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A month later I received a non-reply reply, the most relevant sentence of which was:

“Any member who declares an interest in a meeting is expected to take no part in discussions and step out of the meeting.”

I wrote back a much longer reply, in which I pointed out that the chair of the Royal College of General Practitioners had said:

“it is not about excluding yourself from the room whenever there is a discussion; it is about how it will drive your decision-making overall”.

I pointed out that, as a consequence of hospital closures in north-west London, there had been a shift in funding from hospital to primary care, a greater involvement of private companies in the primary care sector, and an opportunity for those companies to increase their profits by cutting back on the level of service offered.

I principally raised the fact that the information that should be provided is not provided on declaration of interest forms, especially the scope and value of any interest. I listed doctor by doctor and CCG chair by CCG chair what those interests were and how they were not adequately declared. I dealt with seven out of the nine CCG chairs and the medical director. That was in a letter on 20 December.

I received a reply on 3 February which said:

“The Cluster does not hold this data.”

So three months on from my original inquiry, I am none the wiser in relation to these matters.

I advise any hon. Member to look at their CCG declarations of interest online—not Hillingdon, because it does not publish them online. I use Hammersmith and Fulham as an example here. The husband of one member is a partner of Drivers Jonas Deloitte. The first thing I found on the website of Drivers Jonas Deloitte was that it had been appointed to sell the Kent and Sussex hospital in Royal Tunbridge Wells when it closes in 2011. Another member is the owner of a provider of home care services. Another is the brother of the director of a design company that holds a number of contracts with NHS organisations. It might be that none of them has a direct financial pecuniary interest now or in the future, but it shows touching naivety, complacency or worse.

Before the 28 members of the joint PCT board made the decision to close the four A and Es in north-west London, I said at the public meeting that if any of them had or was likely to have interest of a pecuniary nature they should not take part in that decision. One of them rather touchingly volunteered the information that they had sold their shares. What world are we living in when a third of GPs on the new CCGs can hold financial interests in anything from land sales to an alternative provider?

I raised the question with the Prime Minister yesterday and mentioned Dr Goodman, although not by name, and his estimated minimum return of £2.6 million. Again, I got a non-reply in reply. Sooner or later the Government will have to address these matters.

There is another story in the Daily Mail today that states:

“In 1981 there were eight NHS press officers in Britain. Now there are 82 in London alone”.

It is not that there is a lack of spending on publicity in the NHS. Indeed, almost £1 million has been spent on a private consultancy firm simply to carry out the bogus and botched consultation on the closure of A and Es.

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We are seeing the creation of a second-grade health service in north-west London.

Barbara Keeley: A number of months ago, I raised the case of a person who rejoices in the title “NHS head of brands”. There seem to be a whole set of units that keep cropping up.

Mr Slaughter: I am sure that all Members will have similar examples. It is an obscenity that millions of pounds are being spent on spin and disinformation while basic information is not being provided even to Members of Parliament after three months and persistent requests. Sooner or later, these issues will have to be addressed.

Of course, our main preoccupation is to maintain our first-rate health service—our blue light A and Es, our stroke centres and our major hospitals—rather than having it replaced by urgent care centres and minor primary care facilities. That is what we face in north-west London and, I am sure, around the rest of the country. It adds insult to injury if the individuals who are making the decisions to sell the land and to transfer services into the private sector are also the shareholders and owners or if they benefit in any other way. This is a corrupt act and it must be addressed by the Government. They cannot continue to turn a blind eye to it.

Several hon. Members rose

Mr Deputy Speaker (Mr Nigel Evans): Order. Eight Members are trying to catch my eye and we will finish at 5 o’clock, with Charlotte Leslie having the last two minutes. In order to accommodate everybody, as well as interventions, the time limit is now five minutes.

4.13 pm

Andrew Selous (South West Bedfordshire) (Con): The NHS saved my life when I was 24 with an emergency operation in the middle of the night. It was there for me when I needed it, which is why I care so deeply for it.

We have heard some bad examples of what goes on in the NHS, but there are also many examples of excellent care in the NHS every day. NHS staff, especially nurses on busy wards, work extremely hard. They often rush around, have to miss their breaks and get home exhausted. We must all acknowledge that.

Today, we are debating what happened in Mid Staffordshire, but, as others have said, it was, sadly, not an isolated case. We know that 6,000 deaths in 14 other hospitals are being looked at. One area that no other Member has mentioned so far today is the training of our nurses and our doctors. Of course we want our nurses and doctors to be professionally well trained, but it is important that they do not just have academic skills. However good their biology, chemistry or maths, if they are not kind, if they are not compassionate and if they are not caring individuals, perhaps the people responsible for their training need to say to them that a career in the NHS might not be the right career for them and that research or something else might be more appropriate.

The most worrying thing that I have heard in the debate today is the comment that was allegedly made by a nurse to a patient and that was quoted by the right hon. Member for Cynon Valley (Ann Clwyd): “I am a

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graduate, I don’t do sick.” That is not acceptable. Other Members may also have read the article by Charles Moore in

The Daily Telegraph

a number of weeks ago, in which he looked in detail at whose job it is to make sure that patients are cleaned up if they need to go to the lavatory and do not get there in time. The faculty of health sciences at Southampton university made the point that ward sisters always have this responsibility, but went on to say that it is everyone’s job.

When I go round a school, I find that if a head teacher picks up the litter on the ground, surprise, surprise, there is not a lot of litter. When a doctor, however senior, sees a patient to give a diagnosis or a prescription, if that patient needs basic nursing care, no level of seniority in the NHS should be above that. That would send a powerful message that that was everyone’s job, as the faculty of health sciences at the university of Southampton said.

I am pleased that in Bedfordshire clinical commissioning group, the excellent Dr Paul Hassan has told me that there will be unannounced GP visits to the wards of the Luton and Dunstable hospital and other hospitals to which Bedfordshire sends its patients. There will be private TripAdvisor-style patient reports coming back—not report forms handed by a sister to a patient and filled in while the sister is leaning over them, but done genuinely in privacy so that GPs can get a proper report of what is happening. There will be real-time alert buttons on the keyboards of GPs and clinicians so that they can flag it up immediately if things are going wrong. That is excellent. That is the way to get an early indication of what is going wrong.

In addition to outstanding nursing care by caring, compassionate nurses, we need clinical leadership. We need the medical directors and the chief nurses of hospitals to step up to the plate. We need medical directors who are front-line clinicians—that is really important—and we need hospital boards to make sure that they have the proper data. Data on bedsores, for example, should be available at every trust board meeting. If the incidence of bedsores is increasing, that may be an indication that things are going wrong in the hospital. That information should be seized on and acted on urgently.

Above all, we need the medical director and the boards of hospitals to foster an esprit de corps and to create an understanding among all the staff that “we don’t do average” and that excellence is what they should aim for. We need a culture where peer review and challenge are normal, natural, accepted and of benefit to everyone. In that vein I commend the “Getting it Right First Time” report by Professor Tim Briggs, which is looking at a clinically-led hub and spoke peer review model in orthopaedics. That could usefully be extended across the whole of the NHS.

4.18 pm

Mr Bernard Jenkin (Harwich and North Essex) (Con): I am encouraged by the speech from my hon. Friend the Member for South West Bedfordshire (Andrew Selous) because it shows that accountability is not just about supervising organisations, regulators, targets, safeguards, mechanical things and statistics. Accountability is about creatively getting the intelligence into the system about what is happening and reacting to it positively, welcoming

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it and generating the complaints so that more intelligence comes into the system. That is the kind of accountability we want.

As Chairman of the Public Administration Committee, I feel I can add a new dimension to the debate because of what we are thinking about in our inquiry on the future of the civil service. We need to ask ourselves, “What does accountability feel like?” We think we know what accountability feels like, but my goodness, it goes up and down a bit. During the previous Parliament we felt very accountable in some periods, every single one of us. What do we want accountability to feel like in the health service? With the greatest respect to my hon. Friend the Member for Wycombe (Steve Baker), the lawyers must be the last resort. We do not want accountability to be about finger-pointing, blame and holding people to account. Indeed, that is part of the disease that afflicts the health service. We want accountability to be about nursing staff on the ward feeling accountable to each other for sharing information, accountable to the patients and welcoming the information they receive from them, and accountable to their managers and holding them accountable for what they do not feel is being done, in an atmosphere of trust and co-operation.

What is chilling about the Mid Staffordshire story is the question of what accountability felt like in that hospital at that time? To whom did people feel they were accountable. What did they feel they were accountable for? There must have been almost an atmosphere of “Apocalypse Now” in the hospital, in which nobody knew where to turn.

In the evidence we are receiving about the civil service, we have had powerful testimony from an adviser to our Committee, Professor Andrew Kakabadse of Cranfield university, who rather chillingly points out an obvious truth. Very few people who work in a failing organisation do not know that it is failing. Most people in a failing organisation know that it is failing. What is wrong? The answer is that they do not know how to talk about it. They do not know what to say, who to tell—or, if they try to tell people, it will be bad for them—or what to do. So people often just leave failing organisations, saying, “I can’t do anything about it.” I bet most of those on the board of the hospital trust knew it was going wrong and did not know what to do. There is this idea that this was just an isolated case, but it represents a systemic failure. There is absolutely no escaping that.

I remember the Paddington rail crash. One’s instant reaction was, “Well, the driver went through a red light; it must have been his fault,” but everybody knew that there must have been something much more fundamentally wrong. Something was wrong with rail safety. In aviation, when there is a plane crash, it is very rarely the pilot’s fault. Even if it is down to pilot error, that will be down to pilot training and that will be a system failure. We need to look at this issue in an holistic and sensible way.

The reaction of the NHS to the Francis report was immediately to reach for statistics and to start doing things. It immediately started a storm around our local hospital, the Colchester General, by latching on to one statistic and naming it as one of the hospitals being investigated, even though—I have written to Andrew Dilnot at the UK Statistics Authority and got a reply from him—a single statistic should never be used in such a fashion. In fact, the Colchester General is in the

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top quartile of its class of hospital, so that was entirely unnecessary. My wife has just had a knee replacement in that hospital. I was completely confident that she would get good nursing care and she indeed got very good nursing care.

There is now an uncomfortable atmosphere surrounding this issue. There is an atmosphere of denial, and this relates to Sir David Nicholson. Is he still in denial? Is the system still in denial? Can the system change dramatically enough unless people are seen to take responsibility for the culture? It is difficult to argue that he has not been individually responsible for the broad culture in the national health service that has led to this pass.

Mr Deputy Speaker (Mr Nigel Evans): I am sure the House wishes Anne Jenkin a speedy recovery.

4.23 pm

Jackie Doyle-Price (Thurrock) (Con): It is a pleasure to follow my hon. Friend the Member for Harwich and North Essex (Mr Jenkin) and give a south Essex perspective on this issue by speaking about the Basildon and Thurrock Foundation Trust. It was found to have significant failings and high mortality rates in 2009, which led to regulatory intervention, on which the right hon. Member for Leigh (Andy Burnham) will recall delivering a statement to this House. At that time, the Care Quality Commission voiced its lack of confidence in the management at Basildon, but there was no change and no one was held to account.

As we all know—and as my hon. Friend has eloquently explained—institutions fail when they are poorly led. In the event of failure, senior management need to step up to the plate, either to take a grip of matters and force change or to take responsibility. The failure in accountability at that time has no doubt held Basildon back. Subsequent CQC inspections found Basildon failing in terms of care and welfare, safety of premises, safety and suitability of equipment, nutritional standards, dealing with serious incidents, record keeping and cleanliness. That is simply not good enough.

When I challenged the hospital management, the response was invariably, “We’re no worse than anyone else; we just get more scrutiny.” Indeed, in one letter the then chief executive criticised the sensational reporting of some unnecessary deaths at the trust and asked for my assistance in acquiring more positive media coverage, a clear example of the complacency to which the Prime Minister referred when he made his statement to the House on the Francis report. There simply has not been sufficient urgency in addressing weaknesses. That led me to conclude that the trust would not improve without a change in leadership—the same conclusion the CQC reached in 2009.

I also have some wider reflections on the systems of governance. At Basildon, the board clearly failed in its duty to provide effective challenge and to hold the management to account. I think that we need to give a clear indication to directors of foundation trusts that in the event of poor performance, the buck stops with the board. They are accountable and they need to accept that responsibility.

I must say that I found the CQC a very positive ally in seeking better performance at Basildon. I know that it has been criticised by some Members, but my feeling

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is that its powers were quite limited. It certainly had no power to hold senior management to account, a power that is reserved for Monitor. My right hon. Friend the Secretary of State has made his comments about the CQC, but I think that he really needs to look at Monitor. In my experience, the work of Monitor has been very disappointing. In Basildon it was not keen to take any enhanced action. Its view was that the trust was not doing as badly as it had been in 2009 and so the direction of travel was positive, even though it was failing to meet the basic standards of care that the public should be able to expect. I do not think that is good enough. It goes to the heart of what we are debating today: the collective failure of institutions in the NHS to hold people to account when things go wrong. I urge my right hon. Friend to look at whether Monitor is really fit for purpose.

Since I started challenging Basildon and Thurrock NHS Foundation Trust, I have been very heavily criticised, as if by holding the hospital to account for its performance I am attacking the NHS and its staff. The contrary is true. If we really believe in the NHS and in providing the best possible health services for our constituents, we must challenge it when things go wrong. We should have zero tolerance of failure. Do we not owe it to the staff who do their job well to ensure that those who do not are disciplined and held to account for poor conduct?

Thankfully, Basildon and Thurrock NHS Foundation Trust is now under new leadership. There are new non-executive directors who will provide a challenge. We have a new chairman, a new chief executive and a new medical director, and I am encouraged by the messages I have received from them. However, when senior management have been excusing poor practice for so long, there is a need for profound cultural change to get things fixed. An NHS with a stronger emphasis on accountability would have allowed us to start that process in Basildon so much sooner and to save many lives.

4.28 pm

Christopher Pincher (Tamworth) (Con): I would like to make two brief points. First, will my right hon. Friend the Secretary of State, when he comes to review the Francis report, heed the cause of Robert Francis, and indeed the passionate appeal of my hon. Friend the Member for Wycombe (Steve Baker), by extending the provisions on criminal liability so that in the final analysis charges of wilful obstruction of complaints and wilful neglect can be preferred? Had such sanctions been in place 10 years ago, we would have seen charges preferred at Mid Staffordshire, and then we might have seen the interesting spectacle of Ministers and former Ministers being called to the witness box to give evidence in defence of those public officials who were claiming that they were only obeying orders and pursuing the policies of their political masters. I think that sort of sanction would be enough to focus the minds of any Minister, past and present, even those who wriggle and twist to try to avoid their responsibilities.

Secondly, I wish to make a point about culture change. We have had the report and the debate, but it would be foolish to assume that there have been any great strides forward as part of a culture change in Staffordshire. I will give one example. After the Francis report was published on 6 February, South Staffordshire PCT issued a press release which said:

“Much has been learnt”—

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that word again—

“since 2009 and the PCT now operates with quality at the centre of all that we do.”

My constituent Tom Berry might take issue with that statement. Tom is a gifted young man who is pursuing a degree at Wolverhampton university but suffers from spinal muscular atrophy, which means that he can barely move. He has round-the-clock care from a team of carers. When he needs to cough, those carers have to compress his torso—that is the kind of help that he needs. However, those at the Staffordshire NHS cluster seem to have forgotten his needs and want to change his care package, against his wishes, against the wishes of his family and carers, and against the advice of his GP. I have tried to help him, but the head of continuing care in Staffordshire refuses to answer my letters and hides behind lawyers in refusing to acknowledge my calls to heed the advice of Tom’s GP.

When I threatened to blow the whistle on that conduct in this House, I secured a conference call from the chief executive of the Staffordshire NHS cluster, Graham Irwin. He did not bring to that conference call the head of continuing care, or a clinician, or a carer—he brought his press officer, which suggests to me that, in Staffordshire, medical care runs second to media management. Although he was very insistent that Tom’s care package should still be changed, he said that he did not even know whether a proper impact assessment had been done on the effect of that change on Tom’s health. He said that he would go away and look into it, but three weeks later, after another phone call and another letter, we still do not know what is happening.

If Francis is right when he said that our

“comfortable set of assumptions about the NHS have been misplaced”,

he is certainly talking about what is going on in Staffordshire now. We still have a culture of complacency allied to determined obfuscation. I say to my right hon. Friend the Secretary of State that if we are to restore the battered credibility of care in my county, we need to ensure that we put patients, and not the godhead of targets, front and centre. We need to ensure that we recruit, recognise and reward the best people and sack the worst people. As my right hon. Friend the Member for Mid Sussex (Nicholas Soames) said, we cycle too many bad people through our public services. We need to make sure that when there is wrongdoing, people are punished not in the court of public opinion but in a court of law. If we do that, we can rebuild and restore confidence in our health service in Staffordshire, and we will have a system about which we are prepared to blow the trumpet, not blow the whistle.

4.33 pm

Tracey Crouch (Chatham and Aylesford) (Con): I congratulate my hon. Friend the Member for Bristol North West (Charlotte Leslie) on securing this very interesting debate, which has covered lots of issues to do with accountability and transparency, not only at Mid Staffordshire but throughout the entire country. It is clear from the speeches by the right hon. Member for Cynon Valley (Ann Clwyd) and my hon. Friend the Member for Wycombe (Steve Baker) that these concerns go beyond the appalling events at Mid Staffs. My own constituents need reassuring about their patient care, the quality of the information they are receiving and,

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unfortunately, the mortality rates at Medway Maritime hospital. Like other hospitals, it is now under investigation, and we await the outcome with interest.

It often takes a very long time for the truth about these matters to be completely uncovered. In the past, the quality of patient care has, in many respects, been secondary to the hospital meeting its targets. That is a shame, and it is part of the culture that we need to change. I do not want to believe that there is a culture of cover-up in the NHS. Like my hon. Friend the Member for Totnes (Dr Wollaston), I think that all those who work in the NHS—the nurses, the doctors and the consultants—do a brilliant job in delivering good quality care and the best patient outcomes. Unfortunately, that was not the case at Mid Staffs, and concerns about quality of care and mortality rates are spreading. As I have said, constituents are now concerned about the care they receive at the Medway Maritime hospital.

The trust is always incredibly good at responding to my questions, whether they be about what I consider to be the high use of the Liverpool care pathway at the hospital, constituent complaints, dementia care or specific patient services. However, I fundamentally believe that if a constituent has to involve an MP in a complaint, the system has failed. There is a growing perception that if someone complains, it is their fault and they are in the wrong, while the hospital paints itself as the victim of the complaint rather than the other way around. That is wrong.

The Medway Maritime hospital is under investigation for higher than expected hospital standardised mortality rates, and there is currently a specific outlier alert on septicaemia. Worryingly, this is not the first time this has happened. Discrepancies in coding were highlighted way back in 2008 with the discovery that 8% of deaths were being recorded as end-of-life care when the proportion should have been 37%. Adjusting the mortality index to exclude those deaths reduced the hospital’s score by more than a third. A clear manipulation and distortion of the information only served to damage the best outcomes and services for the patients. I hope that that will not happen again. However, as an outsider it appears to me that the complexity of coding is part of the problem with the lack of transparency.

A culture of bullying and its suppression within the NHS has been mentioned. The latest staff survey at the Medway Maritime hospital shows that there is still a perception that bullying is widespread. If we want to improve standards in patient care—which is a key aspiration for the newly restructured NHS—that has to be one of the most important issues to address. I welcome today’s announcement by the Secretary of State, but may I make a practical suggestion that was put to me by a GP this morning? One of the problems with the system for complaints is that they stay within the hospital—they go up to the management board and do not really go beyond it. Instead, complaints could be delivered on a quarterly basis to the new clinical commissioning groups, which would enable people outside the hospital structures to look at potential trends and patterns of poor quality, and at whether there are concerns about specific consultants. We could end up taking the responsibility from the hospital, having the outsider look in, and making more practical changes.

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Greater transparency in the NHS is not just about honesty and accountability, but about better communication. As the most recent ombudsman report highlighted, the common pitfalls are also the result of equivocal language over care, the use of technical language and the failure of insincere apologies. We need to learn the lessons of the Francis report; patients from those families who use my local NHS services deserve nothing less.

4.38 pm

Nick de Bois (Enfield North) (Con): I will never forget the last time I saw my mother. It was three days before the general election in 2005. She had secondary cancer, but she was a fighter, though I make no comparison between her circumstances and the Francis report and the horrors that people went through at Stafford.

There are many reasons why someone might remember the last time they saw their mother, but my experience is overshadowed by a sense of guilt. During my mother’s long stay in hospital—she had been in and out—my brother, who lived abroad, had often been with me and he persistently picked up that the pervading culture on the ward was that he who shouted loudest got attention. My mother would describe how much pain and discomfort she was in—other Members have mentioned similar problems—and say, as elderly people do, “Don’t make a fuss.” To his credit, my brother dealt with it by shouting loud. On that last day, my brother was not with me because he had returned abroad. Unfortunately, I did not shout that day. I went back to the election and my mother sadly died. I am not drawing a comparison with what happened in Stafford, but many patients and relatives will recognise that one has to shout loudly to get heard. That points to a problem with the culture.

In 2005, to their credit, the last Government were increasing spending on the health service. However, that suggests to me that the answer to improving outcomes and care is not about money. We can pour a lot of money in, but it will not do the trick. It has its role, but it is not the final driver. I hope that one of the legacies of Francis will be that we can recognise that the debate needs to move on. It should not be a bidding war between different political parties and ideologies about money. It should be about the thing that matters most: will patients get better, will they receive quality care and will they be treated with respect and dignity, come what may? If we drive a mature debate in this country, we can achieve outcomes on that basis.

As Opposition Members have said, perhaps we can step aside from politics. I am not naive and I do not believe that that will happen. However, every time we debate these matters, let us remember that we have a far greater chance of achieving what we are here to do, which is to provide a health service that is the envy of the world, if we have a mature debate. I say cautiously and with respect that in the light of Francis, our health service cannot currently be the envy of the world, but its ideals are most definitely the envy of the world. We have a duty in this place to set the standards that will make it the envy of the world once more.

I am very conscious of the time, but I would like to make one quick point. We have heard a lot about the culture, but we cannot change it just like that. Culture is thoroughly and utterly inbred within any institution. It starts with the new people it trains—that includes the

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people who are there now—and it touches everything that it does. Everything that an institution does should reflect its culture, and changing the culture therefore takes time.

Where I disagree with some in this House is in my belief that leadership is where culture starts. This House, managers in hospitals and trainers all have a role to play. However, every time I consider the role of the current chief executive, Sir David Nicholson, I come back to the point that although he has voiced sentiments that I welcome in that he said that to achieve care we need an open, transparent and care-led culture, that it is vital for staff to be seen as an asset, and that it is vital for staff to be able to challenge their leaders, the reality is that he is a command-and-control manager. That is his legacy and others have paid a price for it. I believe that his departure, whenever it may happen, is absolutely necessary to change the culture because we need to start at the top and feed it throughout the business. I say that with a heavy heart, because I do not believe that we should be chasing scalps. However, as I said at the beginning, we should be chasing the ultimate outcome of serving our patients and that is one way of doing it.

4.43 pm

Neil Carmichael (Stroud) (Con): This debate has been thorough and, at times, moving. I congratulate my hon. Friend the Member for Bristol North West (Charlotte Leslie) on securing it. I was impressed by the moving speech of the right hon. Member for Cynon Valley (Ann Clwyd) because it demonstrated the tragedy that lies behind this debate.

The Francis report is a disturbing document in many ways. The Prime Minister and the Secretary of State for Health are right that we should not be looking for scapegoats. I do not want us to find any scapegoats and I am sure that you, Mr Deputy Speaker, do not want us to find any scapegoats. We must remind ourselves what a scapegoat is: it is somebody who gets the blame for somebody else’s behaviour. The question that we must ask is who is responsible. That is at the core of this debate. If we cannot find out, we must produce a system that has a mechanism for responsibility.

When someone accepts responsibility, it is refreshing and empowering. If a manager avoids that responsibility, they are effectively acknowledging that they are weak and insufficient at their job. If someone cannot answer those questions and does not feel able to say, “The buck stops with me”, they are not doing their job properly. We need to think about that system of responsibility and accountability.

Can gagging be consistent with effective, decent line management? Absolutely not. A person is effectively saying that someone beneath—or even above—them cannot say what they need to say. A show cannot be run with that kind of mechanism, and we should certainly not be content with the number of gagging clauses we have heard about today. I welcome the end of gagging clauses, and pose the same question that others have asked the Secretary of State: is the move retrospective?

Line management is also about culture because we must be able to trust people when we ask for something to be done, and know that the message is getting out and is clear and fair. That is what good management is. It is not just an issue in the health service; it is an issue in any organisation, and that brings us to the overall

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question of governance. Governance applies everywhere and must be accessible, transparent and something in which people have confidence. As hon. Members have pointed out, there is far too much buck-passing and evasion, and that will not help us arrive at a decent culture for patients, which is what we should be focusing on. Of course we are right to talk about “patients” rather than “targets”, but we also need patients to feel comfortable with the system in which they are operating.

My hon. Friend the Member for Enfield North (Nick de Bois) made a good point about speaking out. Many of us can speak out and do so nearly every day on a variety of subjects. Some patients cannot, however, and need additional advocacy that sometimes does not come easily to them or their friends and family. Just imagine them in a management system in which people cannot listen or talk to each other, let alone take into account the views of patients!

We must have a change of culture and, as the old saying goes, a fish rots from the head. This is about leadership and shaping a culture that effectively manages to spread out everywhere. That culture must be inclusive, transparent and open and effective at empowering people at every level, rather than shutting them down and isolating them in systems that are too complicated to feel comfortable in.

Finally, I welcome the appointment of a chief inspector for hospitals. That is a necessary appointment and will make a huge difference. They must, however, look at the leadership of what he, or she, is inspecting. Leadership is fundamental and matters, and we must ensure it is responsible and accountable.

4.48 pm

Dr Thérèse Coffey (Suffolk Coastal) (Con): It is a pleasure to contribute to this important debate, and I congratulate my hon. Friend the Member for Bristol North West (Charlotte Leslie), and other Members, on securing it. Transparency and accountability are the hallmark of good governance, but they can involve issues such as whether a patient is on the Liverpool care pathway, whether that is transparent and whether their families know, not solely about the running of a particular trust.

I welcome freedom of information requests, which are among the most useful tools available to a Member of Parliament trying to secure information on data held by hospitals, ambulance services and so on. It is extraordinary, however, that we must resort to those tools to try to get that information and help in holding the people running our services to account.

I accept that the NHS is a complex organisation—imagine a hospital that has issues with bed-blockers, social care, or people trying to find a place in a home, or where ambulances are exceeding their handover targets. Those are interlocking issues. I still think, however, that it is important to hold the chief executives and boards of these trusts to account.

I was late today because I was at a meeting with the chairman and chief executive of our ambulance trust. This is not the first time I have had to work with other MPs to highlight particular failures. In a Westminster Hall debate, I called for the chairman of James Paget hospital to step aside. I have not made that call today. I have asked the chairman of the board to consider carefully the potential issues arising from the CQC

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report that is due to come out at any moment. It is frustrating that in trying to hit the target people often miss the point. The point is to care for patients.

The Care Quality Commission and Monitor were mentioned earlier. I welcome the changes made by my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) to introduce unannounced spot checks by CQC. A lot of issues were unveiled as a result of the changes and that is to be welcomed. I welcome the recommendation to merge the CQC and Monitor, as there is a risk of ambiguity over exactly which body is holding people to account. I welcome the move by the Secretary of State to have Ofsted-style inspections. I am sure he will learn lessons and ensure that they are focused on clear issues, and not just on myriad matters that get away from the key point of patient care.

MPs in the east of England came together and, by speaking to the CQC and providing evidence, we managed to stop the ambulance trust gaining foundation trust status, because of the issue of care. Politicians therefore can and should intervene when there is evidence of things going wrong, and not just accept the initial recommendation of Monitor.

I pay tribute to David Hill, chief executive of James Paget hospital. He had been chief executive of the hospital before and went elsewhere in the health care system. He came back and within a week I could see that he had made a difference in the attitude to care. A year on, I am delighted to report that all the warning notices have gone and that in the latest unannounced inspection it was given a clean bill of health. That is great news for the patients and great news for the staff. It is a reminder that being brave and being prepared to incur the wrath of people who assume one is attacking the NHS when one is actually trying to defend the NHS and patients, can be worth hile.

That leads me on to the matter of the difficult jobs we have to do. We have to remind all our governors and board members that they are there to represent the patients. They should not feel cowed. They should be tenacious in pursuing the outcomes that everybody wants in the NHS. These are not easy times—I appreciate that. Let us not have too much hand-wringing about how hard it is. We all know it is, but I believe that politicians of all parties are here to try to support the people. We will not do that by ducking the reality that we have to be accountable. That is true in this House if we let down our constituents, but it is also true for the members of boards who do not hold their chief executive to account and demand nothing but the best for their patients.

4.53 pm

Charlotte Leslie (Bristol North West) (Con): This has been an excellent debate. I thank the Secretary of State, who has been here for the duration of the debate—as

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indeed has the shadow Secretary of State. I think there can be general agreement that there has been a catastrophic failure of leadership. That was well and forensically expressed by my hon. Friend the hon. Member for North East Cambridgeshire (Stephen Barclay). It is worth nothing that although there may have been instances—there certainly have been—of clinical failures, it is only possible to hold to account those managers who have a medical qualification registered with the General Medical Council.

We had a blast of reality from the moving and extraordinarily memorable speech by the right hon. Member for Cynon Valley (Ann Clwyd). I thank her, and the people who wrote to her, for sharing their tragic stories. We had powerful and thoughtful speeches from Members involved in the Mid Staffs tragedy, including my hon. Friends the Members for Cannock Chase (Mr Burley), for Stafford (Jeremy Lefroy) and for Stone (Mr Cash). The debate benefited from the experience of Members who have worked directly in the NHS, including my hon. Friends the Members for Totnes (Dr Wollaston) and for Bracknell (Dr Lee), and from the political experience of those such as the right hon. Member for Holborn and St Pancras (Frank Dobson). I thank everybody for their contributions.

This has been an important debate, in that it has finally provided a voice for many people who have been kept silent for so long. Another lesson that we can draw from it is that it is not systems but people who care in our health service. We can take away from the debate the many mechanisms of accountability and transparency that have been suggested, as well as suggestions of how we can nurture the professionalism and the best instincts of those who work in our NHS. Let that be a mission for all of us. We must also really ensure—perhaps in contrast to what has been done before—that patients are at the very heart of what the NHS is all about.

The debate has been enormously important, and I hope that it marks the beginning of a consensus and of a cross-party drive to ensure that the scandals and tragedies that we have seen throughout our health system never occur again. I also hope that this marks the forming of a platform for the many people out there who do not have the benefit of parliamentary privilege. It is our duty to ensure that their silence—in many cases, a deadly silence—is ended by this debate and that a new era of transparency and accountability, which should be seen in by a new set of personnel in our NHS, begins here.

Question put and agreed to.


That this House believes that in the wake of the Francis Report it is clear that accountability and transparency are of paramount importance to patient safety and trust in the NHS; and further believes that across the NHS individuals found to have breached those principles should face the appropriate consequences.

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Immigration Rules: Sponsors

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

Mr Deputy Speaker (Mr Nigel Evans): Before I call Kerry McCarthy, I must explain that, at 5 o’clock, the hon. Lady will be interrupted so that the same question can be put by the Whip. It is a procedural thing that will no doubt be looked at by the Modernisation Committee.

4.56 pm

Kerry McCarthy (Bristol East) (Lab): The issue of immigration is, as ever, highly topical—I cannot remember a time in my nearly eight years in Parliament when it was not—but I want to focus today on one specific aspect of the immigration rules that has put some of my constituents in a difficult position. I know from the responses I have received from other Members that it has affected some of their constituents, too. A number of Members have asked me whether I would be prepared to take interventions during the debate, and I am happy to do so.

The Government have introduced a new minimum income threshold of £18,600 for someone who wishes to sponsor the settlement in the UK of a spouse, partner, fiancé, fiancée or proposed civil partner whose nationality is not that of one of the European economic area countries. A higher threshold applies if the partner—I shall use that term as shorthand from now on—has a child who requires sponsorship, too. It is £22,400 for one child and an additional £2,400 for each further child. There are also rules about adult and elderly dependants, which I do not have time to address here. The British Medical Association, among others, has raised concerns with me about the operation of those rules.

Significant concerns have also been raised with me about the time it takes to process applications that meet all the rules but, again, I do not have time to address them in detail tonight. I will just say that no newly married couple wants to contend with delays when one partner is trying to join the other in this country, and it would be helpful, and humane, if such cases could be speeded up, especially when they comply with all the rules and it is just an administration problem that is holding things up.

Today, however, I want to talk specifically about the income limits. I accept, as do my colleagues on the Labour Front Bench in the Home Affairs team, that family immigration rules should be firm, but they also need to be fair. We need to keep the rules under review, and to adjust them as appropriate to deal with possible abuses and to manage migration at acceptable levels. I do not feel that it is right, however, that the rules should be used to prevent those in genuine, loving relationships from being able to share a life together in this country, when one of them is already a British citizen.

We have always had the “no recourse to public funds” rule, and I have dealt with many cases in which that has proved an obstacle to people wanting a partner to join them here, but I accept the need for such a rule to protect UK taxpayers, provided humanitarian grounds for exception can be applied. We are not, however, talking about cases where the people involved would be dependent on state support. We are talking about cases

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where the sponsor is in work and is a British citizen, but does not earn enough. By way of illustration, I want to outline the details of three cases. My constituents said they were happy for me to provide the details of their cases, but they did not want their identities revealed. I shall refer to them as Mr X and so on.

The first case relates to Mr X, who for 10 years has lived in Thailand with his Thai wife and their three-year-old child in a long-established relationship. He now needs to return to the UK to look after his elderly parents who are recovering from cancer and are no longer able to travel to Thailand—

5 pm

Motion lapsed (Standing Order No. 9(3)).

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

Kerry McCarthy: As I was saying, Mr X needs to return to the UK to look after his elderly parents who are recovering from cancer. They used to go on a fairly regular basis to visit him, his wife and child, but they are now too ill and infirm to visit. Mr X has a professional job in Thailand, which he has held down for a long time. It is a decent salary according to local rates, but it is not the equivalent of the £18,600 earnings limit in the UK. It is enough to provide him with the same living standards in Thailand as he would have if he were on that sort of salary in the UK—it is obviously a lot cheaper to live there. Under the new rules, Mr X will have to leave his wife behind while he finds work in the UK, which he is not prepared to do—by which I mean not that he is not prepared to find work, but that he is not prepared to leave his wife behind. They are now considering moving to Spain instead, so that he is reasonably close to his parents and it will be easier for his wife to join him, perhaps becoming a Spanish national, which would then allow them to enter the UK.

Kate Green (Stretford and Urmston) (Lab): I congratulate my hon. Friend on securing this debate. She is describing a situation that we on the all-party group inquiry into family migration have heard several times. Does she agree that there is a further nonsense to the situation she describes? If the family is not able to come in and look after the parents, instead of the family providing care, this will pile costs on for public social care and public health services.

Kerry McCarthy: My hon. Friend makes a very good point, as she always does. If I understand the Government’s ideological position on this issue, they want to support families and very much approve of carers taking on responsibility for elderly parents or others within their family network. The rule that we are talking about operates to prevent that from happening.

The second case features Mr Z and Ms Z who came to see me in my constituency surgery a few weeks ago. They were married in the UK in March 2011. She is a British citizen and her husband, who had been living and working in the UK for six years under a valid work permit, is South African. He was in highly paid professional work in the UK, but soon after they married, he was made redundant. Although he could probably have secured another job at a similarly high salary in the UK, they decided to take a chance and move to Cape Town for a couple of years.

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After two years in South Africa, however, they have decided that they want to return to the UK, but the rules changed while they were away. He will not be allowed to join his wife in the UK unless she earns more than £18,600—despite the fact that he is a highly skilled computer programmer who could expect to earn perhaps £60,000 a year in the UK. Before they left for Cape Town, my woman constituent was earning £26,000 a year as a pub manager. As she has been out of work for two years in Cape Town, however, there is a gap in her CV, so she is unlikely to be able to walk straight back into a manager’s position, although she aspires to do so in a couple of years’ time. Wages in the pub trade are not particularly high, so it is likely she will start on a salary below £18,600. As I said, they would have a joint income as a family of about £75,000 because her husband could get a well-paid job, but under the new rules it is based on her income, so he would not be able to join her.

Fiona Mactaggart (Slough) (Lab): My hon. Friend cites a number of cases. I think this whole process is unfair because it is quite clear that families who can afford to maintain themselves without making any demands on public funds are being kept apart. My hon. Friend has cases of people returning to the UK, and just this week I have had two constituents contact me about similar issues. One case was a man returning here from India who has £82,000 in a UK bank. Clearly, he and his wife could properly maintain themselves. However, savings do not count. The man is self-employed, but will not have the long record of employment needed to meet the £26,000-plus requirement, so he is unable to have his wife here with him. The other person—

Mr Deputy Speaker (Mr Nigel Evans): I am sorry to interrupt the hon. Lady, but this is supposed to be an intervention, not a speech.

Kerry McCarthy: Perhaps when I have spoken for a little longer, my hon. Friend the Member for Slough (Fiona Mactaggart) will be able to intervene again and make her second point. Indeed, if she intervenes several more times, she may eventually be able to tell the whole story.

I understand that those who earn less than £18,600 can top it up if they have savings, up to a maximum of £62,000. A constituent who was in that situation came to see me the other day. Perhaps the Minister will be able to clarify the position when he responds, but I think that people have to show that they have had the money in their accounts for six months and it has not just been lent to them.

The final case to which I want to refer is that of a constituent whose girlfriend is based in Hong Kong, but is of Philippine origin. He wants her to join him in the United Kingdom, but they cannot marry. She was married to an abusive husband in the Philippines—she fled to Hong Kong to get away from him—but divorce is illegal in the Philippines, which in itself raises interesting questions. What happens if someone from the Philippines comes to this country and wants to marry a British citizen? What will be the impact on that person’s immigration status if that is not allowed?

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The couple cannot live in the Philippines together, which is an option that they explored. If my constituent were in a relationship with an undivorced woman in the Philippines, he could face seven years in jail and she could face three to four years.

It turned out, after we had looked into it, that my constituent’s income is just enough for him to qualify under the rules. He came to see me because he had heard about the £62,000 savings limit, and thought that he was expected to have that much money in the bank on top of his income. However, if he had earned just £100 a month less, he would not have been able to bring his partner to the United Kingdom either. They were exploring the possible options. His partner was considering going to Canada, and he thought that perhaps he would be able to join her there.

The situation is ridiculous. My constituent has family responsibilities, and is settled in employment in the UK. The fact that he would have been forced to go to the other side of the world to be with his partner when she could join him here seems nonsensical to me.

Mr Virendra Sharma (Ealing, Southall) (Lab): Does my hon. Friend agree that the rules go against the basic principle that families should be united rather than divided? These financial conditions are dividing not only husbands and wives but parents, grandparents and others. Are they not unfair and discriminatory, especially to those outside European Union countries?

Kerry McCarthy: I think that the Government are trying to avoid circumstances in which spouses or fiancées, for instance, are used as a form of chain migration. I have seen that happen, and I accept that the system is open to abuse and should not be abused in that way. I have come across instances in which people first apply for permission for a spouse to join them in this country, and then extend the application to elderly parents, or perhaps younger brothers and sisters. I accept that we have to manage migration to this country, and that we ought to control such situations. However, none of the cases I have cited involves anything like that.

People are increasingly working and studying abroad. People are going off to university in other countries, meeting their partners there, and then not being able to return to the United Kingdom with their partners until they have established themselves on the career ladder. It is not uncommon now for graduates to start work—if they can start work; they may be on unpaid or paid internships or low-paid jobs for the first couple of years after graduating—but to be unable to bring their partners into this country. I recognise the need to ensure that new migrants to the UK do not increase the burden on the British taxpayer, but many couples survive on less than the average income without being a burden on the taxpayer.

Fiona Mactaggart: The earning capacity of the spouse from overseas cannot be taken into account. I received a tragic e-mail today from a man who wrote “I cannot get the money. I fell in love with my wife. What can I do? I am really scared.” His wife speaks fluent English, and is a qualified science teacher in Algeria. She would have been able to contribute to science education in my constituency, but she is not going to be able to come here.

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Kerry McCarthy: That is a valid point and I was about to come on to it. Why is this based only on the sponsor’s salary? As I mentioned, it is highly likely the couple currently living in Cape Town would have a joint income of £75,000 or more, so they would not in any way be a burden on the state.

Basing things solely on the sponsor’s income will inevitably have a differential impact on women who seek to bring their partner here, because, sadly, it is still a fact of life that women are likely to earn less than their partner. Of course, this is even more likely when a child is involved. If a couple wish to return to the UK because the woman is about to give birth—which means she will not be working for the next year or so—they will not be able to do so, even if the man has an offer of a well-paid job here, unless he meets the increasingly stringent rules for getting a work visa, which would mean he would have to work in a specific field where there is a skills shortage.

I want to make a point about flexibility, too. In the current economic climate, people can lose their jobs at the drop of a hat, and these rules do not deal with the realities of life. People can be earning a decent income one day but not the next day, and then be back in work a month or two later. How can the rules be sufficiently flexible to deal with such situations, rather than just penalise people?

What representations has the Minister received about cases that fall into this category? From the research I have done, it is clear there are many such cases. Stories have been reported in the newspapers, too, and many MPs have constituents who are caught up in this situation. What analysis has the Minister done of the sort of people caught under these new rules, and in the light of some of the human stories he has heard—stories of couples who simply want to be able to spend their lives together in the UK—has he given any consideration to revising the rules and allowing more flexibility in decision making?

5.11 pm

The Minister for Immigration (Mr Mark Harper): I am grateful to the hon. Member for Bristol East (Kerry McCarthy) for giving me an opportunity to set out the Government’s thinking. As she was speaking, I was thinking through a number of responses, and I hope I can also respond to the multiple instalment story from the hon. Member for Slough (Fiona Mactaggart), who finally got it all out, I think.

Let me first set out a bit of background to put this matter in context. As part of our general reform of the immigration system across all the routes coming to the United Kingdom, we undertook a major overhaul of the family routes. There were three aims: to prevent burdens on the taxpayer, to promote integration, and to tackle abuse. The hon. Member for Bristol East’s focus has been on the financial requirement, which is the minimum income threshold of £18,600 a year to be met by those wishing to sponsor a partner of non-European economic area nationality to settle in the UK, with higher levels for those who also sponsor dependent non-EEA national children.

The point of the requirement is to prevent burdens from falling on the taxpayer and to promote successful integration. To put the story round the other way and to

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throw it back at the hon. Lady and the hon. Member for Ealing, Southall (Mr Sharma), people can come here to establish their family lives, but we ask that they should not expect the taxpayer to fund that.

The hon. Lady raised the point about no recourse to public funds, which has always been in place, and suggested that was a sufficient protection for the taxpayer. The problem with that is twofold. First, under the immigration rules only some things the taxpayer funds are classed as public funds. The things that are not considered as public funds are NHS costs, social care, contribution-based jobseeker’s allowance, incapacity benefit, maternity allowance, retirement pension and statutory maternity pay. A range of funds, therefore, are not excluded under the no recourse to public funds measure. If someone comes to the UK under no recourse to public funds, we would still have to provide health care to them, therefore, which may well be a burden on the taxpayer.

Fiona Mactaggart: Most of the benefits to which the Minister has referred are contribution-based, and therefore are not relevant. On health care, however, I think most of our constituents would be quite happy if there were a requirement looking at some way of paying for health care, because part of the point of this is that there are lots of cases where people will have enough money on any system, but not on this rule.

Mr Harper: Let me come back to that. The specific cases that the hon. Lady and the hon. Member for Bristol East raised can I think be dealt with elsewhere in the immigration rules; that comes back to the point about representations.

Kerry McCarthy: It seems to me wrong that if someone is earning a modest income, their partner or child cannot access the NHS, but if they are wealthy, they can. Surely that goes completely against what the NHS is meant to be about. The Minister is saying that there is a different rule for people who earn more, meaning that their partners can get NHS treatment.

Mr Harper: No, the hon. Lady misunderstands me, which I am sure is my fault for not explaining the situation. The point is that if someone comes here and we say they have no recourse to public funds, they do have access to the NHS. I think the hon. Lady was arguing that because someone on a modest income who brings their family member here could not access public funds, that would not place a burden on the taxpayer. My point was that if, for example, that person needed to access the NHS, they could, and of course that burden would fall on the taxpayer, even though the income-earner’s contribution to the Exchequer may be very modest.

The other, wider, issue concerns the way our welfare system works. The presence of the partner may of course increase the benefits that the British national is entitled to. Although the migrant might not be entitled to housing benefit, for example, their presence may well increase the amount that the UK citizen is able to claim. That may give rise to a genuine issue about how our welfare system works—that is another debate—but given how it works, it is not quite as simple as saying that because there is no recourse to public funds there is no burden on the taxpayer from their presence.

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I want to say something about a change relating to integration, albeit briefly as it does not fall within the category of finance. We think English language skills are very important, which is why, from October, we are increasing the level of English language skills we expect. That is partly to give those who come here the best possible chance of integrating—participating in the workplace and being part of the community.

Neil Carmichael (Stroud) (Con): The Minister is making a really important point. People are welcome, providing they can contribute to the society they are joining. That is surely good for them, too. Does the Minister agree that the central point regarding language and income is that they feel comfortable, involved and included?

Mr Harper: I do, and that goes back to the central point of the debate.

I was about to give a little background to how we arrived at the particular sums of money involved, because that is helpful—

Fiona Mactaggart: Will the Minister take this opportunity to commit to making sure that in every country, applicants who are trying to come here to join a spouse can actually get the qualifications he is going to require of them?

Mr Harper: My understanding is that people are able to do that. I can tell from the way the hon. Lady is looking at me that there is a point behind her question, so if she will do me the courtesy of dropping me a line, I will examine the argument she is making and get back to her, rather than diverting the debate away from its central point.

Dr Julian Lewis (New Forest East) (Con): At the risk of diverting the debate for just a fraction longer, I worry a bit about this language test. I come from a third-generation immigrant family, and my grandfather to the end of his life spoke English haltingly and with a thick foreign accent. What mattered was that he was able to undertake a productive trade, and that his children and grandchildren were not cosseted by being taught in the language of the country they had left, but were properly educated in the language of the country they had joined. To have too stringent a language test is to look at the problem the wrong way round.

Mr Harper: I was listening very carefully to what my hon. Friend said, and I will reflect on it. I thank him for making that point.

Let me say a little more about the financial changes—

Dr Thérèse Coffey (Suffolk Coastal) (Con): I am glad that my hon. Friend is moving on to that point, because residents in my constituency are surprised that the limit of £18,000 is so low, given that we hear concerns about the benefits cap of £26,000. I am delighted that he is going to explain why the limit is £18,000—of course, it is more for people with children.

Mr Harper: The previous requirement, which I think has been alluded to, was that applicants had to be “adequately maintained”. The courts generally interpreted

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that to mean income equivalent to the level of income support for a British family of that size, which was about £5,500 a year for a couple at that time. Our view was that that level of income was not an adequate basis for sustainable family migration and did not provide adequate assurance that UK sponsors and their migrant partners could support themselves and their children over the long term.

The previous regime also required quite a complex assessment, both for applicants and caseworkers, of current and prospective employment income and other financial means. It made decision making difficult, as was highlighted by the independent chief inspector’s report of 24 January on the processing of applications under the old rules for spouses and partners. Again, that was partly why we wanted a financial requirement that was clear and transparent; applicants would know where they stood, and we could make clear and timely decisions.

The minimum income threshold is £18,600 a year, with a higher amount with those sponsoring dependent children—it is £22,400 for those sponsoring one child and an extra £2,400 for each further child. We based that on the expert advice of the independent Migration Advisory Committee. It gave us a range of figures and that was at the low end. Its figures went up to about £25,000, a level at which someone would be making a net contribution to the Exchequer. The £18,600 level we settled on is broadly the income at which a couple, once settled here, cannot access income-related benefits. It is not an exact match, but it was as close as we can get. Our approach broadly says, “If they are here earning that amount of money, they are going to be able to stand on their own two feet and not expect the taxpayer to support them.”

Kate Green: I understand the logic the Minister is outlining, but when benefits are assessed for a household they are assessed on a household basis. So this approach does not appear to address the point that has been made about ignoring the income of the incoming spouse.

Mr Harper: The hon. Lady makes a very good point, which I am coming on to address. In most cases—this comes back to the point about representations—including one of the cases the hon. Member for Bristol East raised and the one mentioned by the hon. Member for Slough (Fiona Mactaggart), there is often an alternative way, through the immigration rules, of someone getting to the United Kingdom. So the reason we do not take into account—

Kerry McCarthy rose

Mr Harper: Let me just develop the point, because either I will answer it satisfactorily or I will not and the hon. Lady will then be able pick up the point she thinks I have not answered adequately, rather than getting in first. I will make two points. First, we do not take into account the previous income of the migrant partner when they apply for entry clearance mainly because what someone happened to be earning elsewhere is no guarantee of their finding work here. However, in the case she highlighted of the female British citizen with a South African husband and in the case that the hon. Member for Slough mentioned of the skilled science

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teacher, although the partner may not be able to get entry clearance to come to the United Kingdom as a spouse, they would of course be able to apply under our tier 2 skilled working visa to come to the United Kingdom. They could then get entry clearance on that basis and once here in work, earning an income, they would be able to switch into the family route. They could then show that they could earn that level of income and that would then be taken into account. So people who would be able to come here to work in a skilled job could come here under an alternative route and once they have established the fact of earning that level of income, they would be able to change their status under the spouse route, with the appropriate route to settlement. So certainly the South African husband could follow that route and it would work for him.

Kerry McCarthy: My understanding is that he would be able to do that only if his job could not be filled by a UK person. He is a computer programmer and, obviously, there are a lot of those in this country already, so he would not meet the criteria: no employer would say that the skills they required could be met only by him and not by anyone else. He has worked in the UK for six years under a work permit and it was unfortunate that the couple left the UK for a short time and the rules changed while they were out of the country. Had they not done so, they would have been able to go down the route that the Minister suggested.

Mr Harper: Under the tier 2 rule, it has to be a skilled job and they have to undergo a resident labour market test. So if he has a particular employer in mind, the rules may be a little more inflexible in the sense that he may not be able to say a specific employer, but if he has skills to offer, there are many occupations in which there is a shortage of people. If it is an occupation on the shortage occupation list, the employer is not required to undergo a resident labour market test. There are therefore opportunities in certain cases for someone to come here.

The hon. Member for Slough highlighted the issue of savings. Despite the fact that I managed to throw together some maths A-levels, that was a long time ago so I will not try to do the maths in my head. Savings can be used to make up the difference. We look at the amount of savings above £16,000, which is the threshold that is generally disregarded for income-related benefits. If someone holds savings for the period that they are hoping to come to the United Kingdom, which would be 30 months, the savings count as long as the applicants have them under their control for at least six months.

Fiona Mactaggart: Even if they are self-employed?

Mr Harper: I believe that the answer is yes. If inspiration does not strike me before the end of the debate to confirm that, I will write to her.

In the immigration rules laid today, we have made some changes to the evidential requirements. For example, we had cases in which people were in receipt of tax-free stipends from universities. The net amount was below £18,600 and the rules were previously unclear about whether people could gross it up. I had a couple of cases raised with me and I thought it self-evident that people should be able to gross it up. So we have made it clear that that is indeed the case.

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Dr Thérèse Coffey: Does my hon. Friend agree that plenty of companies in this country regularly secure permits to bring talented people to fulfil specific roles? So, it happens now and we are proud to welcome talent into our country to fill those roles.

Mr Harper: My hon. Friend is right. If people have married or are with a partner, they are looking at a particular route. It is worth saying, and her intervention highlights this, that there are alternative routes for people under the immigration rules for some of these difficult cases.

Neil Carmichael: May I go back to the qualification period, for both savings and income? Why did the Government choose six months?

Mr Harper: It was to ensure that people could not abuse the system by holding the money for only a day or two, making the application, succeeding and then giving the money back. It is to make sure that the money is genuinely under someone’s control and available to them rather than their borrowing money that belongs to someone else for a short period. We felt that six months met that requirement without being overly burdensome and putting unreasonable requirements on individuals.

Perhaps I will follow up the point made by the hon. Member for Slough if she speaks to me about the specific case. Inspiration has told me that the savings do not count in that way with self-employed people. If she has a specific case, which it looks like she has, perhaps she will draw that to my attention and I will look at it and see whether I think the rules are sufficient to deal with it.

Thomas Docherty (Dunfermline and West Fife) (Lab): I beg to move, That the House sit in private.

Question put forthwith (Standing Order No. 163).

The House proceeded to a Division.

5.48 pm

Paul Flynn (Newport West) (Lab): On a point of order, Mr Deputy Speaker, the Division seems to be taking an excessively long time.

Mr Deputy Speaker (Mr Nigel Evans): I am sorry, I did not hear the hon. Gentleman.

Paul Flynn: My point of order was about the length of time the Division is taking given the small number of Members present. Are people playing games?

Mr Deputy Speaker: Mr Flynn, I cannot believe that that could possibly happen. If somebody is playing games, I am not sure who it is. You made your point of order just as I was rising to ask the Serjeant at Arms to investigate the delay in both Lobbies.

5.52 pm

Mr Deputy Speaker: I am on the verge of sending somebody to see where the Serjeant at Arms has gone. Has this got anything to do with Comic Relief by any chance? It is that time of year.

Mr Harper: Comic Relief is tomorrow.

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Mr Deputy Speaker: We may still be sitting tomorrow!

The House having divided:

Ayes 3, Noes 82.

Division No. 190]


5.29 pm


Brown, Lyn

Docherty, Thomas

Flynn, Paul

Tellers for the Ayes:

Alison McGovern


Julie Hilling


Abbott, Ms Diane

Abrahams, Debbie

Aldous, Peter

Alexander, Heidi

Amess, Mr David

Bailey, Mr Adrian

Baker, Norman

Barclay, Stephen

Benn, rh Hilary

Benyon, Richard

Blackman-Woods, Roberta

Bottomley, Sir Peter

Brake, rh Tom

Brooke, Annette

Bruce, Fiona

Buckland, Mr Robert

Carmichael, Neil

Clark, Katy

Coaker, Vernon

Coffey, Dr Thérèse

Cooper, Rosie

Crausby, Mr David

Creagh, Mary

Crouch, Tracey

Cruddas, Jon

Dorrell, rh Mr Stephen

Dowd, Jim

Doyle-Price, Jackie

Eagle, Ms Angela

Elliott, Julie

Evennett, Mr David

Gardiner, Barry

Goodwill, Mr Robert

Green, Kate

Gyimah, Mr Sam

Hames, Duncan

Hands, Greg

Harper, Mr Mark

Hollobone, Mr Philip

Horwood, Martin

Jamieson, Cathy

Javid, Sajid

Johnson, Joseph

Jones, Andrew

Kaufman, rh Sir Gerald

Lee, Dr Phillip

Lefroy, Jeremy

Leslie, Chris

Lewis, Dr Julian

Lilley, rh Mr Peter

Mactaggart, Fiona

May, rh Mrs Theresa

McCarthy, Kerry

McIntosh, Miss Anne

Metcalfe, Stephen

Miller, Andrew

Munt, Tessa

Parish, Neil

Penning, Mike

Percy, Andrew

Pound, Stephen

Randall, rh Mr John

Reckless, Mark

Rees-Mogg, Jacob

Reid, Mr Alan

Rosindell, Andrew

Rutley, David

Selous, Andrew

Sharma, Mr Virendra

Sheerman, Mr Barry

Slaughter, Mr Andy

Smith, Henry

Swayne, rh Mr Desmond

Syms, Mr Robert

Timms, rh Stephen

Tomlinson, Justin

Weatherley, Mike

Whitehead, Dr Alan

Wiggin, Bill

Williamson, Chris

Wollaston, Dr Sarah

Young, rh Sir George

Tellers for the Noes:

Anne Milton


Nicky Morgan

Question accordingly negatived.

14 Mar 2013 : Column 594

Thomas Docherty: On a point of order, Mr Deputy Speaker. There is some confusion over whether it is technically possible under “Erskine May” to call for a Division on the Adjournment. Of course, you are the gatekeeper and the guardian of good order, but my understanding is that there have been occasions on which the House has divided on the Adjournment. I believe that after an Adjournment debate on Norway in 1940, there was a Division on the Adjournment. Any guidance that you can give me would be gratefully received.

Mr Deputy Speaker: I thank the hon. Gentleman for his point of order. I know that the House is waiting with eager anticipation for the answer. The answer is that it is gone 5.30, so the Question would not be put in any event. Therefore, the Question cannot be put.

Thomas Docherty: Further to that point of order, Mr Deputy Speaker. I am incredibly grateful for that clarification. I had a brief opportunity in the few moments that I spent in the Aye Lobby to look at “Erskine May”, but I could not find that reference. Is it possible for it to be circulated, for the benefit of Members such as me who are not as knowledgeable as you, Mr Deputy Speaker, so that we do not waste any more of the House’s time?

Mr Deputy Speaker: Some people may interpret what is going on now as being a waste of time, but certainly not the Chair. I am absolutely certain that clarifications on the rules of procedure will be made. The Question could have been put before the moment of interruption, for instance at 5.29, which, as the hon. Gentleman has pointed out, has happened in the past. I think that the last time it happened was in the 1970s. On this occasion, we have clearly gone past the moment of interruption and, therefore, the Question will not be posed.

Jacob Rees-Mogg (North East Somerset) (Con): On a point of order, Mr Deputy Speaker. If the Question that this House do now adjourn cannot be put, how can we decide whether the House is to adjourn or not? Surely if we have missed the opportunity for putting that Question, we need to carry on sitting.

Mr Deputy Speaker: Thank you, Mr Rees-Mogg, for that point of order. We are past the moment of interruption. Had the Minister carried on speaking until half past 5, I would have just stood up and not put the Question.

5.56 pm

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