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House of Commons

Tuesday 16 July 2013

The House met at half-past Eleven o’clock


[Mr Speaker in the Chair]

Business before Questions

London Local Authorities and Transport for London (No.2) Bill [Lords]

Further consideration of Bill, as amended, opposed and deferred until Tuesday 3 September (Standing Order No. 20).

Hertfordshire County Council (Filming on Highways) Bill [Lords]

Second Reading opposed and deferred until Tuesday 3 September (Standing Order No. 20).

Oral Answers to Questions


The Secretary of State was asked—

Tobacco Products (Packaging)

1. Cathy Jamieson (Kilmarnock and Loudoun) (Lab/Co-op): If he will bring forward legislative proposals on standardised packaging of tobacco products. [165198]

The Parliamentary Under-Secretary of State for Health (Anna Soubry): The Government’s policy remains unchanged. We are waiting to see how the legislation recently introduced in Australia pans out before deciding whether to follow.

Cathy Jamieson: Given some of the public health Minister’s previous pronouncements, some of us could be forgiven for thinking that the Government’s policy has changed. Will she advise the House, therefore, on who overruled her support for this policy? Was it the Prime Minister, the Health Secretary or Lynton Crosby?

Anna Soubry: Unfortunately, the hon. Lady has not listened to my last answer or, indeed, to my statement on Friday. The Government’s policy remains unchanged. We are waiting to see the evidence before making a decision. I take the very firm view that the best legislation is based on good evidence.

Mr David Nuttall (Bury North) (Con): Of course, there are those of us who believe it is up to the individual to take personal responsibility for their own health and who entirely support the Government’s decision not to have any extension of the nanny state. Does the Minister agree that, before we introduce any new laws on tobacco, we ought to enforce more strictly the existing laws on not selling cigarettes to children?

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Anna Soubry: My hon. Friend makes a number of excellent points with which I agree, save for one: with great respect, standardised packaging would not be an extension of the nanny state, because it would not impinge on anybody’s freedom or right not only to buy cigarettes, but to smoke them. It is all about ensuring that the package is not attractive, especially to young people, who are at risk of taking up smoking.

18. [165216] Ian Austin (Dudley North) (Lab): Earlier this year, I met young people from Dudley who set up the Kick Ash project campaigning for plain packaging. They showed me evidence from research that plain packaging would stop young people smoking in the first place, which is something every MP ought to be committed to trying to do. If the Government reject plain packaging, will those young people be right to conclude that the Government take the advice of big tobacco companies and their wealthy lobbyists more seriously than the views of young people in Dudley?

Anna Soubry: First, I pay tribute to Kick Ash. I am more than happy to meet those youngsters; they seem to be doing a very good job. Secondly, we are not in anybody’s pocket. I am sure the hon. Gentleman can say he is not in the pocket of any trade unions either. This is an important decision, but we have not made it yet; we are waiting to see how things develop in Australia, and as I say, good laws are based on good, sound evidence. That is the way forward.

John Pugh (Southport) (LD): Is the high evidential threshold being set for the plain packaging proposals to be applied across Government legislation or only where lobbyists are involved?

Anna Soubry: I am rather disappointed at that question from my hon. Friend. I can assure him that the Government take all these issues very seriously. I am proud of our emerging record on public health, but as I say, we have yet to make a decision, because, quite properly, we want to see what happens in Australia, and of course we are also waiting to see what happens elsewhere, notably in Ireland, where the Irish Government intend to introduce this policy. It might or might not be successful.

Ms Diane Abbott (Hackney North and Stoke Newington) (Lab): The Minister says, quite correctly, that the best legislation is based on evidence, but should it not also be untainted by the activities of lobbyists? She will be aware that Department of Health officials met Philip Morris Ltd at the end of January this year, but although minutes of meetings with other tobacco companies that occurred at the same time have been released, the Department insists that the minutes of the meeting with Philip Morris have yet to be finalised. Is it not the truth that the Government are trying to cover their tracks over their relationship with Lynton Crosby and his clients and that when it comes to the decision effectively to drop plain packaging for this Parliament, all roads lead back to No. 10 and Lynton Crosby?

Anna Soubry: I have just seen a piece of straw flying over, which the hon. Lady attempts to clutch at. [Interruption.] “Clutching at straws”—it is a bit lost on the Opposition, but that is more a sign of their difficulties than ours. The minutes of the meeting with that tobacco

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company have been published this morning. The reason for the delay—I very much hope the hon. Lady is not suggesting for one moment that my officials have been in any way dishonest—is because unfortunately the tobacco company did not agree the minutes, and there was some to-ing and fro-ing. I really wish she would not subscribe to conspiracy theories where they do not exist.

Adult Social Care

2. Stephen Timms (East Ham) (Lab): What recent assessment he has made of the effects on NHS services of changes in local authority spending on adult social care. [165199]

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): Data on delayed transfer of care suggest that the interface between health and social care has improved since this Government have been in office. In 2012-13, the number of bed days lost because of delays attributable to social care was nearly 50,000 lower than in the previous year.

Stephen Timms: In May, the King’s Fund report,“Paying for social care” warned that local authority spending is continuing to fall and that fewer people are getting help. It is my understanding that last month an internal NHS document recognised that pressure on social care budgets meant “more delayed discharges”, increasing the problem in accident and emergency. Therefore, cuts to care budgets are increasing delayed discharges. What will the Minister do to tackle that problem?

Dr Poulter: The right hon. Gentleman would have done well to listen to my answer before he read out a pre-prepared question. In 2012-13, the number of bed days lost because of social care delays was 50,000 fewer than the year before. However, he is absolutely right that we need to do more to ensure better integration and better joined-up care between the NHS and social care. That is what this Government are doing, and that is why we have allocated a £3.8 billion fund to do just that in the spending review.

Mr Stephen Dorrell (Charnwood) (Con): Does my hon. Friend agree that there is no solution to the economic challenges facing the health and care system—still less any solution to the quality challenges that are increasingly coming to light—that does not involve proper integration of health and care? Is not the decision announced by the Chancellor a couple of weeks ago the first tangible step of a Government delivering a policy that Governments have talked about for a generation?

Dr Poulter: My right hon. Friend is absolutely right, as always. He is a tremendous advocate—and has been since his time in office—of integrated health and social care, and of the transformation in the delivery of care that we need to make if we are to better look after patients with long-term conditions and the frail elderly. This Government are the first Government who are committed to doing that. Compare that with the real-terms cut in funding for social care that happened under the last Government, according to the Dilnot report.

17. [165215] Julie Hilling (Bolton West) (Lab): Bolton hospital has told me that it needs a much greater concentration on social care. Indeed, a recent NHS

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Confederation survey of NHS chief executives and chairs said that two thirds said that a shortfall in local authority spending had impacted on their services over the past year. Will the Minister finally accept that the Government’s deep cuts to social care are having a serious effect on the ability of the NHS to deliver safe care?

Dr Poulter: I am not sure whether the hon. Lady is referring to the Association of Directors of Adult Social Services report that was published recently. It is important to look at that report in context and not misinterpret the figures. The report shows that spending has been roughly flat in social care, and the last survey also shows that councils are expecting a small increase in expenditure on social care next year. The 20% or £2.7 billion that is often touted by the Opposition in fact represents savings that councils have made through efficiencies, and that money is obviously being reinvested in front-line care.

David Tredinnick (Bosworth) (Con): Will my hon. Friend give an indication of the long-term cost savings of integrating health and social care, as against the short-term cost of making the changes?

Dr Poulter: My hon. Friend is right to highlight the fact that the figures show that last year alone 50,000 bed days that would otherwise have been wasted were saved by investing in social care and implementing the service transformation that we all require. However, this is about making all NHS and social care budgets go further, and recognising that if we are to improve the care of older people, particularly frail elderly people, we have to invest in more community prevention and community-based care, which is what this Government are doing.

Barbara Keeley (Worsley and Eccles South) (Lab): As we have heard, two thirds of NHS leaders have said that the shortfall in social care spending is having an impact on their services. The Minister can try to get rid of that and talk it away, but in week after week of taking evidence in our inquiry into emergency care, the Select Committee on Health has heard the same thing. We know that elderly patients now form a much larger proportion of admissions—40% of admissions to emergency units are people aged 65 to 85. Is not the £1.8 billion cut in spending now really hitting NHS services and making the emergency care crisis worse?

Dr Poulter: I am afraid that the Opposition are very confused about their figures. As I explained earlier, the £2.7 billion—or 20%—figure represents the savings that councils have made to meet demand, and real-terms spending next year is expected to go up. The point from the ADASS and other surveys is that integration works. This Government are investing in integration. According to the Dilnot report, it was the last Government who cut in real terms the amount of spending going to social care between 2005 and 2010—and the hon. Lady was a member of that Government.

Mental Health

3. Bob Stewart (Beckenham) (Con): What steps he is taking to change negative perceptions of mental health issues. [165200]

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The Parliamentary Under-Secretary of State for Health (Anna Soubry): I pay tribute to the work done on this issue by my hon. Friend, as well as by my hon. Friends the Members for Broxbourne (Mr Walker), for Croydon Central (Gavin Barwell), for Loughborough (Nicky Morgan) and many others. They have done a huge amount to remove the taboo associated with mental health. We are funding the “Time to Change” campaign, with up to £16 million being put in from 2011 to 2015. The programme works to support and empower people to talk about their mental health problems and to tackle the discrimination that so many of them face. It includes for the first time a tailored programme of work for children and young people.

Bob Stewart: How confident is my hon. Friend that general practitioners are able to make rapid assessments of potential mental health problems, particularly clinical depression, when patients present themselves perhaps for other non-related matters?

Anna Soubry: We know that a third of GP appointments are mental health-related, so GPs have a lot of experience in tackling mental illness. We also know, however, that it is not covered extensively in GP training, which is why the Royal College of General Practitioners has identified improved care for people with mental health problems as a training priority—this is to be welcomed—through its enhanced GP training programme.

Mr Andrew Love (Edmonton) (Lab/Co-op): Yet mental health spending has been cut over the last two years and we find ourselves in a position where four in 10 mental health trusts do not have safe levels of staffing. What is the Minister going to do about the funding and the staffing levels in our mental health services?

Anna Soubry: Of course, the overall health budget will be rising by some £12 billion by 2015, and in relation to mental health, I have to say that I am exceptionally proud of this Government for making mental health such a priority, notably through the mandate. I think we are to be congratulated on at last recognising how important mental health is. In our view, it underpins almost all public health matters and so many of the troubles and conditions that people present to GP surgeries. Therefore, I think we are doing an extremely good job on this subject.

Francis Report (Staffing Levels)

4. Valerie Vaz (Walsall South) (Lab): What plans he has to implement the recommendation of the Francis report on safe staffing levels. [165201]

The Secretary of State for Health (Mr Jeremy Hunt): We agree with Robert Francis that there is a need for evidence-based guidance and tools to inform appropriate staffing levels. We have set out a number of recommended actions to support appropriate staffing levels in “Compassion in Practice”—the nursing, midwifery and care staff vision and strategy for England.

Valerie Vaz: I thank the Secretary of State for his answer, but Robert Francis said in his report that minimum safe staffing levels lead to helping patient safety. If the Secretary of State agrees with Robert Francis, why does he not implement that recommendation now?

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Mr Hunt: I do agree with Robert Francis, but as he said in Nursing Times, there is an apparent misunderstanding by many people about what his recommendations actually were. This is what he said:

“I did not recommend there should be a national minimum staffing standard for nursing. The government was criticised for not implementing one, which it is said I recommended, which I didn’t.”

Andrew Percy (Brigg and Goole) (Con): As someone who worked in the public services before my election here, I well understand the pressure put on public servants to cover up bad news. I was contacted by a nurse yesterday who informed me that concerns that were raised at a training day were dismissed by a matron—people were told to put them in the bin. Can the Secretary of State assure us that he will do everything to ensure that nurses who are concerned about staffing levels feel free to speak out and will be protected?

Mr Hunt: What my hon. Friend says is incredibly important. We must have a culture of openness and transparency inside the NHS, which means that people at the front line feel empowered to speak up if they think there is a problem. That has not happened in the past, and we are going to put it right.

Andy Burnham (Leigh) (Lab): The Secretary of State will make a statement shortly about the Keogh review. Two of the hospitals investigated are Basildon and Tameside. The previous Government left a warning in place on both trusts about patient safety. This Government have ignored those warnings and allowed both trusts to make severe cuts to front-line staff. Tameside has cut 128 nursing posts and Basildon an unbelievable 345. Given the warnings he inherited, why on earth has he allowed that to happen?

Mr Hunt: I am very surprised that the right hon. Gentleman wants to mention what happened at Tameside. Tameside had high death rates for eight years under Labour. The previous Government ignored a whistleblower in 2005, warnings to Parliament in 2006, a coroner’s report in 2006 and warnings from my predecessor in 2009. To cap it all, in 2009 the hospital was given a “good” rating by the Care Quality Commission. How bad is that?

Andy Burnham: I am afraid the Secretary of State is simply wrong. At the instigation of my hon. Friend the Member for Denton and Reddish (Andrew Gwynne), I ordered unannounced inspections into Tameside. The Secretary of State should get his facts straight before he comes to this Dispatch Box. He did not answer on staffing, and it gets worse, Mr Speaker. Seven of the 14 hospitals in the Keogh review have between them cut a shocking 1,117 nursing jobs on this Government’s watch. Unsurprisingly, A and E performance has plummeted at all seven. All 14 hospitals were meeting the A and E target in my time in office; none of them are meeting it under the Secretary of State. Is not the right response to the Keogh review to stop dithering and act now on safe staffing levels?

Mr Hunt: I am surprised that the right hon. Gentleman wants to talk about the Keogh review before we have made our statement. I am particularly surprised because

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the Keogh review is the review that Labour never wanted to have, with high death rates in all those hospitals stretching back to 2005 and a record of inaction by Labour. As former—




I think the House might be interested to hear this. as former Labour councillor and Mid Staffs campaigner Ken Lownds said today:

“Can you imagine a Keogh review under Andy Burnham or any Labour Health Secretary? Not a chance.”

Children’s Heart Surgery (Review)

5. Jason McCartney (Colne Valley) (Con): Whether the new review of children’s heart surgery units will cover adult as well as paediatric cardiac surgery. [165202]

The Parliamentary Under-Secretary of State for Health (Anna Soubry): I am informed by NHS England that it will include adult surgery in its review of care for people with congenital heart disease.

Jason McCartney: Can NHS England assure us that a clear link will be shown between the feedback from patients, the public and stakeholders and the final configuration of services in the review of the Leeds children’s heart surgery unit?

Anna Soubry: Let me first pay tribute to the work my hon. Friend continues to do in support of his hospital and his children’s heart unit. NHS England has told me that individuals and patient organisations have all been encouraged to engage with and contribute to the local review process. The feedback received will be used to help to inform the outcome of the review of children’s heart surgery at Leeds.

East of England Ambulance Trust

6. Mr Henry Bellingham (North West Norfolk) (Con): What plans he has to meet the acting chief executive of the East of England ambulance trust to discuss that trust’s recovery plan. [165203]

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): The NHS Trust Development Authority is working with the trust to review its action plan and monitor progress in response to the findings of the recent governance review and the Marsh report. Ministers will keep the situation under review.

Mr Bellingham: Is the Minister aware that, in spite of the efforts and professionalism of front-line staff, the organisation has been badly led and has lurched from crisis to crisis? Does he have confidence in the new management team and the recovery plan? Does he not agree that the time might have come to break up this large organisation and move it into smaller units that are closer to the communities?

Dr Poulter: I thank my hon. Friend for that question and his diligent local campaigning on the issue. He is absolutely right that the Marsh review highlighted a failure of leadership at the trust and in the trust board as well as a disconnect between the front-line staff, who work effectively and well, and that leadership. We now have a new team at the top and we must give it time to

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respond to the Marsh report and put in place the right measures. I believe that efficiencies can be made at a back office and regional level, but there is a good case for ensuring that more localised data are presented about ambulance response times countywide.

Mr Jamie Reed (Copeland) (Lab): The East of England ambulance service is failing to meet the needs of patients on the Secretary of State’s watch. The hon. Member for Waveney (Peter Aldous) has said:

“This did not used to happen.”—[Official Report, 25 June 2013; Vol. 565, c. 19WH.]

The hon. Member for Witham (Priti Patel) has said:

“Lives are put at risk.”—[Official Report, 25 June 2013; Vol. 565, c. 2WH.]

Does the Minister agree with those Members, and does he believe that clinical outcomes for patients in the east of England have been affected by the collapsing service over which he has presided?

Dr Poulter: The hon. Gentleman would do well to heed the Marsh review before asking his questions, because it highlights a fundamental, systemic failure of leadership at the ambulance trust which dates back to the last Government’s time in office. As we know, the number of NHS managers in the east of England rose by 86.4% under the last Government, but there was a lack of connection between the managers of the trust and front-line staff. Government Members are promoting clinical leadership, and trusting clinicians and front-line paramedics to deliver a much better ambulance service. I suggest that the hon. Gentleman should prepare his questions more thoroughly in future, and should read the Marsh review before he asks them.

Health Services (Worcestershire)

7. Karen Lumley (Redditch) (Con): What recent assessment he has made of the joint service review on the future of health services in Worcestershire. [165204]

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): The configuration of local health services is a matter for the local NHS. Commissioners in Worcestershire are working with local health care providers and stakeholders to develop proposals for the future provision of acute services across the county, which will be subject to public consultation later this year.

Karen Lumley: Does the Minister agree that the people of Redditch deserve to see the implementation of the two options that he promised in Westminster Hall in February, after 18 months of indecision and uncertainty in Worcestershire about the future of our hospitals, including Alexandra hospital, which he visited with me?

Dr Poulter: It was a great pleasure to visit my hon. Friend’s local hospital, and I agree that it is time that consultation took place on firm proposals. The proposals that we discussed during the Westminster Hall debate appeared to me to have considerable merit, and I understand that local commissioners will present them in a timely manner later this year.

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Kettering General Hospital

8. Mr Philip Hollobone (Kettering) (Con): What assessment he has made of recent improvements in services to patients at Kettering general hospital. [165205]

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): Monitor, as the regulator of foundation trusts, is working with NHS England, the Care Quality Commission and local commissioners to ensure that the trust has robust plans to make the necessary improvements. The emergency care intensive support team has given the trust advice and support to help it to develop plans to improve its A and E performance.

Mr Hollobone: Will the Minister congratulate all those at Kettering general hospital who have been involved in various recent developments? For instance, urology patients are being given the anti-cancer drug mitomycin C, which halves the risk of a recurrence; a CT scanner that is 10 times more powerful than its predecessor is facilitating CT angiography; and 44% of colorectal operations—twice the national average—are being performed on a keyhole basis.

Dr Poulter: I am happy to commend Kettering general hospital for some of the improvements in care that have been made recently. My hon. Friend will, of course, want to ensure that that progress is sustained during the weeks and months ahead. As he will know, Monitor is still overseeing the trust to ensure that patient care and performance remain up to standard.

Andy Sawford (Corby) (Lab/Co-op): I welcome the comments of the hon. Member for Kettering (Mr Hollobone). Kettering general hospital also serves my constituents, and I look forward to meeting the Minister this week to discuss the pressures that are being imposed on it. One of the trust’s main problems is having to spend money from its acute budget on local care home beds. Does the Minister recognise that that should not be happening?

Dr Poulter: The approach that must be adopted to ensure that health and social care services are joined up in the way that we need will vary in different parts of the country, and in accordance with differing health care needs and demographic challenges. I look forward to discussing that and other issues further when I meet the hon. Gentleman and my hon. Friend the Member for Kettering (Mr Hollobone) tomorrow or on Thursday.

NHS 111 Service

9. Siobhain McDonagh (Mitcham and Morden) (Lab): What assessment he has made of the roll-out of the NHS 111 telephone service. [165206]

The Secretary of State for Health (Mr Jeremy Hunt): NHS 111 is now available in more than 90% of England. Despite some problems with the sites where it was launched around Easter, performance has now stabilised significantly. NHS 111 is now the principal entry route for access to the urgent care system, and nearly 600,000 patients accessed the service in May.

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Siobhain McDonagh: Let me take the opportunity to make a confession to the House. Six weeks ago on Friday, I rang 111 as I watched one of my best friends vomit. She had been vomiting for 10 days, had been to see her GP four times, and had telephoned 111 on two occasions, on each of which she was told to go away and take antibiotics.

I did what no Member of Parliament wants to do. I said to the operator, “I am an MP, and I will take this up in the House if you do not deal with it properly.” Forty minutes later an ambulance arrived, and my friend was saved from a massive heart attack. What happens to people who have no one to speak for them, and no one who can say “I am an MP”?

Mr Hunt: The hon. Lady makes a very important point and I do not want to defend that service in the instance she cited at all. It is completely unacceptable if that kind of thing has to happen. The principle of 111—which is for people to have an easy-to-remember number and to be able to be connected to a clinician directly if they need to be, which did not happen with NHS Direct—is a good one, but it is not happening in practice as much as it needs to be. We are broadly meeting our operational standards, but it is not good enough and she has given a very good example as to why.

Miss Anne McIntosh (Thirsk and Malton) (Con): First, may I thank the Under-Secretary of State, my hon. Friend the Member for Broxtowe (Anna Soubry), for responding to the recent debate we held on this issue? When it was my own father in those circumstances, I did not say that I was an MP, as I felt that would be an abuse of the system. I am delighted that North Yorkshire has reported no problems since 111 was introduced, but there is the issue of the deficit for clinical commissioning groups, which we hope will not detract from the 111 service. Can the Secretary of State assure us that the review of funding will be brought forward at the earliest possible moment?

Mr Hunt: I am pleased the 111 service worked more satisfactorily in my hon. Friend’s case. NHS England is working on the funding formula and it hopes to make any necessary changes in time for the next funding round, which starts in April 2014.

Liz Kendall (Leicester West) (Lab): Ministers were repeatedly warned about problems with their 111 roll-out by the Royal College of Nursing, the British Medical Association, the Ambulance Service Network and private providers, but they ploughed on regardless. The result was patients left waiting hours for call-backs, more ambulances sent out and more pressure on already struggling A and Es. I am sure the Secretary of State is aware of the pattern of the seasons, so if he wants to avoid another A and E crisis this winter, can he explain why Bruce Keogh’s review of urgent and emergency care will not even report until next spring?

Mr Hunt: Actually, the hon. Lady is wrong, because Bruce Keogh’s review of urgent and emergency care with respect to vulnerable older people, and particularly with respect to the way the 111 service operates, will report this autumn, precisely so that we can make sure we learn any lessons we need to learn for this winter, and it is very important that we should do so.

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Muscle-wasting Conditions

10. Caroline Lucas (Brighton, Pavilion) (Green): If he will take steps to ensure that people affected by muscle- wasting conditions in the South East Coast NHS area are adequately supported after September 2013; and if he will make a statement. [165207]

The Parliamentary Under-Secretary of State for Health (Anna Soubry): NHS England commissions some elements of neurological services through specialist services commissioning arrangements, while clinical commissioning groups commission general neurological services. I am informed that the Muscular Dystrophy Campaign and the Surrey and Sussex area team are considering funding the care pathway adviser post for a further six months.

Caroline Lucas: I thank the Minister for her answer, but an exploration just for the potential of a mere six months’ reprieve is not good enough. As things stand, for people with muscular dystrophy and their families in the South East Coast region, from September, that is set to be the only part of the country without access to a local care and support advocate. Therefore, will the Minister agree to meet me as a matter of urgency to discuss what can be done to ensure long-term funding for that vital post, which sufferers and their families want to see continue?

Anna Soubry: The simple answer is absolutely yes. My hon. Friend the Member for North Thanet (Sir Roger Gale) has also raised this matter through parliamentary questions and the like. I am more than happy to have that meeting.

Vulnerable Older People

11. Margot James (Stourbridge) (Con): What steps he is taking to improve the care of vulnerable older people. [165208]

The Secretary of State for Health (Mr Jeremy Hunt): We are taking a great deal of measures to improve services for vulnerable older people, who make up the bulk of the work the NHS does, and in particular to make sure they are always treated with dignity and respect.

Margot James: I thank my right hon. Friend for his answer. Earlier this year the Care Quality Commission found that people with dementia end up in hospital more often, stay longer and are more likely to die there. What can he do to encourage greater provision of good-quality specialist care places for patients with dementia in the community?

Mr Hunt: My hon. Friend makes an important point. Nearly 60% of people with dementia are in a care setting, but one of the tragedies is that many of them could continue to live healthily and happily at home for much longer if they were given the support that they needed. Often, however, that support does not arrive until it is too late, when the carer or family member is under too much pressure to be able to look after them. The dementia diagnosis rate at the beginning of this Parliament was less than 40%, but our objective is to get that up to two thirds by the end of the Parliament. Also, we want to ensure that a proper care plan is in place for the two thirds who are diagnosed, so that we can avoid the problems that my hon. Friend has highlighted.

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Hazel Blears (Salford and Eccles) (Lab): Last week, the all-party parliamentary group on dementia published its report, “Dementia does not discriminate”, which deals particularly with the impact of dementia on people from black and minority ethnic communities. There are now 25,000 people from those communities living with dementia—far more than we expected—yet they often receive their diagnoses even later than people with dementia in the rest of the population. Will the Secretary of State fund an awareness campaign through Public Health England aimed at those communities to drive up the diagnosis rates? Will he also ensure that the clinical commissioning groups are commissioning appropriate support services in those communities so that we can provide proper services for everyone living with dementia?

Mr Hunt: I congratulate the right hon. Lady, who is a long-time campaigner on dementia issues. She has raised a really important issue, and I will certainly talk to Public Health England about raising awareness. For those groups, as for everyone, we need to ensure that there is a good care plan in place when they are diagnosed. There is some resistance in the GP community to giving a dementia diagnosis, partly because many GPs worry that not much will happen as a result. We need to ensure that there is a good plan in place, and that is particularly the case for ethnic minority communities.

Mr Graham Stuart (Beverley and Holderness) (Con): Does the Secretary of State agree that areas that are grappling with the highest burdens of chronic illness and disability should receive the highest NHS allocations? Does he have any idea why the NHS Commissioning Board has rejected the advice of the Advisory Committee on Resource Allocation and decided instead to perpetuate the systematic underfunding of areas that serve older people?

Mr Hunt: My hon. Friend is absolutely right to say that NHS resources must be allocated in a way that fairly reflects the need for the NHS in every area. Rurality and age are two important factors in that regard. I can reassure him that the current allocations are not set in aspic. The problem with the recommendations from the Advisory Committee on Resource Allocation that NHS England received before was that they would have meant increasing resources to the areas with the best health outcomes at the expense of those with the worst ones. NHS England thought that that would be inconsistent with its duty to reduce health inequalities, but it is looking at the issue this year and we all hope that it will make good progress.

Andrew Gwynne (Denton and Reddish) (Lab): We all know that one of the most important drivers for improving the quality of care for vulnerable and elderly patients is to ensure the adequate training and regulation of health care assistants. That is something that Labour and Sir Robert Francis QC have called for, but that the Government have so far ducked. Will the Secretary of State now accept that crucial Francis recommendation to help to drive up care standards for the elderly and the vulnerable—yes or no?

Mr Hunt: The reasons that Robert Francis recommended statutory regulation of health care assistants were twofold. First, he wanted to ensure that people who had been

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involved in incidents of poor care could not pop up somewhere else in the system. Secondly, he wanted to ensure that everyone had proper training. We are going to solve both those problems, but I am not convinced that a big new national database of 300,000 people is the way to do it.

South London Healthcare Trust

12. Heidi Alexander (Lewisham East) (Lab): What recent progress his Department has made on negotiations with acute providers on the capital and revenue costs of implementing the recommendations of the special administrator of the South London Healthcare NHS Trust.

The Parliamentary Under-Secretary of State for Health (Anna Soubry): Decisions on funding for each individual hospital are being worked through as part of the implementation planning process, in collaboration with the Department, to ensure value for money for the taxpayer. Decisions need to ensure that capacity is available in the right place and that quality and safety are maintained.

Heidi Alexander: Is it true that King’s College hospital wants £109 million in capital funding alone to cover changes at the Denmark Hill site and at the Princess Royal hospital, given that in January the Secretary of State announced £73 million of additional investment for all the other hospitals in south-east London to deal with displaced patients from Lewisham? Will the Minister explain where the money is coming from? Will she also tell us whether all this will be centrally funded, or whether local commissioners will be asked to pick up the tab?

Anna Soubry: What I can say is that it will be centrally funded, but as to the other detail in the hon. Lady’s question, I will have to write to her with those answers. As ever, my door is open and I am more than happy to meet her to discuss it further.

Clinical Commissioning Groups

13. Mr Barry Sheerman (Huddersfield) (Lab/Co-op): What plans he has to increase the management capability of doctors elected to clinical commissioning groups. [165210]

The Secretary of State for Health (Mr Jeremy Hunt): Clinical commissioning groups have the freedom and autonomy to determine the skills and expertise needed to enable them to deliver improved outcomes for their local communities, and NHS England is developing an assurance framework to ensure that they all have the capacity and capability to do that.

Mr Sheerman: Is the Secretary of State aware that a number of doctors, certainly the ones I have talked to, are deeply concerned about the inadequacy of their management capabilities to run these complex organisations? Is he worried that many of them are saying that they have to turn to private health care people to back them up and give them advice? Is that healthy in the NHS?

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Mr Hunt: I am absolutely aware that there a lack of clinical leadership, and when we go on to the statement later today, I am sure that we will be discussing what needs to be done to improve the quality of leadership, particularly clinical leadership. Very often the best leadership in any hospital or any commissioning group comes from clinicians, and we have much work to do to make that happen. But I do not think that that means that we should duck the challenge; we just have to get on and make sure that people have the right training and can be supported to do the job we need them to do.

Mr Geoffrey Robinson (Coventry North West) (Lab): The Secretary of State seems to be answering a different question. The question was about management training for doctors who are being put in the position, without any training and with no consultation—many are doing this against their wishes—of having to manage in a way that they have never been trained to do and are not inclined to do. Would it not be better to put in place the assurance and the training he talks about before rushing into this madcap reorganisation, which the Government did?

Mr Hunt: May I reassure the hon. Gentleman that, first, these people are not doing these jobs against their will, as they volunteered to do them? Secondly, the quality of CCGs is being assured very closely, and they are receiving a lot of support. But it is a big job because, generally speaking, we want more clinical leaders. They need support in learning management skills in order to do that job well, and across the whole NHS we need to be doing that better.

Fiona Mactaggart (Slough) (Lab): Will the training of clinical leaders include training in legal advice about mergers? I was shocked to see a response from Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust and Poole Hospital NHS Foundation Trust showing that they had already spent more than £1.5 million on legal advice about their merger, which has been prevented by the Competition Commission, and that in future they expect to spend £6 million on this scheme. Is it right that our health money should be going on legal advice?

Mr Hunt: No, and I am as concerned as the hon. Lady that it is difficult to push through the mergers that local commissioners want to happen. We have to operate within the framework of European law, but we are looking at what we can do to make it easier for these things to happen.

Health Tourism

14. Henry Smith (Crawley) (Con): What steps he is taking to tackle health tourism and ensure a fair system of contribution to the costs of the NHS. [165211]

The Secretary of State for Health (Mr Jeremy Hunt): On 3 July, my Department and the Home Office launched co-ordinated consultations on a range of proposals on a new charging system for visitors and migrants in which everyone makes a fair contribution to health care. Those include making temporary migrants from outside the European economic area contribute to the cost of their health care, and introducing easier and more practical ways for the NHS to identify and charge those not entitled to free health care.

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Henry Smith: I very much welcome the statement by my right hon. Friend and support the new visa fee proposal for non-EU foreign nationals who come here and receive NHS treatment. May we also have an assurance that the treatment of EU nationals will be properly audited in the NHS, so that those costs can be recovered through the European health insurance card scheme?

Mr Hunt: My hon. Friend is right to point to the fact that we estimate that we collect less than half the money for which we invoice for “overseas operations” and we identify fewer than half the people who should be invoiced in the first place—that applies in respect of those from inside the EU as well as from outside the EU. We can get refunded for the care we give EU nationals if we are sensible about collecting this money and we put those systems in place. Given the pressures in the NHS, we are absolutely determined to make sure we do so.

Jim Shannon (Strangford) (DUP): I thank the Secretary of State for his statement. Last year health tourism cost the NHS £24 million—that was in one year alone. He has outlined the new system coming in, but will he say how it will be administered? Many of us feel that it might not be as easy to do in practice as it is on paper.

Mr Hunt: The hon. Gentleman is absolutely right. If this is to work, we need a slick system that is easy for hospitals to operate. We have done this in another area, as the NHS successfully and seamlessly invoices insurance companies for the costs of coping with road traffic accidents. At the moment, however, if hospitals declare that someone is chargeable for their NHS care, they do not get paid by the NHS for that care, meaning that they have to collect the money themselves from overseas, so the incentives for hospitals are wrong and we need to sort them out.

20. [165218] Mr Tobias Ellwood (Bournemouth East) (Con): I welcome the Government’s initiatives to tackle health tourism, but what is being done to help hospitals on the front line, such as Bournemouth hospital, better to identify chargeable visitors?

Mr Hunt: We are considering whether something can be done with the NHS number. At the moment, people can visit any GP and, completely legally—whether or not they are entitled to NHS care—get an NHS number. That number can then become a passport that can be used throughout the system, so we are examining whether there is a way of giving people either a temporary NHS number, or a different NHS number, that can be tracked through the system so that if they undergo complex medical care that is chargeable, we are able to trace that and collect the money from them.

Steve McCabe (Birmingham, Selly Oak) (Lab): If we are to make this work, do not we need a clearer idea about the real cost? Is it the £200 million that the Secretary of State has been quoted as using, the £10 million suggested by the Prime Minister, or the £33 million that the Under-Secretary of State for Health, the hon. Member for Broxtowe (Anna Soubry), has cited in a parliamentary written answer?

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Mr Hunt: The truth is that we do not know the cost, which is why we are carrying out an independent audit this summer. The £12 million figure is the amount written off by the NHS each year because of unpaid overseas invoices, but many people think that the costs are much greater. We want an answer for the hon. Gentleman and everyone in the House, so we are carrying out that independent audit and we will publish the results later in the autumn.

Topical Questions

T1. [165223] Kate Green (Stretford and Urmston) (Lab): If he will make a statement on his departmental responsibilities.

The Secretary of State for Health (Mr Jeremy Hunt): I know that the whole House will want to recognise the fact that this month marks the 65th anniversary of the NHS. This country blazed a trail by introducing universal health care coverage in 1948, and the NHS remains the single biggest reason why most people are proud to be British. The whole House will want to note that whatever failings are being exposed by a new era of transparency in NHS care, the overwhelming majority of doctors, nurses, health care assistants and managers do a remarkable job, working incredibly long hours for the benefit of us and our families, and we salute them for all they do.

Kate Green: When changes were made at Lewisham hospital, the Secretary of State refused to meet local campaigners. Following his announcement last week about changes to services at Trafford general hospital, local campaigners from Trafford would like to know if he is prepared to meet them.

Mr Hunt: That is not quite a fair representation of what happened in the case of Lewisham, or indeed for Trafford, because I agreed to meet all local MPs regarding Lewisham. These things are carefully constrained by what is legally possible so as to be fair to all sides, but I met all Lewisham MPs. As the hon. Lady knows, I have agreed to meet her—I think that we are meeting later this afternoon—and I am sure that she will express the concerns of campaigners in Trafford.

T5. [165228] David Rutley (Macclesfield) (Con): Integrating health and social care is an especially important priority in areas with the fastest-ageing populations. With that in mind, do Ministers agree that it is vital to support joined-up initiatives such as Caring Together in north-east Cheshire, which involves the local clinical commissioning group, council and NHS trust?

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): My hon. Friend is absolutely right to highlight such initiatives. That was why the Government, as part of the Health and Social Care Act 2012, set up health and wellbeing boards, which bring together housing providers, the NHS, the third sector and social care locally so that they can look at how to improve and better integrate personalised care, especially for the frail elderly.

T2. [165224] Yasmin Qureshi (Bolton South East) (Lab): In the 1960s and 1970s, the drug Primodos was given to pregnant women, resulting in serious birth defects in

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thousands of babies, who are now adults in their 40s. The then Committee on the Safety of Medicines failed to act in time, the scientist at Schering, the drug manufacturing company, accepted subsequently that he had made up his research, and the solicitor Peter Todd has described the events as the biggest medical and legal cover-up of the 20th century. Will the Secretary of State meet me and the victims of Primodos so that we can present our evidence on what has happened?

Dr Poulter: The hon. Lady is right to highlight the fact that when we have scientific and clinical data, they must be used responsibly, as the MMR scandal also indicated. Of course I would be delighted to meet her to talk through this matter further.

T8. [165231] Stephen Metcalfe (South Basildon and East Thurrock) (Con): In advance of the publication of the Keogh report later today, and following the revelations that Basildon hospital had one of the highest standard mortality rates following catastrophic failures, will my right hon. Friend assure the House and my constituents that he will support the new management regime in its attempts to improve the quality of care? Will he also tell the House if he found any evidence of a systematic attempt by the previous Prime Minister and the previous Government to cover up figures—

Mr Speaker: Order. The hon. Gentleman should not abuse topical questions to ask two questions, and he should be asking not about the policies of the previous Government, but about the policies of the present Government, on which I know the Secretary of State will briefly reply. We are grateful.

Mr Jeremy Hunt: We will, of course, give every support to the management at Basildon to turn around their hospitals. The wonders of modern technology have informed us that the shadow Health Secretary was wrong to say that there has been a decline in nursing numbers in Basildon: they have actually gone up by nearly 100 since the last election.

T3. [165226] Sarah Champion (Rotherham) (Lab): The Francis report recommended that the National Institute for Health and Care Excellence draw up minimum safe staffing levels that would be policed by the Care Quality Commission. It stated that NICE should develop

“evidence-based tools for establishing”

the staffing needs of each service in the NHS which is likely to be required

“as a minimum in terms of staff numbers and skill mix.”

Will the Minister tell us when the Government will act on this and all the recommendations in the report?

Mr Hunt: If the hon. Lady heard the exchange earlier, she will know that what Robert Francis was recommending was evidence-based tools, not a national minimum staffing level. The reason for that is that the number of nurses needed varies from hospital to hospital and ward to ward. We need to make sure that that happens. In the best hospitals it already does. The system that we have—this was supported by the shadow Health Secretary in his evidence to the Francis review—is not one where the Secretary of State sits behind his desk and dictates the number of nurses required in every hospital. If we did

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that, we would not be able to run the NHS properly, but we need to make sure that there are proper standards in place, which is why we have a chief inspector of hospitals to make sure that that happens.

T9. [165232] Stuart Andrew (Pudsey) (Con): It is right that clinicians should speak out about safety in our hospitals, but does my right hon. Friend agree that now is probably not the right time for clinicians to be speculating in the national media about the safety at Leeds heart unit, given that the Department has yet to release the second phase of the review, as this endless speculation is causing great anxiety to already worried parents?

Mr Hunt: I agree with my hon. Friend. He has campaigned very honourably and sensibly for children’s heart services at Leeds. This is not a time for speculation. We will announce this month what the new process will be for resolving Safe and Sustainable. He and I both want this to happen as quickly as possible to remove that uncertainty. Also, we have to find a way of making sure that the data are solid and that we can trust them.

T4. [165227] Keith Vaz (Leicester East) (Lab): Will the Secretary of State join me in congratulating Abbey primary school on becoming the first “silver star” school in Leicester for banning sugary drinks and for promoting healthy eating and exercise? Does he agree that this is the best way of preventing diabetes and obesity in later life?

The Parliamentary Under-Secretary of State for Health (Anna Soubry): Absolutely. I would be delighted to come along and visit the school. May I give full credit to the right hon. Gentleman for his campaign and to the Silver Star charity, which does great work? That is why it is so right that we put public health back in local authorities, where it should always have been and where it was, historically. This sort of local action is very much the way forward, so I congratulate the school and the right hon. Gentleman again.

Andrew George (St Ives) (LD): Further to the question raised by the hon. Member for Walsall South (Valerie Vaz), I have met the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) regarding safe staffing levels and I provided a substantial file of evidence on behalf of the Florence Nightingale Foundation in support of its 1:8 registered nurse to patient ratio. What part of that evidence are Ministers unconvinced by?

Mr Jeremy Hunt: I am sure the evidence to which the hon. Gentleman refers is very persuasive, but I am sure he would agree that a ratio such as 1:8 cannot be applied uniformly across his local hospital or across all local hospitals. It can vary from day to day, depending on the level of illness and the age of the people going into particular wards. The best hospitals have computer models that change the numbers of nurses operating in different wards on a daily basis. Other hospitals do not do that, except on a quarterly basis. That is the change that we need to make.

T6. [165229] Rosie Cooper (West Lancashire) (Lab): Does the Secretary of State believe that making data on individual consultants public is pointless if hospitals

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are using informal mechanisms to frustrate patient choice, such as having a team of specialist nurses decide which consultant a patient is referred to? Will he reinforce patient choice and dissuade hospitals from doing that?

Dr Poulter: The hon. Lady is absolutely right to highlight the fact that we need more transparency in data and that patients have a right to know about the quality of surgical care, but it is also right that we need to look at that carefully across the different surgical specialties, and particularly at the different criteria that might also impact upon good care and good health care outcomes, particularly in oncology.

Andrew Stephenson (Pendle) (Con): Two-year-old Oliver Rushton in my constituency has cerebral palsy and needs a selective dorsal rhizotomy if he is to be able to walk or stand on his own. Unfortunately, after considerable delay, Oliver’s request for NHS treatment has been turned down. He is now getting the treatment, but only after an incredible fundraising effort from his parents, who have personally raised £40,000 to pay for it. Will my hon. Friend meet me to discuss the case?

Dr Poulter: I would be very happy to meet my hon. Friend to discuss that case and the commissioning arrangements for the procedure, and indeed other treatment for patients with cerebral palsy.

T7. [165230] Meg Munn (Sheffield, Heeley) (Lab/Co-op): The guidance that the Government have produced on transferring funds from the NHS to local authority social care makes it clear that the money can be used to plug gaps in social care caused by cuts. Does that not just mean that the local authorities that are under most pressure because they have had the biggest cuts will not be in a position to develop the integrated health and care services that we would all like to see?

Mr Jeremy Hunt: I hope that I can reassure the hon. Lady, because the conditions for accessing that £3.8 billion fund are absolutely clear. Local authorities will not be able to access it unless they can promise to maintain services at their current levels. They are allowed to make financial efficiencies, as is the NHS, and everyone needs to look at that, but not if it means a deterioration in services.

Jeremy Lefroy (Stafford) (Con): Being able to be visited frequently by one’s loved ones is a vital part of improving care for vulnerable older people in acute settings. How is closeness to home being taken into account in any service changes proposed by Monitor or the NHS Trust Development Authority?

Mr Hunt: First, I congratulate my hon. Friend on the admirable way he sticks up for his constituents in Stafford in incredibly difficult circumstances. I think that the whole House recognises what he has done. Secondly, in answer to his question, there is always a balance to be found, because we all recognise that, all things being equal, people would rather be treated nearer to where they live for exactly the reasons he gave. We also need to ensure that people get the best care when they arrive at hospital, which is why it is very important to go through these difficult processes to work out where that balance lies.

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Mr Kevin Barron (Rother Valley) (Lab): Is the Secretary of State aware of the increasing problems there are in A and E because of alcohol? If so, will he tell us what he is going to do about it?

Mr Hunt: There are problems, particularly in large cities and at weekends. In fact, in the case of the reorganisation of services at Trafford general hospital, one of the things that we can invest in as a result is mental health facilities in neighbouring A and Es so that people have better access to the services they need.

Tessa Munt (Wells) (LD): The Secretary of State will be aware of the case of Nadejah, the face of the Teenage Cancer Trust, who at the age of 23 has been refused the CyberKnife cancer treatment that could save her life. Her mother Michelle is here today. Will he intervene so that this young woman gets the treatment that her consultant, Professor Hochhauser, recommends, and will he meet Nadejah’s mother and me so that we can work together to unblock the funding so that she can get the treatment she so desperately needs?

Anna Soubry: I am more than happy to meet the hon. Lady and the family but, as she knows, this is a treatment that we have talked about endlessly, and we have had many meetings, which I am more than happy to continue to have with her.

Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op): Since 2010, thousands of NHS staff have left the NHS with big, fat redundancy cheques, only to go through the revolving door and get new jobs in the NHS, often months later. Will the Secretary of State tell us how much has been spent on redundancy payments and whether he regrets that waste of NHS money?

Mr Jeremy Hunt: The hon. Lady asks that question as if that kind of thing never happened under Labour. The answer is that it is not acceptable, which is why we are changing the rules to ensure that people cannot get payoffs and then walk straight into another NHS job. The other answer is that the reorganisation that she criticises means that we have put more money on the front line, including for 6,000 more doctors, which I think was the right thing to do.

Charlotte Leslie (Bristol North West) (Con): Does the Secretary of State agree it is a scandal that those, such as Gary Walker, Amanda Pollard and Kim Holt, who have exposed the horrors buried in our NHS have either been fired or do not have jobs, but those who are heavily implicated in such cases, such as Barbara Hakin—about whom I have written to the Secretary of State—David Nicholson, and others, still do?

Mr Hunt: My hon. Friend has campaigned long and hard on issues of accountability, and I agree with her basic case, even if I do not agree with her about all the individuals she mentioned. One issue that will arise during today’s statement is that of how people are held accountable. That has been missing in our NHS, and we must put it right.

Grahame M. Morris (Easington) (Lab): There has been much talk about action plans and I am sorry that the Minister of State, Department of Health, the hon.

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Member for North Norfolk (Norman Lamb), is not in his place. Is the Health Secretary aware that Mencap has expressed concerns that the Government’s response to the “Six Lives” progress report by the Department of Health does not set goals or time scales for tackling the issues highlighted in that report?

Mr Hunt: I know that the care services Minister would have liked to be here but he is at his son’s graduation today. I will pass on the hon. Gentleman’s question and ensure that he receives a full response.

Richard Fuller (Bedford) (Con): At the end of this month, the East of England Multi-Professional Deanery will remove junior doctors in paediatric services from Bedford hospital. That will reduce paediatric services, which will obviously cause major concerns for families with children in Bedford and Kempston and north Bedfordshire. Will my right hon. Friend join me and my hon. Friend the Member for North East Bedfordshire (Alistair Burt) in calling for an open and independent inquiry into why clinical supervisory failures continued at Bedford hospital and were not addressed, and into the terrible consequences that resulted from that?

Dr Poulter: I am sure my hon. Friend will be pleased that Health Education England, supported by the General Medical Council, took such rapid action to address concerns over patient safety and the supervision of junior doctors at his hospital. It is right that a rapid action plan has been brought in by local health care commissioners and Health Education England in order to support that, put in place the right supervision for medical staff, and ensure we put things right as quickly as possible.

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John Cryer (Leyton and Wanstead) (Lab): Further to the question from the hon. Member for Bristol North West (Charlotte Leslie), Ministers often—quite rightly—mention the importance of whistleblowers, so why have the Government weakened protection for whistleblowers through the Enterprise and Regulatory Reform Act 2013?

Mr Jeremy Hunt: We are strengthening protection for whistleblowers and are going much further by creating a culture of openness and transparency in the NHS, where people are not bullied if they speak out about poor care.

Mr Adrian Sanders (Torbay) (LD): Torbay is often held up as a model for an integrated care service, but two important services are not fully integrated—mental health care and children’s services. Will the Government encourage the incorporation of all services into a fully integrated health care system?

Mr Hunt: My hon. Friend makes an important point and the heart of what he says is that integrated, joined-up care is most important for those who are regular users of the NHS. Children with complex needs or people with mental health conditions that can improve but not necessarily be cured can really benefit from an integrated approach. I salute what Torbay has done in blazing a trail. We are learning from that and hope that such a process will be rolled out in every part of the country as soon as possible.

Several hon. Members rose

Mr Speaker: Order. I am sorry to disappoint colleagues but we must now move on.

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Northern Ireland

12.33 pm

The Secretary of State for Northern Ireland (Mrs Theresa Villiers): With permission, Mr Speaker, I would like to make a statement about riots in Northern Ireland. I am sure the whole House will join me in condemning that shameful violence and in expressing our profound sympathy and support for police officers who have been injured. It is also a matter of the gravest concern that the right hon. Member for Belfast North (Mr Dodds) was knocked unconscious as he tried to calm the situation on the streets of his constituency. I am certain that I speak for everyone here in wishing him well for a speedy recovery, and we all look forward to welcoming him back to his customary place very soon.

On Friday evening, following the annual 12 July parades, around 5,000 people gathered to protest against the Parades Commission determination not to allow three Orange lodges to return home past the nationalist Ardoyne area. This has been the scene of serious disorder in recent years, including shots fired at police by dissident republicans. Violence erupted as the crowd reached the police line on Woodvale road, preventing access to the route past the Ardoyne shop fronts. This has been followed by further disturbances and rioting on each night since then, mainly in the Woodvale parade/Twaddell avenue area, but also in the Newtownards road in east Belfast, Mount Vernon in north Belfast, Rathcoole in Newtownabbey, Portadown, and Ballyclare.

During these disturbances the police have come under attack from a variety of weapons, including fireworks, petrol bombs, bottles, stones, bits of masonry, iron bars and ceremonial swords. Last night, four blast bombs were thrown at police officers in east Belfast, as well as a pipe bomb improvised explosive device from Brompton park in the Ardoyne. Water cannon and AEP—attenuated energy projectile—plastic bullet rounds have been discharged on four successive nights, and 71 police officers have been injured. I am well aware of the anger felt by many people over the Parades Commission determination in relation to Ardoyne, but however strongly people feel, there can be absolutely no justification or excuse for the disgraceful behaviour we have seen in recent days. Attacks on the police are wholly unacceptable, and I condemn them without hesitation or reservation. It is also utterly disgraceful that the right hon. Member for Belfast North found himself, too, the victim of this violence.

There has been talk of attacks on British identity and culture in Northern Ireland. Well, the sort of behaviour that has been taking place in north Belfast does nothing to promote “Britishness” or the pro-Union cause; rather, it undermines it in the eyes of the overwhelming majority of people in Northern Ireland and in the rest of the United Kingdom. In fact, it is hard to think of anything less British and less patriotic than wrapping yourself in a Union flag and going out to attack the people who are there to maintain the rule of law and protect the whole community.

So now it is the responsibility of everyone with influence, including the Orange Order, community leaders and politicians, to do all we can to defuse tensions and calm the situation. We need temperate language over the coming days. I am afraid that the Orange Order needs to reflect carefully on its role in encouraging mass protests on Friday in a highly volatile situation without the

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careful planning, stewarding and engagement with the police that is so important for keeping people safe when big crowds gather together. While the Orange Order’s announcement of the suspension of its protests was welcome, it is now time for it to call them off completely.

I would like to pay tribute to the outstanding work of the Police Service of Northern Ireland over recent days. The officers have demonstrated fortitude, determination and courage in defending the rule of law. They put their own safety on the line in the face of violent attacks, and they deserve our utmost praise, support and thanks, as do the police officers from Great Britain who provided mutual aid support. I would like to commend the leadership of Chief Constable Matt Baggott and Justice Minister David Ford. I know that meticulous planning took place to ensure that everything possible was done to try to keep people safe over the weekend of 12 July, including bringing approximately 1,000 mutual aid officers from Great Britain.

Of the 4,000 or so parades that take place annually in Northern Ireland, the vast majority pass off without major problems, including hundreds on 12 July. But any rioting is unacceptable, not least because it undermines efforts to secure economic recovery for Northern Ireland and because it makes competing in the global race for jobs and investment that much more difficult.

The way forward has to be through dialogue to find sustainable local solutions to contentious parades, as has been the case, for example, in Derry/Londonderry. I welcomed the talks that took place between members of the Orange Order and Ardoyne residents before the Parades Commission determination. I know how difficult this will be after what has happened, but I believe it is vital that that local dialogue continues. I also welcome the inclusion of parading in the remit of the Executive’s all-party working group and the appointment of the distinguished US former envoy to Northern Ireland, Richard Haass, to chair it. The Government have always made it clear that we are open to a devolved solution if one can be found, but in the meantime we will not tolerate lawlessness on the streets of Belfast any more than we would in any other UK city.

Last week in this Chamber, issues were raised regarding my powers in relation to Parades Commission determinations. Those powers are set out in the Public Processions (Northern Ireland) Act 1998. Section 9 states that I can review a determination made by the Parades Commission only following a request by the Chief Constable. The reason he has not made such a request is that at all times he has been confident that the officers under his command can police the situation. I fully share that confidence.

To those on the streets over recent days taking part in this violence, I say this: so far 60 arrests have been made and emergency courts were sitting at Laganside on Sunday to accelerate the criminal justice process, but that is just the start. No stone will be left unturned in building the case needed for more arrests and more criminal convictions. Those who engage in so-called recreational rioting and attacks on police officers can expect to face the full force of the law.

I am confident that for some that will mean that the next 12 July holiday will be spent not out in the sunshine following the parades, but locked up in prison living with the consequences of the crimes they have committed. I commend this statement to the House.

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12.40 pm

Vernon Coaker (Gedling) (Lab): I thank the Secretary of State for her usual courtesy in giving me advance sight of her statement. I also thank her and her officials for keeping me and my office updated over the course of the weekend. That was very much appreciated and in the best traditions of bipartisanship.

I welcome the Secretary of State’s statement. It is right that the House has the opportunity to discuss these important matters.

I unequivocally condemn the violence that has taken place in Belfast over the past number of days and nights. There is no justification for it. The disgraceful attacks on the police have resulted in dozens of injuries, and the very deliberate attempt to murder officers by throwing blast bombs at them last night was shameful. It is also a matter of huge regret and concern that the right hon. Member for Belfast North (Mr Dodds) was also hurt. We wish him well.

I join the Secretary of State in paying tribute to the PSNI and its colleagues from other UK forces for their bravery and determination in upholding the law. Will she update us on the status of injured officers? Are any still receiving treatment? How many have returned to duty? Will she also tell us how many are PSNI officers and how many are from other UK forces? Is she able to say how many mutual aid officers are still undertaking duties in Northern Ireland, and how long she expects that to continue?

We know that the costs of policing large-scale public order incidents can be high. Does the Secretary of State have an estimate of how much the policing operations have cost to date, and who will meet that cost? Will it be her Department, the Department of Justice or a combination of the two?

There is always concern at the involvement of paramilitaries in or on the margins of contentious parades and protests. Has the Secretary of State looked at who was involved and who is being arrested? Is there any indication that loyalist paramilitaries or dissident republicans have organised or taken part in any of the violence?

The origins of the appalling scenes we have witnessed lie in a dispute about parading. We have been here before. Does the Secretary of State agree that meaningful dialogue and working towards local agreement is the key to finding a solution? It has worked well in other places, as she has said. The Orange Order held a peaceful, enjoyable and colourful celebration of 12 July as part of the UK city of culture celebrations in Derry/Londonderry. That was able to happen because of dialogue and communication between neighbours in an atmosphere of mutual respect and good will.

Will the Secretary of State update the House on what discussions she has had with the First and Deputy First Ministers, the Orange Order, residents’ associations, and local political and civic representatives over the weekend? Does she agree that, as Secretary of State, she has an important role to play in having further discussions over the coming weeks in north and east Belfast? As well as condemning the violence that has already taken place, does the Secretary of State agree that we need to work together to ensure it ends and does not occur in the future and to address some of the causes of these problems?

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My view is that the British and Irish Governments still have a hugely significant role to play in helping to resolve all these issues. Does the Secretary of State agree that they should both be involved in the talks convened by the First Minister and Deputy First Minister, which are being facilitated by Richard Haass? Will she confirm that the Northern Ireland Office is working with the Office of the First Minister and Deputy First Minister on that, and has she discussed it, or will she discuss it, with the Tanaiste?

In conclusion, it is crucial to bring people together to look at what needs to happen now to prevent a repeat of what has happened over the weekend, when a disagreement that was not addressed led to significant tensions between communities and ended in unacceptable violence. What part can the Secretary of State play in the discussions that need to take place?

The main message that I and, I think, the House want to send is this: we encourage all those who are working to find a solution to these matters to keep going, to keep talking and not to give up. I say to those who are involved in parading and protesting, Unionist and nationalist, that respecting the law, respecting their neighbour and respecting the wishes of people right across the community to live in peace is the only way forward. That has been done in other places across Northern Ireland and it can be done in Belfast.

Mrs Villiers: I very much welcome the comments of the shadow Secretary of State and particularly his joining me in condemning the violence. He is right to identify some of the attacks as deliberate attempts to murder police officers, which is utterly unacceptable and shocking. I will run through his long list of questions.

On the gravity of the injuries, the last update that I received was that overall, the injuries were not serious, although some police officers have been hospitalised. All those who were hospitalised as a result of the riots on 12 July were released from hospital fairly soon afterwards. I am not quite sure of the position on all the injuries that occurred last night, but my impression from my conversation with the Chief Constable this morning is that, thankfully, the injuries are again not of a serious nature. On the distribution of the injuries between mutual aid officers and PSNI officers, the figure for mutual aid officers over the weekend was two. Again, it is not clear whether any mutual aid officers were among those who were injured last night.

On the number of mutual aid officers, about 1,000 have been deployed over the past few days. Some will be going home and fresh mutual aid officers will be coming to Northern Ireland to provide assistance, so the numbers are relatively flexible. The Chief Constable is ensuring that he has the necessary resources.

The cost of the policing operation falls on the Department of Justice. Another damaging consequence of the events of recent days is that they put more pressure on police budgets.

The PSNI will naturally investigate what evidence there is of the involvement of the paramilitaries and assess who needs to be arrested. There has been a claim of responsibility from Oglaigh na hEireann in relation to the pipe bomb improvised explosive device that was thrown from the Ardoyne at police officers.

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I agree that meaningful dialogue is the way forward. I have had a range of conversations on parading matters over recent months with residents’ groups, the Orange Order, the First and Deputy First Ministers, and other leading members of Northern Ireland’s political establishment. The Northern Ireland Office also sponsored a conference at Cardiff to promote dialogue and to keep people in touch with the police and one another in an attempt to defuse tensions in such situations.

I have had a number of conversations with the Tanaiste about the current situation and about a way forward, for example through the Richard Haass working group. I look forward to supporting the Executive in respect of the work of that group in whatever way they request.

Mr Laurence Robertson (Tewkesbury) (Con): I condemn the violence of the past few nights, for which, as the Secretary of State has said, there can be no excuse. I pay tribute to the brave men and women of the PSNI who risk their lives every day to try to keep the peace. I extend my best wishes to the right hon. Member for Belfast North (Mr Dodds), whom I saw on the morning of 12 July at the Ardoyne. He was doing his best to maintain peace and calm in that area when there was something of a difficult situation, seemingly caused by the determination of the Parades Commission.

I was at several other places in Belfast on Thursday night and on Friday. With the exception of the Ardoyne in the morning, among the thousands of people I saw celebrating, there was not a single problem. Does the Secretary of State agree that the trouble has been caused by a very few people who were determined to cause trouble from the outset? Does she agree that those people in no way represent the good and decent people of Northern Ireland?

Mrs Villiers: I agree that we should in no way judge the people of Northern Ireland by the actions of the disgraceful minority who have brought violence to its streets. I acknowledge that many thousands of people on the streets on 12 July were there just to celebrate a cultural event. They caused no problems whatever and were not remotely involved in the violence that followed later in the evening.

Several hon. Members rose—

Mr Speaker: Order. Before I call the right hon. Member for Lagan Valley (Mr Donaldson), I too wish a full and speedy recovery to the right hon. Member for Belfast North (Mr Dodds). I think I speak for colleagues in saying that we look forward to welcoming him back to his place before very long.

Mr Jeffrey M. Donaldson (Lagan Valley) (DUP): Thank you for those kind words, Mr Speaker. I am sure that my right hon. Friend the Member for Belfast North (Mr Dodds) will have heard them as he recovers this afternoon. I also thank the Secretary of State, the Opposition spokesman, the Chairman of the Select Committee, the hon. Member for Tewkesbury (Mr Robertson), and all hon. Members who have spoken to me and my colleagues in recent days for their kind comments. I am confident that my right hon. Friend will be back with us before long.

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We on this side of the House unequivocally condemn the violence that has occurred in recent days, and in the past, on the whole issue of parades. No violence can be justified in these circumstances. We stand firmly for the rule of law. Does the Secretary of State agree that it is important that the rule of law is applied fairly and impartially, and that whether it is a loyalist rioter or a Sinn Fein MLA obstructing the police in the course of their duty, the law must be applied equally, fairly and impartially?

We pay tribute to the police officers who have been injured and wish them a speedy recovery. We support the police, just as we support the rule of law. We do, however, have issues regarding the consistent lack of intervention by the police in the Short Strand area of east Belfast, where they have failed to protect people lawfully processing on the public highway. We need to examine why adequate protection is not afforded to those parading peacefully and lawfully. That is not, in any sense, to condone violence resulting from people being put under attack.

We have grave concerns about the operation of the Parades Commission. There is no doubt that the clear perception among many people in Northern Ireland is that the decision on the Ardoyne parade rewarded the violence of the previous year, to which the Secretary of State alluded in her remarks. That violence included dissident republicans opening fire on the police in the Ardoyne, and a huge of amount of petrol bombs and other devices being thrown at the police. We must not have a situation, in any circumstances, where violence is seen to be rewarded.

Finally, on the all-party working group, in which I have been asked to participate on behalf of my party, we are committed to finding ways forward on all of these contentious issues, including parades. However, may I say to the Secretary of State that if a shared future is to mean anything, it has to include shared space? If we have a situation in Northern Ireland where there are no-go areas, where one side of the community is not welcome, that is not a shared future and not shared space.

Mrs Villiers: I reiterate my sympathies to the right hon. Member for Belfast North, who was doing such brave work to try to look after his constituents and found himself the victim of unacceptable violence. Of course I agree with the right hon. Member for Lagan Valley (Mr Donaldson) that the rule of law should be applied impartially, and I am absolutely convinced that the PSNI does that. I note his comments on what he perceives as the handling of the Short Strand area. Again, I hope I can provide reassurance that proportionality and fairness is at the heart of everything the PSNI does, whether in Short Strand or elsewhere. I note his comments on the Parades Commission. As I said, I understand the concerns about its decision, and I know that the debate continues on the future of the Parades Commission. I think the way forward to resolve these problems is through local dialogue, but channelling efforts, enthusiasm and energy into looking at options for future reform through the Richard Haass working group is also an important way forward. I also agree that in a shared future we need shared space. We need to find a way to ensure that different traditions can be celebrated in an atmosphere of mutual respect and understanding.

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Bob Stewart (Beckenham) (Con): Obviously, and thankfully, the Army was not called in to support the PSNI. May I ask my right hon. Friend whether there remains an infantry unit in theatre that could do such a role if required?

Mrs Villiers: I believe that it is inconceivable that we would see the Army back on the streets of Northern Ireland dealing with public order issues.

Mr Peter Hain (Neath) (Lab): May I associate myself with the Secretary of State’s statement? Anybody who has done her job will know its difficulties. However, may I press her to be more directly engaged, despite the meetings she has had, with the different groups that are very sensitive on this issue: from the Orange Order to republican groups, dissident groups and loyalist groups? There is a feeling in Northern Ireland, fairly or unfairly, that she is not rolling up her sleeves enough and getting people around the table. Is the Parades Commission perhaps being too aloof and legalistic in the way it is proceeding? It, too, needs to get into the negotiation business and not simply make determinations.

Mrs Villiers: I assure the right hon. Gentleman that I have been engaged in a whole range of discussions with the Orange Order, residents’ associations and a long list of people involved in these matters. I got the Northern Ireland Justice Minister, the PSNI and the Parades Commission around the table to talk about these issues. As far I am aware, that has never happened before. All of that took place in the months running up to 12 July —there was not a last-minute series of meetings immediately before the parades that has sometimes happened in the past. I am always keen to roll up my sleeves to get involved and do whatever I can. The reality is that this remains an extremely difficult problem to resolve, but I will be doing my very best, working with Northern Ireland politicians.

Stephen Lloyd (Eastbourne) (LD): I would also like to express my support and appreciation for the Secretary of State’s statement, and my party’s concern for the right hon. Member for Belfast North (Mr Dodds). I would like to make two points. First, the police have been through a brutal time over the weekend. As usual, the PSNI has performed absolutely superbly and I wish to express my party’s support for the courage and behaviour of the police. Secondly—the Secretary of State alluded to this in her statement—have the Government made a formal point to the relevant Orange Order to ask whether it sincerely feels in its heart that it helped or hindered events over the weekend?

Mrs Villiers: I hope that the Orange Order is reflecting on the scenes of violence—they do not help any cause. They certainly do not assist the cause of cultural tolerance, and they certainly do not make it easy to resolve the matter next year in a way that is acceptable to all sides.

Ms Margaret Ritchie (South Down) (SDLP): In condemning the violence right across Belfast and in other parts of Northern Ireland, and in extending best wishes to the right hon. Member for Belfast North (Mr Dodds), may I ask the Secretary of State whether she agrees that the responsibility for the violence and disorder lies with the perpetrators rather than the lawful

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authority of the Parades Commission? Does she further agree that the violence stems from anger, and that that anger stems from rhetoric used by certain members of the loyal orders and certain members of the Unionist parties? Will she, along with me, urge them to desist from making such comments, so that a shared society can be built throughout Northern Ireland?

Mrs Villiers: I agree that the people responsible for the violence are the perpetrators: the people chucking petrol bombs and attacking the police in this disgraceful way. It is important that, in the coming days, all of us who care about Northern Ireland seek to calm the situation and that a lead be given by the Orange Order. Northern Ireland’s political leadership has made it clear that it wants the situation calmed and that it condemns the violence, so I hope that the people on the streets will heed that call and realise that the violence is hugely damaging to Northern Ireland and does not support any cause. It is time for the debate about parades to come off the streets and to be channelled into a political process.

Mr Philip Hollobone (Kettering) (Con): Does the Secretary of State believe that the level of disorder and the number of injuries to police officers would have been greater had it not been for the effective deployment of water cannon? Given that hundreds of police officers from Great Britain have now seen how this equipment can be effectively deployed, will she share her assessment of its use with the Home Secretary, so that water cannon can be deployed in Great Britain to deal with future public order disturbances on the mainland?

Mrs Villiers: I am inclined to agree that without the ability to deploy water cannon, there could have been more injuries to police officers. I am certainly happy to share with the Home Secretary the experience in Northern Ireland of deploying water cannon, if she would like me to do that.

Naomi Long (Belfast East) (Alliance): I join the Secretary of State in condemning those engaged in violence, whether in seeking to breach a determination or in attacking lawful parades, thereby providing a further challenge to the rule of law and causing further damage to Northern Ireland’s reputation. I also extend my best wishes to the right hon. Member for Belfast North (Mr Dodds).

My primary concern is both for my constituents living in the areas affected—on the Newtonards road and in the Short Strand—whose lives are put at risk, who are terrified in their homes and whose neighbourhoods are left like war zones in the aftermath of these riots, and for the police who must protect the public and uphold the law in difficult circumstances. Does the Secretary of State agree that until such time as an agreement on an alternative to the Parades Commission is agreed by all parties in Northern Ireland, that body remains the lawful authority in these matters and that its rulings must be upheld—no ifs, no buts—if law and order is not to be undermined more generally?

Mrs Villiers: The hon. Lady is absolutely right. The Parades Commission is the lawfully constituted authority; its determinations must be obeyed and the rule of law must be respected. Visiting her constituency, I saw the devastating impact that disorder had during the flags

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protest, and I know that the continuation of violence over recent days is deeply depressing for her constituents, not least for the businesses whose trade is disrupted.

Nigel Mills (Amber Valley) (Con): While not condoning the violence over the weekend, does the Secretary of State not agree that there is a fear that the Parades Commission ruling placed the police in an impossible situation, having to police an unpoliceable order, and that with hindsight it might have been better to use the mechanism in place for exceptional circumstances to try to find a solution for the march that was acceptable to all sides?

Mrs Villiers: As I said in my statement, the PSNI was confident at all times that it could police whatever determination the Parades Commission made, and in those circumstances it was not appropriate and my powers to intervene were not triggered.

Mr Gregory Campbell (East Londonderry) (DUP): I thank you, Mr Speaker, and other hon. Members for their best wishes, which I shall pass on to my right hon. Friend the Member for Belfast North (Mr Dodds).

The Secretary of State has indicated the reprehensible nature of the violence and the attacks on police and property, which we all condemn outright and without reservation. She must now ensure that comprehensive discussions take place immediately—not next May or June, but immediately—to resolve all outstanding parades involving protests and violence. She also needs to engage with the Office of the First Minister and Deputy First Minister to ensure that marginalised and embittered communities see more investment and jobs in their areas so that they do not get caught up in violence.

Mrs Villiers: I agree that comprehensive discussions are needed on issues such as parading, which is why I welcomed the establishment of the Haass group. As I said, I am happy to help in whatever way I can, and yes I am working closely with the First Minister and Deputy First Minister on the kind of economic measures needed to boost the economy in Northern Ireland, including through our economic package, which I hope will help the people in those deprived communities.

David Tredinnick (Bosworth) (Con): Does my right hon. Friend agree that it makes it more difficult for law enforcement agencies if parade routes are changed at short notice? We need the maximum possible notice.

Mrs Villiers: Certainly, for those organising big events, whether in Northern Ireland or elsewhere, advance planning is crucial to keeping people safe.

Paul Goggins (Wythenshawe and Sale East) (Lab): The Secretary of State has made several references to the all-party talks under Richard Haass looking into a range of contentious issues, including parading. Will she take this opportunity to emphasise the importance of all those involved, including the Orange Order, engaging in a serious search for solutions, not simply blocking proposals, as happened after the Hillsborough Castle agreement?

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Mrs Villiers: Yes, I will. It is important that the loyal orders, including the Orange Order and the Royal Black Institution, engage. As well as the Richard Haass process, the Cardiff process is continuing, following on from the conference sponsored by the Northern Ireland Office, as a way to try and defuse tensions and reduce the risk of violence occurring at individual parades.

Andrew Stephenson (Pendle) (Con): It is worth remembering, and respecting the fact, that in the main Orangemen and women do not come out to annoy Catholics and that the majority of parades over the weekend, including the one that I observed, passed without incident. It is clear, however, that parades remain the rawest of issues and that the scenes in Belfast were an utter disgrace. My right hon. Friend the Secretary of State said that about 1,000 officers from England, Wales and Scotland were involved over the weekend. Can she confirm that the same number, and more, remain available to assist if trouble flares up again in the coming days?

Mrs Villiers: Yes, I can assure my hon. Friend that conversations about our mutual aid presence in Northern Ireland are continuing, and the Chief Constable is confident that he can secure the mutual aid resources he will need over the coming days.

Mark Durkan (Foyle) (SDLP): I thank the Secretary of State for her statement, which I regret she had to make, and commend the comments from the shadow Secretary of State.

Does the Secretary of State agree that if there is rent-a-rant leadership, people cannot escape responsibility for rent-a-mob violence? She referred, rightly, to the positive example on Friday of the Orange Order having its parade in the city of Derry, where it was accepted and respected, but does she understand that the dialogue model used there did not deliver immediately but took purpose and patience? Wider civic and commercial interests were able—and often required—to weigh in to ensure a wider perspective. Will she encourage the Haass dialogue to provide a channel for those wider civic and commercial interests as well?

Mrs Villiers: I am happy to do that. The business community made it clear that it wanted a peaceful 12 July weekend. I continue to encourage the business community to engage on these matters for the same reasons that the hon. Gentleman outlines: because they played such a positive role in Derry/Londonderry. I also agree that a sustainable local solution will not be found in just a few days, but will require further work. I hope that the Orange Order and the residents will continue the conversation they started; at the time, both sides said it was positive.

David Simpson (Upper Bann) (DUP): I join other right hon. and hon. Members in condemning the violence. The Secretary of State mentioned community engagement. She will know that in my constituency the Orange Order stages a weekly protest—and has done for 13 years —because the residents of the Garvaghy road will not engage on trying to resolve the issue. Community engagement is one of the big problems; that cannot be allowed to continue.

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Mrs Villiers: It is important for both sides to engage, certainly in relation to the Ardoyne. I hope that the resident group and the loyal orders will be willing to continue the conversation.

Kate Hoey (Vauxhall) (Lab): The Secretary of State will know that last year the Parades Commission allowed the Orange Lodges to return through the Ardoyne in buses, but that they were attacked and shots were fired. No statement was made in the House and the genuine perception was that the violence was rewarded, because this year the Orange Lodges were not allowed to follow the same route. Does she share my concern about the make-up and working of the Parades Commission? Is it not time to face reality—it is not working? There must be a different way of doing this; certainly, the Parades Commission is not the answer.

Mrs Villiers: As I have said, I am aware of the concern felt about the determination, but it has the force of law. Determinations have to be respected, regardless of people’s view of the Parades Commission and the way decisions are taken. However, I am also clear that I am open to reform of the way those decisions are taken if local consensus can be achieved. I look forward to working with the Executive on those matters when the Haass group starts its work.

Kevin Brennan (Cardiff West) (Lab): In many ways, it was appropriate that the conference was held in Cardiff, given that anyone who has visited Belfast and Cardiff will know the similarities, in terms of maritime history, architecture and the friendly nature of all the people in both cities. Will the Secretary of State recommit to the statement that came out of the conference, which said:

“We commit to resolve our differences through dialogue and non-violent means, underpinned by the principles of equality, inclusiveness, respect for difference, and non-discrimination”?

Mrs Villiers: Yes, I am entirely happy to associate myself with that statement, and I hope that we hear that message coming out clearly from across Northern Ireland’s political and civic leadership over the coming days.

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Hospital Mortality Rates

1.10 pm

The Secretary of State for Health (Mr Jeremy Hunt): I would like to make a statement about Professor Sir Bruce Keogh’s review of hospitals with high mortality rates, which is being published today.

Let me start by saying that in the health service’s 65th year, this Government are deeply proud of our NHS. We salute the doctors, nurses and other professionals, who have never worked harder to look after each and every one of us at our most vulnerable. We recognise that the problems identified today are not typical of the whole NHS or of the care given by many wonderful NHS staff; but those staff are the ones who are most betrayed when we ignore or pass over poor care. The last Government left the NHS with a system that covered up weak hospital leadership—[Interruption.]

Mr Speaker: Order. As is the normal practice, right hon. and hon. Members can expect extensive questions—as can the Secretary of State—but the statement must be heard.

Mr Hunt: Thank you, Mr Speaker. The last Government also failed to prioritise compassionate care. The system’s reputation—[Interruption.] This is uncomfortable for hon. Members. The system’s reputation mattered more than individual patients; targets mattered more than people. We owe it to the 3 million people who use the NHS every week to tackle and confront abuse, incompetence and weak leadership head-on.

Following the Francis report into the tragedy at Mid Staffs, the Prime Minister asked Professor Sir Bruce Keogh, the NHS medical director, to conduct a series —Interruption.] I know they tried to shout down whistleblowers such as Julie Bailey, but we are not going to let that happen here. The Prime Minister asked Professor Keogh to conduct a series of “deep-dive” reviews of other hospitals with worrying mortality rates. No statistics are perfect, but mortality rates suggest that since 2005, thousands more people may have died than would normally be expected at the 14 trusts reviewed by Sir Bruce.

Worryingly, in half those trusts, the Care Quality Commission—the regulator specifically responsible for patient safety and care—failed to spot any real cause for concern, rating them as “compliant” with basic standards. Each of those trusts has seen substantial changes to its management since 2010, including a new chief executive or chair at nine of the 14. However, although some have improved, failure or mediocrity is so deeply entrenched at others that they have continued to decline, making the additional measures I am announcing today necessary.

This time, the process was thorough, expert-led and consisted of planned, unannounced and out-of-hours visits, placing particular weight on the views of staff and patients. Where failures were found that presented an immediate risk to patients, they were confronted straight away, rather than waiting until the report was finished. We will be publishing all the reports today, alongside unedited video footage of the review panel’s conclusions—all of which I am placing in the Library. Today I will also set out the actions the Government are taking to deal with the issues raised. I would also like to

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record my sincere thanks to Sir Bruce and his team for doing an extremely difficult job very thoroughly and rapidly.

Sir Bruce judged that none of the 14 hospitals is providing a consistently high quality of care to patients, with some very concerning examples of poor practice. He identified patterns across many of them, including professional and geographic isolation, failure to act on data or information that showed cause for concern, the absence of a culture of openness, a lack of willingness to learn from mistakes, a lack of ambition, and ineffectual governance and assurance processes. In some cases, trust boards were shockingly unaware of problems discovered by the review teams in their own hospitals. Today I can therefore announce that 11 of the 14 hospitals will be placed into special measures for fundamental breaches of care. In addition, the NHS Trust Development Authority and Monitor have today placed all 14 trusts on notice to fulfil all the recommendations made by the review. All will be inspected again within the next 12 months by the new chief inspector of hospitals, Professor Sir Mike Richards, who starts work today.

The hospitals in special measures are as follows: Tameside Hospital NHS Foundation Trust, where patients spoke of being left on unmonitored trolleys for excessive periods and where the panel found a general culture of “accepting sub-optimal care”; North Cumbria University Hospitals NHS Trust, where the panel found evidence of poor maintenance in two operating theatres, which were closed immediately; Burton Hospitals NHS Foundation Trust, where the panel found evidence of staff working for 12 days in a row without a break; and North Lincolnshire and Goole NHS Foundation Trust, where the panel identified serious concerns in relation to out-of-hours stroke services at Diana, Princess of Wales hospital. The panel also witnessed a patient who was inappropriately exposed where both male and female patients were present. [Interruption.]

The list continues: United Lincolnshire Hospitals NHS Trust, where there were a staggering 12 “never events” in just three years and the panel had serious concerns about the way “Do not attempt resuscitation” forms were being completed; Sherwood Forest Hospitals NHS Foundation Trust, where patients told of being unaware of who was caring for them, and of buzzers going unanswered and poor attention being paid to oral hygiene; East Lancashire Hospitals NHS Trust—[Interruption.]

Mr Speaker: Order. We cannot have a running commentary on the statement as it is delivered. I remind the House that last Wednesday—when there were scenes of grave disorder manifested by Members on both sides of the House—the public reaction to that exceptionally bad behaviour was understandably negative. I appeal to right hon. and hon. Members on both sides of the Chamber to show courtesy and restraint. They can rely upon me to protect their interests—if they were here on time for the statement—to question the Secretary of State, but the statement must be heard.

Mr Hunt: The panel also highlighted issues of poor governance, inadequate staffing levels and high mortality rates at weekends at East Lancashire Hospitals NHS

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Trust. Patients and their families complained of a lack of compassion and being talked down to by medical staff whenever they expressed concerns.

The remaining hospitals in special measures are as follows: Basildon and Thurrock University Hospitals NHS Foundation Trust, where there were seven “never events” in three years and concerns over infection control and overnight staffing levels; George Eliot Hospital NHS Trust, where the panel identified low levels of clinical cover, especially out of hours, a growing incidence of bed sores and too much unnecessary shifting of patients between wards; Medway NHS Foundation Trust, where a public consultation heard stories of poor communication with patients, poor management of deteriorating patients, inappropriate referrals and medical interventions, delayed discharges and long accident and emergency waiting times; and Buckinghamshire Healthcare NHS Trust, where the panel found significant shortcomings in the quality of nursing care relating to patient medication, nutrition and observations, and heard complaints from families about the way patients with dementia were treated.

For those 11 trusts, special measures mean that each hospital will be required to implement the recommendations of the Keogh review, with external teams sent in to help them do this. Their progress will be tracked and made public. The TDA or Monitor will assess the quality of leadership at each hospital, requiring the removal of any senior managers unable to lead the improvements required. Each hospital will also be partnered with a high-performing NHS organisation to provide mentorship and guidance in improving the quality and safety of care.

Three of the 14 hospitals are not going into special measures. They are the Colchester Hospital University NHS Foundation Trust, the Dudley Group NHS Foundation Trust and the Blackpool Teaching Hospitals NHS Foundation Trust. Although there were still concerns about the quality of care provided, Monitor has confidence that the leadership teams in place can deliver the recommendations of the Keogh review and will hold them to account for doing so.

This is a proportionate response in line with the findings of the review. Inevitably, there will be widespread public concern not just about these hospitals but about any NHS hospital, and some have chosen to criticise me for pointing out where there are failures in care, but the best way to restore trust in our NHS is transparency and honesty about problems, followed by decisiveness in sorting them out. The public need to know that we will stop at nothing to give patients the high-quality care they deserve for themselves and their loved ones. Today’s review and the rigorous actions that we are taking demonstrate the progress this Government are making in response to the Francis report. I shall update the House in the autumn on all of the wide-ranging measures that we are implementing, when the House will be given a chance to debate them in Government time.

The NHS exists to provide patients with safe, compassionate and effective care. In the vast majority of places it does just this, and we should remember that there continues to be much good care even in the hospitals reviewed today. Just as we cannot tolerate mediocre or weak leadership, we must not tolerate any attempts to cover up such failings. It is never acceptable for Government Ministers to put pressure on the NHS to suppress bad news, because in doing so they make it less likely that poor care will be tackled.

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We have today begun a journey to change this culture. These 14 failing hospital trusts are not the end of the story. Where there are other examples of unacceptable care, we will find them and we will root them out. Under the new rigorous inspection regime led by the chief inspector of hospitals, if a hospital is not performing as it should, the public will be told. If a hospital is failing, it will be put into special measures with a limited time period to sort out its problems. There will be accountability, too: failure in the NHS should never be a consequence-free zone, so we will stop unjustified pay-offs and ensure it will no longer be possible for failed managers to get new positions elsewhere in the system.

Hand in hand with greater accountability, there will be greater support. Drawing inspiration from education, where super-heads have helped to turn around failing schools, I have asked the NHS Leadership Academy to develop a programme that will identify, support and train outstanding leaders. We have many extraordinary leaders such as David Dalton in Salford Royal and Dame Julie Moore of University hospital Birmingham, but we need many more to provide the leadership required in our weaker hospitals.

At all times, this Government will stand up for hard-working NHS staff and patients who know that poor care and weak leadership have no place in our NHS. It was set up 65 years ago with a pledge to provide us all with the best available care, and I am determined that the NHS will stand by that pledge. We owe its patients nothing less. I commend this statement to the House.

1.23 pm

Andy Burnham (Leigh) (Lab): First, let me join the Secretary of State in thanking Sir Bruce Keogh and his team for this important review. Having worked closely with Sir Bruce, I know him well and have the utmost respect for him. His review presents a challenging but accurate picture of care standards and failings at the 14 trusts. As with both Francis reports, we accept the findings of this report in full.

The statement we have just heard, however—the partisan statement—was not worthy of the excellent report that Sir Bruce has delivered today. The Health Secretary claimed at Health questions that this was a historical report, all about the past and the last Government. Well, I have got news for him: it is not. Trusts were identified on the basis of mortality data for 2011 and 2012. This report is about the right hon. Gentleman’s Government and failings that are happening now on this Government’s watch.

Anyone who supports the NHS must always be prepared to shine a spotlight on its failings, so it can face up to them and improve. In so doing, we must be fair to staff and the NHS as a whole. I am pleased to say that Sir Bruce is fair in his report. He says early in the report that the failings of the 14 hospitals must be put in context, stating that mortality in “all NHS hospitals” has been falling over the last decade by about 30%. He rightly reminds us of

“decades of neglect in the NHS in the 1980s and 1990s”,

and he speaks of the challenge facing the last Government in their early days. The key issue, he said,

“was not whether people were dying in our hospitals avoidably, but that they were dying whilst waiting for treatment.”

The last Labour Government dealt with that issue; I am proud of it and we are proud of our record on the NHS.

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The balanced picture presented in this report is not recognisable from the Government briefing appearing in the weekend newspapers. In fact, this report exposes one of the more cynical spin operations of recent times. Nowhere in this report does the claim of 13,000 avoidable deaths appear. Sir Bruce is clear, so let me quote him directly:

“However tempting it may be, it is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths”,

but that is precisely what this Government chose to do in advance of this report. They made unfounded claims, which will have alarmed people in the areas served by the 14 hospitals, and they have questioned the integrity of the staff working in those hospitals in difficult circumstances—and all for their own self-serving political ends. That is simply unworthy of any responsible Government. On reading this review, the diversionary spin operation now makes sense because it reveals evidence of deterioration at all 14 hospitals on their watch.

Let me turn to one of Sir Bruce’s central findings—unsafe staffing. One of the report’s major concerns is that trusts have allowed staffing levels to drop to dangerously low levels. It says:

“When the review teams visited the hospitals, they found frequent examples of inadequate numbers of nursing staff in some ward areas.”

Already, the review team has had to intervene on staffing levels in three trusts to protect patient safety.

The Secretary of State claimed in his comments that the Care Quality Commission had failed to spot any problems. Working with the CQC during the last Government, I left in place warnings about five of these hospitals. The Secretary of State claims that we were covering up, so let me answer on the question of Ministers’ integrity and cite the Francis report, which said that there was no evidence that any Minister received or ignored advice that would have led to safe outcomes. Let me quote to him from a letter sent by Baroness Young to the Prime Minister yesterday:

“CQC was not pressurised by the previous Government to tone down its regulatory judgments or to hide quality failures.”

It is outrageous for the Secretary of State to come to the House today and repeat those concerns without a shred of evidence to back them up.

Five of the trusts examined by Keogh had warnings in place, and it is shocking that they have been allowed to cut staff to unsafe levels on this Government’s watch. Overall, seven of the trusts in the review have cut front-line staff by a shocking 1,117. The great sadness is that it appears Ministers are in danger of forgetting the lessons of Stafford, where Robert Francis identified “dangerous cuts” to the front line as a primary cause of care failures. Like Robert Francis, Sir Bruce makes recommendations on appropriate staffing levels. Is it not the case that the Secretary of State can no longer ignore these authoritative calls, and will he take urgent action on safe staffing levels in these 14 trusts and across the NHS? Will he accept that the loss of over 4,000 nursing jobs that has now been laid bare under this Government is a monumental mistake, while £3 billion has been siphoned out of the NHS front line to pay for reorganisation that nobody wanted and nobody voted for?

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Let me turn to A and E performance, the barometer of the health service and a wider indication of problems across hospitals. The report highlights major failings in A and E at many of the trusts and we know that the NHS has just come through the worst winter for a decade. At the end of last year, all 14 trusts were in breach of the Government’s A and E target—when, under the previous Government, all 14 were meeting the A and E target.

Sir Bruce is clear that urgent action is needed to improve A and E. Let me quote the report:

“We have established that one of the primary causes of high mortality in these hospitals are found primarily in urgent and emergency care, and particularly in care for frail and elderly patients…All trusts were functioning at high levels of capacity in the urgent care pathway. This frequently led to challenges in A&E and, as a consequence, cancellation of operations due to bed shortages and difficulty meeting waiting time targets.”

Will the Secretary of State now take immediate action, working with the whole health economy in these 14 areas, to bring each trust back up to the national standards on A and E that his Government have set? Will he accept that it is not fair to these hospitals to blame them alone, as the devastating cuts to social care are a major driver of pressure in hospitals?

Finally, on what happens next, the simple truth is that people watching will want solutions rather than point scoring. Surely the right response to the Keogh review is now to accept the Francis recommendations in full, particularly on minimum staffing. A duty of candour on individuals will help bring the culture change we need at local level and, of course, we need to see the regulation of health care assistants. Will the Secretary of State work with us now on early implementation of the Francis recommendations? He spoke earlier of a new era of transparency. If he means what he says, will he now publish the NHS risk register? For all we know, it might well have predicted some of the failings we are reading about today.

It is a sad fact that mistakes will be made in any walk of life, even in the NHS. What matters is how the NHS responds. Rather than pulling down the shutters and pushing people away, it is right that we should hold a mirror up to the NHS so that it can act on its failings. We must also be fair to people working in the NHS by ensuring that an accurate picture is presented. Sir Bruce has had to take the extraordinary step already of distancing himself from the Government briefings that appeared at the weekend. I hope the Government will learn a painful lesson from this: you should not play politics with people’s lives and you should not play politics with the NHS, on which all people depend.

Mr Hunt: Mr Speaker, it is hard for a serving Health Secretary to admit that things can go wrong in the NHS, but we know today that it is even harder for a former Health Secretary. We have heard nothing but shameful denial. The right hon. Gentleman—[Interruption.]

Mr Speaker: Order. Mr Irranca-Davies, you look as though you are about to explode. I am worried about you. I think you probably need to have a lie down or to take some sort of medicament—it might be of benefit to you. You must calm yourself.

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Mr Hunt: The right hon. Gentleman talked about being partisan and party political. It is not party political to highlight poor care; it is doing the right thing for patients.

Let us look at what independent people have said about Labour’s time in office. Roger Davidson, the former head of media at the CQC, said that

“there were conversations between the CQC and Ministers to the effect that the CQC would not cause any trouble…The message that ‘we don’t want bad news’ infected the whole organisation”.

Professor Brian Jarman—[Interruption.] I think Opposition Members might want to listen to this, because it is what independent people are saying. Professor Jarman, who invented hospital standardised mortality indices, said that

“the problem was ministerial pressure, even from Number 10.”

This is most damaging: the right hon. Gentleman talked about what Barbara Young, Labour peer and head of the CQC, said under pressure from the Labour Whips, but what did she say under oath to the Francis inquiry? She said that

“the government hated the idea…the regulator would criticise it… We were under more pressure, I think, when Andy Burnham became minister, from the politics.”

That is what a Labour peer said. These people are not Government supporters—at least, not of this Government —but were trying to do their job in exposing poor care and the right hon. Gentleman stopped them.

The right hon. Gentleman talks of spin, but I will tell him who had to fight hardest against spin: the whistleblowers he tried to shut up. What do they say? James Titcombe, who tragically lost his son at Morecambe bay, tweeted that

“you made big mistakes Andy, it’s time you admitted it.”

Julie Bailey, who lost her mother at Mid Staffs, said that Labour crushed the culture of care from the NHS. [Interruption.] Deb Hazeldine, from Mid Staffs, who lost a relative, said that the shadow Secretary of State was trying to “defend the indefensible”—[Interruption.]

Mr Speaker: Order. It is very difficult to imagine how anyone can hear these exchanges. The content of questions and answers is to be determined by Members, but I gently remind the House of the need for good order and that this is not a debate. There will be debates, but this is not a debate but a statement on which there is questioning, to which there is then a ministerial answer. This is not an opportunity for general speechifying but for responses to specific questions made with economy so that I can accommodate all interested colleagues.

Mr Hunt: Thank you, Mr Speaker. I would have hoped that the Opposition would want to listen more respectfully to what whistleblowers said about their attempts to expose poor care.

Let me respond to what the right hon. Gentleman says. He says that Labour tackled the problems, but the evidence shows the opposite. We talked about Tameside earlier, but what about Basildon? There were high death rates for nine years under Labour—in every year since 2001. Half the staff said they would not want their own friends and family treated there. Ministers received 237 letters between 2005 and 2010, yet what did the CQC do? It rated the hospital as “good” and within four weeks Ministers were shamed into launching an investigation into high mortality rates—[Interruption.]

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Mr Speaker: Order. I have tried to explain the position calmly—[Interruption.] Order. I shall do so once more. I think the Secretary of State will appreciate that he has been asked questions about present arrangements to which we need pithy replies, not a lengthy statement about events of the past that happened before he had responsibility. We cannot have that. If that is what he is planning to read out, we will simply move on. A brief conclusion to his answer is now required and sought by the House.

Mr Hunt: So, Mr Speaker, let me briefly take the final two points raised by the right hon. Gentleman. He says the trusts have got worse since 2010, but what does he do when I criticise the lack of progress—[Interruption.]

Mr Speaker: Order. My impression is that the Secretary of State is now seeking to treat of matters since May 2010 and he must be given the opportunity to do so, with colleagues and people outside being able to hear the answers.

Mr Hunt: Thank you, Mr Speaker.

What does the right hon. Gentleman do when I criticise the lack of rapid progress in tackling failure in our hospitals? He criticises me for making an unbelievable statement and states that there are no coasting hospitals, but today proves that he is wrong. What is unbelievable is his total refusal to admit that it is not just a question of coasting hospitals, but a Labour party that has coasted for too long on its reputation on the NHS.

Finally, the right hon. Gentleman says that we are trying—[Interruption.] This is difficult for Labour Members to hear, so let us get to the point. He says that we are trying to run down the NHS. Let me say this: if we did not believe in the NHS, we would not be tackling these problems. The best way to support the NHS is not to ignore poor care, not to muzzle the CQC, not to ignore requests for public inquiries and not to ignore warnings constantly. If founding the NHS is considered Labour’s proudest achievement, today is its darkest moment as a Labour Government are exposed as caring more about their own reputation than about our most vulnerable citizens in the NHS—[Interruption.]

Mr Speaker: Order. Has the Secretary of State finished his answer? He has. We are grateful and I thank him for saying that he has finished.

Several hon. Members rose

Mr Speaker: Order. I remind the House of the long-established and generally adhered-to convention that Members who were not present at the start of a statement do not rise to question the relevant Minister. That has long been regarded as a discourtesy, and it should not happen. I have a list of Members who arrived late, but I hope that they will not render it necessary for me to draw attention to the fact. I ask those who arrived late, in all courtesy, not to rise to their feet.

We will now make progress as expeditiously as we can, led by the Chair of the Health Committee.