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Clauses 1 to 3 ordered to stand part of the Bill.

Schedule agreed to.

The Deputy Speaker resumed the Chair.

Caroline Lucas: On a point of order, Mr Deputy Speaker. I wonder whether consideration could be given to how our business could be organised better, so that legitimate amendments could be put to a vote rather than being talked out. My amendment was supported by at least four parties, and the amendment of the hon. Member for St Ives (Andrew George) would no doubt have received significant support as well, but there was no time for that happen. I think that it would be a worrying precedent if the only amendments put to a vote were those tabled by members of the official Opposition.

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Mr Deputy Speaker (Mr Lindsay Hoyle): I understand the hon. Lady’s frustration, but the amount of time given was agreed by the House on 8 January, and unfortunately the time allowed today has been squeezed on that basis. We are now eating into Third Reading time, which we would have lost completely had more Divisions been allowed.

Andrew George: Further to the point of order, Mr Deputy Speaker. As the hon. Member for Brighton, Pavilion (Caroline Lucas) has pointed out, there is some disappointment among those who wished to test the temperature of the Committee. We were readily allowed to engage in the two-dimensional tribalism represented by previous Divisions, but we had no opportunity to ensure that the more nuanced and considered debate on other issues was brought to a proper conclusion, because those who wished to express a view had no opportunity to do so in the Lobbies.

Mr Deputy Speaker: That was, in fact, the same point of order. Again, I understand the frustration that is felt, but—quite rightly—it is not for the Chair to decide the amount of time that is allocated for a debate. It is for the House to make that decision, and it did so on 8 January. No doubt the hon. Gentleman will wish to take the matter up with the Whips in future.

Bill reported.

Third Reading

9.33 pm

Mr Duncan Smith: I beg to move, That the Bill be now read the Third time.

The Bill moves into its Third Reading with—I believe—its fundamental principles intact. I thought that my hon. Friend the Minister of State’s closing speech before the votes answered, in detail, many of the questions that remained after the debate on the amendments, but now, on Third Reading, I think it important to make further progress.

The arguments that we advanced when we presented the Bill were first and foremost about affordability. Our main argument concerned the need to reduce the historic deficit left by Labour. As I have said to my colleagues throughout the coalition, at no stage have we made our decisions lightly. This is not something that, at the start, we would have wanted to do, and I want to come back to that point in a moment. We were left a legacy of disaster and spending that was out of control, and our priority must be to get that back under control. If we do not do that, the poorest in society will fare the worst—that is the main point to make.

Let me give an illustration of the point I was making. Under the previous Government public spending ran to excess, while the cost of working age welfare increased by some 60% in real terms, as has been said on a number of occasions. Money was poured into what became an over-inflated system; as my hon. Friend the Minister of State, has said, for every £3 taken in tax £4 was actually borrowed, with the result that we had a growing deficit. It was one of the worst deficits in Europe, if not the worst in the western world. We spent £170 billion on tax credits alone between 2003 and 2010. For all the talk about this being absolutely about people in work, 70% of that money went on child tax

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credits, chasing a target that Labour never hit, and that was payable regardless of whether parents were in work or not.

Mrs Anne Main (St Albans) (Con): Will my right hon. Friend give way?

Mr Duncan Smith: No, I am going to make a little progress now, although I will give way later. I recognise that some who did not get a chance to speak earlier may wish to say a few words, and I want to give them a little time to do so.

The previous Government appeared to have no care or concern for the fact that more than £10 billion was wasted and lost eventually through fraud, error and overpayments, nor that the rest of the money altogether failed to meet its aim. There was already a problem with fraud and error on tax credits, but, worse still, the previous Government did not even record overpayments, so we have no idea to what degree that system was damaged. However, we do know—

Mr Byrne rose

Mr Duncan Smith: I said that I would make a little progress and then give way. I wish to make one point, which is that £4 billion has had to be written off as a direct result of this inability to get the money back, with a further £4 billion likely to be written off directly as a result of Labour’s massive failure to control that budget.

The second part of our approach is important and it relates to the issue of fairness, which my hon. Friend the Minister of State addressed. We do not do these things lightly, but we do want to make sure that those paying the tax bill for those receiving it in welfare recognise that their taxes are well spent; we want to ensure that those in work paying their taxes do not see the rises for those on welfare outstripping their own. We have already discussed the increases, so this is fundamentally an issue of fairness.

Debbie Abrahams (Oldham East and Saddleworth) (Lab) rose

Mr Byrne rose—

Mr Duncan Smith: I said I would give way, so I will give way to the right hon. Member for Birmingham, Hodge Hill (Mr Byrne) now.

Mr Byrne: Over the past month or two, as the Secretary of State has warmed up the debate for tonight’s Bill, he has launched attack after attack on tax credits. Will he just accept the principle that tax credits are important in helping to make sure that people are better off in work and, indeed, that that is why he is not abolishing tax credits but incorporating them into the new system of universal credit? Will he just set that point straight for the House?

Mr Duncan Smith: I have said all along that I do not doubt that at the beginning the intention was to try to improve the lot of those working on low incomes; I have never attacked that as a principle. The point I am making tonight is that there seemed to be a loss of control. In 2005, the then Government stuck a 58% increase into tax credits just before an election—almost 70% of

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all the money in tax credits goes on child tax credits—and they were, in a way, bribing an electorate in the hope that these people would vote for them because they felt that there would be some reason why they would not get the money afterwards.

I wish to make one important point to the right hon. Gentleman on tax credits, because he has asked me about them. The reality was that the previous Government ended up, through tax credits and child tax credits, attempting to chase a target that, as the economy improved, ran away from them. This became spending for an arbitrary target, and the taxpayer was chasing a target that the previous Government never achieved.

Mr Byrne rose—

Mr Duncan Smith: I will not give way. Progress on tackling child poverty stalled, and the previous Government missed their 2010 target by some 600,000 children.

Debbie Abrahams rose—

Mr Duncan Smith: No, I will not give way yet. From 2004 until the last election the previous Government spent £171 billion trying to hit their target, and that was where the problem came from. They wrecked what might have been a good process because they turned it into a target-chasing process, which never succeeded finally.

Debbie Abrahams: Some 200,000 children will be pushed into poverty as a result of this uprating measure, according to the assessments, so how can the Government claim to have any commitment to reducing child poverty?

Mr Duncan Smith: Let me put the figures in the round within the period of spending review. My hon. Friend the Minister of State made a very good point, with which I agree and which I have made in the past—we do not trumpet our progress because we think the process of setting a target around 60% of the median income line was a recipe for nightmare problems and excess spending. We do not claim that that is the right way to measure the problem. The hon. Lady will have noticed that in answer to a parliamentary question last week, we said that we will go into full public consultation about a better way to measure real child poverty that the coalition Government will set and measure ourselves against—[Interruption.] Income will be part of it, but not the dominant part that her Government made it. If she and her party were honest—when I made this point on Second Reading, I noticed one of her Front Benchers nodding his head—they would admit that when they worked out the arbitrary target in 1997-98, they thought that they would not be in power that long and that they could achieve the targets along the way. What they ended up in doing was create a nightmare for themselves.

Some £170 billion were spent on tax credits but targets to halve child poverty by 2010 were missed by 600,000. Easier successes were found and then later the rate fell from 26% to 23%. It dropped further between 2002 and 2005 but that coincided with a 75% increase in spending on tax credits from £13.2 billion to £22.9 billion. Throughout that period, the amount of severe child poverty was absolutely static.

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Simon Hughes (Bermondsey and Old Southwark) (LD): The Secretary of State knows that the Liberal Democrats are not comfortable about this sort of Bill, but my hon. Friend the Minister of State argued that, in difficult circumstances, we must take difficult measures. Will the Secretary of State reaffirm the Government’s commitment to taking children out of poverty, to the basic principles of the welfare state and to go on seeking to ensure that all those who cannot work through no fault of their own—carers, unemployed people and pensioners—will continue to be supported? Will he reaffirm that we intend there to be a fairer society at the end of this Government than there was at the beginning?

Mr Duncan Smith: That is my genuine intention. My right hon. Friend will know that his hon. Friend the Minister of State and I have worked to ensure that what we do to get the deficit down through universal credit and the other reforms—even those for pensions—will improve the lot of the poorest in society. If we take the figures on that relative income point across the period covered by the spending review, we can see that some 350,000 children net will be lifted out of poverty, even if we take into account the effect of this Bill. I can tell my right hon. Friend that that is absolutely our purpose and one that I believe we can stand by.

Alun Cairns (Vale of Glamorgan) (Con): Will my right hon. Friend give way?

Mr Duncan Smith: I want to make a little progress before I give way again.

We need to remind ourselves that although the Opposition spent the debate in Committee going on and on at my hon. Friends about taxes on the wealthy coming down, we are raising more in tax from the wealthiest than they ever planned to throughout the whole of their spending programme. Hon. Members should remember that Labour was the party that said early on that it was

“intensely relaxed about people getting filthy rich”.

We will take no lessons from the party that did not raise the upper rate to 50% until the last month or two before it lost the election.

Hugh Bayley (York Central) (Lab): Will the Secretary of State give way?

Mr Duncan Smith: I shall give way in a second, but I want to make a little more progress.

Let me deal with the point about deficit reduction, which is really important. The Opposition did not answer a key question during our debates in Committee. They have voted against every single measure to reform and reduce the overall spending on welfare so that we can get the deficit under control. Let me quote somebody whom they might remember. The quote is this:

“from 2005 onwards Labour was insufficiently vigorous in limiting or eliminating the potential structural deficit.”

That was their former Prime Minister, Tony Blair. I agree with him. In 2005 the previous Government raised spending dramatically as a device for electoral success, as we said earlier. Time and again Labour has voted against our reforms.

Mr Byrne rose

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Mr Duncan Smith: Before I give way, let me give some examples. The Opposition opposed the Welfare Reform Bill, and that would have cost £2.1 billion in extra spending. They rejected the benefit cap—a further £500,000. Reversing tax credit savings would cost £5.5 billion. Reversing the child benefit savings would cost £1.7 billion. Voting against this Bill would cost another £1.9 billion. That money would need to come from somewhere.

If I give way to the right hon. Gentleman now, I would like to hear him tell us how exactly he would reduce the overall spending. Please, nothing on the bankers bonus tax, which has been spent at least 10 times already. If he tells us that he would get long-term unemployed people back to work, he should remember that under his Government the long-term unemployed figures doubled.

Mr Byrne: I am grateful to the Secretary of State for giving way. We have said that contributory employment and support allowance should be limited to two years. We have said that there should be an independent gateway for disability living allowance. We have said that we should switch the way we uprate benefits from RPI to CPI. We have said that there should be a benefit cap which, yes, is different in London from the rest of the country, but a benefit cap none the less. We have said that disregards in tax credits should be reduced. Crucially, we have said that there should be a two-year limit on jobseeker’s allowance. That is a far bigger list than the current Chancellor of the Exchequer ever set out when he was in opposition. We think welfare spending should come down. We think getting people back into work is the way to do it. That is why we think the Secretary of State should have brought forward plans to sort out the Work programme, which is failing, and to fix universal credit, which is in disarray.

Mr Duncan Smith: I wonder why I bothered to give way to the right hon. Gentleman. Every one of those statements was a spending commitment. They were not reductions. Every one of them would still leave a Labour Government with a vast bill to pay. I remind the Opposition that what they have opposed remains the reality. They are stacking up spending commitments without one single observation about how they would make the savings necessary to cut the deficit that they left us—one of the worst deficits, as I said before. Their proposed raid on pensions, which they wanted to talk about, would not cover it. They have already spent several times over all their little gimmicks. Voting against the Bill is another spending commitment.

Hugh Bayley rose—

Mr Duncan Smith: I will give way to the hon. Gentleman, but first I want to deal with some of the claims that the right hon. Member for Birmingham, Hodge Hill made in the course of the debates on the Bill. The first claim that he made was that spending on out-of-work benefits was falling before 2010. That is not true. The figures published show that between 1997-98 and 2010-11 spending on out-of-work benefits rose by £2.6 billion. There we have it. Even the Opposition’s attempt to whitewash what was a very small idea is not true. Overall benefits and tax credit spending increased by £75 billion, from £122 billion to £197 billion, which is 60% in real terms.

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The Opposition’s decision to vote against the Bill has financial implications equivalent to 48,000 nurses’ salaries or more than 500,000 primary school places. That is the kind of mess that they have got themselves into because they have taken the easy course in opposition, which is to oppose everything and to come up with no serious proposals.

Hugh Bayley: In York there is a particularly large gap between private sector rents and the levels of housing benefit because the broad rental market area for York includes a number of towns 20 miles away, such as Malton, Norton and Easingwold, where rents are about 40% lower. A new clause was tabled that suggested that the Department should analyse those gaps on an annual basis, but there was not time to discuss it. How would the Secretary of State respond to that proposal? Would he support such a proposal if it were made in another place?

Mr Duncan Smith: We are always analysing what we are doing with local housing allowance and housing benefit generally, so that is an ongoing process for us. We are also testing our proposals for universal credit when it comes to housing.

I know that I need to conclude, but I want to say something, as the hon. Gentleman touches on the subject. When we brought in the housing benefit changes, we heard all sorts of threats that those would lead to total disaster. One of the myths propagated by the Opposition was that 82,000 people across London would lose their homes. The reality is, so far, that the figure is up by just under 600. The myth was that 134,000 people would have to move or become homeless. The reality is that across the country, the numbers of those in temporary accommodation is up by only about 900.

In conclusion, the changes that we are putting forward are down to the first point that I made, the second point being that we need to carry them out in the fairest possible way. As my hon. Friend the Minister said earlier, we do not take this course of action lightly, but we know that if we were to go on borrowing at the rate that the last Government would have, we would punish the poorest.

I say to the Opposition that it is not good enough simply to take the easy course. When in government, they left us with the worst deficit and high borrowing that would have completely devastated those who pay their mortgages. They need to come to the Dispatch Box and tell us now how they would be fair to those who have to pay the highest tax bills.

9.50 pm

Mr Byrne: I rise to oppose Third Reading. I have not been in the House for as long as the Secretary of State, but never in my years here have I seen so much taken from so many so fast. It is a disgrace that the Government should have rammed the Bill through the House in just two weeks. I hope that the other place will have listened hard to our debates today and seen how little time has been granted to us in the Commons to debate measures that will hurt thousands and thousands of our constituents.

In the fortnight since the Bill was introduced, claim after claim made by the Government has simply fallen apart. Originally, we were told that the Bill would not hurt working people, that the Government would protect

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disabled people, and that they cared about “family-raisers”, to use the Prime Minister’s term, yet in vote after vote tonight the Government have refused to stand by their word. They have refused to protect working people or to offer safeguards for disabled people, and we have heard nothing remotely credible from them about how child poverty will be tackled. After tonight’s debate, no one will believe that there is such a thing as compassionate conservatism. To be frank, it was always a wild claim and, lo and behold, so it has turned out.

When the Bill was first presented to us, we were invited to believe that it was squarely aimed at those of our neighbours who were “sleeping off a life on benefits”, in supposed contrast with a Budget that allegedly helped working people and gave effect to the Prime Minister’s determination, expressed to the party faithful—their number is dwindling—at his party’s conference. He said:

“They call us the party of the better-off”.

That is true; we do. He continued:

“no: we are the party of the want to be better-off, those who strive to make a better life for themselves and their families.”

How does the Bill help those who are striving to be better off? The Institute for Fiscal Studies could not have been blunter: 7 million working people will be hurt by the Bill. The impact of changes announced in the autumn statement will be, between now and April 2015, to reduce the real income of the one-earner working family by £534 on average, net of any increase in the personal allowance. That is why this is a strivers’ tax, pure and simple, which we will oppose.

Andy Sawford (Corby) (Lab/Co-op): Does my right hon. Friend agree that it makes much more sense to uprate by inflation in this Parliament and then take stock, with a proper zero-based budgeting look at this in the next Parliament?

Mr Byrne: My hon. Friend is absolutely right that it would make sense to uprate in line with inflation for the rest of this Parliament, but frankly we do not know what kind of mess will be inherited in the next Parliament, which is why my right hon. Friend the shadow Chancellor is right to say that a zero-based review will be needed.

In the seven minutes that remain, I want to make two more points. One is about disabled people, who the Chancellor and Secretary of State said would be protected under the Bill. The Chancellor said that he would “support the vulnerable” and that disability benefits would be

“increased in line with inflation”—[Official Report, 5 December 2012; Vol. 554, c. 879.]

Then we learned the truth: 3.4 million disabled households will be hit by the Bill, admitted the Pensions Minister in a written answer. On average, they will be £156 a year worse off. Hundreds of thousands of people on employment and support allowance—people who the Department says have a disability—will be £87.50 a year worse off.

Alun Cairns: Will the right hon. Gentleman give way?

Mr Byrne: No. Given the hon. Gentleman’s support for a programme motion that has given me six minutes to respond to a Bill that takes hundreds of pounds off thousands of his constituents, he will forgive me for carrying on.

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Some 206,000 disabled people will be £62 a year worse off as a result of this Bill. The Government have been caught red-handed trying to keep the truth from this House.

I am glad that today we have had an extensive debate on child poverty, because we were told nothing about how many children and how many working parents would be hurt by this Bill. Only in the past couple of weeks has the truth finally emerged. I want to put on record Labour Members’ gratitude to the Child Poverty Action Group for ruthlessly exposing the impact of the Bill and the cumulative impact of other measures.

The Secretary of State spent some time casting doubt on the strategy for tackling child poverty, which I seem to remember he voted for when he supported the Child Poverty Act 2010. On 24 November 2004, the Prime Minister said:

“I believe that poverty is an economic waste and a moral disgrace. In the past, we used to think of poverty only in absolute terms… That’s not enough. We need to think of poverty in relative terms.”

The Chancellor was even blunter when he said to the News of the World: “We’re all in this together. I’m not going to balance the Budget on the backs of the poor.” That encouraged the Secretary of State to wade in on “Sky News” in June 2010, when he said that “you have” to make savings

“but protect the poorest and that’s my absolute priority.”

How hollow those words ring tonight.

The truth is now before us: 200,000 children will be pushed into poverty as a result of this Bill. According to the Child Poverty Action Group, the measures in this Bill, alongside other measures that have been introduced, mean that 1 million children will be pushed into poverty by this Government. That will be the Secretary of State’s legacy. He spent all those years trying to persuade us that the Conservative party was finally a party that cared about poverty, and now, because the Chancellor needed a new year’s dividing line on welfare, he is accountable for putting 1 million children into poverty. It is well and truly clear that the nasty party is back.

This is about not just children but their mothers. A fortnight ago, my hon. Friend the Member for West Bromwich East (Mr Watson) published a list of 106 battle- ground constituencies. In those seats, there are 150,000 mothers who will be hurt by this Bill, losing £180 a year. In fact, as a result of measures put through by this Government, they are now losing £1,400, and tonight Members on the Treasury Bench voted to allow that to continue. They were given the chance to protect those 150,000 mothers and they chose not to. Over the next few months, we will be getting in touch with mothers in those constituencies and making it very clear that their Member of Parliament had a chance to protect their maternity pay and chose not to. Right now, the price of children’s clothing is rising by 4.5% and food prices are rising by 3.6%. Working mothers going on to statutory maternity pay are losing £180 a year at a time when someone on £1 million a year is getting a £2,000 tax cut. How are Government Members going to justify that to people in their constituencies?

Penny Mordaunt: Will the right hon. Gentleman give way?

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Mr Byrne: No, there is too little time.

It is a disgrace that this Bill is being rammed through the House tonight. The Secretary of State did not want public hearings and Ministers did not want to defend the detail of the Bill in Committee. We hope that the other place will give it the scrutiny that was denied to Members of this House.

The tragedy is that there is another way to bring down welfare spending. Long-term unemployment is now rising towards the 1 million mark, as is youth unemployment. Nothing in this Bill fixes the Work programme, which gets only 2.6 people out of every 100 back into work, or fixes the disarray that is now unfolding in universal credit. What the Government should have been doing tonight is bringing us measures to bring down unemployment, long-term unemployment and youth unemployment, and to save this country the cost of failure. Instead, the debate on this Bill has shown a Government and Secretary of State who are hellbent on making savings and clearing up the cost of the failure of a rising unemployment bill by taking that money from working people—6,000 working people for every Conservative-held marginal constituency.

10 pm

Debate interrupted (Programme Order, 8 January)

The Deputy Speaker put forthwith the Question already proposed from the Chair (Standing Order No. 83E), That the Bill be now read the Third time.

The House divided:

Ayes 305, Noes 246.

Division No. 138]

[

10 pm

AYES

Adams, Nigel

Afriyie, Adam

Aldous, Peter

Alexander, rh Danny

Andrew, Stuart

Arbuthnot, rh Mr James

Bacon, Mr Richard

Baker, Norman

Baker, Steve

Baldry, Sir Tony

Baldwin, Harriett

Barclay, Stephen

Barker, rh Gregory

Baron, Mr John

Barwell, Gavin

Bebb, Guto

Beith, rh Sir Alan

Bellingham, Mr Henry

Benyon, Richard

Beresford, Sir Paul

Berry, Jake

Bingham, Andrew

Birtwistle, Gordon

Blackman, Bob

Blackwood, Nicola

Blunt, Mr Crispin

Boles, Nick

Bone, Mr Peter

Bradley, Karen

Brady, Mr Graham

Brake, rh Tom

Bray, Angie

Brazier, Mr Julian

Bridgen, Andrew

Brine, Steve

Browne, Mr Jeremy

Bruce, Fiona

Bruce, rh Sir Malcolm

Buckland, Mr Robert

Burley, Mr Aidan

Burns, Conor

Burns, rh Mr Simon

Burrowes, Mr David

Burstow, rh Paul

Burt, Alistair

Burt, Lorely

Byles, Dan

Cable, rh Vince

Cairns, Alun

Campbell, rh Sir Menzies

Carmichael, rh Mr Alistair

Carmichael, Neil

Carswell, Mr Douglas

Cash, Mr William

Chishti, Rehman

Clegg, rh Mr Nick

Clifton-Brown, Geoffrey

Coffey, Dr Thérèse

Collins, Damian

Colvile, Oliver

Cox, Mr Geoffrey

Crabb, Stephen

Crouch, Tracey

Davey, rh Mr Edward

Davies, Glyn

Davies, Philip

de Bois, Nick

Dinenage, Caroline

Djanogly, Mr Jonathan

Dorries, Nadine

Doyle-Price, Jackie

Drax, Richard

Duddridge, James

Duncan, rh Mr Alan

Duncan Smith, rh Mr Iain

Dunne, Mr Philip

Ellis, Michael

Ellison, Jane

Ellwood, Mr Tobias

Elphicke, Charlie

Eustice, George

Evans, Graham

Evennett, Mr David

Fabricant, Michael

Fallon, rh Michael

Field, Mark

Foster, rh Mr Don

Fox, rh Dr Liam

Francois, rh Mr Mark

Freeman, George

Freer, Mike

Fuller, Richard

Garnier, Sir Edward

Garnier, Mark

Gauke, Mr David

Gibb, Mr Nick

Gilbert, Stephen

Glen, John

Goldsmith, Zac

Goodwill, Mr Robert

Gove, rh Michael

Graham, Richard

Grant, Mrs Helen

Grayling, rh Chris

Green, rh Damian

Grieve, rh Mr Dominic

Griffiths, Andrew

Gummer, Ben

Gyimah, Mr Sam

Hague, rh Mr William

Halfon, Robert

Hames, Duncan

Hammond, rh Mr Philip

Hammond, Stephen

Hands, Greg

Harper, Mr Mark

Harrington, Richard

Harris, Rebecca

Hart, Simon

Harvey, Sir Nick

Haselhurst, rh Sir Alan

Hayes, Mr John

Heald, Oliver

Heath, Mr David

Heaton-Harris, Chris

Hemming, John

Henderson, Gordon

Herbert, rh Nick

Hinds, Damian

Hoban, Mr Mark

Hollingbery, George

Hollobone, Mr Philip

Holloway, Mr Adam

Hopkins, Kris

Howarth, Sir Gerald

Howell, John

Hughes, rh Simon

Hunt, rh Mr Jeremy

Hurd, Mr Nick

Jackson, Mr Stewart

James, Margot

Javid, Sajid

Jenkin, Mr Bernard

Johnson, Gareth

Jones, Andrew

Jones, rh Mr David

Jones, Mr Marcus

Kawczynski, Daniel

Kelly, Chris

Kirby, Simon

Knight, rh Mr Greg

Kwarteng, Kwasi

Laing, Mrs Eleanor

Lamb, Norman

Lancaster, Mark

Lansley, rh Mr Andrew

Latham, Pauline

Laws, rh Mr David

Leadsom, Andrea

Lee, Jessica

Lee, Dr Phillip

Lefroy, Jeremy

Leslie, Charlotte

Letwin, rh Mr Oliver

Lewis, Brandon

Lewis, Dr Julian

Lidington, rh Mr David

Lilley, rh Mr Peter

Lloyd, Stephen

Lopresti, Jack

Lord, Jonathan

Loughton, Tim

Luff, Peter

Lumley, Karen

Macleod, Mary

Main, Mrs Anne

Maude, rh Mr Francis

May, rh Mrs Theresa

Maynard, Paul

McCartney, Karl

McIntosh, Miss Anne

McLoughlin, rh Mr Patrick

McPartland, Stephen

McVey, Esther

Menzies, Mark

Mercer, Patrick

Metcalfe, Stephen

Miller, rh Maria

Mills, Nigel

Milton, Anne

Mitchell, rh Mr Andrew

Mordaunt, Penny

Morgan, Nicky

Morris, Anne Marie

Morris, David

Morris, James

Mosley, Stephen

Mowat, David

Mulholland, Greg

Munt, Tessa

Murray, Sheryll

Murrison, Dr Andrew

Newmark, Mr Brooks

Newton, Sarah

Nokes, Caroline

Norman, Jesse

Nuttall, Mr David

O'Brien, Mr Stephen

Offord, Dr Matthew

Ollerenshaw, Eric

Osborne, rh Mr George

Ottaway, Richard

Paice, rh Sir James

Parish, Neil

Patel, Priti

Paterson, rh Mr Owen

Pawsey, Mark

Penning, Mike

Penrose, John

Percy, Andrew

Perry, Claire

Phillips, Stephen

Pickles, rh Mr Eric

Pincher, Christopher

Prisk, Mr Mark

Pritchard, Mark

Pugh, John

Raab, Mr Dominic

Randall, rh Mr John

Reckless, Mark

Redwood, rh Mr John

Rees-Mogg, Jacob

Reevell, Simon

Rifkind, rh Sir Malcolm

Robathan, rh Mr Andrew

Robertson, rh Hugh

Robertson, Mr Laurence

Rosindell, Andrew

Rudd, Amber

Ruffley, Mr David

Russell, Sir Bob

Rutley, David

Sandys, Laura

Scott, Mr Lee

Selous, Andrew

Shapps, rh Grant

Sharma, Alok

Shelbrooke, Alec

Shepherd, Sir Richard

Simmonds, Mark

Simpson, Mr Keith

Skidmore, Chris

Smith, Miss Chloe

Smith, Henry

Smith, Sir Robert

Soames, rh Nicholas

Soubry, Anna

Spelman, rh Mrs Caroline

Spencer, Mr Mark

Stephenson, Andrew

Stevenson, John

Stewart, Bob

Stewart, Iain

Stewart, Rory

Streeter, Mr Gary

Stride, Mel

Stuart, Mr Graham

Stunell, rh Andrew

Sturdy, Julian

Swales, Ian

Swayne, rh Mr Desmond

Swinson, Jo

Swire, rh Mr Hugo

Syms, Mr Robert

Thurso, John

Timpson, Mr Edward

Tomlinson, Justin

Tredinnick, David

Truss, Elizabeth

Tyrie, Mr Andrew

Uppal, Paul

Vaizey, Mr Edward

Vara, Mr Shailesh

Vickers, Martin

Villiers, rh Mrs Theresa

Walker, Mr Robin

Wallace, Mr Ben

Weatherley, Mike

Webb, Steve

Wharton, James

Wheeler, Heather

White, Chris

Whittaker, Craig

Whittingdale, Mr John

Wiggin, Bill

Willetts, rh Mr David

Williams, Stephen

Williamson, Gavin

Wilson, Mr Rob

Wollaston, Dr Sarah

Wright, Jeremy

Wright, Simon

Yeo, Mr Tim

Young, rh Sir George

Zahawi, Nadhim

Tellers for the Ayes:

Mark Hunter

and

Joseph Johnson

NOES

Abbott, Ms Diane

Abrahams, Debbie

Ainsworth, rh Mr Bob

Alexander, rh Mr Douglas

Alexander, Heidi

Ali, Rushanara

Allen, Mr Graham

Anderson, Mr David

Austin, Ian

Bailey, Mr Adrian

Bain, Mr William

Balls, rh Ed

Banks, Gordon

Barron, rh Mr Kevin

Bayley, Hugh

Beckett, rh Margaret

Begg, Dame Anne

Benn, rh Hilary

Berger, Luciana

Betts, Mr Clive

Blears, rh Hazel

Blenkinsop, Tom

Blomfield, Paul

Blunkett, rh Mr David

Bradshaw, rh Mr Ben

Brennan, Kevin

Brown, Lyn

Brown, rh Mr Nicholas

Brown, Mr Russell

Bryant, Chris

Buck, Ms Karen

Burden, Richard

Burnham, rh Andy

Byrne, rh Mr Liam

Campbell, Mr Alan

Campbell, Mr Ronnie

Caton, Martin

Chapman, Jenny

Clarke, rh Mr Tom

Clwyd, rh Ann

Coaker, Vernon

Coffey, Ann

Cooper, Rosie

Cooper, rh Yvette

Corbyn, Jeremy

Creagh, Mary

Creasy, Stella

Cruddas, Jon

Cryer, John

Cunningham, Alex

Cunningham, Mr Jim

Cunningham, Sir Tony

Curran, Margaret

Dakin, Nic

Danczuk, Simon

Darling, rh Mr Alistair

David, Wayne

Davidson, Mr Ian

De Piero, Gloria

Denham, rh Mr John

Dobson, rh Frank

Docherty, Thomas

Donohoe, Mr Brian H.

Doran, Mr Frank

Doughty, Stephen

Dowd, Jim

Doyle, Gemma

Dromey, Jack

Dugher, Michael

Durkan, Mark

Eagle, Ms Angela

Eagle, Maria

Edwards, Jonathan

Efford, Clive

Elliott, Julie

Ellman, Mrs Louise

Engel, Natascha

Esterson, Bill

Evans, Chris

Farrelly, Paul

Field, rh Mr Frank

Fitzpatrick, Jim

Flello, Robert

Flint, rh Caroline

Flynn, Paul

Fovargue, Yvonne

Francis, Dr Hywel

Gapes, Mike

Gardiner, Barry

George, Andrew

Gilmore, Sheila

Glindon, Mrs Mary

Godsiff, Mr Roger

Goggins, rh Paul

Goodman, Helen

Greatrex, Tom

Green, Kate

Greenwood, Lilian

Griffith, Nia

Gwynne, Andrew

Hain, rh Mr Peter

Hamilton, Mr David

Hanson, rh Mr David

Harman, rh Ms Harriet

Harris, Mr Tom

Havard, Mr Dai

Healey, rh John

Hendrick, Mark

Hepburn, Mr Stephen

Hillier, Meg

Hodge, rh Margaret

Hodgson, Mrs Sharon

Hoey, Kate

Hopkins, Kelvin

Horwood, Martin

Hosie, Stewart

Howarth, rh Mr George

Hunt, Tristram

Huppert, Dr Julian

Irranca-Davies, Huw

Jamieson, Cathy

Jarvis, Dan

Johnson, rh Alan

Johnson, Diana

Jones, Graham

Jones, Mr Kevan

Jones, Susan Elan

Jowell, rh Dame Tessa

Joyce, Eric

Kaufman, rh Sir Gerald

Keeley, Barbara

Kendall, Liz

Kennedy, rh Mr Charles

Khan, rh Sadiq

Lammy, rh Mr David

Lavery, Ian

Lazarowicz, Mark

Leech, Mr John

Leslie, Chris

Long, Naomi

Love, Mr Andrew

Lucas, Caroline

Lucas, Ian

MacNeil, Mr Angus Brendan

Mactaggart, Fiona

Mahmood, Shabana

Mann, John

Marsden, Mr Gordon

McCabe, Steve

McCann, Mr Michael

McCarthy, Kerry

McClymont, Gregg

McCrea, Dr William

McDonagh, Siobhain

McDonald, Andy

McDonnell, Dr Alasdair

McDonnell, John

McFadden, rh Mr Pat

McGovern, Alison

McGovern, Jim

McGuire, rh Mrs Anne

McKechin, Ann

McKenzie, Mr Iain

McKinnell, Catherine

Meacher, rh Mr Michael

Mearns, Ian

Miliband, rh David

Miliband, rh Edward

Miller, Andrew

Mitchell, Austin

Morden, Jessica

Morrice, Graeme

(Livingston)

Morris, Grahame M.

(Easington)

Mudie, Mr George

Munn, Meg

Murphy, rh Mr Jim

Murphy, rh Paul

Murray, Ian

Nandy, Lisa

Nash, Pamela

O'Donnell, Fiona

Onwurah, Chi

Osborne, Sandra

Owen, Albert

Paisley, Ian

Pearce, Teresa

Perkins, Toby

Phillipson, Bridget

Pound, Stephen

Powell, Lucy

Raynsford, rh Mr Nick

Reed, Steve

Reeves, Rachel

Reid, Mr Alan

Reynolds, Emma

Reynolds, Jonathan

Ritchie, Ms Margaret

Robertson, Angus

Rotheram, Steve

Roy, Mr Frank

Roy, Lindsay

Ruane, Chris

Ruddock, rh Dame Joan

Sanders, Mr Adrian

Sarwar, Anas

Sawford, Andy

Seabeck, Alison

Sharma, Mr Virendra

Sheerman, Mr Barry

Shuker, Gavin

Skinner, Mr Dennis

Slaughter, Mr Andy

Smith, rh Mr Andrew

Smith, Nick

Smith, Owen

Spellar, rh Mr John

Straw, rh Mr Jack

Stringer, Graham

Stuart, Ms Gisela

Sutcliffe, Mr Gerry

Tami, Mark

Teather, Sarah

Thomas, Mr Gareth

Thornberry, Emily

Timms, rh Stephen

Trickett, Jon

Turner, Karl

Twigg, Derek

Twigg, Stephen

Umunna, Mr Chuka

Vaz, rh Keith

Vaz, Valerie

Walley, Joan

Watts, Mr Dave

Weir, Mr Mike

Whiteford, Dr Eilidh

Whitehead, Dr Alan

Williams, Hywel

Williams, Mr Mark

Williamson, Chris

Wilson, Phil

Winnick, Mr David

Winterton, rh Ms Rosie

Wishart, Pete

Woodward, rh Mr Shaun

Wright, David

Wright, Mr Iain

Tellers for the Noes:

Julie Hilling

and

Jonathan Ashworth

Question accordingly agreed to.

21 Jan 2013 : Column 137

21 Jan 2013 : Column 138

21 Jan 2013 : Column 139

21 Jan 2013 : Column 140

Bill read the Third time and passed.

Business without Debate

Committees

Mr Deputy Speaker (Mr Lindsay Hoyle): With the leave of the House, it will be convenient to take motions 2, 3 and 4 together.

Ordered,

Culture, Media And Sport

That Mr Adrian Sanders be discharged from the Culture, Media and Sport Committee and Mr John Leech be added.

Justice

That Karl Turner be discharged from the Justice Committee and Graham Stringer be added.

Transport

That Mr John Leech be discharged from the Transport Committee and Mr Adrian Sanders be added.—(Mr Geoffrey Clifton-Brown, on behalf of the Committee of Selection.)

21 Jan 2013 : Column 141

East Midlands Ambulance Service

Motion made, and Question proposed, That this House do now adjourn.—(Mark Lancaster.)

10.14 pm

John Mann (Bassetlaw) (Lab): I rise to highlight the problems of the reorganisation and funding of the East Midlands ambulance service. The problem has been covered up because, over the last 18 months, the service has lost the contract for non-emergency transfers of patients to Arriva trains and buses. Regardless of the question of service, the impact on the East Midlands ambulance service is £5 million a year. That was told to me, in advance of the loss of the contract, by the senior officials who ran the service. That £5 million a year has not been put back in additionally by the Government. Therefore, £5 million of cuts are required in the service.

To make those cuts, the service is attempting to reconfigure, which has a detrimental impact on my constituency and elsewhere, as I shall outline. Before doing so, I wish to highlight another problem for the Minister to respond to: targets and how they are set. There is currently an in-built pressure for ambulance services to meet specific targets. The reconfiguration is happening in the context of meeting those targets, but there are perverse incentives within many of them.

I shall highlight that with one example, but there could be many. A mother sadly lost her child last year. The mother went into premature labour at 29 weeks and the child, Jessica Day, died at birth. When the mother went into premature labour, she had a midwife with her and an ambulance was called, but none was available. A response vehicle with a single paramedic came, but Jessica Day’s mother needed—medically—an immediate transfer to an intensive care unit within a hospital to give the baby, Jessica, a chance of survival. Had that immediate transfer happened, on the balance of probabilities, Jessica would be alive. It did not happen because no ambulance was available. In fact, the nearest ambulance was on its way back from Sheffield on the M1 in Yorkshire.

That in itself is a major issue, but perhaps equally major is the fact that the target was met. Despite the fact that the mother with the baby needed to be in hospital immediately but did not get there for an hour and two minutes, the target was met, because a car arrived with a paramedic within 19 minutes. The mother and baby needed to be in an ambulance, and it was the right medical decision not to transfer them in their own car, which was available, as that would have endangered the mother as well. That is a graphic illustration of the problem.

As we see repeatedly, not least in respect of elderly people, if the target is not met, the ambulance does not come for many hours. For example, one 80-year-old pensioner was laying in a garden for more than an hour with a broken hip. Because the immediate response target could not be met, the emergency was de-prioritised, and the ambulance was sent somewhere else to meet another target—the second incident may or may not be as urgent. The longest wait I know of for an emergency response is 10 hours, but it is often three or four hours—with “often” not meaning daily, but certainly weekly. That needs to be looked at.

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I also see a problem emerging with improvements. How could improvements be a problem? Over the last 11 years as an MP, I have called for a vast increase in the number of community defibrillators. I would like to see them in every community building, every significant employer, most small employers, every school and every parish council, with trained responders to use them. That would be wonderful, and a wise expenditure. All those defibrillators would be maintained by the East Midlands ambulance service, and every time one was used, it would be deemed to be an eight-minute response. Therefore there is a perverse incentive not to have community defibrillators in areas such as mine, because it would mean fewer ambulances. The community first-responder with the defibrillator would meet the response time, but the ambulance would not come in that minority of cases in which the patient needed to get to hospital. That is no good for my constituents.

It is similar for strokes. I would like to see localised thrombolysing done immediately in the way it is done in Iceland, for example. The brain image is scanned and sent to the consultant, wherever they are. They analyse it instantly and the decision on thrombolysing is made. That is done without having to take people to hospital, but we are light-years away from that simple system. The reconfiguration of the ambulance service now under way will worsen that situation.

There are bigger problems for people who do not live in a city. I want to go through some mathematics with the House to show the problems. The problem of averaging to meet targets means that, by definition, high-density cities will always be prioritised over low-density rural areas. I have a theoretical example, but it could be real in the east midlands. Suppose we have a city of 900,000 people and a rural constituency of 100,000 people. The average time for an ambulance to get to a job is much shorter in the city because of the density of population. In other words, the propensity of any square kilometre to have an incident is much higher simply because of the density of population. Therefore there will be a much higher level of vehicle cover in the city. But a 95% response time in the city and a 60% response time in the rural area—with the population figures I have given—results in a 91.5% response time overall. If those figures are reversed, with a 60% response time in the city and a 95% response time in the rural area—the exact opposite—the overall response time falls from 91.5% to 63.5%. Therefore, by definition, setting response times as they are means that ambulance services will disproportionately put their resources in the high-density cities rather than in rural areas. That is bound to happen, and the problem when the service faces a shortage of money is that when it reconfigures to meet response times, it has to downgrade the rural areas. It is not possible to do otherwise if response times alone are taken into account. The Minister needs to look at how the response times are set.

These are major issues for the Government, and I do not make those points in a hostile, partisan way. These are issues that successive Governments have looked at, but no solution has been found. Those things have to be changed. As well as Bassetlaw hospital, we use Doncaster royal infirmary—we are part of the same trust. We use Sheffield hospitals for heart attacks and cancer. However, the East Midlands ambulance service plans have been reconfigured to take us to King’s Mill in Ashfield, which is an entirely different area.

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Gloria De Piero (Ashfield) (Lab): The loss of ambulance stations in semi-rural areas is a particular concern. The town of Eastwood in my constituency faces the loss of its ambulance station. Does my hon. Friend agree that closing an ambulance station cannot help already poor response times?

John Mann: The figures I have presented to the House show this in-built bias against rural and semi-rural areas, and, not least, former mining communities. We have the proposals to close Worksop and Retford ambulance stations and to have one hub in Ashfield’s King’s Mill hospital to serve my population. The population of Bassetlaw will have a parking lot with a potential portakabin under the original proposals.

Toby Perkins (Chesterfield) (Lab): Was my hon. Friend as surprised as I was to hear that the initial consultation has been replaced by a subsequent one which is suggesting doubling the number of hubs? I welcome the fact that there was some element of listening, but it suggests that the original plans were miles away from what was safe for the people in the east midlands.

John Mann: As you might imagine Mr Deputy Speaker, in Bassetlaw we had the biggest response to the consultation, with more than 19,000 people involved directly in the consultation, and we had the largest public meetings. We found one person—I will not name his political party, but he was the campaign organiser for a small party—in favour. All the other 19,000 who signed up were against it—every single person in the public meetings was against it. All the staff were against it—every single one of them. They were all against it because, if the ambulances and the base are shifted out of the area and we have just a parking lot with a portakabin, we will have an even worse second-rate, service in Bassetlaw. The averages will be maintained as the cities get our ambulances and we will not have them, and we will become the bit of the response time that is not met. My constituents will continue to die unnecessarily.

What I want from the East Midlands ambulance service, therefore, is a proper rethink. It is clearly rethinking, but I want to ensure that Worksop and Retford ambulance stations stay open. If they want to juggle the minutiae of where the management is based, I am not worried about that and neither are my constituents, but we want two proper bases. We want the Gainsborough ambulance service maintained to keep accessibility in the north-east part, the rural part, over the border in Lincolnshire. That is what we need if we are to maintain the kind of service that my constituents expect. They pay their taxes. We have our illnesses like everybody else. What is unacceptable to all of my constituents and to me is that former mining areas and rural areas have a worse ambulance provision than the rest of the country. We are not prepared to accept that. East Midlands ambulance service must come back with a proper proposal. In that proposal, Worksop and Retford ambulance stations will need to stay open so that there is a proper base to allow the staff to continue to do their excellent job. I thank the people of Bassetlaw for the way they have responded. They will continue to do so to ensure that we get the service that they deserve.

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10.29 pm

The Parliamentary Under-Secretary of State for Health (Anna Soubry): I congratulate the hon. Member for Bassetlaw (John Mann) on securing this debate. Were it not for the fact that I now sit on the Front Bench, I would have put in for a similar debate—there is no doubt about it—such is my concern, as the constituency MP representing Broxtowe, about the situation with East Midlands ambulance service. It is important that I recognise that interest, because I, too, have had many concerns about EMAS, although they are perhaps slightly different from those the hon. Gentleman has described. As a result, I had a meeting with the chief executive of EMAS, Mr Philip Milligan, a week last Friday. I believe that he has since met the hon. Gentleman, so he will have heard about many of the issues that the hon. Gentleman raised in the House today, and rightly so.

I do not believe that this is simply a matter of finance—that is certainly not where my concern lies—or about the “Being the Best” scheme, which has been out for consultation, as the hon. Gentleman described. My concern, and that of many other hon. Members whose constituencies are covered by EMAS, is about poor response times, notably for elderly people who have fallen. My hon. Friend the Member for Loughborough (Nicky Morgan), for example, has had difficulties in her constituency, and I have had half a dozen problems in mine, with frail elderly people with suspected fractures having to lie on the floor, sometimes for up to four hours, despite being less than 10 minutes from the Queen’s medical centre in Nottingham. My hon. Friend the Member for South Derbyshire (Heather Wheeler) is nodding in agreement, as no doubt she has heard of similar experiences in her constituency. That situation is unacceptable, and I hope to offer some insight as to why that is the case.

Heather Wheeler (South Derbyshire) (Con): In South Derbyshire we have had numerous cases of elderly people falling over in a park and having to wait hours for an ambulance. Residents have come to put blankets on them because they know that they should not be moved. We are 15 minutes from Burton hospital, but we cannot do anything because we rely on the professionals.

Anna Soubry: I am grateful to my hon. Friend for her intervention, but I think that it is also important to pay tribute to the ambulance staff who work for EMAS and the outstanding work they do. It is also important to point out that between October 2010 and December 2012 EMAS recruited 65 new front-line staff, so something is going on that is not right. Many people are of the view that unfortunately it is the way that EMAS is being run that is at the heart of the problem.

Mr Mark Spencer (Sherwood) (Con): I wonder whether my hon. Friend is aware that Nottinghamshire fire and rescue service, if it has to be the first responder, is often left to look after patients until an ambulance arrives, which could be up to an hour, so the fire engine is not available to deal with a much more important issue.

Anna Soubry: As ever, my hon. Friend makes an important point, and it is one that I will certainly look at further. I hope that those in EMAS who are listening to the debate will take that comment on board.

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In response to the points made by the hon. Members for Ashfield (Gloria De Piero) and for Chesterfield (Toby Perkins), I do not think that it is as simple as saying that the closure of an ambulance station will de facto reduce the service available. Ambulances do not sit in ambulance stations waiting to respond to a local incident. They spend most of their time out of ambulance stations on the road so that they can respond to emergency calls. EMAS reported—these are important facts that should be widely publicised; I am sure the hon. Member for Bassetlaw will ensure that they are—a total turnover of £169.5 million in its 2011-12 final accounts and a £1.4 million surplus. It has also reported surpluses in the previous three years. I understand that for 2012-13 the trust received £3.5 million funding as its share of the EMAS contract from Bassetlaw primary care trust. As I have said, my concern is not so much about the money, but about the way the service is being operated.

Let me turn to the “Being the Best” review. EMAS tells me that it recognises that its response times in rural areas do not match the response times in city centres. In response, EMAS published its “Being the Best” change programme in 2012, which outlined plans designed to ensure that response times and the service provided to all the people of the region were improved. As the hon. Member for Bassetlaw described, EMAS has consulted clinical commissioning groups, overview and scrutiny committees and local people on its proposals. As we have been told, it received substantial feedback from the people of Bassetlaw, with a petition from some 9,000 people. The business case should be presented to the board on 25 March, allowing the trust additional time to review alternative options and develop final proposals for the board to consider.

I am told that a number of options are being considered. They include the “do nothing” option, which involves making no changes to the configuration of ambulance stations; the “do nothing-plus” option, which involves making no changes to the configuration of ambulance stations, but making an additional resource investment in more ambulance vehicles and staff; and the “do minimal” option, which involves making the minimum changes necessary to deliver current service standards in a safer and more effective manner. That option would retain all the current stations and introduce the 118 new community ambulance posts. The fourth option would establish 13 hubs, plus 118 community ambulance posts—I know that my hon. Friend the Member for High Peak (Andrew Bingham), along with many hon. Members, has expressed his concern about that option. The fifth option—a new option—would establish 27 hubs, plus 108 community ambulance posts, and is being considered as a direct result of the consultation feedback.

Andrew Bingham (High Peak) (Con): Does my hon. Friend think, like me, that although the hub and spoke model has merit, the key is where the hubs go? High Peak is very rural; we need a hub, as I am sure the hon. Member for Bassetlaw (John Mann) feels he does.

Anna Soubry: That is a very good point. My hon. Friend has summed it up—we are having an outbreak of cross-party unity. As he says, the key point is the positioning of the hub. One of the attractions of the hub approach is that the mechanics would be in place to ensure that the vehicles were ready at the beginning of a

21 Jan 2013 : Column 146

shift. At the moment, paramedics are responsible for that, which does not seem to be a very good use of their time. There is therefore much merit in establishing 27 hubs in the right areas to ensure that we have a service that is fit for purpose.

There is something else that needs to be, not so much explored, perhaps, as exposed. The hon. Member for Bassetlaw has quite properly commented on the difficulty of having targets, and I could not agree with him more. This debate is a good example of where top-down, Government-led targets have blighted an ambulance service—no doubt there are many other examples in the NHS. That is why, when this Government were elected, for many of us it was on the basis that these targets, far from freeing up services and making them better, were strangling them and making them worse. This debate is an example of targets doing all the things they were designed not to do, constricting a service and making it worse. It is worth bearing it in mind that it was in 1997, I believe, that the ambulance service suffered from such targets. I hope that there will be more cross-party agreement and moving forward, so that although there are laudable aims that all services should have, we should not necessarily set rigid targets, which then create exactly the sort of horribly sad cases that the hon. Gentleman told us about.

John Mann: Is the Minister saying that she is going to get rid of them?

Anna Soubry: No, the Minister is not saying that she is going to get rid of them; what I am saying is that I take the view—as the hon. Gentleman does—that targets are not particularly improving services. I think there is a case for re-examining targets, and I hope he would join me in saying to the ambulance service, “Let’s look again at these targets in the NHS to see whether they’re doing the job we want them to do,” because it is precisely because of these targets that elderly people in my constituency have been lying on floors for up to four hours while ambulances have to go to meet a target.

Toby Perkins: The hon. Lady seems to be saying that the ambulance service is so focused on targets that it is incapable of recognising that leaving an old lady lying on the floor for four hours is reprehensible and appalling. She is letting the ambulance service off tremendously lightly to suggest that that is reasonable.

Anna Soubry: I am not saying that it is reasonable at all. What I am saying is that this was the system introduced under the last Labour Administration— a Government whom the hon. Gentleman supported. These are the precise consequences of that system; it is the perversion of that system that has led us to a situation in which targets have to be hit. I can assure hon. Members that I explored this matter with Mr Milligan, and an elderly lady lying on the floor with a suspected fractured hip does not fall into the category of an emergency life-threatening situation. These are not definitions imposed by this Government; these are the consequences of the 13 years of the previous Administration. I take the view that the situation needs urgent review, and I will certainly be making that recommendation in the Department that we need to look again at the ambulance service.

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Mr Dennis Skinner (Bolsover) (Lab): Does the Minister agree that a lot of people in the east midlands, including many of the Members who have spoken here tonight, are dealing with pretty much the same kinds of characteristics in the old mining areas and rural areas? In my area of Bolsover and mid-Derbyshire, it seemed as though the 17 control centres were going to be reduced to two. I get the impression that the Minister is saying that most of the 27 would be likely to remain. It is hard for me to say this, but do we have a cross-party agreement to save those in mid-Derbyshire that cover Bolsover as well?

Anna Soubry: I have to say that, for the first time, I am almost speechless. It is not for me to say what is my preferred option. That decision has to be made at a local level. As the hon. Gentleman might imagine, however, I may have a point of view on the preferred option, and I am entitled to make my view known to EMAS, as indeed I will. I take the hon. Gentleman’s important point about the former coal-mining communities —they are similar to my own, although mine is not on the same scale as Bolsover. I make the point again, however, to be fair to EMAS, that the reason it has gone through this process—which has been painful for many people—is precisely because it wants to improve its service. It recognises that rural areas do not receive the kind of service that urban areas do.

Chris Heaton-Harris (Daventry) (Con): In the last couple of minutes, will the Minister address the concept of regionalisation of a service such as this? We have previously seen money being wasted on the regionalisation of the fire service, and many of us with constituencies on the periphery of the East Midlands ambulance

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service really worry about this. The hon. Member for Bassetlaw (John Mann) talked about the hospitals outside the region that his constituents go to. My constituents go to hospitals in Oxford, Coventry and elsewhere. Does this mean that those of us in the rural outreaches of the east midlands are the ones who have to pay for this centralisation?

Anna Soubry: My hon. Friend’s intervention raises a point that I hope I can help him with. There is absolutely nothing to prevent an ambulance in Daventry from going to whichever hospital offers the best treatment for that particular patient. Exactly the same applies in Bassetlaw. Under the new rule, there will be nothing to prevent a patient from going to Doncaster royal infirmary, or up to Sheffield, or indeed down to the Queen’s medical centre in Nottingham. The changes will not affect the ultimate decision of which is the best hospital for that particular patient—[Interruption.] The hon. Member for Bassetlaw is chuntering at me. Does he wish to intervene on me?

John Mann: I was saying that we need the ambulance to be there in the first place in order for it to take people to those hospitals. That is the whole point.

Anna Soubry: With great respect to the hon. Gentleman, he misses the more important and indeed more valid point that just because there is an ambulance station in a particular town or village, that does not mean to say that there is always an ambulance sitting there waiting to serve that town or village. What is important is—

10.44 pm

House adjourned without Question put (Standing Order No. 9(7)).