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House of Commons

Tuesday 27 November 2012

The House met at half-past Eleven o’clock


[Mr Speaker in the Chair]

Business Before Questions

City of London (Various Powers) Bill [Lords] (By Order)

Second Reading opposed and deferred until Tuesday 4 December (Standing Order No.20).

Oral Answers to Questions


The Secretary of State was asked—

Health Visitors and Nurses

1. Barbara Keeley (Worsley and Eccles South) (Lab): How many (a) health visitors and (b) nurses there were in the NHS in May 2010 and the latest month for which figures are available. [129934]

The Secretary of State for Health (Mr Jeremy Hunt): The number of full-time equivalent qualified nurses and midwives employed in the national health service in England in May 2010 was 310,793, and in August 2012 it was 304,566. The number of full-time equivalent health visitors in May 2010 was 8,092 and in August 2012 it was 8,067, with an additional 226 health visitors employed by organisations not using the electronic staff record.

Barbara Keeley: I thank the Secretary of State for that answer. The recent Care Quality Commission report found that 10% of NHS hospitals did not meet the standard of treating people with respect and dignity, and underpinning that poor care were high vacancy rates and hospitals that have struggled to make sure they have enough qualified staff on duty at all times. That shows us the real impact of losing those thousands of nurses. So does he agree that it is urgent that this Government take action when understaffing in the NHS results in poor care?

Mr Hunt: I absolutely agree with the hon. Lady that nowhere in the NHS should allow low staff numbers to lead to poor care. What was interesting about the CQC report, which was a wake-up call for the whole NHS, was that institutions under financial pressure, as the whole NHS is, are delivering excellent care in some places and delivering care that is unsatisfactory and not good enough in other places. On her specific question about nurses and nurse numbers, it is important to recognise that across the NHS as a whole the nurse-to-bed

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ratio has increased. Every NHS bed is getting an extra two hours of care per week compared with the situation two years ago.

Miss Anne McIntosh (Thirsk and Malton) (Con): Will the Secretary of State give an instruction, irrespective of the numbers, that we go back to traditional nursing methods, as now that we have an almost all-graduate nursing profession we seem to have lost touch with true, caring nursing?

Mr Hunt: I have some sympathy with what my hon. Friend is saying, although it is important to recognise, as we have this debate about nursing, that the vast majority of nurses in the NHS do an outstanding job and we are very lucky to have them giving their lives to the NHS. Next week, at the chief nursing officer’s conference, we are launching a new vision for nursing, which will put compassion and the patient at the heart of what nurses do. I hope that will address some of her concerns.

Andy Burnham (Leigh) (Lab): Last week, official statistics revealed that 7,134 nursing jobs had been lost under the coalition—almost 1,000 of them in the last month on the Secretary of State’s watch. The very next day, the Care Quality Commission warned that 16% of hospitals in England are not meeting the CQC standard for adequate staffing levels. Is this not prima facie evidence that the NHS and patients are not safe in his hands? Will he urgently intervene to stop the job losses?

Mr Hunt: The reason why the CQC undertook its shocking investigation into the state of care in our country was that this Government introduced dignity and nutrition inspections, which never happened when the right hon. Gentleman was Secretary of State. He talked about numbers employed in the NHS, so let us look at them. Yes, there has been a 2% decline in the number of nurses, but there has been an increase in the nurse-to-bed ratio. There has been a 4% increase in the number of midwives, a 5% increase in the number of doctors and an increase of more than 50% in the number of health visitors—their number went down when he was in office. How much worse would those numbers have been if we had had the cut in NHS funding that he wanted?

Brain Tumours

2. Mary Macleod (Brentford and Isleworth) (Con): What steps the Government are taking to raise awareness of and help those who have brain tumours. [129935]

The Parliamentary Under-Secretary of State for Health (Anna Soubry): Forgive me, Mr Speaker, but as you can hear—you may indeed be pleased to hear this—I am losing my voice. This is a serious matter, as you know, and I pay tribute to all the work you did on behalf of people suffering from brain cancer. The Government are proud to have been behind some important initiatives, such as promoting among general practitioners direct access to MRI scans. From January next year we are introducing a pilot scheme to alert people to the particular symptoms of common cancers, and we are confident that that will improve awareness about brain tumours.

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Mary Macleod: I thank the Minister for her answer, but in the UK about 4,800 adults and 100 children lose their lives to brain tumours each year. Brain tumours kill more children than any other cancer, kill 65% more women than cervical cancer and kill more males under 40 than any other cancer, yet only 0.7% of Government funding goes to brain tumour cancer research. Will the Minister meet my constituent, Romi Patel, and others who have had brain tumours to discuss with them what more the Government can do to save lives?

Anna Soubry: The short answer is yes, I am more than happy to meet my hon. Friend’s constituent to discuss this matter. The figures she relies on for the amount of money going into brain tumour research are based on 2006 data, but the simple answer is that of course we can do far more. I pay tribute to the great advances made by a number of charities, including Headcase Cancer Trust, in my constituency, and others such as the Joseph Foote Trust. They are all raising considerable amounts of money specifically for research projects such as the one at Portsmouth university. I am more than happy to meet my hon. Friend’s constituent. This is an important topic on which we can do more.

Mr Speaker: I thank the Minister for her answers, including her very generous and gracious remarks. I wish her a full and speedy recovery.

David Tredinnick (Bosworth) (Con): Does my hon. Friend the Minister agree that Penny Brohn Cancer Care, based near Bristol, which offers a unique combination of physical, emotional and spiritual support designed to help patients live well with the impact of cancer, is an organisation that should be supported? Can she confirm that such organisations are eligible for funds from the cancer drugs fund?

Anna Soubry: It is important that we consider all aspects of how we can treat cancers. We also need to bear in mind the people who care for those with cancer, as we sometimes forget them. Any organisation—especially in the charitable sector—that offers treatments that help people and their families and carers is to be welcomed.

Mental Health

3. Paul Burstow (Sutton and Cheam) (LD): What plans he has to improve the quality and quantity of mental health crisis care services. [129936]

The Minister of State, Department of Health (Norman Lamb): Mental health is a priority for this Government. That is reflected throughout the first mandate to the NHS Commissioning Board. The quality of all services, including crisis mental health, must improve. It is for the Commissioning Board, working with local commissioners and partners, to commission services in response to need.

Paul Burstow: I welcome that answer, particularly as regards the strengthening of the NHS constitution. My hon. Friend will accept that a mental health crisis is a very frightening thing to happen to a person and can be life threatening. The charity Mind has shown that there is unacceptable variation across the country in the quality and accessibility of crisis services. Does the Minister

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agree that just as the Government have rightly shone a light on the variability of physical health services, we need to do the same for mental health services? We need an atlas of variation for mental health services that hon. Members and others can use to challenge local commissioners to improve.

Norman Lamb: I am grateful to my right hon. Friend for that question. Atlases of variation are an important way of raising standards and we will be discussing their future use with the new commissioning organisations. He is also right to highlight the absolute importance of having parity of esteem between physical and mental health. The Government’s mandate makes it absolutely clear that there must be parity between mental and physical health services.

Hazel Blears (Salford and Eccles) (Lab): There are 800,000 people in this country who are living with the effects of Alzheimer’s and dementia. For some of those people, challenging behaviour is a serious issue. Will the Minister ensure that every clinical commissioning group has a lead for dementia in the mental health field so that that can be taken seriously in every community in the country?

Norman Lamb: That is absolutely a priority for the Government and the right hon. Lady is right to highlight its importance. The NHS Commissioning Board will work with local clinical commissioning groups to ensure that we raise the standards of health and care services, but she is absolutely right to highlight the importance of substantially improving access to dementia services.

Rehman Chishti (Gillingham and Rainham) (Con): Can the Minister clarify how often mental health centres and hospitals are inspected and how often patients are spoken to to help improve the service?

Norman Lamb: The Care Quality Commission inspects all services. Of course, there is now a registration system for such services. The hon. Gentleman is absolutely right to highlight the importance of ensuring that mental health services are regarded as just as important as physical health services, which has not always been the case.

Bridget Phillipson (Houghton and Sunderland South) (Lab): Does the Minister agree that when people are experiencing a mental health crisis, the initial response that they receive when seeking help is vital? What steps are he and his Department taking to make sure that staff in accident and emergency departments are able to respond appropriately?

Norman Lamb: I am grateful to the hon. Lady for raising that important point. A fortnight ago I visited Heartlands hospital in Birmingham, where the RAID—rapid assessment, interface and discharge—team provides brilliant access for people arriving in accident and emergency who have a mental health problem, and ensures that they get immediate access to mental health services. That sort of best practice not only improves health and well-being for those individuals, but saves the system money. We need to spread that best practice across the country. I am very grateful to the hon. Lady for raising it.

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Consultancy Costs

4. Graeme Morrice (Livingston) (Lab): How much the NHS spent on consultancy in (a) 2010-11 and (b) 2011-12. [129937]

The Secretary of State for Health (Mr Jeremy Hunt): The amount spent by strategic health authorities, primary care trusts and NHS trusts on consultancy services in the financial years 2010-11 and 2011-12 was £291 million and £278 million respectively—a 39% fall in expenditure, compared to the last year of the previous Administration.

Graeme Morrice: In 2010 the former Secretary of State said he was

“staggered by the scale of the expenditure on management consultants”.

However, in the past year alone foundation trusts have increased their spend on consultancy by 25% and NHS trusts have increased their spend by 13%. Is the new Secretary of State just as staggered?

Mr Hunt: With respect to the hon. Gentleman, a 39% fall in consultancy expenditure compared to the last year of the previous Administration is something that we are rather proud of. If he wants to know what the Health Secretary is directly responsible for, direct Department of Health expenditure on consultancy in the past year was £3 million. In the last year of the previous Government it was £108 million.

Andrew Bridgen (North West Leicestershire) (Con): Has my right hon. Friend made any recent assessment of the total efficiency savings achieved in the NHS over the past two years under the Nicholson challenge?

Mr Hunt: We are making good progress on the Nicholson challenge. This year we expect to save £5.8 billion under that important programme to improve efficiency in the NHS so that we can treat more people.

Andrew Gwynne (Denton and Reddish) (Lab): The Secretary of State cannot have it both ways. Is he aware that in the past year alone Monitor spent more than £9 million on NHS transition costs, with a staggering £5.6 million of that being squandered on management consultants? Is this not a further sign of a Government with their priorities all wrong, wasting precious public money on management consultants to push through a reorganisation that nobody wanted, while they are handing out P45s to our nurses?

Mr Hunt: If the hon. Gentleman is shocked at consultancy spend in the NHS today, he will be even more shocked to know that it was nearly double when his party was in power.

National Pay Agreements

5. Mr William Bain (Glasgow North East) (Lab): What estimate he has made of the number of foundation trusts considering plans to opt out of NHS national pay agreements. [129938]

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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): The previous Labour Government gave foundation hospitals additional freedoms to set their own pay terms and conditions for staff and, as a result, the information is held locally, not centrally.

Mr Bain: I thank the Minister for that non-answer. Will he recognise that with average wages 6.8% lower for full-time workers than they were when this Government took office, people are right to be sceptical about the Government’s record in pay? Why is he sitting back and doing nothing while the national character of our health service is being destroyed through regional pay arrangements?

Dr Poulter: It is worth reminding the hon. Gentleman that, as I outlined in my first answer, it was the previous Government who gave foundation trusts additional freedoms to set their own pay terms and conditions outside national frameworks. This Government are working closely with NHS employers and the trade unions to make sure that we maintain “Agenda for Change” and national pay frameworks as fit for purpose, and we are very pleased with that. If the hon. Gentleman wants to ask why there is regional pay and freedoms for employers to set regional pay, he should ask those on his own Front Bench, some of whom were Ministers when these freedoms were set.

John Pugh (Southport) (LD): Does the Minister recognise that the recent progress in national negotiations over greater flexibility is very encouraging and makes the efforts of the south west consortium and others both disruptive and pointless, in context?

Dr Poulter: We have had encouraging results from national pay negotiations at the recent NHS Staff Council, and unions are to consult their members on those results. There is general agreement that we need to maintain national pay frameworks, provided they are fit for purpose. I hope my hon. Friend will find that the south west pay consortium, which has been somewhat heavy-handed in the way that it has conducted its affairs, also sees the benefit of maintaining national pay frameworks. That is why we would like to see a quick resolution of the matter at a national level.

Cancer Drugs Fund

6. Pauline Latham (Mid Derbyshire) (Con): What recent assessment he has made of the cancer drugs fund. [129939]

The Secretary of State for Health (Mr Jeremy Hunt): Since October 2010, more than 23,000 patients in England and more than 1,600 patients in NHS East Midlands have benefited from the additional £650 million funding for cancer drugs that this Government have committed to providing.

Pauline Latham: I thank my right hon. Friend for that answer, but I have previously raised in the House a constituency case where the NHS East Midlands cancer drugs fund would not pay for drugs that other CDFs would pay for, such as Avastin for second-line treatment of bowel cancer. Sadly, my constituent has since died because she could not get funding for the drugs she

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needed, having spent all her own money funding the treatment herself. Will my right hon. Friend meet me and my late constituent’s consultant, Dr Bessell, to discuss how we can end this postcode lottery?

Mr Hunt: Proud as we are of the cancer drugs fund, to hear such stories is extremely distressing, and our first thoughts are with the family of my hon. Friend’s constituent. We will of course look into the issue she raises, which is a cause of great concern. I know that the Under-Secretary of State for Health, my hon. Friend the Member for Broxtowe (Anna Soubry), is a neighbouring MP and would be happy to meet her to discuss the matter.

Liz Kendall (Leicester West) (Lab): The reality is that the Government are ripping away the foundations of better cancer care. The former Health Secretary made a clear promise from the Dispatch Box to protect cancer network funding, but the NHS South East London and greater midlands cancer networks both say that their budgets and staff have been slashed. The NHS medical director, Sir Bruce Keogh, says that cancer networks are an NHS success story, and Macmillan Cancer Support says it is nonsensical to cut their specialist expertise. Why do the Government not agree?

Mr Hunt: Cancer networks are here to stay and their budget has been protected. They are extremely important. The hon. Lady uses hyperbolic phrases such as “ripping away the foundations of better cancer care”, so perhaps she would like to talk to the 23,000 people who have benefited from the cancer drugs fund that her Government failed to introduce.

George Freeman (Mid Norfolk) (Con): I congratulate my right hon. Friend on the cancer drugs fund and the ring-fencing of the budget for cancer, which delivers important benefits in research, not least by funding new treatments by new companies that would not otherwise be able to sell their product and by generating important evidence on health economics. As a Mo-bro, I am very aware that medicines are better than surgery. Will he give the House some reassurance that the Government plan to renew the cancer drugs fund?

Mr Hunt: We are committed to finding a way of ensuring that people who have benefited from the cancer drugs fund—23,000 to date—can continue to receive that kind of support. That is something we can do because we protected the NHS budget, unlike the Labour party, which wanted to cut it.

Treatment Rationing

7. Luciana Berger (Liverpool, Wavertree) (Lab/Co-op): What steps he is taking to ensure that primary care trusts do not ration access to NHS treatments and operations. [129941]

12. Kate Green (Stretford and Urmston) (Lab): What steps he is taking to ensure that primary care trusts do not ration access to NHS treatments and operations. [129946]

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): Rationing on the basis of cost alone is completely unacceptable. That is why the Government

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are increasing the NHS budget by £12.5 billion over the life of this Parliament and giving front-line health care professionals the power to decide what is in the best interests of patients.

Luciana Berger: I listened closely to the Minister’s answer. My constituent, Raymond Hickson, has been told that he has a leaking valve in his upper leg, causing varicose veins. His leg will eventually fill with blood, rendering him unable to walk and, therefore, to work, as he is currently employed in a manual job. He has been refused a simple operation on the basis that he now does not fit the PCT criteria, although he has had two similar operations in the past 15 years. What advice would the Minister give Mr Hickson and others like him, who are clearly the victims of treatment being rationed?

Dr Poulter: It is worth pointing out to the hon. Lady, who raises a legitimate point about that gentleman’s case—[Interruption.] The right hon. Member for Leigh (Andy Burnham) says “Do something”, but this type of rationing of varicose vein surgery occurred when the previous Labour Government were in power—[Interruption.] It did, and rationing of many other types of services was much worse. It is this Government who have introduced the cancer drugs fund to stop the rationing of cancer treatments to patients, which has benefited 23,000 extra patients, and many more elective procedures are taking place across the NHS every single day. On the specific case the hon. Lady raises, obviously if her constituent has a specific concern, there are safeguards in place locally for him to raise it if he thinks the decision is not based on clinical criteria.

Kate Green: Trafford primary care trust offers one cycle of in vitro fertilisation treatment to women up to age 29. The Minister will be aware that the National Institute for Health and Clinical Excellence guidance is for up to three cycles and up to age 39. Last year the all-party group on infertility pointed out that a very large majority of PCTs were not meeting the NICE guidance. Why does he think that is, and what is he going to do about it?

Dr Poulter: Of all Ministers in the House, the hon. Lady has probably asked the right one about this issue. This is a long-standing problem that goes back many years. There has been great variability in the availability of IVF in different parts of the country, and, at a national level, NICE finds that unacceptable. I will be taking the matter forward, and I assure her that we will make sure that we do all we can to iron out that variability and follow NICE guidelines so that everyone can receive the best IVF treatment.

Mr Stephen Dorrell (Charnwood) (Con): Does my hon. Friend agree that the best way to ensure that high-quality care continues to be available to all patients, as and when they need it, is to ensure that the health and care systems are brought together into a single joined-up system so that, in the words of Mike Farrar of the NHS Confederation, we operate a care system with a health adjunct rather than a health system with care support?

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Dr Poulter: My right hon. Friend has, over many years, been a very strong advocate—probably the strongest advocate in this House—for integrated care, which this Government are determined to make a reality. He is absolutely right that we need properly joined-up care that we properly deliver when we face up to the big health care challenges of how we better look after people with long-term conditions and older people. The only way to do that is to deliver more care in the community, and that has to be achieved through more joined-up and integrated care.

Mr Nick Gibb (Bognor Regis and Littlehampton) (Con): My constituent, Jennifer Payten of Bognor Regis, needs dental implants because her temperomandibular disorder means that dentures cause pain and severe headaches. For the past 10 years, Ms Payten has been passed from NHS trust to NHS trust in a Kafkaesque nightmare that no one in modern Britain should have to tolerate. I have written to the Secretary of State about this matter. However, will the Minister personally look into Ms Payten’s case to help to unblock the logjam and ensure that my constituent receives the health care that she needs to enable her to return to a normal life?

Dr Poulter: I thank my hon. Friend for his question. He is right to raise this, because it has been a very long-standing problem. I am sure that he would welcome, with me, the fact that under the current Government over 1.1 million more people are receiving access to NHS dentistry. However, this is a difficult case, and I am happy to meet him to discuss it further and see what I can do to help to unblock the problem.

Andy Burnham (Leigh) (Lab): Ministers have repeatedly promised to ban rationing of treatment by cost in the NHS. If the Minister is presented with evidence that this is still continuing, will he today give the House a categorical assurance that he will act immediately to stop it?

Dr Poulter: It has been very clear in all the criteria for NHS commissioners set by the previous Government and by this Government that decisions about local health care treatment have to be based on clinical need, and that those decisions are for local commissioners. The difference is that this Government will make sure that doctors, nurses and health care professionals are in charge of budgets and setting health care priorities rather than the managers the previous Government chose to favour, who did not always have experience of front-line care and did not always understand some of the challenges that patients were facing.

Andy Burnham: I will take that as a yes. The Minister is going to have a busy day, because this afternoon he will have on his desk new evidence that I will send him showing that an estimated 52,000 patients in England are being denied treatment and kept off NHS waiting lists because of new restrictions imposed under his Government on cataracts, varicose veins, carpal tunnel syndrome, and other serious treatments. Ministers boast of lower waiting lists, but that is because they have stopped people getting on to the waiting lists in the first place. Patients in pain and discomfort, unable to work, are being forced to pay for treatment. How many more people will have to suffer before he finally acts?

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Dr Poulter: We have already highlighted in earlier answers the fact that under the previous Government health care rationing was far worse on varicose veins, which one of the right hon. Gentleman’s own Back Benchers mentioned, and elsewhere. This Government are very proud of our record whereby 60,000 fewer patients are waiting more than 18 weeks than under the previous Government and 16,000 fewer patients than in May 2010 are waiting longer than a year. Waiting times are coming down, infection rates in hospitals are coming down, and people are getting better care. This Government ended the worst health care rationing scandal of all—the fact that people with cancer were not getting access to the drugs they needed. Now, 23,000 people are getting access to that care. If he could not do anything about rationing, he should at least recognise that this Government have done something and have made a real difference to people’s lives, particularly patients with cancer, by reducing rationing.

Tim Farron (Westmorland and Lonsdale) (LD): Those of us who live in rural areas such as south Cumbria have faced the rationing of acute services for years—not rationing by price, but rationing by distance. Will the Minister encourage Morecambe Bay, which will undertake its review of the allocation of services in the coming months, to allocate accident and emergency services back to Westmorland general hospital, where they would be closer to the people whose lives they could save?

Dr Poulter: As my hon. Friend is aware, from next year the NHS Commissioning Board will have responsibility for commissioning local services and for setting the funding formula. I would be happy to raise his issue with the board, because it is true that, historically, the capitation formula has not recognised the fact that there are a lot of older people in rural areas and further distances to travel. The previous Secretary of State, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), took steps towards reviewing the formula and I assure my hon. Friend that the Government will be looking into it further.

Clinical Commissioning Groups

8. Chi Onwurah (Newcastle upon Tyne Central) (Lab): Whether he has put in place measures to ensure that clinical commissioning groups do not become for-profit organisations. [129942]

The Parliamentary Under-Secretary of State for Health (Anna Soubry): Clinical commissioning groups were established in statute. They are, accordingly, public bodies and cannot become private, for-profit organisations.

Chi Onwurah: I thank the Minister for that answer. As we know, most GPs go into medicine to make people well, but now that her Government have made the NHS subject to competition law there is real fear in Newcastle and across the country that they will find themselves obliged to turn a profit from their patients. Is this not, as Professor Ham of the King’s Fund has said, a further step towards privatisation?

Anna Soubry: No. I would urge the hon. Lady, if I may, to exercise care when claiming that this is a privatisation of the NHS. It certainly is not. GPs’ surgeries, such as

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those in her own constituency, have always been private businesses. A GP surgery in the hon. Lady’s own constituency, where, in my view, she has been engaged in considerable scaremongering, was put out to tender under rules introduced by the previous Labour Government. Indeed, it was the previous Government who brought in privatisation to the NHS on a scale that we had never seen before in this country. I am proud that it is this coalition that is making sure that the tariffs are fair and no longer favour the private sector.

Paul Maynard (Blackpool North and Cleveleys) (Con): One way that the clinical commissioning groups can support the values of the NHS is to back the new social enterprises—forms of business enterprise—that are now delivering NHS services central to our health-care reforms. Is the Minister aware that my local clinical commissioning group wants to shut down a 60-bed rehabilitation unit provided by nurses and owned by a social enterprise called Spiral, without any adequate provision for a replacement? Will she meet me to discuss this worrying development?

Anna Soubry: Yes, of course I will meet my hon. Friend. I hold a ministerial surgery on Monday evenings and would be grateful if he came along to one, but I would be happy to meet him in any event. These are local decisions that will be made by local commissioners, but they should always commission in the interests and to the benefit of the people whom they serve.

Vulnerable Groups (Access to Health Care)

9. Charlie Elphicke (Dover) (Con): Whether he has recently reviewed how access to health care treatment can be made easier for vulnerable groups; and if he will make a statement.[Interruption.] [129943]

The Parliamentary Under-Secretary of State for Health (Anna Soubry): I am so sorry, Mr Speaker, I was getting carried away. It is my hon. Friend the Member for Dover (Charlie Elphicke) who has asked a question, is it not? [Interruption.] It does not help when the right hon. Member for Leigh (Andy Burnham) shouts at me. I am at a profound disadvantage, because I cannot shout back—not that I would ever want to raise my voice, of course. I do not seek sympathy, just parity. Opposition Members should listen with great care. This Government introduced in statute an absolute duty on the NHS to ensure that health inequalities, which, of course, rose under the previous Administration, are at last reduced.

Charlie Elphicke: My constituents in Deal are concerned that consultant out-patient services may be withdrawn from their much-loved hospital. Is it not right that GP commissioners should be particularly mindful of services to vulnerable people in rural areas who find it hard to travel?

Anna Soubry: Indeed it is. That is one of the great joys of the CCGs. As other Ministers have alluded to, we are putting commissioning decisions into the hands of the people who know best—the health professionals. When they exercise their commissioning responsibilities, we urge them to ensure, as I am sure they will, that they deliver the very best services for the people they serve.

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Ms Diane Abbott (Hackney North and Stoke Newington) (Lab): On the question of vulnerable groups, does the Minister support the proposal of the hon. Member for Bracknell (Dr Lee) to ration NHS drugs, either by adopting the Danish system in which people have a personal budget for drugs and have to pay to top up, or by removing the right to free prescriptions for long-term conditions such as diabetes? Does she appreciate how much harder that would make life for millions of people in vulnerable groups, or is this the real face of the coalition on the NHS—drug rationing?

Anna Soubry: At my ministerial surgery last night, which has been somewhat scorned by Opposition Members, I met my hon. Friend the Member for Bracknell (Dr Lee) and discussed his proposals at length. I do not agree with his proposals, but I welcome the debate. There is nothing wrong with a healthy debate. However, on this one, he and I disagree.

Pancreatic Cancer

10. Naomi Long (Belfast East) (Alliance): How much the Government have spent on (a) treatment, (b) diagnosis and (c) raising awareness of pancreatic cancer since May 2010. [129944]

The Parliamentary Under-Secretary of State for Health (Anna Soubry): We cannot provide the absolute figures on how much we have spent on pancreatic cancer in particular, but some £200 million has been spent on cancers of that type. This month is pancreatic cancer awareness month and I welcome all the hon. Lady’s work towards that.

Naomi Long: I recently met some families in my constituency who have been directly affected by pancreatic cancer. One of their main concerns is late diagnosis, which contributes to this cancer having the worst survival rate of the 21 most common cancers in the UK. What assessment has the Department made of the recommendations in the early diagnosis report by Pancreatic Cancer UK, such as improved referral pathways and assessment tools, direct access for GPs to diagnostic tools, and the development of a National Institute for Health and Clinical Excellence quality standard for pancreatic cancer as a means of improving the speed of diagnosis and survival?

Anna Soubry: I am very grateful for the work of Pancreatic Cancer UK. We have put the proposals from its seminar last June into the guidance that we are issuing. I am meeting Pancreatic Cancer UK, other cancer charities and other people who are involved in cancer work this afternoon. I will be happy to raise the matter with them directly and to meet the hon. Lady and representatives of this very good cancer charity. She is right to expose the fact that this cancer is difficult to diagnose. We will be launching pilots in January and I hope that more people will take advantage of that campaign and come forward if they have any symptoms.

NHS South-West Pay, Terms and Conditions Consortium

11. Kerry McCarthy (Bristol East) (Lab): What contact there has been between his Department and the director of the NHS south-west pay, terms and conditions consortium. [129945]

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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): Since the south-west consortium’s plans were made public in May this year, Department of Health officials have been in contact with NHS employers, NHS trade unions and the south-west consortium better to understand the views of all parties. The Department of Health wants to find a resolution and supports national pay awards.

Kerry McCarthy: I thank the Minister for that response and for his acknowledgement earlier that the way in which the south-west consortium has handled the negotiations has been heavy-handed. It is appalling that staff found out about the plans only through the leaks as, it appears, did the Department. Will he go back to the director of the consortium and urge him to put everything on hold in the south-west while national pay discussions are continuing? As the Minister says, this ought to be about national pay, not regional pay.

Dr Poulter: I fully agree with the hon. Lady and I take her concerns on board. However, because of the additional freedoms introduced by the previous Government, local employers in foundation trusts throughout the NHS have additional freedoms to set their own pay, terms and conditions. Under the rules introduced by the previous Government, it is impossible for us to intervene directly in the matter, except by continuing to encourage trade unions and NHS employers to meet the national agreements. If national terms and conditions are agreed to, I am sure that they will be endorsed at a regional level by the south-west consortium.

Andrew George (St Ives) (LD): I am very pleased that the Minister will be meeting a cross-party delegation of MPs from the south-west next week to discuss this issue. In view of his answer to the hon. Member for Bristol East (Kerry McCarthy), is he confirming that Health Ministers have no powers at all to intervene in the negotiations between employers and their staff?

Dr Poulter: It is worth putting it on the record that it was the previous Labour Government who introduced foundation trusts in 2003 and set them free from direct accountability to Ministers. That includes the ability to set their own pay, terms and conditions. It was Labour that removed the power of the Secretary of State to direct foundation trusts, and it is Labour, not the Government, that needs to decide whether it supports the legislation that it put in place in government. We endorse national pay frameworks and will do all that we can to preserve them.


13. Mr David Amess (Southend West) (Con): What recent representations he has received on strategies to support patients with osteoporosis. [129947]

The Minister of State, Department of Health (Norman Lamb): The Department of Health has received no recent representations on strategies to support patients with osteoporosis. From April this year, osteoporosis was included in the quality and outcomes framework, giving GP practices financial incentives for diagnosing and treating osteoporosis in their patients.

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Mr Amess: Does the Minister welcome the new Falls and Fractures Alliance that will hold its first board meeting next month? It has been set up specifically to reduce admissions to hospitals resulting from falls, fall-related injuries or hip fractures in the over 65s.

Norman Lamb: I very much welcome the establishment of the alliance, and I applaud the work of the National Osteoporosis Society, Age UK, and the all-party group of which I think the hon. Gentleman is a member. We know that if we follow the evidence, we can substantially reduce the number of falls and fractures, thereby increasing health and well-being and reducing the cost to the system.

Health Care Provision (South-East London)

14. Simon Hughes (Bermondsey and Old Southwark) (LD): What the process is for deciding the future of health care provision in south-east London; and if he will make a statement. [129948]

The Secretary of State for Health (Mr Jeremy Hunt): The trust special administrator at South London Healthcare NHS Trust will be making recommendations to me on the future of the trust’s services. Those recommendations will inevitably impact on the services provided by other trusts in the south-east London health economy.

Simon Hughes: When the Secretary of State considers outer south-east London health arrangements, and problems that are not at all of his making, will he bear in mind that all five Members of Parliament for Southwark and Lambeth are clear that plans by King’s Health Partners for a super-trust across Lambeth, Southwark and beyond should be put on hold until we know the implications for inner south-east London of any changes that happen further out?

Mr Hunt: I will certainly bear in mind the right hon. Gentleman’s comments. The decision time scale for the South London Healthcare NHS Trust is very quick as prescribed in the National Health Service Act 2006. I must make a decision on that by 1 February, so the situation will soon become clear.

24. [129958] Dame Joan Ruddock (Lewisham, Deptford) (Lab): The trust special administrator’s report proposes the closure of the full A and E service at Lewisham hospital —which currently sees 115,000 people a year—and asserts that 30% of that department’s work can be transferred to the community. Will the Secretary of State provide evidence of how that can be done, especially considering a cash-strapped NHS and a local authority that is suffering from deep cuts by his Government?

Mr Hunt: I remind the right hon. Lady that the Government have not cut the NHS budget; we have protected the NHS budget. There is an ongoing consultation on the proposal that she mentions. It will finish on 13 December and I hope she will contribute to it. I will receive the recommendations of the trust special administrator at the beginning of January, and I will then make my decision.

Clive Efford (Eltham) (Lab): The 2010 Conservative manifesto stated:

“We will stop the forced closure of A and E and maternity wards, so that people have better access to local services,”.

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They then closed the accident and emergency department at Sidcup, having promised to save it, and they now plan to close the A and E at Lewisham hospital. Is that not a betrayal of people in south-east London and the NHS?

Mr Hunt: The hon. Gentleman should talk to the shadow Minister on the Opposition Front Bench, the hon. Member for Leicester West (Liz Kendall), who said yesterday that she would not automatically oppose all reconfigurations. The coalition Government have introduced four tests, which were not used by the previous Government. Those tests state that we will not impose closures of A and E and maternity units unless there is local clinical support, and evidence that it will benefit local people and improve patient choice. The tests exist to provide precisely the safeguards about which the hon. Gentleman is concerned.


15. Chris Ruane (Vale of Clwyd) (Lab): What recent assessment he has made of the treatment of repeat episode depression by (a) drugs and (b) mindfulness-based intervention. [129949]

The Minister of State, Department of Health (Norman Lamb): The National Institute for Health and Clinical Excellence has evaluated and recommended the use of mindfulness-based therapies as a psychological intervention for the prevention of relapse, within its guideline, “Depression: the treatment and management of depression in adults”. Drug treatment is also useful in the management of enduring depression.

Chris Ruane: The number of prescriptions issued for anti-depressants has gone from 9 million to 46 million in the past 10 years. NICE has recommended mindfulness as a better treatment than drug therapy for repeat episode depression, but it has not been taken up by the NHS. Will the Minister meet a delegation of MPs and mindfulness experts from across the UK to discuss how mindfulness can play its full role in helping the NHS and people with mental health problems?

Norman Lamb: I acknowledge the hon. Gentleman’s work on promoting the case for psychological therapies, including mindfulness, and would be happy to meet him and a delegation of experts. The Government have massively increased psychological therapies—nearly 1 million people in the past two years accessed psychological therapies through the improving access to psychological therapies programme. We are totally committed to improving access to psychological therapies to cure the imbalance in access to services for people with mental health problems that has existed for a very long time.

Ambulance Trust Budgets

16. Lisa Nandy (Wigan) (Lab): What assessment he has made of the possible effect on patient safety of reductions to ambulance trust budgets. [129950]

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): The budgets for individual ambulance trusts are set by local health care commissioners. In 2012-13, the budgets are increasing nationally by £2.5 billion.

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To ensure patient safety, ambulance trusts are required to meet national performance standards in respect of their response times.

Lisa Nandy: Does the Minister share my concern that 100,000 more patients than two years ago wait more than half an hour to be transferred from ambulance to A and E? If so, how on earth can he justify making his top-down reorganisation of the NHS a priority rather than sorting out that appalling situation?

Dr Poulter: The priorities for local ambulance trusts and the funding allocations are set locally. The hon. Lady will be pleased that between 2010-11 and 2011-12, an additional £9 million was put into the front line of the ambulance service in her area to help address some of the problems she outlines. Under this Government, more money is going to the NHS than before and more money is going into local ambulance services—£2.5 billion nationally. We should contrast that with the approach taken by the right hon. Member for Leigh (Andy Burnham) on the Opposition Front Bench, who said that to increase spending to address those problems would be irresponsible.

Several hon. Members rose

Mr Speaker: Order. We must find time for Dr Coffey.

Dr Thérèse Coffey (Suffolk Coastal) (Con): The Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), is my constituency neighbour. He will know that, although the East of England Ambulance trust is hitting its targets for the entire region, it is not helping in Suffolk. Will he advise on what more we can do locally to ensure that it serves all rural patients?

Dr Poulter: The problem has affected both Suffolk and Norfolk—the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), also takes an active interest in it. One problem was that the managers of the local ambulance trust were not listening to front-line staff on how to design and deliver services. In a staff survey, only 4% of front-line staff in the East of England Ambulance Service said they were being properly listened to, which is completely unacceptable. This Government, in contrast to the previous one, want to put front-line professionals in charge of running services, meaning that, in future, more patients will be properly prioritised and ambulance response times will be better met.

Mr Speaker: Order. These matters could be considered further in an Adjournment debate, which might be a suitable length for the subject.

Topical Questions

T1. [129959] Jack Dromey (Birmingham, Erdington) (Lab): If he will make a statement on his Departmental responsibilities.

The Secretary of State for Health (Mr Jeremy Hunt): I am pleased to report an NHS performing at record levels. There are half a million more out-patient appointments every year since the last election, nearly 1 million more people go through A and E every year, and there are

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1.5 million more diagnostic tests every year. To clarify a previous answer, the number of health visitors will go up by more than 50% during the course of this Parliament.

Jack Dromey: The Erdington walk-in centre is at the heart of our high street. It is much loved, much used and cost-effective, yet it is at risk of closure because of the combination of a £76 million reduction in expenditure by Birmingham primary care trusts and health service reorganisation. Thousands of local people have expressed their concern and elected a users committee. Will the Secretary of State meet the users of the centre and me?

Mr Hunt: I am happy to look into the issues the hon. Gentleman raises. The purpose of the reforms is to put more money on to the front line and into primary care, where we can save the most lives.

T2. [129960] Sir Tony Baldry (Banbury) (Con): The new mandate for the NHS includes a very welcome objective for it to be a world leader in end-of-life care. Can we have an indicator in the commissioning outcomes framework on deaths in preferred places of care to ensure that new commissioning groups prioritise better end-of-life care, and to ensure that those who want to die peacefully at home have the best opportunity to do so?

The Minister of State, Department of Health (Norman Lamb): I thank my hon. Friend for that question. The NHS outcomes framework includes an indicator on the quality of end-of-life care as it is experienced by patients and carers, which is based on the VOICES survey of bereaved relatives. The proposals for reform to the NHS constitution include a right for patients and families to be involved fully in discussions, including at the end of life.

T3. [129961] Graham Stringer (Blackley and Broughton) (Lab): What action does the Minister intend to take to reduce the number of unplanned emergency admissions to hospital by sufferers of muscular dystrophy and other neuromuscular conditions?

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): I thank the hon. Gentleman for that question and for his concern about this matter. One of the key challenges for the NHS is to ensure that we deliver better care in the community, deliver more preventive care and provide better support to people with long-term conditions, such as muscular dystrophy and diabetes, in their own homes. A key part of the reforms is to make sure that a lot of services are commissioned from the community by the local commissioning groups. We have already seen that that has reduced inappropriate admissions. For example, in my part of the world in Suffolk, they have been reduced by 15% for older people.

T4. [129963] Mr Aidan Burley (Cannock Chase) (Con): Yesterday, I received a letter from the chief executive of Monitor, which asked me and the Asset Transfer Unit to undertake feasibility work to develop a professional business case for the local community to take ownership of Cannock Chase hospital. This would be done through its transfer to a community interest company, which would then take over running the hospital estate, securing the building for the people of Cannock Chase. Will the

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Secretary of State welcome these proposals, which would be the first of their kind in the UK, and work with us as we develop a plan for the local community to own its hospital?

Mr Jeremy Hunt: I congratulate my hon. Friend on his campaigning and hard work on this issue, which represents an interesting way forward for community hospitals. I wish him every success and I know that hon. Members in all parts of the House will watch carefully what happens in Cannock.

T5. [129964] Heidi Alexander (Lewisham East) (Lab): I would like to press the Health Secretary further on the unsustainable providers regime, which has been enacted in the South London Healthcare NHS Trust. Given that the statutory guidance for that regime explicitly states that it is not to be used as a back-door route to service reconfiguration, why are Lewisham A and E and maternity services earmarked for closure? If that is not a service reconfiguration, can he tell me what is?

Mr Hunt: What this issue is addressing—it was legislation introduced by the hon. Lady’s Government in 2006—is a clearly unsustainable situation with South London Healthcare. The proposals have to look at making sure that there is sustainability throughout an entire local health economy. I have not made any decisions at all. I will wait for the proposals to come to me at the end of the year, and I will then make my decision in January.

T6. [129965] Andrew George (St Ives) (LD): There is mounting evidence that clinical care failure is as much to do with inadequate staff levels as anything else. In view of that, do Ministers agree that it is worth looking at the merits of establishing mandatory registered nurse to patient ratios across secondary and tertiary care wards?

Dr Poulter: I thank my hon. Friend for that question. This point has been raised before and although it sounds like a good idea in principle, the problem is that different aspects of care in different wards—for example, an older people’s ward compared with a ward that looks after younger people—will have differences in the intensity of nursing. Therefore, a mandated ratio would be difficult to implement. A ratio may be counter-productive to making sure that we can give more intensive nursing cover where it is needed, and could even encourage a race to the bottom.

T8. [129968] Lilian Greenwood (Nottingham South) (Lab): A recent Schizophrenia Commission report highlighted catastrophic failings in the care of people with severe mental illness. We know that suicide rates rise during times of economic hardship and that record numbers of people are being detained under the Mental Health Act. The Government have said that mental health should have parity with physical health, so why has funding for mental health services been cut for the first time in a decade?

Norman Lamb: Whenever the NHS is under financial pressure, there is the risk that mental health services will get squeezed. As the Health Select Committee identified, that is exactly what happened under the last Labour

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Government in 2006. I share the hon. Lady’s concern, however, about the report on schizophrenia highlighting how money is used: too many people in in-patient facilities and not enough prevention work. I am committed to working with others to ensure that we use the money more wisely to get better care for those patients.

T7. [129967] Tessa Munt (Wells) (LD): Since the Prime Minister made his radiotherapy promise to current and future cancer patients last month, cancer centres all over the country have been telling me that it cannot be delivered, because there is not enough investment in new radiotherapy machines and in the recruitment and training of staff to operate them. Will the Secretary of State give the same financial commitment to the annual radiotherapy fund as he is giving to the cancer drug fund, and will he meet me to discuss the matter?

The Parliamentary Under-Secretary of State for Health (Anna Soubry): I thank my hon. Friend for her question, because it touches on a matter of concern to me, notwithstanding the £15 million radiotherapy innovation fund, which, as she said, was announced by the Prime Minister. Indeed, last night, at my ministerial surgery, the hon. Member for Easington (Grahame M. Morris) came along to discuss this very matter, and he raised several important issues, all of which I have this morning taken up with my officials. I am more than happy to meet my hon. Friend to discuss the matter further, however, as I think there is work to be done.

Paul Goggins (Wythenshawe and Sale East) (Lab): My 20-year-old constituent, Martin Solomon, has blood cancer and is currently receiving expert treatment at the Christie in Manchester. He needs a stem cell transplant, but finding a match is difficult, especially as he has mixed heritage, and his best chance is from an umbilical cord donation. Will the Secretary of State do two things to help Martin? First, will he reinvigorate the campaign within the black and ethnic minority communities to increase stem cell donations, and, secondly, will he establish a cord collection centre in Manchester, so that mothers can donate cord after the birth of a baby and give young people such as Martin an extra chance to find a match?

Anna Soubry: I thank the right hon. Gentleman for raising an important topic. I send my heartfelt sympathies to his constituent. As he identified, this is a real problem. Yes, is the short answer to his first question. I met officials several weeks ago to discuss exactly this problem, as we need to do more in that area. Of course, this is a national scheme. Whether there is a need for a local scheme in Manchester is a moot point, but his constituent will be able to access the national scheme. I am more than happy to discuss the matter further with him.

Mr Peter Bone (Wellingborough) (Con): Neuroblastoma is a nasty cancer that affects fewer than 100 children a year. Thanks to the previous Labour Minister, Ann Keen, we persuaded the previous Prime Minister that it should be treated on the NHS without the need for a referral. Unfortunately, there seems to be some slippage, with some primary care trusts refusing to pay for the treatment. Will the Secretary of State look into the matter and see if they can be given the correct information, which is that they should be providing this treatment?

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Mr Jeremy Hunt: I will absolutely look into that issue. We are keen to ensure that people with rare diseases, including rare cancers, are not discriminated against because it is more expensive to do the research and get the drugs necessary to treat them.

Tom Greatrex (Rutherglen and Hamilton West) (Lab/Co-op): The Minister will be aware that the process of making Kalydeco available to people with cystic fibrosis in England is much further advanced than in Scotland, where the G551D gene is two to three times more prevalent—a point highlighted by the Daily Record yesterday in respect of seven-year-old Maisie Black from Burnside in my constituency. Will the Minister clarify that the roll-out in England will not be restricted, so that young children, who have the least accumulated lung damage and therefore most to benefit, do not lose out on the chance of benefiting from this transformational drug?

Norman Lamb: The specialised commissioning groups will receive advice at their December board meetings and are expected to finalise their advice on the clinical and cost-effectiveness of Kalydeco early in the new year. The aim is to provide consistent national advice on the use of the drug for a sub-group of patients with cystic fibrosis.

Steve Baker (Wycombe) (Con): Aylesbury constituent Mrs Evans-Woodward is a young woman who has had five heart attacks. One evening her husband drove her to Wycombe’s heart attack unit with a racing pulse, but she was turned away to the minor injuries unit, which again turned her away to the accident and emergency unit in Stoke Mandeville, before suggesting that she sit outside and call an ambulance, which she duly did—all of this with a racing pulse of 180. This is not good enough. It is an appalling prioritisation of bureaucracy over simple human care and compassion. Does it not show that the NHS needs to become much more accountable to patients?

Dr Poulter: My hon. Friend is absolutely right, and I am very sorry to hear of the case he outlined. Clearly the care that his constituent received was more than substandard. If a patient needs immediate treatment, they should always receive it. This Government are quite rightly ensuring that we embed good care in everything we do. We have beefed up the role of the Care Quality Commission to improve the inspection of care quality throughout the NHS and the care sector. We are also introducing a friends and family test to pick up on examples of bad care, so that the NHS can properly learn from them locally and so that these things do not happen.

Mr Speaker: We are extremely grateful. Extreme brevity is now required from Back and Front Benchers alike.

Andy Sawford (Corby) (Lab/Co-op): On 12 November the Secretary of State gave a categorical assurance to my constituents that there was absolutely no threat to accident and emergency and maternity services at Kettering general hospital. Does he stand by it, will he repeat it today and will he specifically confirm that obstetrics

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and major injury and trauma services in accident and emergency are no longer at risk at Kettering general hospital?

Dr Poulter: I thank the hon. Gentleman for his question, and I welcome him to the House and congratulate him on his victory in the recent Corby by-election. I think he has already admitted on the record that there was a lot of scaremongering during the by-election campaign about the NHS locally. One of the main reasons for concerns about the NHS is the indebtedness of many hospitals in the east of England region, because of the record of the previous Government, who signed many of them up to private finance initiative deals. I will restate for the record once again today that, as I understand it, A and E and maternity services at Kettering at the moment are safe, and there is no consultation directly on the table at the moment. He should make sure he gets his facts right before he raises questions in the House.

Mr Stewart Jackson (Peterborough) (Con): Last week it was a great pleasure to visit Age UK Peterborough, whose No. 1 priority is dementia care, which coincides with the NHS priorities that my right hon. Friend the Secretary of State outlined earlier this week. Will he put in place procedures to make available capital moneys for the construction of dementia care facilities locally?

Mr Jeremy Hunt: I can announce that we have already put in place such funds, because dementia is one of the biggest challenges we face across the entire health and social care system. We need more capital funds, but we also need massively to increase the shockingly low diagnosis rates. At the moment, only 42% of the 800,000 people with dementia are being diagnosed properly and therefore getting the treatment they need.

Mr Barry Sheerman (Huddersfield) (Lab/Co-op): Is the Secretary of State worried about the high level of qualified managers leaving the NHS—fleeing the NHS—to go to other places or retire early when there are few people in clinical commissioning groups with any management experience at all?

Mr Hunt: There is always a role for excellent managers in the NHS, but this Government’s priority is front-line clinicians, which is why the number of doctors has increased by 5,000 since we have been in power and why administration costs have been cut, which will save the NHS £1.5 billion every year.

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Duncan Hames (Chippenham) (LD): Valued health workers in Wiltshire will appreciate the Minister’s commitment today to national pay negotiations, but they will be frustrated that he does not have the power to force them on foundation trusts. Will he at least make a direct appeal from the Dispatch Box today to the management of those trusts in the south-west consortium to participate fully in national pay negotiations?

Dr Poulter: I thank my hon. Friend for his question. He is absolutely right. I made it clear earlier that I felt there had been some heavy handedness in the way some of those trusts had behaved—although they are quite understandably exercising freedoms that the previous Government gave them. We want national pay frameworks to remain fit for purpose, which is why we endorse the national pay negotiations that are under way. I would recommend that trusts in the south-west listen to what happens in those negotiations, so that we can ensure that national pay frameworks are fit for purpose in the south-west.

Mr Speaker: Last but not least, Meg Munn.

Meg Munn (Sheffield, Heeley) (Lab/Co-op): Is the Secretary of State disappointed by the low number of GPs who have come forward to take on accounting officer roles in clinical commissioning groups, and can he say why he thinks that is?

Mr Jeremy Hunt: I am actually very encouraged by the enthusiasm of the GPs who are running clinical commissioning groups up and down the country. They are going to transform services and, most of all, they are going to integrate services at a local level. That is something that has long been talked about but not delivered before in the NHS.

Several hon. Members rose

Mr Speaker: I am sorry to disappoint colleagues. As they know, I could happily listen all day to them asking questions and to Ministers answering them—[Interruption.] The Under-Secretary of State for Health, the hon. Member for Broxtowe (Anna Soubry) does not seem entirely convinced of the merits of my explanation, but, in any case, time is against us and we must now move on.

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Credit Card Debt Limit

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

12.34 pm

Yvonne Fovargue (Makerfield) (Lab): I beg to move,

That leave be given to bring in a Bill to require credit card companies to discharge a debt when three times the equivalent of the principal sum owed has been paid in interest; and for connected purposes.

Payday lenders have rightly been the focus of a large amount of media attention, but I would now like to focus attention on to another form of borrowing, and on to the credit card companies that cause detriment to an even larger number of people. The aim of the Bill is to limit the total amount of interest paid on credit card borrowing and so prevent debts from spiralling upwards and out of control.

Credit cards, though undeniably useful and convenient, are a major cause of agony for many of my constituents, particularly those struggling with everyday finances. Research commissioned by StepChange—the new name for the Consumer Credit Counselling Service—suggests that at least 3 million households are in financial difficulty, with a further 3 million at risk. It further suggests—I do not disagree—that credit cards play a significant part in those people’s predicament.

The number of people seeking help with credit card debt has risen sharply in the past five years. It was already high back then, but the recession has seen it rise even further. Whereas people previously used credit cards for luxury or exceptional purchases, many are now using them simply to make ends meet, as well as committing to further credit card borrowing when one card is maxed out, in order to plug the gap in their household finances. Multiple credit card debt is now a feature of life in the 21st century and it figures disproportionately in many debt problems. Using one credit card to pay off another results in a vicious cycle of increasing debt, as interest and other charges are added to the initial capital sum. This can lead to a real sense of hopelessness and despair, as the balance hardly reduces over time.

The situation has not gone completely unnoticed, however, and there has been some effort to address the issue. The Office of Fair Trading, for example, has published guidance on irresponsible lending, calling on lenders to take action when a borrower fails to make minimum repayments or when he or she is paying off credit card debt by using another credit card. The lending code that was agreed in 2010 included a commitment not to increase credit limits when there was evidence of the borrower being in financial difficulties, and a requirement to ensure that the minimum repayment included at least 1% of the balance owed. However, I recently looked at the example of a Lloyds card that had £1,000 on it. It would take 17 years and nine months to pay down that amount using minimum repayment levels. So the measures in the lending code are not enough, certainly for today’s borrowers who are already in debt and whose debts are growing. That is why I am proposing a cap on credit card debt. Such a cap could help borrowers now.

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My Bill would place the cap at three times the original sum borrowed, after which there would be no liability to pay. That would effectively limit the amount by which creditors could increase the size of a debt by the addition of interest and charges when people were struggling. This is not about letting people off lightly or allowing them to default on their debts. Credit card companies would still get their profits. It is about giving people a guarantee that their debt would be paid off at some definite future date and that it would not spiral upwards. The measure would also send a message to lenders that they had to take their responsibilities towards struggling customers more seriously.

Yes, some technical matters would need to be ironed out, and the maths is not simple—the interest rate would clearly affect the time it would take to build up three times the initial capital, for example—but it is important that something should be done to prevent people from falling into a high-cost credit trap. The distinctive feature of credit cards is that minimum monthly payments reduce the outstanding balance by only a very small amount. That is why they are such a poor way to borrow. The 1% rule encapsulated in the lending code agreement of 2010 was well meant, but it will do nothing to limit interest charges, and it could extend the loan period if the capital paid off reduced the monthly minimum payments.

The answer could ultimately lie in converting the credit card debt agreement into a fixed-term loan, in which the proportion of the payment going to reducing capital increased each month, or at least in finding a way in which the capital element of the minimum payment could be fixed in regard to the original amount borrowed. The important thing is to reduce the speed of the pay-down. We cannot have people in this debt for 20 or more years, as some of my constituents have been, and my Bill will achieve that. It might still take many years for the magic “three times” threshold to be reached, but at least borrowers will be able to see for the first time light at the end of the tunnel.

I cannot conclude my speech on the Bill without encouraging the borrowers who are having problems paying their debts—whether it be to credit card companies, payday lenders or banks—to seek help from a free agency such as a citizens advice bureau or StepChange as early as possible. That is possibly the most important way of easing the burden, but I believe that there are other measures that we could operate proactively to support borrowers in financial difficulty, which is why I have added my voice to this debate. I commend the Bill to the House.

Question put and agreed to.


That Yvonne Fovargue, Nic Dakin, Jonathan Edwards, Stephen Lloyd, Nick Smith, Heidi Alexander, Tracey Crouch and Andrew Percy present the Bill.

Yvonne Fovargue accordingly presented theBill.

Bill read the First time; to be read a Second time on Friday 25 January 2013, and to be printed (Bill 96).

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European Union (Croatian Accession and Irish Protocol) Bill

Considered in Committee

[Dawn Primarolo in the Chair]

Clause 1

Approval of Croatian Accession Treaty

12.42 pm

Mr David Nuttall (Bury North) (Con): I beg to move amendment 6, in page 1, line 7, after ‘approved’, insert

‘, except for those provisions requiring the full application by the United Kingdom in respect of the Republic of Croatia, seven years after Croatian accession, of EU law on the free movement of workers’.

On Second Reading, referring to the report of the European Scrutiny Committee on the Croatian accession procedure—“Croatia: monitoring the accession process”—the Minister said:

“We will have other opportunities during later stages of the Bill to explore the points that my hon. Friend the Member for Stone (Mr Cash) and his Committee raised”.—[Official Report, 6 November 2012; Vol. 552, c. 762.]

It appears that it is thanks only to the fairly modest, minor and small amendments tabled by my hon. Friend the Member for North East Somerset (Jacob Rees-Mogg), who is not in his place, and me that the Committee has the opportunity this afternoon to discuss anything at all at this stage of the Bill’s progress. I hope that, if for no other reason, the Minister will welcome this debate and the amendments that have been tabled.

Although the Government have made it clear that they intend to take whatever measures they can to stop an influx of Croatian workers during the seven-year transitional period, the risk of such an influx after the transitional period has elapsed nevertheless remains. The amendment would provide a solution to that problem.

Under European Union law, as soon as accession takes place, Croatian nationals will have the right to move to and live in the United Kingdom if they are self-employed, or have sickness insurance cover and “sufficient resources” for themselves and their family members

“not to become a burden on the social assistance system of the host Member State”.

12.45 pm

Angus Robertson (Moray) (SNP): I lived in central Europe for some time. When this matter was last discussed, I asked whether the Government shared my impression that the country most associated with the departure of citizens of the former Yugoslavia to work elsewhere, perhaps as Gastarbeiter, was either Germany or Austria. Given that that is also the background to Croatian accession, does the hon. Gentleman not agree that Croatian citizens wishing to live and work elsewhere in the European Union are most likely to choose the countries with which they have long-standing historical and economic ties—Germany and Austria? If so, how can he possibly believe that there is likely to be, in any circumstances, an “influx” of Croatian citizens into the United Kingdom?

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Mr Nuttall: I will deal with that point more fully later in my speech, but let me respond to it briefly now. The hon. Gentleman may be right in saying that there are other countries that are closer geographically or with which Croatians have historical links, to which they will wish to move. Nevertheless, this country’s economic position, and the fact that the most widely spoken second language of Croatians is not German but English, provides evidence that there is—I shall use the word that I used earlier—a risk that some Croatians will want to move to the United Kingdom. We do not know how many there will be, and I shall say more about that later as well.

Keith Vaz (Leicester East) (Lab): Will the hon. Gentleman give way?

Mr Nuttall: Yes, I will certainly give way to the Chairman of the Home Affairs Committee.

Keith Vaz: Under the Government’s proposals, Croatian citizens will be in exactly the same position as citizens of Romania and Bulgaria. They will be part of the transition process, and they will be able to work here only if there is a job for them to do. They will apply for registration cards, and if they are students they will be given certificates of eligibility. It will not be a case of their simply turning up and working; there are very severe restrictions, as I know from representations that I have received. In view of that, why is the hon. Gentleman fearful that a whole lot of people will suddenly arrive and start trying to work?

Mr Nuttall: Again, I will come to that point later in my speech, but, again, I will respond to it briefly. We know that following earlier accessions the number of people coming to work in this country, or to seek work, has significantly exceeded the original estimate.

As I said earlier, during the transitional arrangements EU nationals will have the right to come here if they are self-employed, or have sickness insurance cover and sufficient resources to ensure that they do not become a burden on

“the social assistance system of the host Member State”.

Certain family members—spouses, dependent children, children under 21, and dependent parents and grandparents of a Croatian meeting either of those criteria—will also have the right to live in the United Kingdom.

Martin Horwood (Cheltenham) (LD): The hon. Gentleman is talking about the risks, but of course there are opportunities as well. Is not the experience of many countries with warm Mediterranean coastlines that rather a lot of British people end up moving to them, taking advantage of the business and cultural opportunities that European Union membership brings for both countries?

Mr Nuttall: I am sure you would not wish me to be drawn off the subject of Croatia, Madam Deputy Speaker. My hon. Friend may well be right about that, although none of my constituents have expressed to me a desire to go to look for work in Croatia. They may all have a secret desire to do that, but I am not aware of a great number of my constituents seeking that opportunity at the moment.

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We know what happened when Romania and Bulgaria joined the European Union in 2007. According to the Home Office’s impact assessment, the number of national insurance numbers issued to Bulgarians and Romanians increased by 560% and 710% respectively two years after accession. We do not have the precise figures, but it is likely that a number of those will have been Romanians and Bulgarians working in the UK under the seasonal agricultural worker scheme and the sector-based scheme, which the current Government have stated will not be open to Croatians.

Moving for work is likely to be the reason why most Croatians will want to emigrate to the UK, and this amendment focuses on worker immigration. Let us be clear that after the seven-year period has elapsed the UK will have to apply full EU law on the free movement of workers. So a Croatian could move to the UK and compete with a British national for any job, and a Croatian so employed would have the right to reside in the UK. Of course, it is not purely the number of Croatians seeking work that would boost the number of people living within our shores, because the worker could bring their spouse, their children under the age of 21, together with any other dependent children, and their dependent parents and grandparents. While all those parents have the right to reside in the UK under EU law, they would all be entitled to equal treatment with British citizens, unless EU law stated otherwise. Of course that would include access to state welfare.

Jim Shannon (Strangford) (DUP): Does the hon. Gentleman agree—perhaps he does not—that Croatia has the potential to be a tourist destination similar to Spain 20 or 30 years ago? If so, there is every possibility that more people will want to go from the United Kingdom to Croatia because of job opportunities and because the countries around it have stable economies.

Mr Nuttall: The hon. Gentleman may well be right that lots of UK nationals will want to visit Croatia. All the evidence suggests that its desirability as a destination is increasing for UK holidaymakers, but that strays from my concern about the need to protect workers in this country. Once full EU law applies, a Croatian national, together with their family members, could move to and stay in the UK if they were looking for work. The Government already grant EU immigrants in the UK looking for work access to income-related jobseeker’s allowance. If a Croatian had been employed in the UK for 12 months continuously but had then lost their job, they would retain their right to reside in the UK indefinitely, provided they registered as a jobseeker. A Croatian would acquire the same right to reside if, having been in work, they then decided to take up vocational training. It would be fair to ask how many Croatians are likely to arrive on this basis. Unfortunately, even the Home Office’s impact assessment states that it has no “robust estimates” of the likely number of Croatian immigrants after accession, so no realistic estimate can be made—in other words, we simply do not know.

It has been suggested, including by the hon. Member for Moray (Angus Robertson), that the evidence points to the fact that most Croatian migrant workers will be attracted to Germany. However, as the Home Office impact assessment points out, the most widely spoken second language in Croatia is not German, but English.

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Angus Robertson: Will the hon. Gentleman concede that the most widely spoken second language among Croatians who have been prepared to move thus far and live, work and have businesses elsewhere, and who are likely to attract people from Croatia to work elsewhere, is German, and that they are in the German-speaking countries of Austria and Germany?

Mr Nuttall: I do not know whether that is true or not, because I do not know the respective numbers. Even if one assumes, for the purposes of this debate, that it is true, it does not detract from what the position may be in the future if, as is more than likely, Croatia accedes to the European Union and its nationals have a new framework within which to examine their options. They may well, for a variety of reasons, choose to come to this country. It is reasonable to assume that once the UK is forced—we have no choice in this matter at the moment—to drop the transitional arrangements, our country could become a very attractive destination for those Croatians who have gone to the trouble of learning English as their second language.

We can also make a useful comparison with what happened after Lithuania, a country with a population some 20% smaller than Croatia, joined the EU in 2004. The Home Office estimates that about 134,000 Lithuanians are now living in the UK. Of course the major factor in determining whether a significant number of Croatians decide to move to the UK is probably the state of the Croatian economy relative to our own. The EU’s own figures from EUROSTAT show that unemployment in Croatia is running at about 15%, which is almost double the UK’s level. World Bank figures show that Croatia’s gross national income per capita in 2011 was equivalent to $13,850, compared with a UK figure of $37,780.

Emma Reynolds (Wolverhampton North East) (Lab): If I understand the hon. Gentleman properly, he is talking about what will happen after the seven-year transition period, and those statistics will be tremendously inaccurate by then. It is unlikely that he will be able to produce statistics that predict the levels of unemployment in our country and Croatia seven years after accession.

1 pm

Mr Nuttall: The hon. Lady makes a valid point. The position at the end of the seven-year transitional period will indeed be relevant, although of course we can only consider the statistics we have now. There might well be—who knows—some miracle growth in the Croatian economy as a result of it joining the European Union that leads to the complete transformation of its economy. If we consider the situation with other economies in the European Union, we can see that that idea stretches the bounds of credulity a little.

Angus Robertson: The hon. Gentleman has looked at the subject very closely so I am sure he will have considered the experience of Croatia’s neighbour, which is, of course, Slovenia, a former constituent part of Yugoslavia. Does he concede that in recent years the economic upswing in Slovenia has been remarkable?

Mr Nuttall: The hon. Gentleman makes a fair point. There might be a sudden upswing in Croatia’s economy. However, rather than running the risk that there might

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not be such an upturn, the amendment would leave it open for this country to put in place a different set of criteria to ensure that the transitional arrangements could be kept in place until we were sure that the upturn had happened, rather than when we merely thought that it might happen.

Keith Vaz: I am not clear about the hon. Gentleman’s arguments. Is he suggesting a further transitional period? He is obviously not suggesting no transitional period, even though his amendment makes it clear that he wants the clause approved without the transitional arrangements. Is he arguing for a longer period?

Mr Nuttall: My view is that the Government could negotiate a different set of criteria, which might involve a longer period, if they were linked to an equalisation of the economic imbalances between respective member states. That is the key.

Wayne David (Caerphilly) (Lab): To be clear on the implications of the amendment, if it were passed, does the hon. Gentleman agree that it would put a stop to Croatia’s membership of the European Union because we would effectively have to go back and renegotiate the whole package for Croatia to enter the EU? It would effectively put an end to that membership.

Mr Nuttall: One can only surmise that that might be the case; I have no doubt that our European neighbours might be more than happy to agree to my suggestions. That prompts a question: if the Government were unable to deliver what is, in the scale of European affairs, a minor adjustment to the arrangements governing member states, how on earth would they ever be able to repatriate the powers Members on both sides of the House talk about so often? I do not want to go down that road, but I was asked the question, Madam Deputy Speaker—

Angus Robertson: Sounds like you do.

Mr Nuttall: No.

A fact that is as worrying as the difference between the comparative present wealth—I accept that I am using the current statistics—of Croatia and the UK is EUROSTAT’s prediction that the Croatian economy will contract by 1.9% this year and will not grow at all next year whereas UK growth will be just under 1% next year. All the evidence points to the fact that the UK could well prove to be an attractive destination for Croatians looking for work, for better paid work or for any job so that they have the opportunity to improve their command of the English language.

When one considers the various measures the Government have taken to control the numbers of immigrants coming to the UK from outside the EU, is it not logical that we should now start at least to question whether placing a simple arbitrary time limit on the restrictions that apply to migrant workers from accession countries to the EU is enough? Would it not make sense when there are significant imbalances between the relative economic positions of would-be new entrants and the UK for more rigorous restrictions to be applied as long as those disparities exist?

Our first duty must be to protect the interests of British workers. It does not make logical sense for the Government to argue for stricter controls on immigration on the one hand while agreeing to new EU treaties that

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will almost certainly lead to thousands and perhaps tens of thousands more workers arriving in the UK on the other.

Martin Horwood: Once again, the hon. Gentleman seems to assume that the traffic will be entirely one way and to be obsessed with the idea that Croatians would have to come to this country to learn English. He does not look like someone who goes clubbing regularly in Malaga, Ibiza or Ayia Napa—perhaps it would broaden his horizons—but all those places were probably in disadvantageous economic situations relative to the United Kingdom to start with. Accession offered an opportunity for kids to go clubbing and on holiday, for British businesses to invest, for British jobs to be created and for wealth to be created for British companies. These things can work reciprocally, and that is the opportunity that Croatia might offer to this country, too.

Mr Nuttall: My hon. Friend makes a fair point and I have no wish to do anything to prevent UK nationals from travelling to Croatia if they want to. It is for the Croatians to determine who they want to allow into their country and the conditions they want to impose on people who want to visit or remain within their borders. I am saying that I think that the vast majority of British nationals would want our Government to do exactly the same thing. Indeed, that is what the Government are doing for the rest of the world, but somehow, when it comes to the EU, an entirely different set of rules and regulations apply.

On that basis, I commend my amendment to the House.

Keith Vaz: It is a pleasure to follow the hon. Member for Bury North (Mr Nuttall). All his speeches on EU matters have reflected his close interest on this subject, and it is right that he should bring his concerns to the House before Croatia’s accession. I do not agree with what he said, but he has every right to express his views and to have the House debate their merits.

I congratulate the Minister for Europe and the Government on how they have conducted the negotiations that mean that Croatia will become the 28th member of the European Union. As a former Minister for Europe whose responsibility was the EU enlargement that brought in the first major set of accession countries since the reunification of Europe after the fall of the Berlin wall, I know how difficult these negotiations are. We had to visit quite a number of countries, and I am sure the Minister has had to do the same, but at least we are dealing now with just Croatia. It must have been a very difficult task and I congratulate him on what he has done. It is right that we should focus on the amount of money that the EU has given Croatia; I think that about €1 billion have been given in support. So Croatia is ready for accession and we look forward to welcoming it.

The amendment tabled by the hon. Member for Bury North deals with immigration, which is always a contentious subject in the House, but in recent years EU migration to the UK has also become contentious. I should place on record my belief that the arrival of eastern European migrants in this country has made Britain a better place. They have contributed enormously to our country, helped our economy, provided new skills and brought in an enviable work ethic. Not all of them, incidentally,

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have arrived in huge numbers and then decided to stay. Some, of course, have stayed; some have returned to their countries of origin.

Enormous numbers of Poles, we were told, were coming to flood our towns and cities, take our jobs, take over our pubs and take our women—or whatever the saying is when foreigners arrive in a different country. That did not happen. The myths put about by some tabloid newspapers did not materialise. In fact, those immigrants have been model citizens contributing to our country in cities such as Bristol, Leicester and London. We welcome them and we welcome what they have done.

We need to have the argument on EU migration in the context of what has happened before. If we focus almost exclusively on all the negative aspects of EU migration, we miss the real importance of enlargement and the way in which these countries have made the European Union stronger and wider, and have created more jobs in our country. I think that as a result of Croatia coming in, exports from our country to Croatia will increase, as they have done to other EU countries.

I want to examine two aspects of what the hon. Member for Bury North said. The House needs to know that his arguments were directed against the whole notion of Britain being in the European Union, rather than just against letting little Croatia in. He makes arguments much deeper than the ones about enlargement, and those are for another day. As the House knows, I favour an in/out referendum because it gives the British people the opportunity to have their say on this and other issues, so on that matter I am on the same side as the hon. Gentleman, and I supported his Bill when he put it before the House.

If we look at the immigration issue and are sensible about it, however, we will find that we are limited anyway in extending transitional arrangements beyond what has been agreed by the Government. When the Minister replies, he will be able to tell us whether we are right or wrong, but the seven-year transition is the same arrangement as we had for Romanians and Bulgarians. That has not been a huge success, if I may say so. I have had representations from the Romanian and Bulgarian ambassadors about the length of time it takes for their citizens to exercise their treaty rights in order, for example, to get their permits to work in this country—their worker registration cards.

1.15 pm

The fact is that it now takes between eight and nine months for a Romanian citizen to write to the UK Border Agency and get approval to work here. I do not believe that this helps our reputation as a country that welcomes people from the EU who want to come here and work legitimately. We are not talking about people coming to work here illegally, or about people who do not wish to comply with the law of this land. We are talking about people who want to pay their tax and national insurance, want to be part of Britain and want to comply with the law. They are having to wait up to eight months just to get their cases seen to by the UKBA.

Opening up the can of worms that is the UKBA is not the purpose of today’s proceedings, but interestingly, according to the report of the chief inspector last week,

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he discovered that at one stage last year 100,000 letters from MPs, applicants and solicitors were left unopened in Liverpool. Some of the applications from Romanian and Bulgarian citizens to come into this country may well have been among those letters, which could explain why things have taken so long, but the fact is that it takes the UKBA a very long time to process such applications.

I hope that as well as telling us whether the transition period can be extended, as the hon. Member for Bury North would like, the Minister can give us an assurance that once Croatia comes in, if its citizens wish to apply for their certificates and accession documents in order to work here, the process will be smooth and efficient

I did not quite get the point that the hon. Member for Bury North was making about English as a second language. In countries such as Romania and Bulgaria, English is a second language. The Romanian, Bulgarian and Croatian citizens whom I have met speak English beautifully. I am not saying that every single Romanian, Bulgarian and Croatian is expert at speaking English, but I did not understand the hon. Gentleman’s point. He will find that they understand and speak our language extremely well. If they want to live and work here, they make a big effort to learn English so that they can speak it well and get jobs in this country.

I would be interested to know, perhaps not today but at another time, what the hon. Gentleman meant. I find that all those who have come from eastern Europe—Poland, Hungary and others in the first wave of accession countries, right the way through to Croatia—want to be able to come here, settle in, integrate and be part of our country, in the same way as the 1 million British citizens who currently live and work in mainland Europe, if I may call it that, are able to contribute to the economies of Poland, Romania, Croatia and France. Over 1 million British citizens and their dependants live in the European Union and work there, but I do not see those countries and those Parliaments having the kind of arguments that we sometimes have here about those who come from EU countries.

Mr Russell Brown (Dumfries and Galloway) (Lab): As I have pointed out on a number of occasions, in around 2008-09 the largest group of people who entered the UK, numbering around 85,000, were UK citizens returning home when things got difficult on the European mainland.

Keith Vaz: I agree entirely.

To say that there are no skills shortages in this country in the sectors where some of those from the accession countries have come to work is completely wrong. Speeches that I have heard from the Scottish National party and its leader, for example, acknowledge a shortage of people for a number of skilled jobs. I have heard them say in their speeches that they want to encourage people to come to Scotland in order to work there. Such shortages exist in various parts of the country, where people will be most welcome to come and work in those sectors.

Jacob Rees-Mogg (North East Somerset) (Con): Does not the right hon. Gentleman agree that it is a little odd that the about-to-be Governor of the Bank of England, who is a Canadian subject of Her Majesty, will have to jump through lots of hoops in order to work here,

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whereas someone from an EU member state can simply come here as they wish? Surely my hon. Friend the Member for Bury North (Mr Nuttall) is right that we should keep more restrictions.

Keith Vaz: I am glad that the hon. Gentleman raises that point, because I understand that the new Governor of the Bank of England will apply for British citizenship, but if he has to wait as long as most people have to wait, his term will have expired before he gets it. Unfortunately, he is already married with two children and so cannot marry an EU citizen in order to get here more quickly. Otherwise, he could become an EU citizen and would not need to apply for British citizenship. Anyway, the hon. Gentleman is trying to distract me into a debate on the merits of citizenship applications, but I will not be tempted, even though I have huge respect for him and his great knowledge of the subject.

This is about exercising treaty rights. The Government have decided to have a seven-year transition period, as the previous Government did with regard to Romania and Bulgaria, uncomfortable though that was, and I think that is the right and sensible course of action. When a country joins the European Union, if it is to be the kind of European Union I want us to belong to, every country and every citizen should ultimately be treated equally. Sadly, some EU citizens are treated differently because they happen to come from certain countries, which I think is wrong.

I appreciate the sincerity, honesty and principles of the hon. Member for Bury North, who was against the treaty in the first place, but once a country signs up to a treaty and successive Governments have endorsed it—the British people have not done so since we entered the EU, which is why I favour a referendum—they sign up to all of it. That is the least the Government can do to protect the labour market, but at the end of the seven years the transitional arrangements will lapse, as they will for Romania and Bulgaria on 31 December 2013, and rightly so in my view.

The Home Secretary announced that she was looking carefully at those arrangements for Romania and Bulgaria and could extend the transition period, but I knew that of course that would never happen. Her view on this aspect of policy, which is that emergency measures could be introduced to prevent people from Greece or Italy coming here if there is a crisis in those countries, has come to nothing. She wrote to me and mentioned work going on, but not much work can be done on laws that we have signed unless we break our work on the treaties. I am absolutely certain that the Foreign Office’s view on such emergency arrangements is different from that of the Home Office because, funnily enough, I have seen no such proposals come before the House to try to stop Greek citizens, for example, coming here. That would be very difficult, if not impossible, to do. All we can do with accession countries is give them a seven-year transition.

Wayne David: I very much agree with the point my right hon. Friend is making, as he knows, but I think that we must be frank with ourselves and recognise that one of the problems in this debate is what happened in 2003, when the Home Office grossly underestimated the number of migrants who would come here from the 10 accession countries. I think that explains in part why

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many people in this House and beyond are concerned about the enlargement agenda. We must recognise that we got the figures wrong and learn the lessons from that.

Keith Vaz: My hon. Friend, who had a distinguished career as a Member of the European Parliament, is absolutely right. We must have that debate. The Home Office got it wrong on that occasion, but I do not think that any of us clever people sitting in the House of Commons got it right either. Nobody predicted that there would be a flood of people, to use the tabloid expression, rushing into this country. They were boom times, when people were willing to open the United Kingdom’s doors and allow people into the country.

Immigration will always be an emotive and difficult subject. As we speak, the Mayor of London is in Mumbai telling the Government that all their facts and figures on student immigration are wrong. However, we have limited control over EU migration, which is why it has been raised today. The only possible control that the Government could introduce was the seven-year transition, and they are right to introduce it.

Ultimately, however, we have to be fair to EU colleagues and say that if their citizens wish to come here to work, we will process their applications for work permits and accession documents quickly. That is the deal that ought to be done by a nation that, as the Prime Minister said yesterday, is the beneficiary of what my hon. Friend the Member for Caerphilly (Wayne David) did when he was an MEP, what shadow Ministers did when they were on the Government Front Bench and what others did in the 13 years of the Labour Government: they built up alliances with countries such as Poland, Hungary and the other accession countries. They will not forget the stand taken by our country in allowing their citizens to come here to work.

I think that it is absolutely right that we have these transitional arrangements, but let us also understand the fundamental principle: if we sign up to a treaty, we have to abide by its words and ensure that, in doing so, we are fair to the other citizens of Europe and treat them as equally as possible.

Emma Reynolds: It is a great pleasure to follow my right hon. Friend the Member for Leicester East (Keith Vaz). He is right to point out that the issue of economic migrants coming here from other European Union countries is a sensitive one. It is something that always comes up in the context of new accessions, and in the case of Croatia, as we have seen with the amendment, it has come up again.

The Opposition are in favour of applying a maximum transition period of seven years to the free movement of people coming from Croatia, which is what we applied, when in government, in the case of Romania and Bulgaria. However, the amendment refers to the period beyond the seven-year transition, and I think that we need to bear in mind the context. As the hon. Member for Moray (Angus Robertson) has already pointed out, the Croatian people have strong links with Germany and Austria and it is not yet clear whether the Governments of those two countries will impose transitional periods—it is open to them not to. Given that Germany’s economy is doing incredibly well, especially compared with our own, and given that unemployment there is very low indeed, it might decide not to impose a transition period or to impose a period shorter than the full seven years.

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It is also worth bearing it in mind that there are 4.4 million people in Croatia, so it will not be a large member state. I ask the hon. Member for Bury North (Mr Nuttall) not to underestimate the Croatian people or be complacent about our own economic growth. He talked about the relative difference between our unemployment and theirs. Our unemployment, to my mind, is still too high, and their unemployment rate is currently higher than ours. However, if we consider previous accession countries, such as Poland, which has avoided recession, let alone a double-dip recession, or Slovenia, whose economy has been transformed and whose prosperity is to be admired, as the hon. Member for Moray pointed out, we see that it is somewhat complacent and perhaps misleading to suggest that after the seven-year period the Croatian economy will not have improved and that the unemployment rate will not have fallen. I think that we should view the matter in that context.

My right hon. Friend the Member for Leicester East pointed out that as a member of the European Union and a signatory to the European treaties, the UK has rights and responsibilities, and one of the responsibilities is to abide by the rules of those treaties. One of the principles of the founding treaties is the so-called four freedoms—the free movement of people, capital, goods and services. The accession treaty before us is a negotiation among all the member states of the European Union and the new member state of Croatia, and the seven-year transition period that is negotiated within that framework is a derogation from the principles in the European treaties. If the amendment tabled by the hon. Member for Bury North were to be passed—which is highly unlikely, but let us say it is for the sake of argument—then it would either scupper the accession treaty altogether or put us in a situation in which our Government could be taken to court by the European Commission or another member state.

1.30 pm

Angus Robertson: Does the hon. Lady agree that it would be helpful if the Minister clarified, perhaps on the basis of legal advice, that that would indeed be the consequence of the amendment? This is not just a debating point about something that we think is a good idea or that we disagree with; it could have a fundamental impact on Croatia’s potential accession to the European Union, which would be very serious.

Emma Reynolds: I could not agree more. It would be useful if the Minister gave us the exact legal advice on the implications of the amendment and whether it would indeed scupper Croatia’s accession, which would be regrettable.

Jacob Rees-Mogg: I am sorry to disagree with the hon. Lady, but I remind her that the Bill includes the protocol for Ireland, which was to allow the Irish not to ratify the Lisbon treaty and then to do so at a later date with certain guarantees. As it is possible to do that for Ireland, a protocol to a future treaty could allow amendments passed by this House to be incorporated, allowing Croatia to accede in the normal manner.

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Emma Reynolds: I respectfully disagree with the hon. Gentleman. The accession treaty with Croatia has been negotiated in good faith, and its conditions and provisions state that an existing member state has the option to put in place a transition period of up to seven years. Labour Members are in favour of the treaty; indeed, there is cross-party support for the accession of Croatia. If we were to pass the amendment—again, that is highly unlikely since I do not see a great mass of supporters on the Government Benches—I believe, although I would welcome clarification, that that would derail the accession process because we are considering an accession treaty with a temporary derogation with regard to the free movement of people.

Jacob Rees-Mogg: I am grateful to the hon. Lady for giving way again, because this is an important point that is worth following through. The treaties are not treaties until they have been ratified by the normal constitutional process of all the member states. If, in the normal constitutional process, a reservation with the treaty is found, that can lead to amendments being brought forward later, as with Ireland. There is clear precedent for that within the European Union.

Emma Reynolds: There is no clear precedent with regard to the accession of new member states. I believe that such a provision goes against the accession treaty with Croatia that has been negotiated with the 26 other member states and our Government. An amendment of this kind would send us back to the start of negotiations. All 16 member states that have already approved the treaty, and we and the remaining member states, would have to go back to the drawing board, along with Croatia, yet again to reopen what has been a very long and arduous process—a thorough process, and rightly so—for Croatia in its negotiations to join the European Union. This is not like the Irish protocol. It is not a post-factual situation—it has to apply from now on—and it is part of the accession treaty that we are discussing. We cannot just alter it and expect something to happen in future that would help us. I totally disagree with the hon. Gentleman.

I would welcome clarification of this matter, given that Opposition Front Benchers do not have a whole army of Foreign Office civil servants to help us—

Ian Lucas (Wrexham) (Lab): You’ve got me.

Emma Reynolds: I have my hon. Friends, obviously, whose help and advice are always most welcome.

I look forward to the Minister’s response, but I am pretty confident that my interpretation is correct, and we therefore do not support the amendment.

The Minister for Europe (Mr David Lidington): I thank my hon. Friend the Member for Bury North (Mr Nuttall) for tabling the amendment. He was prompted to so by the seriousness of these issues, and the right hon. Member for Leicester East (Keith Vaz) rightly complimented him on that.

The issues that my hon. Friend spoke about are very important, and I can give him one immediate reassurance. He feared that this might be the last time that Parliament could discuss potential migration from Croatia and, indeed, other aspects of Croatia’s accession process,

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but there will be at least two further opportunities. First, next year, probably in the spring, the Home Office will bring forward the statutory instrument to provide the detail on and to implement the transitional arrangements on migration. That legislative instrument will have to be dealt with by the affirmative procedure, so I would expect a debate in a statutory instrument Committee, attendance at which is open to any Member of the House, and subsequent approval to be given by the House as a whole in the normal way, as for any other statutory instrument.

Secondly, next March we are expecting the European Commission to publish its third and final interim report on monitoring how Croatia has made progress with the various accession chapters of the negotiating process. That report will be subject to the normal parliamentary scrutiny process. It will go to the European Scrutiny Committee, and it will be open to the Committee, if it so chooses, to refer it for debate on the Floor of the House or in a European Committee.

Graham Stringer (Blackley and Broughton) (Lab): Is that not the real issue? The reports from the European Commission that we have before us are full of hope, but they say, in effect, that Croatia is not compliant and that in some areas it is going backwards. The big issue on immigration is not what the hon. Member for Bury North (Mr Nuttall) talked about; it is that the new EU boundary with Bosnia is insecure. Beyond the Report stage, this House will not have a full chance to debate the Commission’s third report.

Mr Lidington: It will be for the European Scrutiny Committee to choose whether to refer the Commission’s third report for debate in the House. As I said on Second Reading, the Croatian Government have made enormous progress towards implementing their integrated border management plan and establishing on the EU external border a system of fully operational border control posts, which are part of its accession process. The key outstanding issue is the Neum corridor, where a small part of Bosnia and Herzegovina divides two pieces of Croatian territory. However, matters are now well under way to put the border control posts in place and to make available the relevant technology and trained staff. It is not just the Commission’s view, but that of the British Government, too, that Croatia is fully on course to meet the obligations into which she has entered.

Graham Stringer: Could the right hon. Gentleman clear up a matter of fact? The House of Commons research paper states:

“A further issue is weaknesses in border management: Croatia’s border with Bosnia and Herzegovina will be one of the longest in Europe, posing challenges to EU security, and Croatia has so far made only moderate progression.”

Footnote 42 notes that that information came from the European Commission on 10 October 2012, which was not long ago. The Commission is clearly saying that progress is not being made, which is in direct conflict with what the right hon. Gentleman is saying.

Mr Lidington: We debated this at some length on Second Reading, but I will take advice and might give a detailed answer later in today’s proceedings.

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In response to the point raised by the right hon. Member for Leicester East, we acknowledge that there have been unacceptable delays to the processing of applications from Romanian and Bulgarian citizens. The UK Border Agency has taken action to provide additional staff resources to deal with that and is confident that the Government’s published target standards for turning around such applications will be met by the new year.

Bob Stewart (Beckenham) (Con): I hope the Committee will forgive me if this has been covered in earlier debates when I was not present, but is it true that if Croatia acceded to the European Union, it would be easier for the International Criminal Court to serve an indictment on an alleged war criminal who happened to be Croatian than is currently the case because Croatia is not a member of the European Union?

Mr Lidington: I am not certain about the position of the International Criminal Court, but I will either respond to that question later in the debate or write to my hon. Friend. What I will say is that, in the context of this amendment, which relates to migration, once Croatia has become a full member of the European Union, the normal EU arrangements to combat illegal migration and to secure the return of illegal migrants, overstayers and others will become fully operational. As I hope to say if I reach the later stages of my planned remarks, there is already evidence that Croatia has been very energetic in preparing for those new duties and in implementing a system for dealing with illegal third-country migrants, and that will be to the benefit of every European Union member state.

Angus Robertson: Perhaps it would be helpful if I followed up on the intervention by the hon. Member for Beckenham (Bob Stewart) on the potential arrest of a European Union citizen. That, of course, would be subject to the existing procedures for a European arrest warrant, which, indeed, would be beneficial in trying to deal with serious crime, including international war crimes. Would that not underline the total folly of a member of the European Union walking away from a commitment to use European arrest warrants, which the current Tory Government are considering doing?

Mr Lidington: I am not going to get drawn into a further debate about the 2014 opt-in, opt-out decision on justice and home affairs. As the Government have pledged, there will be ample opportunities to debate that at length in the House.

I think that everybody in the House shares the concerns of my hon. Friend the Member for Bury North about the need to ensure the appropriate management of potential labour market risks, particularly at a time when there are serious tensions in the UK labour market. At the same time, we have to acknowledge that the principle of freedom of movement has given enormous opportunities to British citizens. Roughly 1 million British people live and/or work in other member states of the European Union at present.

1.45 pm

The Government have been clear from the start that we intend, as a matter of course, to impose transitional controls on workers from any new member state. In the

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case of Croatia, we have concluded that these restrictions should be as rigorous as the terms of the accession treaty allow and should provide no greater level of access than that already enjoyed by Croatian workers prior to their joining the European Union. That would put Croatian citizens on a par with workers from Romania and Bulgaria, who are subject to such vigorous control already.

Let me be clear about what the existing provisions make possible. The powers in the treaty provide for member states to apply transitional control to workers for at least five years, with a review after the first two years, at which time member states are required to notify the Commission whether they intend to maintain transitional restrictions beyond the first two-year period. After five years, those controls may be extended by a further two years in the event of serious labour market disturbance or threat thereof, bringing the total to seven years. The powers in the treaty provide controls that can be imposed robustly and meet the UK’s stated commitment to impose transitional controls for an appropriate period without undermining our long-standing and principled support for EU enlargement. These controls cannot be extended beyond the seven-year period.

I am afraid that it will disappoint my hon. Friend that the provisions for transitional restrictions on migration from Croatia in annexe V(2) of Croatia’s accession treaty make it very clear that the controls are derogations from the articles in the treaty on the functioning of the European Union, which provide for the free movement of people between different member states in order to exercise treaty rights under European law.

My hon. Friend the Member for North East Somerset (Jacob Rees-Mogg) asks what could happen if the Committee agrees the amendment. The United Kingdom could be in breach of the free movement principles in the EU treaties, which could lead to the UK being infracted by the European Commission. The accession treaty would stand, provided that we and other member states went on to ratify it, but the UK would be in breach of it.

The Irish protocol, to which my hon. Friend alluded, was a different beast. It is important to recall that Ireland’s ratification of the Lisbon treaty awaited the outcome of their second referendum, which in turn followed the negotiation of the Irish protocol by EU Heads of State and Government, but the text of the treaty did not change by one word between the first and second Irish referendum. Ireland went on to ratify the Lisbon treaty as it had originally been agreed before the Irish protocol was finalised and had been through the Brussels process, and, as is happening here and elsewhere in Europe, before its ratification by the 27 member states according to their respective national procedures. The Irish protocol is a very different question.

Jacob Rees-Mogg: Applying the amendment to line 7 on page 1 of the Bill would make it say that the accession treaty would be approved,

“except for those provisions requiring the full application”.

It would, therefore, be a conditional approval of the treaty and I do not believe that the European Court of Justice could rule us in breach of treaty obligations, because Croatia would not have them until the treaty was ratified under our normal constitutional procedures,

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which, thanks to the European Act 2011—which the Minister presided over—require an Act of Parliament that is unqualified.

Mr Lidington: I simply do not think that we can have 27 countries agreeing unanimously on a treaty text and committing themselves to ratifying it, only for 26 countries to ratify it while one country chooses to do so up to a point and not ratify one particular element. My hon. Friend was right in his earlier intervention that it is legally and constitutionally possible for a separate protocol or derogation to be negotiated at the time of an accession treaty to exempt one or more member states from particular obligations. However, that has not happened with any other accession treaty hitherto.

The United Kingdom, under successive Governments, has been committed to the enlargement of the European Union since Margaret Thatcher championed the idea when the iron curtain began to crumble. I remain, in that respect, an enthusiastic Thatcherite. The entrenchment of not just free and open markets, but, even more importantly, the rule of law and democratic institutions in eastern and central Europe that has been brought by enlargement has been of benefit to the long-term strategic interests of the UK, as well as being in the interests of Europe as a whole.

Wayne David: The Minister has made an important point. He should not hide his light under a bushel. I urge him to make that point more forcefully and regularly to his Back Benchers.

Mr Lidington: My hon. Friends know where I stand on these issues. We always have a good-tempered but serious debate. The points that my hon. Friends have raised this afternoon reflect concerns that are expressed by many thousands of people—

Mr Nuttall: Millions.

Mr Lidington: Possibly by millions of people, in every constituency in this country. It is right that Parliament should be seen to be paying close attention to those concerns, which are being ably expressed by my hon. Friend the Member for Bury North in supporting the amendment.

Croatia has a small population of only 4.5 million people. The levels of emigration from Croatia to EU member states are currently very low. The official Croatian statistics suggest that in 2011, about 2,000 Croatians migrated to EU member states. The hon. Member for Moray (Angus Robertson) is right that half those people went to Germany and that a fair number of the others went to Austria.

The UK Border Agency’s statistics state that in 2011, 115 Croatian nationals were admitted to the UK for the purposes of employment. Of course, those 115 people will have had to meet the same tests as anybody else who comes here from a third country anywhere else in the world. They will have had to apply successfully under the points system or perhaps as a person of independent means. If we look at the patterns of migration from Croatia and the history of Croatian migration to this country, and set that in the context of a small country with a small population, the Government judge

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that there is little risk of a mass migration of Croatian nationals to these shores when the seven-year transitional period is up.

I do not think that the travel is likely to be one-way. For example, several thousand British people are now resident in Bulgaria, largely because the Black sea coast is an attractive place in which to settle and is less expensive than the parts of Spain and the western Mediterranean that had previously been fashionable. I can envisage the Adriatic coastline of Croatia becoming a magnet for people from elsewhere in Europe who are seeking a warmer climate in which to settle. I therefore do not think that freedom of movement will be exercised in one direction only.

In conclusion, the accession treaty, which has been signed by all member states already, provides for only a temporary imposition of transitional controls up to a maximum of seven years. It is not possible to extend transitional controls on Croatian nationals beyond the seven-year period. The Government’s careful judgment is that the existing flexibility provided by the accession treaty will protect the stability of the United Kingdom labour market as we would wish. I hope that, having heard the assurances that I have given, my hon. Friend the Member for Bury North will choose not to press his amendment.

Mr Nuttall: We have had a useful and interesting debate on the amendment. I thank the right hon. Member for Leicester East (Keith Vaz), who is not in his place, the hon. Member for Wolverhampton North East (Emma Reynolds), the Minister and all the Members who have intervened.

I suspect that the Government’s view on this matter and the stance that is widely taken by Members will only add to the concerns of many of my constituents and, as the Minister has said, of people across the United Kingdom.

Emma Reynolds: Will the hon. Gentleman confirm whether any of his constituents have written or spoken to him to raise specific fears about Croatian nationals coming here to work after the maximum seven-year transitional period?

Mr Nuttall: No, they have not. However, I often receive representations about immigration in general and difficulties with finding work. I will be honest and say that nobody has said that they are worried about Croatia specifically, but people have said that they are concerned about what will happen if large numbers of people from other countries come to this country and about how that will affect them. That particularly affects people who feel that they are competing for jobs with people who have come to this country from abroad.