, a sign of a growing ability to work across traditional regional divisions and a demonstration of the breadth and unity in the international coalition in support of the Libyan people.

On the economic front, since my statement on 4 April further Libyan entities have been sanctioned, and the regime is now subject to some of the most comprehensive economic sanctions ever agreed by the United Nations.

On military matters, since NATO assumed full control over all military operations on 31 March, more than 3,500 sorties and 1,500 strike sorties have been conducted. This action has seriously degraded Gaddafi’s military assets and prevented widespread massacres planned by Gaddafi’s forces. Gaddafi’s forces remain unable to enter Benghazi, and it is highly likely that without these efforts Misrata would have fallen, with terrible consequences for that city’s brave inhabitants. Yesterday, Italy announced that its aircraft would take part in ground strikes, and the United States Government have contributed Predator unmanned aerial vehicles to the coalition forces. My right hon. Friend the Defence Secretary is in Washington today to discuss the military situation.

Heavy fighting continues around the towns of Brega, Ajdabiya, Yefren and Misrata. The regime’s indiscriminate shelling of residential areas in Misrata shows that it continues to target the civilian population. Gaddafi has shown that he has no regard for civilian lives. The International Criminal Court prosecutor has said that there is evidence of a case against Gaddafi for crimes against humanity. We look forward to the prosecutor’s report to the UN on 4 May. By his actions, it is clear that Gaddafi has no intention of observing the conditions

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in Security Council resolution 1973 that I described to the House earlier this month. He has repeatedly ignored the ceasefires that he himself has announced. Our military action is defined by the UN Security Council resolutions. We are also clear that Gaddafi should go, and it is impossible to see a viable or peaceful way forward for Libya until he does so.

The Libya contact group’s statement made it clear that, in contrast to Gaddafi, we and our allies regard the national transitional council as a legitimate interlocutor representing the aspirations of the Libyan people. Our diplomatic mission in Benghazi is working with it. Our special envoy, Christopher Prentice, will shortly be succeeded by John Jenkins, currently Her Majesty’s ambassador in Baghdad.

Last week, I announced our decision to expand this mission with a small advisory team of British military officers. Their sole purpose is to support the NTC’s efforts better to protect civilians by advising on military organisational structures, communications and logistics. They are not involved in training or arming the opposition’s forces, nor are they executing or providing operational military advice. This is fully in line with the UN resolutions, and I reiterate to the House that we will remain wholly in accordance with the UN resolutions, retaining the moral, legal and international authority that flows from that. We have supplied vital, non-lethal equipment to assist the NTC in protecting civilian lives. So far, this consists of telecommunications equipment and body armour. We are considering with our international partners further requests.

In the coming week, we hope to agree internationally the process for establishing a temporary financial mechanism to provide a transparent structure for international financial support for the financial requirements of the NTC, such as public sector pay. Yesterday, Kuwait announced about £110 million of support for the NTC.

I am sure that the House will join me in paying tribute to the skill, bravery and professionalism of the men and women of the UK and our allies’ armed forces. Their actions in the NATO operations have saved many lives and their efforts are essential to bringing a lasting peace and a better future for the Libyan people, who have suffered so much at the hands of this brutal regime. I also pay tribute to those from the international humanitarian community who have put their lives on the line to help their fellow human beings.

The UK is supporting the other needs of the Libyan people in every way we can. The humanitarian situation in the west of the country is getting worse every day. Many civilians in Misrata lack access to basic necessities, including food, water and electricity. There is a shortage of some crucial medical supplies. That is why my right hon. Friend the Secretary of State for International Development announced last week that the UK will provide medical and other emergency supplies, and undertake the evacuation of 5,000 migrants stranded at Misrata port in squalid conditions. The UK has so far given more than £13 million to meet immediate humanitarian needs through funding for medical and food supplies and emergency shelter, and assisting in the evacuation of poor and vulnerable migrants. In Misrata alone, British support has given 10,000 people food and 2,000 families water and hygiene kits, and it has provided essential medical staff. The regime must

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guarantee unfettered humanitarian access and not just give broken promises, which put the lives of aid workers and volunteers at risk.

The wave of demand for change in the Arab world continues to gain momentum in other nations. As I said earlier today, we condemn utterly the violence and killings perpetrated by the Syrian security forces against civilians who are expressing their views in peaceful protests. That violent repression must stop. President Assad must order his authorities to show restraint and to respond to the legitimate demands of his people with immediate and genuine reform, not brutal repression. The emergency law should be lifted in practice and the legitimate aspirations of the people met.

The United Kingdom is working intensively with our international partners to persuade the Syrian authorities to stop the violence and to respect the basic and universal human rights to freedom of expression and assembly. Syria is at a fork in the road. Its Government can still choose to bring about the radical reform which alone can provide peace and stability for Syria in the long term, and we urge them to do so, or they can choose ever more violent repression, which can only bring short-term security for the authorities. If they do so, we will work with our European partners and others to take measures, including sanctions, that will have an impact on the regime. Given our concerns for British nationals in Syria, we changed our travel advice on Sunday to advise against all travel there and to advise that British nationals should leave unless there is a pressing need for them to remain.

On Yemen, the UK welcomes this morning’s news that the efforts of the Gulf Co-operation Council countries to resolve the political deadlock are close to success. I understand that President Saleh and the parliamentary opposition have accepted the GCC’s proposal. That is potentially good news. Both sides now need to come together to confirm their commitment to the peaceful, inclusive and timely transition process that the GCC has brokered. The UK remains committed to its long-standing support for Yemen in these difficult times.

Although the immediate situation in Bahrain is calmer, there continue to be credible reports of human rights abuses. I urge the Government of Bahrain to meet all their human rights obligations and to uphold political freedoms, equal access to justice and the rule of law. Dialogue is the way to fulfil the aspirations of all Bahrainis. I urge all sides, including opposition groupings, to engage with each other.

In Egypt, which I will visit shortly, we welcome the actions being taken by the authorities to move towards a broad-based, civilian-led Government and an open and democratic society.

In Tunisia, we are providing support with EU partners to help its Government meet the wishes of the Tunisian people. On 11 April, the commission responsible for bringing together opposition parties and civil society approved the draft law for the constituent assembly elections scheduled for 24 July. That is a step towards free and fair elections, and an open and democratic society.

The European Union has a crucial role to play in the southern Mediterranean. The great changes in the Arab world are truly historic, and the response from the

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nations of the EU should be bold and ambitious. The review of the European neighbourhood policy is due to be published in a fortnight. We have been making the case that we have the opportunity to use that policy to help the peoples of the southern Mediterranean achieve their desire for freer and more prosperous societies. A renewed neighbourhood policy should see the EU using its economic magnetism to encourage and support political and economic reform in neighbouring countries. A partnership of equals should reward those who make the necessary political and economic reforms and, importantly, withdraw benefits from those who do not.

Finally, it remains essential that progress is made in the search for a just and lasting solution to the Israeli-Palestinian conflict. That is what the majority of ordinary Palestinians and Israelis demand of their leaders. The extraordinary changes in the region are an opportunity to be seized, not an excuse for further prevarication leading to more frustration and discontent.

In our response to the dramatic events in north Africa and the middle east, we will continue to stand for reform, not repression, and for the addressing of grievances rather than brutal reprisals. It is a policy in accordance with our own beliefs, in line with our own national interest and in pursuit of the peace and prosperity of the wider world.

Mr Douglas Alexander (Paisley and Renfrewshire South) (Lab): I thank the Foreign Secretary for advance sight of his statement this afternoon.

I join the Foreign Secretary by saying that the Opposition, too, support the Gulf Co-operation Council initiative to resolve the current crisis in Yemen and achieve a peaceful political settlement. I also associate myself with his remarks regarding the continued need for a focus on the Israeli-Palestinian conflict and the need for a review of the European neighbourhood policy.

I begin with Syria. Every Member will have been appalled by the recent reports of Government violence and repression there. First, on the question of UK nationals, can the Foreign Secretary provide an estimate of the number who are in Syria at present, and can he assure us that all contingency plans are in place should it prove necessary, in time, for them to leave?

Of course, I fully support the Foreign Secretary’s condemnation this afternoon of the actions of the Syrian Government, but it was only a few weeks ago, on 27 January, that he travelled to Damascus to meet President Assad. From those conversations, how likely does he judge it that President Assad will now heed the calls for restraint and reform?

I welcome the Foreign Secretary’s statement that work is under way at the United Nations. Can he provide more detail on what progress has been made regarding a statement and/or a resolution from the Security Council? In particular, will he outline what financial sanctions and freezes at UN or EU level are being discussed to make clear the international community’s condemnation?

In a statement this morning, the Foreign Secretary said:

“There needs to be accountability for the deaths that have occurred.”

Of course, I concur with that statement. What discussions have been entered into regarding the investigation of accusations of crimes against humanity and regarding

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Human Rights Watch’s call for an official commission of inquiry? Finally, what discussions has he held with the Turkish Government, among others, to marshal a unified condemnation of the recent actions and assess possible ways forward in the region?

Although news regarding Bahrain has subsided slightly, the reports of the arrests of opposition figures and deaths in custody, and allegations of torture and the denial of medical treatment, are of course extremely concerning. Will the Foreign Secretary update the House on the progress of the political reform process initiated by King al-Khalifa? Will he also tell us what recent discussions he has had with the Crown Prince, who, it has been reported, has been close to reaching agreements with the protestors? Britain’s historically close ties to Bahrain should give us all the more reason to be clear and unequivocal in our urging of reform, not repression, as a response to popular protests on those islands.

I join the Foreign Secretary in commending our men and women in the armed forces, and those of our allies, for their brave service in Libya while the House has been in recess. The specific operational steps announced by the Government during that time—providing telecommunications, body armour and 10 military advisers—each had an operational rationale reflecting the new realities on the ground. Although we understand that rationale, will the Foreign Secretary now update the summary of legal advice provided to the House to cover each of the announcements made during the recess? The ad hoc and apparently unco-ordinated manner in which they were announced, rooted in no clearly articulated plan, has, I fear, served only to increase anxieties held by many members of the public.

In truth, none of those specific measures is likely significantly to affect the strategic situation in Libya. As things stand, neither Benghazi nor Tripoli appears likely imminently to fall to either side. Can the Foreign Secretary therefore give the House a somewhat fuller assessment of the military situation than he has so far shared with us? I ask that because the Prime Minister’s official spokesman stated this morning, in summarising the Foreign Secretary’s report to the Cabinet, that we need to

“prepare for the long haul”,

yet a press release was published only this weekend on the Foreign Office website entitled, “Foreign Secretary denies claims of stalemate in Libya”. The situation on the ground led the US chairman of the joint chiefs of staff, Admiral Mike Mullen, to observe on Friday that

“Libya is moving towards stalemate”.

Can the Foreign Secretary share with the House the information or insight on military progress that was available to him that was apparently not shared with America’s most senior military figure?

That brings me to the question of political objectives and the military mission. On 21 March, the Prime Minister told the House from the Dispatch Box that resolution 1973

“explicitly does not provide legal authority for action to bring about Gaddafi’s removal from power by military means.”—[Official Report, 21 March 2011; Vol. 525, c. 713.]

On 14 April, in an article in The Times, the Prime Minister and the Presidents of the US and France said that

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“so long as Gaddafi is in power, Nato and its coalition partners must maintain their operations so that civilians remain protected and the pressure on the regime builds.”

Would the House be correct to understand that the language in that article means that in the view of the British Government, UN Security Council resolution 1973 cannot be enforced without Gaddafi’s departure? Given the article’s explicit commitment to maintaining NATO operations “so long as Gaddafi” remains “in power”, will the Foreign Secretary clarify whether a Libya free of Gaddafi is a political aim—incidentally, that aim is shared by all in the House—or a military objective of the British Government? Will the Foreign Secretary further say whether, following that joint statement, American fighter aircraft have once again engaged in ground-assault operations, and whether that statement of aims has led to any significant alteration of the US force posture?

Does the Foreign Secretary agree that there is no plan, no mandate and no appetite for NATO ground troops attempting to fight their way into Tripoli to remove Gaddafi? If so, can he offer a clearer way forward, beyond the intensification of the current efforts that he spoke about in his opening remarks, to achieving the outcome that the Government seek? It is vital that he does so, not simply to ensure that the Government address the concerns at home and abroad, but, crucially, to convince Gaddafi’s henchmen that there is a credible strategy in place to ensure that his brutal attacks on civilians will not prevail.

We seek as broad a coalition as possible for these efforts, and in that spirit I add my welcome to the addition of Italian fighter aircraft to the mission, which we heard announced today. Will the Foreign Secretary update the House on the precise number of EU, NATO and Arab League countries that are participating in the military operation, and on what efforts are being made to expand those numbers further? Does he believe that the contact group is proving agile and effective enough to direct the mission? Does he further agree that the comparison last week by the Defence Secretary of the current mission in Libya with the Afghanistan campaign, where a decade on we have about 11,000 troops in theatre, not only ignores the different order of magnitude of threat posed by al-Qaeda and its supporters, but needlessly threatens support for the mission at home and abroad? In the light of that comparison, and given the continuing national security threat being confronted in Afghanistan, will the Foreign Secretary assure the House that no personnel or equipment will be redeployed from Afghanistan to Libya?

The Government are acting in Libya for principled reasons, but that does not remove our obligation to look at practical questions. In conclusion, in the light of this morning’s statement, which mentioned a “long haul” in Afghanistan, what further diplomatic measures are being pressed by the Government on the international community to strengthen the isolation of, and to increase the pressure on, Gaddafi’s regime?

Mr Hague: I am grateful to the right hon. Gentleman particularly for what he said about various countries at the beginning of his questions. I am sure that the whole House will join him in welcoming the seemingly successful efforts of the Gulf Co-operation Council in relation to Yemen. There is also agreement across the House,

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I think, about the importance of the middle east peace process and a bold and ambitious European neighbourhood policy.

The right hon. Gentleman asked some specific questions about Syria. About 700 British nationals in Syria are now registered with us, although some of them of course will be dual nationals with their families in Syria, and we should not assume that they would want to leave Syria whatever the circumstances there. However, we have contingency plans for their evacuation. Previous to the change of travel advice on Sunday, we advised them to consider leaving Syria by commercial means, and it is still possible to do so—for instance, over the land border to Lebanon and by commercial flights still running every day out of Damascus.

The right hon. Gentleman asked about the conversations that I had with President Assad at the end of January. From those conversations, I think I can fairly say that what has happened in Syria over the past couple of weeks will have come as a surprise to the President and the Government. I asked him then why he thought that Syria would be different from what had already begun to happen in Egypt and Tunisia, and he said that it was because of Syria’s clear ideology, the continuing resistance to Israel and the popular support for the Government in Syria. Clearly, however, there are common aspirations in many of these countries for economic freedom and greater political rights, and therefore the position of the Syrian authorities in relation to their population was not as strong as he and his Government assessed. Of course, we have many differences with the Government of Syria on many foreign policy subjects that I discussed with him. For a long time Governments of the United Kingdom have urged the Government of Syria in the direction of greater respect for human rights. Had they taken that advice, including from previous Foreign Secretaries, such as the right hon. Member for Blackburn (Mr Straw), they would be in a stronger position today.

The right hon. Member for Paisley and Renfrewshire South (Mr Alexander) was right to ask about work with the Turkish Government. I regard them as holding a central position in working with other nations on how we should proceed on Syria. I discussed the matter at length last night with the Turkish Foreign Minister, Ahmet Davutoglu, and we are in close and daily touch with the Turkish Government. The work on what may happen at the UN and in the EU is of course at a preliminary stage, and it will be difficult at the UN Security Council, because not all the permanent members will see this in the same light, so I do not want to raise expectations of action at the Council. That would be unrealistic. However, we are working closely with our European and American colleagues on the Council to see how we can proceed, and we are doing initial work on what action the EU could take. However, I cannot go into more detail about that at this stage.

On Bahrain, the dialogue between the Government and the opposition is not overtly progressing. However, the authorities there have reiterated to us their determination to proceed with and reignite that dialogue. I spoke recently to the Foreign Minister of Bahrain, Sheikh Khalid al-Khalifa, to ask for his commitment to that, as well as to investigation of the human rights issues that I have mentioned in the House, and he has given those

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commitments. As I said in my statement, therefore, we look to all sides in Bahrain to commit themselves to that dialogue. That is the only way forward for a country in Bahrain’s situation. However, I do not have any reports of success in that dialogue to give to the House now.

The right hon. Gentleman asked about Libya and our various announcements over the recess of non-lethal assistance to the transitional national council. It was my decision in every case to make public the information as soon as possible about every form of assistance. It might have satisfied his desire to avoid what he called ad hoc announcements had we waited to put them all together, but in my view it would not have satisfied the interests of full transparency and of giving Parliament the necessary information as soon as it became available by depositing it in the Library. This is a fast-moving situation. How we help the transitional national council has to be agreed with other countries in order that we do not duplicate what they do, so how we are able to assist the council will change from week to week. However, we will keep the House informed as rapidly as possible, as we did over the recess, even if that means that announcements come out at different times and are followed one after the other.

It is important to remember that the military situation remains fluid and has not settled into a stalemate. Hon. Members will be aware of how much the situation in Misrata has changed over recent days. Fighting has gone backwards and forwards on the western borders of Libya, and although there is a fairly static situation on what might be called the eastern front, between Brega and Ajdabiya, it has not yet settled into what one would call a long-term stalemate. The military mission is defined by the United Nations resolution, and what the Prime Minister said about that on 21 March absolutely stands. That has not changed, although it is the common assessment of all NATO and Arab League nations involved—there might be a difference of view in some African Union nations—that it is impossible to see a way of securing the full implementation of the UN Security Council resolution while Colonel Gaddafi remains. That is why it is quite right to reiterate, as we all do in this House, that Gaddafi should go. However, the military mission remains defined by the UN Security Council resolution, and there has been no change in the Government’s approach to that.

On the question of NATO participation, there are 16 nations participating in the military effort at the moment. The shadow Foreign Secretary asked whether the contact group of 21 nations and seven international organisations was unwieldy. My experience so far is that it is not unwieldy—provided that it is well chaired, which it has been—but works together well. Having such a wide spread of nations and international organisations might initially look unwieldy, but it allows the contact group to continue the international legitimacy and the broad-based coalition that are present on this occasion and in these operations, the lack of which has sometimes bedevilled our efforts and those of the previous Government in foreign affairs, so it is important to maintain that.

The right hon. Gentleman asked about the Defence Secretary’s remarks about Afghanistan. The Defence Secretary was simply saying that we wanted Afghans to be able to take on responsibility for their own security;

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he was not comparing the conflict in Libya to the conflict in Afghanistan, and we should not give that impression. I absolutely agree with the shadow Foreign Secretary that NATO ground troops will not be going into Tripoli to resolve this matter. It is clear in UN resolution 1973 that there should be no foreign occupation of any part of Libya. We will adhere strictly to that, as to all other parts of the resolution. The strategy going forward is what I set out in the statement—to intensify the diplomatic, economic and military pressure.

The point that I made at the Cabinet this morning was that in this situation, time is not on the side of Gaddafi. We are often asked in international conflicts whether time is on our side. We should be confident that in this situation—given this coalition, this range of sanctions and these intensifying efforts—time is not on the side of Gaddafi, and the members of his regime need to know that. The resolve of the international community to implement the UN resolutions—and our resolve, separately from those resolutions, that he should go—is undiminished; indeed, it is strengthened by the experience of recent weeks. We have already achieved the saving of thousands of lives, the assembly of a remarkable international coalition and the prevention of the regime’s re-conquest of Libya by force, which could also have destabilised Egypt and Tunisia. These things have been worth achieving in the last five weeks, and if we continue to intensify our work in the way that I have described, we will indeed go on to success.

Several hon. Members rose

Mr Speaker: Order. The Front-Bench exchanges, although enlightening and engaging in equal measure, have nevertheless consumed almost half an hour. I am very keen that there should be time for Back Benchers to contribute. Short questions and short answers are required.

Sir Peter Tapsell (Louth and Horncastle) (Con): May I suggest to my right hon. Friend that it may be over-optimistic to assume that the civil war in Libya will cease when Colonel Gaddafi departs the scene? As he knows, the estrangement of Tripolitania and Cyrenaica dates back to the Punic wars, which is why in 1946 Ernest Bevin wanted to restore Mussolini’s single Libya to its two historic entities. Moreover—if you will bear with me for a moment longer, Mr Speaker—we could impose an immediate partition on the country by air power alone. That would enable us to remove by sea those rebels on the coastal strip who found themselves on the wrong side of the dividing line, before they were massacred by the inland tribes.

Mr Speaker: It is always a pleasure to listen to the hon. Gentleman. When I have heard him, I invariably feel better informed, and somewhat improved.

Mr Hague: Well, so do I. I absolutely take my hon. Friend’s point about the Punic wars and the historical division between Tripolitania and Cyrenaica, but I have to say that I do not think that that is the solution in this particular case, in the 21st century. All the people we have spoken to in the transitional national council are very much committed to the territorial integrity of Libya as a whole. The country could not be so easily

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partitioned as my hon. Friend might think, in that there is strong support for the opposition forces throughout Libya, including in the west, in cities in the western mountains and in Misrata. The people of Misrata do not want to be taken away to the east; they want to stay in their own city, with their rights being respected and their lives being preserved. There is no simple east-west division in Libya now, in contrast to what has happened in previous centuries or, indeed, in previous millennia.

Mr Bob Ainsworth (Coventry North East) (Lab): Fear is growing that, although we are doing enough to keep this operation going, we are not doing enough to bring it to a successful conclusion. If stalemate or de facto partition are unacceptable, and if the people cannot be properly protected while Gaddafi is in place, surely we need to make enough effort, now that we are engaged in this operation, to bring it swiftly to a conclusion, and to bring to an end the suffering in Libya. Surely that means doing more than is currently being done.

Mr Hague: I understand the right hon. Gentleman’s concern. Other Ministers and I went to the NATO meeting in Berlin to ask for an increased tempo in the military operations, as well as increased support from other countries for military operations, some of which we have secured. He will have heard us talking about Italy earlier. However, when he says that the situation needs to be brought to a conclusion more rapidly, he is really calling for a military effort that is very different in its scale and in its nature. I would say to him that that would not be in accordance with UN resolution 1973. The large-scale use of ground troops, for instance, would not be in accordance with the resolution. Whatever we do, it is vital to keep the legal, moral and international authority that comes from working within the United Nations resolutions. I must therefore resist his demands for a more rapid or overwhelming military solution to the situation. We have to continue to intensify the pressure on Gaddafi through diplomatic, economic and military channels, but we must stay within what is legal and internationally supported.

Sir Malcolm Rifkind (Kensington) (Con): Does the Foreign Secretary accept that the Government’s twin fundamental aims of protecting civilians and requiring the departure of Gaddafi cannot be achieved by coalition air power alone—or, indeed, by diplomatic and economic pressure—and that the achievement of those aims will require giving military support to the insurgents? I welcome the fact that instructors have been sent to Benghazi, but does the Foreign Secretary not agree that much more military support could be given that would be consistent with the UN resolution, which allows all necessary measures for the protection of civilians throughout Libya?

Mr Hague: The first point to make to my right hon. and learned Friend is that these are not instructors. I would not refer to them as instructors. It is a military liaison team; it is working on headquarters organisation. I stress that these officers are not involved in arming or training the forces of the opposition side in Libya. Our position—my right hon. and learned Friend has brought it up before—is that we will help with non-lethal equipment. The British Government have taken no decision to arm or equip the opposition forces with lethal equipment. I

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have expressed our view of the legality of that before, which is that the arms embargo applies to the whole of Libya, but that it is legal under the UN resolution to supply equipment to protect civilian life in certain circumstances. Other nations may wish to do that or to interpret the resolution in a different way. We interpret it in that way and believe that the best way for us to help is to supply the non-lethal equipment that I have mentioned.

Jeremy Corbyn (Islington North) (Lab): May I congratulate the Foreign Secretary on delivering an absolutely brilliant piece of Foreign Office speak for the last 10 minutes? He assured us that there was to be no ground intervention, yet military forces are being sent to assist the British diplomatic mission. He assured us that there was no intention of regime change, and then promptly called for a regime change. What exactly is the Government’s position on Libya? Is it to have a partition; is it the overthrow of Gaddafi; is it to hand over the oil and banking interests to Qatar; is it the sale of arms to the whole region? What on earth are the Government’s long-term intentions on Libya? Will he please explain?

Mr Hague: I accept the hon. Gentleman’s congratulations in the spirit in which they were offered, and I am tempted to go over my whole statement again. Our attitude to the whole issue of change in the middle east is that if it goes right, it will be one of the greatest advances in human freedom and world affairs that we have seen—certainly since the end of the cold war, and in some ways comparable to it. If it goes wrong, however, leading to more authoritarian regimes or a long period of violent disorder, it will provide a serious threat to our own national security and that of the whole of Europe, with new breeding grounds for terrorism, uncontrolled migration and threats of extremism. We therefore have to do what we can to make sure that change goes in the right direction, not the wrong direction. That is what we want for Libya and what we want for other countries. We are able to help in each country in different ways, but that is the context in which our Libya policy sits.

Sir Menzies Campbell (North East Fife) (LD): Notwithstanding my right hon. Friend’s careful and circumspect response to the shadow Foreign Secretary, is it not clear that the United Kingdom and France are disproportionately bearing the burden of the offensive air campaign? Why is it that our NATO allies are not making a better contribution, and is the Foreign Secretary disappointed by their failure to do so?

Mr Hague: It is certainly true that the United Kingdom and France make a huge contribution and, most of the time, the largest contribution to the campaign. I hesitate to use words like “disproportionate”, as I must say that the contribution—including an offensive strike capability—from countries such as Denmark and Norway is, considering their size as countries and the size of their armed forces, very much proportionate to the efforts that we are making. We should not think that only the United Kingdom and France are contributing. There are 16 nations involved in the military activity. As my right hon. and learned Friend knows, Arab nations are also involved. In response to our recent requests, other countries have brought other military assets into play—Spain, for example,

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providing additional air-to-air refuelling capability and Italy bringing in ground-strike capability. At all times, the United States continues to supply about a quarter of all sorties flown, even in periods when it is not taking part in ground strike. The right hon. and learned Gentleman can see that the burden is spread more widely than the headlines sometimes give the impression, but would we like a greater contribution from some other nations and did we say so at the NATO meeting in Berlin? Well, yes, we did.

Tony Lloyd (Manchester Central) (Lab): The Foreign Secretary has quite rightly referred to the legal, moral and international base that resolution 1973 mandates, and it is imperative that we stick within it. In that context, can he restrain those voices calling to go beyond that—as, for example, the call to target Colonel Gaddafi and others—and make them desist, because that sort of thing will not keep the coalition together?

Mr Hague: I am trying to restrain them, as I restrained the right hon. Member for Coventry North East (Mr Ainsworth) a moment ago in relation to a parallel subject. As for the question of specific targets, we will not go into it. Who or what become legitimate targets depends on how they behave. I will not expand, and no Minister will expand, on who or what will be a target.

Mr John Redwood (Wokingham) (Con): Given that the Libyan regime can place its forces in heavily congested urban areas and fight house to house, and given the terms of the resolution, is it not the case that the NATO forces are in no position to exert any influence over the outcome of this civil war?

Mr Hague: No. Although NATO air forces are constrained by having to operate entirely from the air—obviously there can be problems with air operations on days when the weather is bad—they have clearly had a huge and, so far, decisive impact. Had it not been for those NATO-led air operations, Benghazi would have fallen and Gaddafi would have reconquered the entire country; I think that Misrata would have fallen.

As my right hon. Friend says, it is very difficult when forces are making themselves look like civilians and fighting at close quarters in a city like Misrata. Nevertheless, there is a good deal of evidence that in recent days they have been pushed back. The use of a Predator unmanned aerial vehicle over Misrata is something that the regime forces have to worry about and, I think, have worried about greatly over the past 48 hours, however clever they may think they are at concealing themselves.

Mr Geoffrey Robinson (Coventry North West) (Lab): May I compliment the Foreign Secretary on his attitude to this difficult matter? May I also urge him to continue to resist the calls that have come from certain important Members of Parliament, notably a former Foreign Secretary and a former Defence Secretary, my fellow Coventrian the right hon. Member for Coventry North East (Mr Ainsworth)?