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House of Commons

Tuesday 25 February 2014

The House met at half-past Eleven o’clock


[Mr Speaker in the Chair]

Oral Answers to Questions


The Secretary of State was asked—

Out-of-hospital Care

1. David Rutley (Macclesfield) (Con): What progress he has made on improving out-of-hospital care for the frail and elderly. [902623]

The Secretary of State for Health (Mr Jeremy Hunt): We will ensure that everyone over the age of 75 has a named GP, responsible for delivering proactive care for our most vulnerable older people in the best traditions of family doctors. Through our £3.8 billion better care fund, we are also merging the health and social care systems to provide more joined-up health and social care.

David Rutley: I welcome the steps that my right hon. Friend is taking to improve and enhance the quality of care for the elderly. Given that east Cheshire has one of the fastest-growing ageing populations in the UK, will he tell the House what specific steps he is taking to improve out-of-hospital care in and around Macclesfield? Furthermore, does he agree that it is vital that appropriate funding is in place to take care of the elderly and most vulnerable patients?

Mr Hunt: May I congratulate my hon. Friend on the campaigning work he does in his constituency on health matters? I commend the Eastern Cheshire clinical commissioning group for its “Caring Together” programme and for the fact that Cheshire was selected as one of the 14 integrated care pioneers. I hope that it will blaze a trail in joining up the barriers that have bedevilled our health and social care system for too long, so that his constituents are not pushed from pillar to post because of arguments about budgets and people can be discharged on time. I think his area is blazing a trail.

Hazel Blears (Salford and Eccles) (Lab): The national dementia strategy has been fundamental in improving care for many frail and elderly people with dementia living in the community. The strategy is due to expire in April—in two months’ time. Will the Secretary of State give a commitment to the House now that the national dementia strategy will be renewed? I understand that we

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have the Prime Minister’s dementia challenge, but, like many of us, Prime Ministers come and go. We need a strategy and not simply the Prime Minister’s challenge.

Mr Hunt: I can assure the right hon. Lady that this Prime Minister is here to stay. Indeed, I can also reassure her that the national dementia strategy is here to stay. As she has announced that she is stepping down at the end of this Parliament, may I thank her for her campaigning on dementia, which, I think, came from a family connection with the issue? She has attended many of my dementia meetings and the G8 dementia summit. She has made a really important contribution, and I thank her for that.

Paul Burstow (Sutton and Cheam) (LD): May I follow up on the question that the right hon. Lady has just asked? The Secretary of State has said that the national strategy is here to stay and that is very welcome, but the national strategy was drafted with the intention that it would expire this year. It would be useful if he now indicated the intention to refresh and update it so that we have a clear road map for at least the next decade.

Mr Hunt: I know that my right hon. Friend showed great interest in this issue when he was in my Department. When I say that the strategy is here to stay, I mean that it is here to be refreshed and updated. We are subscribing to some big new ambitions, including that by the time of the next election two thirds of people with dementia will be diagnosed and have a proper care plan and support for them and their families. That is a big improvement on the 39% of people who were diagnosed when we came to office. There is much work to do, but I assure him that we are absolutely committed to delivering.

Lyn Brown (West Ham) (Lab): Some hospitals are making a virtue out of quick discharge for their stroke victims. Is the Secretary of State convinced that elderly stroke victims, perhaps those without people to advocate on their behalf, are getting appropriate care and that their care and rehabilitation are not being scrimped on or rationed?

Mr Hunt: No, I am not convinced. We need to do much better when it comes to the discharge of vulnerable older people, especially when they leave hospital not cured and still with a long-term condition. They may be recovering from a stroke or dementia or any other condition. We need to have much better links between hospitals and GPs and to have named accountable GPs in the communities looking after those very people.

Dr Thérèse Coffey (Suffolk Coastal) (Con): I was disappointed with the allocation of funding by NHS England for care around the country because it did not reflect the demands of the elderly population. People in my constituency have to do a 200-mile round trip to receive support such as cardiac care. Will the Secretary of State ask it to think again for future years?

Mr Hunt: My hon. Friend is right to campaign hard on that issue. I agree that the funding formula does not always do justice to people, especially those in sparsely populated rural areas. I know that NHS England is trying to do what it can to move to a more equitable

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funding formula, but it is not something that can be done overnight. I encourage her to keep pressing on that issue.

Mr Jamie Reed (Copeland) (Lab): Welcome back, Mr Speaker. Easy access to GPs is a key part of out-of-hospital care for elderly and frail people. Days after the election, the Prime Minister scrapped Labour’s guarantee that gave patients a GP appointment within two working days, and took away funding that kept thousands of surgeries open in the evenings and at weekends. Now the Royal College of General Practitioners is warning that 34 million patients will fail to get an appointment. Will the Secretary of State listen to the Patients Association, bring back the 48-hour appointment guarantee and help older people to see their doctor when needed?

Mr Hunt: The reason that we got rid of that guarantee was that the number of people who were able to see a GP within 48 hours was falling in the last year in which the target was in place. It was not working, and that is why the British Medical Association and the Royal College of General Practitioners were against it. In the same survey that the hon. Gentleman quoted, the RCGP said it estimated that there had been a 10% increase in the number of GP appointments compared with when his Government were in office.

Maternity Care

2. Steve Brine (Winchester) (Con): What recent steps he has taken to improve maternity care. [902624]

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): We have made improving maternity services—so that women have a named midwife responsible for ensuring personalised care—a key objective in our mandate to NHS England. Since May 2010, the number of midwives has increased by more than 1,500 and a record number—in excess of 5,000—are now in training. Over the past two years I have set up a £35 million capital investment fund, which has already seen improvements to over 100 maternity units.

Steve Brine: My local foundation trust is currently exploring a major service change which would see the creation of a new acute care hospital to handle the sickest and most complex patients. It would leave midwife-led units only in Winchester and Basingstoke, and centre consultant-led services on the new site. Does the Minister feel confident that the clinical case for this kind of centralisation has been made? Would he be comfortable to see it rolled out across the NHS?

Dr Poulter: My hon. Friend is right to highlight the fact that such decisions are clinical decisions and need to be made at a local level to ensure safe care, both with appropriate numbers of obstetricians in obstetric-led units and to give women the choice to deliver in midwifery-led units where appropriate. I am pleased that we, as part of the fund that I outlined earlier, have been able to give Hampshire Hospitals NHS Foundation Trust £50,000 to provide enhanced facilities in birthing rooms at Florence Portal house.

Kate Green (Stretford and Urmston) (Lab): In 2012 representatives of Group B Strep Support met the Minister and received a commitment that the gold standard of enriched culture medium testing would be introduced, which can facilitate preventive treatment

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for women in labour. Just before Christmas, Public Health England announced that the testing would not go ahead from 1 January. Can the Minister say why not and when the test will be introduced?

Dr Poulter: Group B strep is an important issue. I have seen in my clinical practice the devastating effect that the disease can have on newborn babies and on families, so we are doing all that we can to support work on it and ultimately to develop a vaccine to prevent the condition. I would like to correct the hon. Lady on the record. I met Group B Strep Support with the Chief Medical Officer and we undertook to investigate the applicability of the test. The clinical evidence unfortunately does not support its introduction, and we have to be guided by clinical evidence.

17. [902640] Guy Opperman (Hexham) (Con): My hon. Friend has visited the Hexham midwife-led maternity unit, which provides exemplary care. Can he update the House on what steps the Department of Health is taking to prevent excessive screening of pregnant women away from midwife-led units? Surely health care is about choice, not diktat.

Dr Poulter: My hon. Friend is right. It was a pleasure to visit and open the new facilities at his local birthing unit. He has been a tremendous champion for the midwifery-led unit in his constituency, and I pay tribute to him for that. He is right that it is important that women have choice. These are local decisions by local health care commissioners, but I hope that it will give him some reassurance that the number of midwifery-led units has increased from 87 in 2007 to 152 in 2013 precisely because of the investment that the Government are making.

Keith Vaz (Leicester East) (Lab): During pregnancy, two out of 10 women become diabetic. What additional funding is being given to train nurses to deal with this very difficult situation?

Dr Poulter: The right hon. Gentleman makes an important point. We need to provide additional personalised one-to-one support for all pregnant women, in particular those who have or who develop medical problems. That is why we are investing in more midwives—we have 1,500 more than in 2010—and why the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists have developed guidelines and protocols to support front-line professionals in making sure that those women get extra support and have a safe delivery.

21. [902644] Karen Lumley (Redditch) (Con): As my hon. Friend is aware, we have been in a two-year battle to secure services at the Alexandra hospital in Redditch, including maternity. Will he meet me to discuss the best way forward to secure safe maternity care for all the mums-to-be in Redditch?

Dr Poulter: My hon. Friend has a distinguished record of more than four years of campaigning hard for local health care services in Redditch, and her constituents should be proud of what she has done on their behalf, fighting for Redditch hospital and local services. I shall be delighted to meet her to talk further about the local challenges for maternity care.

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Mark Durkan (Foyle) (SDLP): In the Minister’s earlier answer, was he saying that enriched culture medium testing is not a safe, simple and effective test for group B strep carriage?

Dr Poulter: We have had many debates in this House about group B strep and the effects of the disease. The point about enriched culture medium testing is that it takes time for bacteria to grow in culture, and the fact is that there is also evidence from the Royal College of Obstetricians and Gynaecologists. Public Health England has looked at that evidence and it has decided that it is not a test that is effective to be introduced during pregnancy. That is the medical evidence and we have to be guided by it. There are many other things that we need to do about group B strep, not least supporting the development of a vaccine, which is ultimately the best way forward.

Mr John Leech (Manchester, Withington) (LD): Will the Minister tell the House what assessment he has made of the impact of the Immigration Bill on the maternity care of vulnerable women who would be expected to pay for their care?

Dr Poulter: Of course we need to have a health service in this country that is self-sufficient, and we have a national health service, not an international health service. However, it is right that we ensure that we look at all areas of the health service when we are applying new policies and directives, and make sure that we protect vulnerable patient groups. That is exactly what the Government are doing and we are working with the NHS to ensure that women always receive high-quality maternity care at the point of need.

Cap on Care Costs

3. Laura Sandys (South Thanet) (Con): What progress has been made on introducing a cap on care costs. [902625]

The Minister of State, Department of Health (Norman Lamb): Everyone will be protected against catastrophic costs by the insurance that the cap will provide from April 2016, in line with the Dilnot commission’s recommendations. We are currently putting the legislative framework for the cap in place, and will consult on draft regulations and guidance to implement the cap in autumn of this year.

Laura Sandys: Best behaviour, Mr Speaker.

Does the Minister agree that greater investment in pre-emptive and preventive measures, such as GP annual assessment for those who are getting older, might keep the new old just a little younger?

Norman Lamb: I start by paying tribute to my hon. Friend for the work that she has done while she has been a Member of Parliament. I know that she has announced her decision to stand down, and she has done excellent work campaigning for elderly people and others in her constituency and beyond. She is absolutely right. The cap will, first of all, help people to prepare and plan for old age, which is an incredible advance. Also, the £3.8 billion better care fund is the biggest ever shift towards preventive health care and GPs will play a critical role in that.

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Mr Jim Cunningham (Coventry South) (Lab): What is the Minister doing to encourage local authorities to provide more places for care, particularly with the reduction in costs? Is he aware that local authorities are finding it difficult, because of Government cuts, to fund those places?

Norman Lamb: I am conscious that finances in local government are tight, but the better care fund, which I mentioned just now, has been widely welcomed. I was with a director of adult social care last Friday, who told me that his authority was planning to pool not just its share of the better care fund but the whole of its social care budget with the local health budget. That sort of radical, innovative thinking is exactly what we want and it will ensure that we protect services for vulnerable people.

Mr Stephen Dorrell (Charnwood) (Con): Does the Minister agree that the steps that the Government are taking to reform the funding of care for the elderly represent long overdue action to deal with an issue that has bedevilled this world for more than 20 years? Tony Blair promised the Labour conference in 1997 that he would deal with it, and he did precisely nothing about it.

Norman Lamb: I remember the quote from Tony Blair well—he did not want to live in a country where people have to sell their homes to pay for care. However, over 13 years of the last Labour Government nothing happened. There were lots of commitments—manifesto commitments and so on. However, I am proud of the fact that this coalition Government are implementing reform, and it is long overdue.

Dispensing Doctors (NHS)

4. Nic Dakin (Scunthorpe) (Lab): What assessment he has made of the role of dispensing doctors in the NHS. [902626]

The Parliamentary Under-Secretary of State for Health (Jane Ellison): Patients can take their prescriptions to any pharmacy where they wish to have their prescriptions dispensed, but we know that in remote and rural areas, where pharmacies may not be viable, NHS England may authorise GPs to dispense to patients, provided that certain criteria set out in regulations are met.

Nic Dakin: Dispensing doctors play an important part in rural areas, as the Minister said, but they face particular challenges at the moment. Will she meet me and representatives of the Dispensing Doctors’ Association to discuss these challenges?

Jane Ellison: I am always happy to meet colleagues. I think that Earl Howe leads on the matter in the Department, and I shall draw the hon. Gentleman’s concerns to his attention. It is for NHS England to ensure that everyone has a pharmacy available to them, and I am aware that the CCG allocation formula includes allowances for rurality, but we know that this is a particular challenge.

General Practice Extraction Service

5. Mr Geoffrey Robinson (Coventry North West) (Lab): Whether patients are able to opt out of the general practice extraction service by telephone or online. [902627]

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The Secretary of State for Health (Mr Jeremy Hunt): People can opt out of the care.data programme through their GP surgery. Depending on the surgery, that may well be done online or by telephone.

Mr Robinson: Is the Secretary of State aware that the Government’s handling of the scheme has been shambolic from the very start and that their failure to communicate is nowhere better illustrated than in Pulse, the GP’s magazine, in which an article states that only 15% of members of the public surveyed knew that they had the right to opt out? What will he do to restore public confidence in a scheme that could be very beneficial?

Mr Hunt: It is a pleasure—I think for the first time—to take a question from someone who might be one of my constituents in Godalming. However, I do not agree with the hon. Gentleman that the process has been shambolic. The programme has been in place for 25 years, so it is important to understand that this big public debate is happening because this Government did something that the previous Government did not do: we said that if we are going to use anonymised data for the benefit of scientific discovery in the NHS, people should have the right to opt out. We introduced that right and sent a leaflet to every house in the country, and it is important that we have the debate—[Interruption.] The right hon. Member for Leigh (Andy Burnham) complains, but he did not want to give people the right to opt out when he was Health Secretary.

Dr Sarah Wollaston (Totnes) (Con): The Secretary of State will be aware of the report in The Daily Telegraph setting out how hospital episode statistics data were sold to insurance companies, which were able to match that information with credit ratings data. Nothing will undermine this valuable project more than a belief that data will be sold to insurance companies, so will he set out the way in which he will investigate how that sale was allowed to happen and categorically reassure the House that there will be no sale of care data to insurance companies?

Mr Hunt: My hon. Friend is absolutely right to raise that issue and I am happy to give that assurance. That incident is one of the reasons why we set up the Health and Social Care Information Centre through the Health and Social Care Act 2012, in the teeth of opposition from the Labour party. Following the establishment of the centre, the guidelines in place mean that such a thing could not happen. She is also right that it is important that we reassure the public because, let us not forget, it was this important programme that identified the link between thalidomide and birth defects, that identified that there was no link between MMR and autism, and that helped to identify the link between smoking and cancer, so it is vital that we get this right.

20. [902643] Mr David Crausby (Bolton North East) (Lab): Virtually everyone wants to improve patient care in the NHS, so why not scrap the underhand way in which the care.data programme has progressed so far, and instead provide a diverse choice of ways to opt in, limit the use of medical data to the NHS and keep the public’s personal information out of the hands of the private sector?

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Mr Hunt: May I gently tell the hon. Gentleman that the reason why we are having the debate is that this Government decided that people should be able to opt out from having their anonymised data used for the purposes of scientific research, which the previous Labour Government refused to do? When they extended the programme to out-patient data in 2003 and to A and E data in 2008, at no point did they give people the right to opt out. We have introduced that right, which is why we are having the debate.

Dr Julian Huppert (Cambridge) (LD): There are of course huge benefits from using properly anonymised data for research, but it is difficult to anonymise the data properly and, given how the scheme has progressed so far, there is a huge risk to public confidence. Will the Secretary of State use the current pause to work with the Information Commissioner to ensure that the data are properly anonymised and that people can have confidence in how their data will be used and how they can opt out?

Mr Hunt: I will do that, and NHS England was absolutely right to have a pause so that we ensure that we give people such reassurance—[Interruption.] When we had a pause before, the result was the very good Health and Social Care Act, which is doing good things for patients throughout the NHS. This programme is too important to get wrong, and while I think that there is understanding on both sides of the House about the benefits of using anonymised data properly, the process must be carried out in a way that reassures the public.

Andy Burnham (Leigh) (Lab): When he was appointed, the Health Secretary declared it his personal mission to have a “data revolution” in the NHS, but what he has presided over is a spectacular collapse in public confidence in the use of patient data. The only revolution he has created is a growing public revolt against his care.data scheme. Coming after his NHS 111 shambles and the court humiliation over Lewisham hospital, it cements a reputation for incompetence. When was he first warned about problems with care.data and what action did he take?

Mr Hunt: The shadow Secretary of State searches for NHS crises with about as much success as George Bush searching for weapons of mass destruction. My first contact with that programme, when I was told about it, was to decide to do something that he never did as Health Secretary: to say that every single NHS patient should have a right to opt out of having their data used in anonymised scientific research. I think that was the right thing to do. Of course we are having a difficult debate, but its purpose is to carry the public with us so that we can go on to make important scientific discoveries.

Andy Burnham: Again, the right hon. Gentleman never takes responsibility—it is always somebody else’s fault. Even by this Government’s standards, this is a master-class in incompetence. First, we have this useless glossy leaflet. He said that it has gone to every home, but that is not true, because homes that have opted out of junk mail have not received it. Many people report that they still have not had it through their letterbox. Secondly, when people cannot even get through to their GP practice on the phone, as we heard earlier, or get an

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appointment, he has made it almost impossible to opt out of the scheme. Has this cavalier approach not built an impression that the Government are taking patient confidentiality for granted in trying to force through the scheme, increasing public mistrust and putting the important scheme at risk?

Mr Hunt: It is intriguing that the shadow Secretary of State has chosen not to talk about a winter crisis, because it has not happened, despite the fact that he predicted it time after time. Let me tell him what was cavalier: the previous Labour Government’s refusal to give patients a right to opt out of giving their data to this programme, even though it was going on for their whole time in office. We believe that we should have a data revolution, but to do that we need to carry the public with us, which is why we need to have this important debate and give people the reassurance they deserve.

Mental Health Crisis Beds

6. Rushanara Ali (Bethnal Green and Bow) (Lab): What recent assessment he has made of the number of available mental health crisis beds for young people in England. [902629]

14. Ms Karen Buck (Westminster North) (Lab): What recent assessment he has made of the number of available mental health crisis beds for young people in England. [902637]

The Minister of State, Department of Health (Norman Lamb): NHS England has a rapid review under way to identify commissioning solutions to pressures on specialist beds for children and young people. It inherited varied provision across regions and a lack of capacity in some parts of the country for particular need. For the first time, available beds are monitored weekly, and small increases in capacity have already been secured.

Rushanara Ali: I thank the Minister for that answer, but 1,500 mental health beds have closed since 2011, which is causing a wider crisis, and a recent Care Quality Commission report found that, in one area over the previous year, 41 children had been detained in police cells because health-based places of safety were either not available or not staffed—and one of those children was 11 years old. How can that be acceptable?

Norman Lamb: The reduction in the number of mental health beds has been a long-term trend—it happened under the previous Labour Government—and rightly so, because we have to move away from institutional care. However, crisis beds must always be available. I completely agree that it is intolerable for children to end up in police cells, but that is not new; it has happened for many years and did not start in 2010. When we talk about parity of esteem, we mean it. There must be absolute equality between the ways in which mental and physical health are treated. Last week we launched a crisis care concordat to ensure that children do not end up in police cells.

Ms Buck: The clinical director of child and adolescent mental health services in my mental health trust recently said:

“Sometimes we have to make 50 to 100 phone calls around the country looking for a bed… young people shouldn’t be shunted around the country into inappropriate facilities.”

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Another psychologist dealing with a case in my constituency told me:

“It is very difficult to get young people into in-patient services at present due to the high number of cases and reductions in funding from NHS England.”

Is that not an intolerable situation in which to leave traumatised young people? How quickly will the Minister’s review be completed so that we can end that tragedy?

Norman Lamb: The review being undertaken by NHS England will report in March. I agree that that situation is intolerable, but I have made it very clear on many occasions that there is an institutional bias against mental health in the NHS. Interestingly, the Health Committee report on deficits in 2006-07 specifically made the point that mental health was particularly targeted, so that always happens when NHS finances are tight. However, it cannot happen, because there has to be parity of esteem, including in the way in which money is distributed in the NHS.

Jeremy Lefroy (Stafford) (Con): In Stafford hospital, many young people with mental health problems are extremely well treated in normal in-patient wards. That should not be the case, but no other facility is available. What will happen if those in-patient beds are no longer there?

Norman Lamb: As far as possible, we should be trying to ensure that children with mental health crises can remain at home; it does not make sense, in very many cases, to put them into in-patient care. However, we have made it clear, as has NHS England and as was confirmed in the crisis care concordat last week, that beds should be locally available whenever they are needed.

19. [902642] Sarah Champion (Rotherham) (Lab): Will the Minister indicate when a clear strategy for the commissioning of tier 4 mental health beds will be determined and what additional resources will be made available to support the mental health needs of children and young people? The current situation is intolerable.

Norman Lamb: I mentioned earlier that the rapid review that is being undertaken by NHS England will report in March. It is essential that we have sufficient beds available, as close to home as possible, for children and young people. As I also said earlier, as far as possible children should be cared for at home, and only as a last resort should they go into in-patient care.

Liz Kendall (Leicester West) (Lab): The pressure on children’s mental health beds is now intolerable. Earlier this month, the 14-year-old daughter of one of my constituents desperately needed a bed but the local trust’s chief executive told me that not a single bed was available anywhere in the country in the NHS or the independent sector. The Minister has said that this is unacceptable as though it is nothing to do with him, but he voted for an NHS reorganisation that is wasting time and money as vulnerable children are forced on to adult

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wards or transported hundreds of miles across the country. When the review reports, what action will he take and by when will it be implemented?

Norman Lamb: For a start, we now have 15,000 more clinicians working on the front line than when this Government came into office in 2010. Also, in the reforms that the hon. Lady mentions, we legislated for parity of esteem so that mental health is treated equally with physical health. However, I have accepted her case and agree that the situation is intolerable. We have to make sure that beds for children and young people are available when they are needed.

Alternative Medicines (NHS)

7. Mr Andrew Turner (Isle of Wight) (Con): What proportion of medicines prescribed in the NHS are alternative medicines; and what the annual cost is of dispensing such prescriptions. [902630]

The Parliamentary Under-Secretary of State for Health (Jane Ellison): The net ingredient cost to the NHS of homeopathic preparations dispensed in the community in England was £143,000 in 2012, which represents 0.002% of the overall NHS prescription cost in the community for the same period. The prescription cost analysis data from which we extract this information do not separately identify other alternative medicines.

Mr Turner: I thank the Minister for that answer. At the urging of Councillor John Nicholson, Isle of Wight council has asked the health and wellbeing board to recognise the value of alternative and complementary therapies and elect a representative to the board. Will the Minister and her Department work with that representative to evaluate the cost-effectiveness of such treatments?

Jane Ellison: I am aware that there has been interest in this matter in my hon. Friend’s clinical commissioning group. The provision of alternative and complementary therapies is decided by CCGs, which have to take into account National Institute for Health and Clinical Excellence guidance and local health needs and priorities. The responsibility is with CCGs to achieve value for money and to make sure that they are delivering improvements in the quality of care and patient outcomes, and it is against those standards that we would expect them to measure those therapies.

Jim Shannon (Strangford) (DUP): In the past 12 months there has been great advancement in new medications and alternative medicines, with new drugs for multiple sclerosis, for type 2 diabetes and for hepatitis C, and advancements in heart operations, rare diseases, and so on. Will the Minister indicate the time scale for the announcement of new medications and their availability on the NHS?

Jane Ellison: The hon. Gentleman, who follows these matters closely, is aware that medicines go through a process by which they are approved and recommended. Once they are in that position, it is, as I say, down to CCGs to make decisions about which treatments are appropriate for their patients and to measure them against the standards that I laid out.

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David Tredinnick (Bosworth) (Con): I congratulate right hon. Friends on setting up the herbal working group to improve regulation of herbal medicine and its practitioners. Is the Minister aware that there is a problem of supply, in that most people have to pay for their herbal medicine and it is not necessarily available from clinical commissioning groups? Will she issue guidance? Perhaps we should have a mapping exercise in order to understand where the demand is in this country.

Jane Ellison: As I have just said, there is guidance for CCGs on how to operate in the area of alternative and complementary therapies and we have no current plans to add to that guidance.

Female Genital Mutilation

8. Margot James (Stourbridge) (Con): What steps his Department is taking to tackle female genital mutilation. [902631]

The Parliamentary Under-Secretary of State for Health (Jane Ellison): We recently announced that all NHS acute hospitals must provide information on patients who have undergone female genital mutilation, but that is just one element of a wider-ranging programme of work that is under way in order, most importantly, to improve the way in which we care for girls and women who have undergone FGM and to follow up on, respond to and prevent FGM. I will make further announcements in due course.

Margot James: I congratulate my hon. Friend on all the work she has done to combat this abhorrent crime since she entered Parliament. Will she confirm that the data reported to her Department will be used to mount educational campaigns to stamp out FGM in the vicinity of hospitals reporting patients who have been abused in this way?

Jane Ellison: We anticipate that we will be able to share the data collected with all appropriate Government Departments and partner organisations. On local education campaigns, I see no reason why requests to access the data would not be approved. We want to build a proper national picture of what is going on with FGM so that we can do all we can both to care for victims and to stamp out this abuse.

John Cryer (Leyton and Wanstead) (Lab): On the issue of widening education, could the Minister encourage her colleagues at the Department for Education to write to schools to raise awareness of this abhorrent practice?

Jane Ellison: Fahma Mohamed, the brilliant young woman who has led the campaign on this, will meet the Education Secretary today and there is a lot of work under way across all Government Departments. There was recently a cross-Government declaration on the things that are going on to stamp out FGM and to care for its victims. The hon. Gentleman’s question is a matter for the Department for Education, but I assure him that the Government as a whole are hugely committed to wiping out FGM within a generation and to caring for its victims.

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Veterans’ Health

9. Julian Smith (Skipton and Ripon) (Con): What steps his Department is taking to improve the health of veterans. [902632]

13. Chloe Smith (Norwich North) (Con): What steps his Department is taking to improve the health of veterans. [902636]

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): We are rightly proud of the courage and dedication of our armed forces and it is our duty to ensure that veterans receive the best possible care. We continue to improve the health care of our veterans. The Government have invested £22 million in providing enhanced mental health and prosthetic services over the past few years.

Julian Smith: Alex Bentley, who chairs the Royal British Legion in Skipton and is the most incredible, passionate campaigner for our armed forces, has serious concerns about how the armed forces covenant is being applied by hospitals and local councils. Is there anything the Minister can do to champion the cause of this excellent Government scheme at local level?

Dr Poulter: Aside from the cash investment of £22 million directly in veterans services, we have made it a clear priority in the NHS mandate to make sure that the armed forces covenant becomes a reality in the NHS. We have now identified nine specialist prosthetic centres for veterans who have lost limbs and been injured in combat, and a massive amount of investment is going into services for veterans with mental health problems, including a 24-hour helpline. A lot of investment is being made at the national level and locally, and there will also shortly be dedicated resource for training local professionals on the ground.

Chloe Smith: I welcome that response. Will the Minister reassure me that he will properly join up his work with that of the Department for Work and Pensions and the Ministry of Defence? Like many other Members, I know of at least two veteran constituents who clearly need joined-up health and welfare. The voluntary sector helps—including the Matthew Project’s new “Outside the Wire” service in Norfolk—and I expect the same of the Government, who have rightly signed the armed forces covenant.

Dr Poulter: My hon. Friend makes an important point. This is not just about providing good health care services, but doing so in a joined-up way. We now have a seriously injured leavers protocol to help the transition of servicemen and women who leave the armed forces and return to civilian life. That is about taking a holistic view of their health and care needs, and any other needs that they may have, in providing the right support when they return to civilian life. It is being rolled out very effectively across the country.

Mental Health Services

10. Andy Sawford (Corby) (Lab/Co-op): What assessment his Department has made of the availability of mental health services. [902633]

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The Minister of State, Department of Health (Norman Lamb): Our mandate to NHS England makes it clear that everyone who needs it should have timely access to the best available treatment. NHS England is currently gathering information about access to and waiting times for mental health services. We will use this information to set new national access standards for the first time, to be introduced from 2015.

Andy Sawford: The Safe Haven in Corby provided crisis out-of-hours support to 1,300 people with mental health problems last year. For the first time ever, it has been asked to tender for its future funding. It was eight minutes late with its tender, and the service is going to be cut. What will happen to the people who need that service in the future? Will the Minister meet me to discuss it?

Norman Lamb: I am very happy to talk to the hon. Gentleman about that. My understanding is that the local CCG undertook a retendering exercise with a view to maintaining and, indeed, improving mental health services locally. As he says, Safe Haven did not submit its tender in time. It had a right to appeal, and it chose not to appeal. The CCG is absolutely committed to ensuring that it improves mental health services locally.

Mr David Heath (Somerton and Frome) (LD): Not only do mental health services not get the attention that they sometimes deserve, but the condition of individuals is often exacerbated by the inability of the benefits system to recognise episodic illness and by the insensitivity and incompetence of Atos in work capability assessments. Will the Minister talk to his colleagues in the Department for Work and Pensions so that we can have a system that is suitable and fit for people with mental illness?

Norman Lamb: I thank my hon. Friend for his question. Indeed, I share the concerns that he raises, and I have recently met my hon. Friend the Minister responsible for benefits specifically because I have those concerns. There needs to be much closer working between mental health services and the benefits system locally.

Mr Kevan Jones (North Durham) (Lab): The Minister knows that early intervention therapy or talking therapies can relieve pressure not only in access to beds, but in helping individuals. He has just told the House that he will look at assessments of waiting times. Will he tell the House exactly what force or lever he will have to ensure that local trusts implement such targets?

Norman Lamb: I think it was a big mistake to leave out mental health when the 18-week maximum waiting time limit was introduced for physical health services. To me, that is inexplicable, so I am determined to correct it: from next year, there will be waiting times standards for mental health. Indeed, when the Care Quality Commission inspects and regulates providers, it will ensure that those access standards are met, in the same way as applies for physical health.


11. Annette Brooke (Mid Dorset and North Poole) (LD): What reports he has received on the possible reclassification of ME/CFS by the World Health Organisation. [902634]

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The Parliamentary Under-Secretary of State for Health (Jane Ellison): The World Health Organisation is currently developing the 11th version of the international classification of diseases, which it aims to publish in 2017. No discussions have taken place between the Department and the WHO on the reclassification of ME/CFS, but the WHO has publicly stated that there is no proposal to reclassify ME/CFS in ICD-11.

Annette Brooke: I thank the Minister for her answer. Many people will be greatly relieved about that. As chair of the all-party group on myalgic encephalomyelitis, I receive many representations about GPs in this country still not necessarily recognising the condition. Will she look into that, and will she work with her counterparts in the DWP on the benefits side as well?

Jane Ellison: I am aware that this is a very difficult, complex and emotive area. I have heard before the point that the hon. Lady makes about GPs. I am very happy to take up her points and discuss them with her.

Private Health Care Sector

12. Ian Lavery (Wansbeck) (Lab): What recent meetings he has had with representatives of the private health care sector. [902635]

The Secretary of State for Health (Mr Jeremy Hunt): In the past three months, I have had two meetings with private sector health care providers, both in China, helping them to win export orders. In the same period, I have had 20 meetings with traditional NHS providers.

Ian Lavery: Private health companies with strong links to the Conservative party have been awarded contracts to run NHS services worth about £1.5 billion, which surely raises serious questions about the level of influence of Conservative donors on health policy. In the interests of transparency, will the Secretary of State commit to publishing a list of private health care companies that have made donations to the Conservative party?

Mr Hunt: The difference between donors to the Conservative party and donors to the Labour party is that our donors do not write our policies. While we are talking about private sector health care providers, I remind the hon. Gentleman of what an unnamed shadow Cabinet Minister told The Independent last week:

“We all remember when Andy was Health Secretary and happily contracting out bits of the NHS to the private sector… You have to ask yourself what’s changed.”

Steve Baker (Wycombe) (Con): The NHS diagnostic centre in Wycombe, which is operated by the private sector, does a fantastic job. Will the Secretary of State join me in congratulating and thanking Opposition Members for all that they did to extend private and independent provision in the NHS?

Mr Hunt: I am happy to do that. My hon. Friend may be interested to know that in the last four years of the last Government, private sector contracts in the NHS doubled—something that this Government have not been able to match. It is important to look at the facts before we start any hares running with respect to privatisation.

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Sex-selective Abortion

15. Fiona Bruce (Congleton) (Con): When he plans to publish his Department’s new guidelines on sex-selective abortion. [902638]

The Parliamentary Under-Secretary of State for Health (Jane Ellison): The Government will publish more detailed guidance on compliance with the Abortion Act 1967 shortly. That will include guidance on sex-selection abortions and restate our view that abortion on the grounds of gender alone is unlawful.

Fiona Bruce: Britain’s biggest abortion provider, the British Pregnancy Advisory Service, has advice on its website claiming that the law is “silent on the matter” of gender-selective abortion. In a leaflet, it actually states that it is not illegal. How does the Minister propose to address that, and to send out the clear message that strong legal action will be taken against anyone who is involved in that wholly unacceptable practice?

Jane Ellison: Although the Abortion Act does not mention gender specifically, the Government are clear that abortion on the grounds of gender alone does not meet the criteria set out in the Act. If evidence comes to light that doctors or organisations are sanctioning abortions for that reason alone, we will refer it to the police.

Nadine Dorries (Mid Bedfordshire) (Con): The Minister is quite right that the Abortion Act does not state that the practice is illegal. Organisations such as Marie Stopes International operate under an ethical and professional framework in which they state that they will not perform abortions on the basis of sex selection. However, the chief executive of BPAS has said that

“there is no legal requirement to deny a woman an abortion”

if she wants to abort a female. The Government commission abortion services from BPAS and Marie Stopes. Does the Minister not think it is about time to have a closer look at BPAS, which is headed by a chief executive who condones sex-selection abortions?

Jane Ellison: That is exactly why we want to reissue the guidance on this matter. I cannot add to what I have said. I say with complete clarity that the Government’s view is that sex-selection abortion—abortion on the grounds of gender alone—is illegal and we will report it to the police if we are given evidence of it.

Accident and Emergency Attendances

16. Mr Virendra Sharma (Ealing, Southall) (Lab): What assessment he has made of trends in the number of attendances at type 1 accident and emergency departments since 2009-10. [902639]

The Parliamentary Under-Secretary of State for Health (Jane Ellison): We have debated the hon. Gentleman’s concerns about the A and E services in his area in the past. I want to reassure him that, despite the overall growth in attendances at A and E—we know that there is pressure on A and E—the changes that are recommended for his area have enormous clinical support across all the local CCGs and trusts.

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Mr Sharma: I thank the Minister for her response. Will she explain why attendances at hospital A and E departments increased by 16,000 in the last three years of the Labour Government, but by 633,000 in the first three years of this Government?

Jane Ellison: As the hon. Gentleman knows, we have often debated in this House the many reasons for the increased pressure on A and E. However, the rate of growth in the first three years of this Government has been lower than the rate of growth in the last three years of the last Government. We are responding to the pressures. That is why the Secretary of State has addressed issues such as named GPs for older patients and the integration of social care. We acknowledge that there is pressure on A and E; it is the action that the Government are taking to respond to it that really counts.

Andrew Gwynne (Denton and Reddish) (Lab): Ministers again deny that England’s A and E departments are in crisis. The Secretary of State did so in response to my right hon. Friend the Member for Leigh (Andy Burnham) earlier. It just will not wash any more. In the past two weeks, 10,743 patients waited on trolleys for up to 12 hours because no hospital beds were available and 52 patients waited for even longer. Does the Minister really think that it is acceptable that patients are experiencing the worst fortnight in A and E this winter while she is complacently sitting on her hands?[Official Report, 27 February 2014, Vol. 576, c. 10MC.]

Jane Ellison: There is no complacency on the Government Benches, and attendances are half what they were under Labour. Week after week we have heard those on the Opposition Front Bench come to the House to talk up a crisis in our NHS, but the NHS has responded incredibly well throughout the winter. I pay huge tribute to the staff of the NHS for what they have done in responding to this. The Government are taking long-term action to reduce pressure on A and E; even the College of Emergency Medicine rebuts the Opposition line that there is a crisis in A and E this winter.

Topical Questions

T1. [902658] Julian Sturdy (York Outer) (Con): If he will make a statement on his departmental responsibilities.

The Secretary of State for Health (Mr Jeremy Hunt): I would like to thank Public Health England and the NHS emergency services for their extraordinary work during the recent floods, and say that this House is proud of their dedication and commitment to help those in great need. Since the previous Health questions, we have also had the first anniversary of the Francis report on Mid Staffs. As a result, I am proud that the Government have taken significant steps to restore compassionate care to all parts of our NHS, with a regulator now free from political interference, failing hospitals being turned round, and more nurses, midwives and health visitors in our NHS than at any time since 1948.

Julian Sturdy: The family of my eight-year-old constituent Ben Foy have been fighting for more than two years for the funding of sodium oxybate—a drug that his doctors feel could help him cope with narcolepsy and cataplexy. This is a particularly distressing condition for Ben and

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his family, but sadly, after all this time there is still complete confusion as to who has responsibility for Ben’s commissioning request. Will the Secretary of State look into the matter and clear up that confusion?

Mr Hunt: I reassure my hon. Friend that I have looked into Ben Foy’s case, and NHS England has confirmed that it is responsible for commissioning his care. The particular drug that my hon. Friend mentioned is not recommended by the manufacturer for use by children and adolescents, but I am happy to arrange for him to meet NHS England and get to the bottom of the issue.

Andy Burnham (Leigh) (Lab): I want to return to care.data—an important scheme that needs to be saved from the incompetence of this clownish coalition. The Secretary of State said earlier that I was in search of a crisis, but now I will offer him a solution. If the Government work with us to introduce a series of tough new safeguards to protect patients, we will work with the Secretary of State to help rescue this failing plan. Those safeguards include tougher penalties for the misuse of data, Secretary of State sign-off on any application to access data, full transparency on organisations granted access, and new opt-out arrangements by phone or online. Will he meet me to discuss changes to the Care Bill to put that important scheme back on track?

Mr Hunt: The right hon. Gentleman has still not addressed the fundamental question of why he did not introduce an opt-out for the use of personal data, which this Government are doing. We have taken more steps than his Government ever did, and we will continue to work hard to ensure that this important scheme goes ahead. The right hon. Gentleman should know better.

T2. [902659] Penny Mordaunt (Portsmouth North) (Con): There is great unmet need among older people in our communities, particularly for dementia care and support. In Portsmouth we are holding a community summit to join up local agencies to meet that unmet need. Will the Minister meet me to discuss what central Government can do to ensure that advice on additional funding streams is clearly and readily available?

The Minister of State, Department of Health (Norman Lamb): I thank my hon. Friend for that question and pay tribute to the agencies in Portsmouth that are coming together to hold the summit and discuss that critical issue. The Prime Minister’s challenge on dementia has made real progress in improving diagnosis rates and the way that society treats dementia, and I would be happy to meet my hon. Friend to discuss the issue further.

T4. [902661] Barbara Keeley (Worsley and Eccles South) (Lab): Further to the answer given earlier to my hon. Friend the Member for Wansbeck (Ian Lavery), the lobbyist John Murray and an organisation funded by large pharmaceutical companies led a consultation and co-wrote a report for NHS England on the future of commissioning for £12 billion of NHS services. Will the Secretary of State tell the House whether it is now

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Government policy to have lobbyists and big drug companies drafting reports that directly influence the commissioning of NHS services?

Mr Jeremy Hunt: Let me say this to the hon. Lady: we have very clear rules, and for people who are involved in industry and have a self-interest we have important protections to ensure there is no conflict of interest. Let us be clear: the private sector has an important role to play in the NHS, but it grew far faster under the previous Government than it has done under this one. We are not going to take any lessons about being in hock to the private sector.

T3. [902660] Lorraine Fullbrook (South Ribble) (Con): As the NHS comes through another winter, when it has delivered an outstanding service to more patients than ever before, how does my right hon. Friend assess the damage done by the unfounded scaremongering talk of crisis by the Opposition and some parts of the media?

Mr Hunt: My hon. Friend is absolutely right. I encourage those on the Opposition Front Bench in particular to talk to a few people in A and E and ask whether they think they have been supportive, in a very difficult winter, by whipping up all these scare stories when, in fact, because of their hard work, we are seeing 2,000 more people every single day in less than four hours than when the shadow Secretary of State was Health Secretary. A and E is performing better than ever.

T5. [902662] Ms Margaret Ritchie (South Down) (SDLP): There are nearly 500 UK-trained medical practitioners now working in Australia, of whom 6% never return owing to the better conditions available there. What steps will the Secretary of State and his ministerial team take to ensure that we retain those qualifying in emergency medicine this year, to keep local A and E departments open in Britain and Northern Ireland?

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): I would like to point out to the hon. Lady that it is not unusual for doctors in training to work overseas to improve their medical experience. Many of my contemporaries did that, and every one I know has returned to work in the NHS in the UK. It is a common phenomenon that benefits doctors’ experience. What we have done, unlike the previous Government, is ensure that we now have a 100% fill rate for people entering A and E common stem training.

T6. [902663] Pauline Latham (Mid Derbyshire) (Con): What assessment have the Government made of the decision by the National Institute for Health and Clinical Excellence not to recommend ipilimumab as a first-line treatment for advanced melanoma, except in clinical trials? Will the Minister join me in calling on NICE to reverse this decision and ensure that patients receive earlier access to this treatment to improve their chances of survival?

The Parliamentary Under-Secretary of State for Health (Jane Ellison): I know that my hon. Friend is really concerned about this, but NICE is an independent body so it would not be appropriate for me to interfere in an ongoing appraisal. NICE has recommended a number of other treatments for advanced melanoma, and NHS

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commissioners are required to fund them where clinicians want to use them. I want to give her some encouragement: this spring a trial will begin of an awareness programme on melanoma in the south-west of England, working with Cancer Research UK.

T7. [902664] Gavin Shuker (Luton South) (Lab/Co-op): I am grateful to the Minister for her previous answer on female genital mutilation. With that in mind, what action will she take regarding the three Tory MEPs Nirj Deva, Sajjad Karim and Timothy Kirkhope who voted against the motion, in the European Parliament on 11 December, strongly condemning the disgraceful practice of FGM?

Jane Ellison: I am aware of this case. The point made is rather unfair. My colleague Marina Yannakoudakis MEP has dealt with this issue in correspondence with other Members. The motion was a composite motion. All Conservative MEPs completely condemn FGM, but there was a technical reason why they voted in that way. It is clear that the Conservative party—along, I think, with all Members—absolutely condemns this practice. I am happy to give the hon. Gentleman the detail on that vote afterwards.

T8. [902665] Dr Julian Huppert (Cambridge) (LD): Papworth hospital is a world-renowned heart and lung hospital. For years, it has wanted to move to Cambridge, supported by Addenbrooke’s hospital, Cambridge university, the British Heart Foundation, AstraZeneca and many more, but it has been put on hold yet again. Will the Secretary of State make sure that this move, which will help patients, help to develop new treatments and save money, will happen?

Dr Poulter: My hon. Friend will be aware that local commissioners take decisions on local services. I will be happy to meet him to discuss this matter further, so we can talk through his concerns and ensure that local health care services are as strong as possible.

T10. [902667] Bill Esterson (Sefton Central) (Lab): The village of Melling has grown in recent years, yet its surgery hours have been cut drastically. Elderly and disabled residents now face a four-hour round trip by public transport to see their doctor. How can cuts in surgery hours, like those in my constituency, be justified if the Government are serious about having a first-class NHS?

Mr Jeremy Hunt: We absolutely want to make primary care more accessible and that is why we are introducing named GPs for everyone aged 75 or more from April. This is a significant and important reversal of, I think, a mistake that everyone now agrees was made in 2004 when named GPs were abolished. Its purpose is to make GPs more accessible to the people who need them the most.

T9. [902666] Jason McCartney (Colne Valley) (Con): The father of one of my constituents passed away at the weekend, one of 8,700 people who are diagnosed with pancreatic cancer each year in the UK, of whom only 3% will survive beyond five years. That survival rate has not changed in over 40 years. Will my right hon. Friend update the House as to what the Government are doing to improve patient outcomes for those with pancreatic cancer?

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Jane Ellison: I thank my hon. Friend, and I know that many hon. Members have raised this issue because pancreatic cancer outcomes remain extremely difficult. We want to see the best outcomes for all cancer patients. There has been a big investment by the Government in diagnosis and screening—£450 million—and last year we were involved in piloting a tool to support GPs in diagnosing cancer earlier, including pancreatic cancer, in over 500 GP practices. That pilot is currently being evaluated.

Mike Kane (Wythenshawe and Sale East) (Lab): The Manchester Evening News recently highlighted the enormous pressures faced by Wythenshawe accident and emergency after the downgrading of Trafford accident and emergency. Will the Secretary of State meet me to discuss this and to tell me when Wythenshawe will receive the extra funds that it has been promised?

Mr Jeremy Hunt: I welcome the hon. Gentleman to the House and congratulate him on representing in his constituency a fantastic hospital; I have been to Wythenshawe hospital and it is superb. Some big changes are happening in the Greater Manchester area that will lead to that part of the country having some of the best NHS care in the country. Obviously there is a difficult transition in A and E services between Trafford and Wythenshawe, and I am happy to meet him to discuss it further.

Nicholas Soames (Mid Sussex) (Con): Does my right hon. Friend agree that it is unacceptable that investigations into failures in hospital services take so very long? There has recently been one in my constituency: a very sad and badly handled case connected with mental health. Does my right hon. Friend agree that the authorities need to provide answers very promptly to families who are left completely beleaguered by such behaviour?

Mr Hunt: I absolutely agree with my right hon. Friend. One of the tragedies that the Francis report helped us to uncover was that so many failings had been allowed to persist for so long: in the case of Mid Staffs, between 2005 and 2009. We owe it to families to be much quicker, which is why there is now a time limit on the failure regime: hospitals must be turned around within a fixed period of time or go into administration. Otherwise, we will not have safe hospitals in our areas.

Barry Gardiner (Brent North) (Lab): The Minister earlier told the House that 1,500 new midwives had come on stream since the Government started, but, of

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course, the Government promised that there would be 3,000 delivered by 2015. Midwives are very good at delivery; how good is the Department?

Dr Poulter: We have trained more midwives. To go back to a previous question, it was under the previous Government that trained midwives from this country were having to go and work overseas. That is no longer the case. We now have 5,000 more in training—a record number—to make sure that we provide more midwives. I would also like to welcome the hon. Gentleman back to this country.

Andrew Bridgen (North West Leicestershire) (Con): Last year I spent a busy and informative day with the East Midlands ambulance service on the road. It was clear speaking to those professionals that a large proportion of individuals taken to A and E would be better served by going to their GP or by accessing other services. However, the ambulance service felt completely disempowered to advise or even to refuse to take anyone to A and E who requested it.

Mr Jeremy Hunt: That is one of the things we need to be much better at—linking up the services offered by ambulance services. I would add that pharmacies have a big role to play in this, as one in 11 or 12 A and E appointments could be dealt with at a pharmacy. My hon. Friend is absolutely right that this is something we need to do better.

David Wright (Telford) (Lab): A hugely expensive review of A and E services is going on in Telford, the Wrekin and Shropshire. The Secretary of State was in Telford a couple of weeks ago but did not have the courtesy to let me know. Will he say whether we will retain full 24-hour, seven-day-a-week services at Telford and whether there will be downgrade of our A and E?

Mr Hunt: First, I apologise to the hon. Gentleman if my office did not let him know that I was visiting, an oversight for which I take responsibility. I had a good visit to the Redwoods, a superb mental health in-patient unit where I learned a great deal. I am not aware of any plans to change or downgrade his A and E.

Several hon. Members rose—

Mr Speaker: Order. Time is up. As usual, demand has exceeded supply. Before we come to the ten-minute rule motion, we have a point of order.

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Point of Order

Mr David Winnick (Walsall North) (Lab): On a point of order, Mr Speaker. I wonder whether you can advise me on how we can secure a statement from the Chancellor of the Exchequer, or another Treasury Minister, about the substantial extra sums that are being given to the leading bank executives, the most senior people: the chief executives and their colleagues. For example, the chief executive of HSBC is to receive an extra £32,000 a week on top of his salary of more than £1 million a year.

May I point out, Sir, that the annual salary in my borough is about £22,000? The sheer greed of the bankers involved is quite disgraceful. A Treasury Minister is in the Chamber now; I wonder whether he will respond.

The Exchequer Secretary to the Treasury (Mr David Gauke) indicated dissent.

Mr Winnick: The Minister shakes his head. I can well understand his embarrassment, because we are constantly told that we are all in it together. Why can we not have a statement about what is happening in the banking industry? If the Minister is not willing to respond to my point of order, may I suggest that we should have some opportunity to raise the issue in the Chamber?

Mr Speaker: I am grateful to the hon. Gentleman for his point of order. I understand that Ministers from the Department for Business, Innovation and Skills, who may be thought to have some interest in the matter, will be answering questions in the Chamber next week, and that the tabling of Treasury questions will take place next Wednesday. I know that the hon. Gentleman will agree with me that it is always useful to have a bit of information, and I therefore proffer that to him and to the House.

The hon. Gentleman has made his point, and the Exchequer Secretary has certainly heard it—

Mr Winnick: But has remained silent.

Mr Speaker: He has not chosen to respond. We do not always have debates by means of point-of-order exchanges. However, the point has been registered very forcefully, and Ministers will be conscious of what the hon. Gentleman has said.

The hon. Gentleman is an extremely ingenious character. I feel sure that he will be present at business questions, and—I say this in the friendliest possible spirit—I know that when he has a bone in his mouth, he is inclined to chew on it, and to chew on it relentlessly. I feel sure that that is what he will do in this instance.

If there are no further points of order, we will come now to the ten-minute rule motion, and to the ever-patient Mr Benedict Gummer.

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National Insurance (Renaming)

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

12.36 pm

Ben Gummer (Ipswich) (Con): I beg to move,

That leave be given to bring in a Bill to make provision for National Insurance to be known as Earnings Tax; and for connected purposes.

About 102 years ago, in this Chamber’s predecessor, David Lloyd George rose to introduce national insurance. Starting just before four o’clock in the afternoon, he began one of the most detailed and complicated of speeches given from the Treasury Bench: one that would, I imagine, have tested even the stamina of those excellent Minsters— my brother from Ipswich, the Exchequer Secretary to the Treasury, my hon. Friend the Member for South West Hertfordshire (Mr Gauke), and my brother from Suffolk, the Minister for Skills and Enterprise, my hon. Friend the Member for West Suffolk (Matthew Hancock)—who are sitting there now.

Lloyd George explained the need: the harsh conditions experienced by working people around the country, and the dangers that they faced if they fell sick or could not find work. He described the insurance systems that were provided by insurance companies, employers, friendly societies and trade unions. He measured their efficacy and worth, identifying where coverage was greatest and where it was most sparse. He then set out the solution: a national insurance fund into which workers, employers and the state would pay, to provide for medical aid for sick workers, maternity cover for workmen, their wives and women workers, benefits for limited periods of unemployment, and payments in time of sickness. The provisions would be managed through the existing private institutions, except for unemployment payments, which would be provided by the labour exchanges.

All that took the Chancellor more than two hours to describe. It was after 6 pm when he concluded:

“something like 15,000,000 of people will be insured, at any rate against the acute distress which now darkens the homes of the workmen wherever there is sickness and unemployment. I do not pretend that this is a complete remedy. Before you get a complete remedy for these social evils you will have to cut in deeper. But I think it is partly a remedy. I think it does more. It lays bare a good many of those social evils, and forces the State, as a State, to pay attention to them. It does more than that. Meantime, till the advent of a complete remedy, this scheme does alleviate an immense mass of human suffering”.—[Official Report, 4 May 1911; Vol. 25, c. 644.]

Thus was made the first substantial plantation of the welfare state.

I am giving this account because I think it important to explain why national insurance was called national insurance. There was indeed a fund, one that was intended to be in surplus within 15 years of its creation, at which point Lloyd George anticipated that additional benefits would be made available, most likely to the families and dependants of workers. Well, the fund did not work out quite like that, but the scope of the scheme was expanded as he had predicted, with a major reform by the post-war Attlee Government. Further changes in the 1970s and 1980s continued the mutation of this great piece of legislation, expanding its scope, scrapping the “stamp” and complicating the rates at which insurance was paid.

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At every turn, the link between contributions and benefit, which from the beginning was not entirely true, was eroded, to the point where it now barely exists. That link will become nugatory with the introduction of universal credit and the single state pension, both considerable reforms of this coalition Government. What remains of national insurance is not really a contributions-based system, but a system of entitlement whereby a certain number of years of payment entitles the recipient to additional benefits.

Let us be straight. National insurance is now a tax. It has all the features of a tax. Money paid in this financial year in national insurance contributions is used to pay this year’s costs of pensions, health care and much else besides. The surplus in the national insurance fund is transferred to other Government spending. The more robust commentators have explained that it is not an insurance system but a giant Ponzi scheme.

That is not, however, how national insurance is universally perceived. The reaction of members of the public to news of this ten-minute rule Bill illustrates well the confusion. One person e-mailed me saying:

“we have earned our pension. It is by its very own definition entitlement paid for by a total lifetime of our contributions, not a benefit paid for by someone else’s income tax.”

But that is precisely what it is. However, the fiction of contributions persists. Someone commenting on a report in the Daily Mail said:

“I’ve paid a full stamp for 44 years and never taken out of the system now they say the insurance I’ve paid all my working life is no longer valid. If this was a business they’d be sued.”

That’s as may be and therein lies the reason why so many of Lloyd George’s successors have been reluctant to come clean about what national insurance really is. As one person on Twitter said:

“Nobody likes a ‘tax’ and to call a tax ‘insurance’ is a spin coup in itself.”

Were national insurance a much smaller tax, we would call it a stealth tax. That was certainly how the right hon. Member for Kirkcaldy and Cowdenbeath (Mr Brown) used it, when he increased NI contributions having promised not to increase income tax. That is the principal reason why I wish to see reform. We know the struggle we have, in this place, to improve the conversation our voters have with the people sent here to represent them. I firmly believe that, if we are clearer about the amount of money we take from people in tax—if that figure were more simply presented—and if we explain equally clearly how it is spent on their behalf, we will have done something important to reconnect voters with their democracy.

A small but important part of that is coming clean about national insurance. I propose we call it earnings tax, because it is a tax on earnings, but we could equally

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call it additional income tax, or employment tax. Such a change would have no impact on people’s current entitlement or on the rates at which NI is currently charged. It would, however, be an important first step in the merging of income and earnings taxes, as proposed most recently by the TaxPayers Alliance, the Institute of Directors and the Chartered Institute for Payroll and Pensions Professionals. I believe that such a merger would have far wider benefits; it would not just benefit the people those organisations represent. But that discussion is for another time. All I propose at this stage is a twofold reform: first, a simple change of name, which would cost next to nothing; and secondly, the merger of the national insurance fund into general Government funds, which would save administration costs that would far more profitably be spent elsewhere. The result would be that we would have made an important move in being clearer, simpler and more transparent about how our constituents are taxed, on what and where it is spent.

I must admit to feeling some trepidation and regret at treading on ground laid so splendidly by the Welsh wizard. His presentation had the desired effect. It made less controversial a scheme that might otherwise have been opposed, as indeed it was in any case—not least by some of the trade unions. Most importantly, it did, as he thought it would, lay

“bare a good many…social evils”

and force

“the State, as a State, to pay attention to them.”—[Official Report, 4 May 1911; Vol. 25, c. 644.]

Over a century, the state has paid attention to them. The provisions were not by any means remedies, as he had hoped, but life for the millions and generations of the least privileged and the less unfortunate is much better as a result. That is a giant achievement, but we must not let romance get in the way of honesty. National insurance is no longer what it was designed to be. We now pay for the welfare state of Lloyd George’s creation out of general taxation. We should therefore get rid of the fiction of national insurance contributions and call it what it is: an earnings tax.

Question put and agreed to.


That Ben Gummer, Steve Baker, Mr Graham Brady, Mr Robert Buckland, George Freeman, Nicholas Soames, Mr Brooks Newmark, Priti Patel, Mr Dominic Raab, Jacob Rees-Mogg, Justin Tomlinson and Mr Andrew Turner present the Bill.

Ben Gummer accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 20 June; and to be printed (Bill 175).

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Pensions and Benefits Uprating

Mr Speaker: With the permission of the House, the motions on the draft Guaranteed Minimum Pensions Increase Order 2014 and on the draft Social Security Benefits Up-rating Order 2014 will be debated together.

12.46 pm

The Minister of State, Department for Work and Pensions (Steve Webb): I beg to move,

That the draft Guaranteed Minimum Pensions Increase Order 2014, which was laid before this House on 27 January, be approved.

Mr Speaker: With this we shall discuss the following motion, on the draft Social Security Benefits Up-rating Order 2014:

That draft Social Security Benefits Up-rating Order 2014, which was laid before this House on 27 January, be approved.

Steve Webb: Let me deal first with what is an entirely technical matter that we attend to each year, and not one that I imagine we shall need to dwell on today. The Guaranteed Minimum Pensions Increase Order 2014 provides for contracted-out defined benefit schemes to increase their members’ guaranteed minimum pensions that accrued between 1988 and 1997 by 2.7%, in line with the increase in the consumer prices index to the previous September.

I should like to turn now to the Social Security Benefits Up-rating Order 2014. As part of his autumn statement, my right hon. Friend the Chancellor of the Exchequer announced the rates of tax credits for 2014-15, and today we are debating the order that will uprate those social security pensions and benefits for which my Department is responsible. As the House will be aware, we are not here to discuss the Welfare Benefits Up-rating 2014 Order, which was made on 24 January. Those rates increased by 1% under that order, and were debated in Parliament during the passage of the Welfare Benefits Up-rating Act 2013.

Turning to the benefits and pensions in the Social Security Benefits Up-rating Order 2014, I shall deal first with the basic state pension. Despite the current tough fiscal context, this Government remain committed to protecting those who have worked hard all their lives, which is why we have stood by our triple-lock commitment to uprate the basic state pension by whichever is the highest of earnings, prices or 2.5%. This year, as prices were greater than average earnings and greater than 2.5%, the basic state pension will increase by CPI at 2.7%. The new rate of basic state pension will therefore be £113.10 a week for a single person, an increase of £2.95 from last year. That means that the basic state pension is forecast to be around 18% of average earnings from April 2014, a higher share of average earnings than at any time since 1992. Our triple-lock commitment means that someone on a full basic state pension can expect to receive £440 a year more than if it had been uprated by earnings since the start of this Parliament.

On pension credit, we have continued to take steps to ensure that the poorest pensioners will benefit in full from the effect of our triple lock. Each year, the standard minimum guarantee must, by law, be increased at least in line with earnings. That means that the minimum increase this year would be 1.2%. However, to ensure

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that the poorest pensioners benefit from the full cash value of the increase in the basic state pension, we decided again to increase the value of the standard minimum guarantee credit, in this case by 2%, so that single people will receive an increase of £2.95 a week and couples will receive an increase of £4.45 a week. Again, consistent with our approach last year, the resources needed to pay this above-earnings increase to the standard minimum guarantee have been found by increasing the savings credit threshold, which means those with higher levels of income will see less of an increase.

Let me now deal with additional state pensions. This year, the state earnings-related pension scheme—SERPS—and the other second pensions will rise by 2.7%, which means that the total state pension increase for someone with a full basic state pension and average additional pension will be about £3.75 a week, or just under £200 a year. Unlike under the Labour party, which froze SERPS in 2010, this will be the fourth year in a row that the coalition has uprated SERPS by the full value of CPI.

In these debates, we discuss the most appropriate measure of inflation by which to uprate benefits. I have had the pleasure of such exchanges with the right hon. Member for East Ham (Stephen Timms) several times, and I want to refer him back to something he said three years ago in the corresponding debate. We were using CPI rather than RPI—the retail prices index—and it is CPI which underlies these motions. He described the move to CPI as “ideological”; that is an interesting description of a choice of price index, but he regarded it as an ideological shift. He went further in expressing his distaste for this measure, saying:

“As for the view of my party, I simply refer the Secretary of State to what the leader of my party has said, which is that the suggestion that the change should be made for a period—perhaps up to three years—would be something that we could consider. If that proposition were on the table, we would be happy to consider it.”—[Official Report, 17 February 2011; Vol. 523, c. 1187.]

So his position three years ago was that, perhaps for three years, we might use CPI because it saves a bit of dosh but that the Labour party was committed to RPI.

I therefore hope that when the right hon. Gentleman responds and gives his party’s position on these motions he will clarify whether that is still his position. He will realise, first, that RPI has now been dropped by the Office for National Statistics as an official statistic because of methodological concerns. So I would be surprised if he remained committed to going back to RPI. Perhaps he thinks we should use CPIH, as he complained that we did not have owner-occupier housing costs in the measure that we are using. If that is his position, he would obviously be arguing for a lower increase in benefits this year, because at the moment the level of CPI is above that of CPIH. Given that he was opposed to a permanent switch to CPI, given that RPI has been dropped as an official statistic and given that some of the other measures are lower than the one we are using, I am slightly puzzled by his position—I am sure that by the time we have heard his speech we will no longer be puzzled.

On disability benefits, this year the coalition will ensure that those who face additional costs because of their disability, and who perhaps have less opportunity to increase their income through paid employment, will see their benefits increase by the full value of CPI. So disability living allowance, attendance allowance, carer’s

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allowance, incapacity benefit and personal independence payment will all rise by the statutory minimum of 2.7% from April 2014. In addition, those disability-related and carer premiums paid with pension credit and working-age benefits will also increase by 2.7%, as will the employment and support allowance support group, and the limited capability for work and work-related activity element of universal credit. Pensioner premiums paid with working-age benefits will increase in line with pension credit.

At a time when the nation’s finances remain under real pressure, this Government will be spending an extra £3.3 billion under these orders, and related orders, in 2014-15. We will thus continue to help support those who are not currently in work, first, by increasing the main rates of working-age benefits by 1%, and by ensuring that pensions, and benefits that are designed to help with the additional costs of disability, are protected against the cost of living. Of that, we will be spending about £2.7 billion extra on state pensions, including an above-inflation increase, and more than £600 million on people of working age. Nearly £600 million will be going to disabled people and their carers. Our decisive action to limit to 1% the increases in the main rates of most working-age benefits is part of our overall economic strategy, which has substantially brought down the deficit.

In this order, we continue: first, to maintain our commitment to the triple lock, meaning that the basic state pension will reach its highest level as a percentage of average earnings for two decades; secondly, to protect our poorest pensioners with an over-indexation of the standard minimum guarantee, so they too will feel the benefit of our triple lock; and, thirdly, to protect the benefits that reflect the additional costs that disabled people face as a result of their disability, through increases to disability living allowance and attendance allowance, carer’s allowance and the main rate of other disability benefits in line with CPI. I have set out our ongoing commitment to ensure that no one is left behind, and I commend these orders to the House.

12.54 pm

Stephen Timms (East Ham) (Lab): I thank the Minister for his explanation and confirm that I do not intend to express concerns about the draft Guaranteed Minimum Pensions Increase Order 2014. However, I do wish to make some comments about the draft Social Security Benefits Up-rating Order 2014. As he has said, this is a rather thinner debate than the corresponding ones he and I have enjoyed in previous years, because a big chunk of what we have debated previously is now covered by the Welfare Benefits Up-rating Act 2013, which imposed a 1% uprating this year and next, and so is outside the scope of these orders.

One thing I have not entirely understood—the Minister touched on this and I would be grateful if he explained it—is how the corresponding order for tax credits will be dealt with. Some elements of tax credits uprating are not covered by the 1% constraint. Clearly, with so few people in receipt of universal credit, he is not the Minister responsible for in-work benefits—that responsibility remains with the Treasury—but I wonder whether he could explain how the parliamentary process dealing with those tax credits is to be handled.

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This is the fourth year since the announcement of the triple lock for the basic state pension. In rhetorical terms the triple lock has, no doubt, been successful, but, unfortunately, the reality has been rather different, because, once again, the increase in the state pension is less this year than it would have been if the uprating method previously used was still in place. In RPI terms, this is a real-terms cut for the third year in a row in the value of the basic state pension. The RPI last September was 3.2%, whereas the pension uprating delivered by this order is 2.7%. So in RPI terms, this is quite a big cut of 0.5%—a full half percentage point—in the value of the state pension, which is a bigger real-terms cut than last year. If the basic state pension had been uprated in line with RPI since 2010, the weekly rate for a single person would be more than a pound higher than the figure we are debating today, at £114.21.

Steve Webb: Clearly RPI is bigger than CPI—that is a statement of fact—but does the right hon. Gentleman think that RPI is a good measure of inflation?

Stephen Timms: I will come on to deal with that. The point I wish to make is that the triple lock is frequently presented to us, as the Minister did again today, as being extraordinarily generous to pensioners. It is presented as some great superlative, whereas in fact it has delivered a lower uprating than the previous formula—the one in place before the last election—in every one of the three years when it has been used, and in the first year it was due to be used it would have delivered such a low uprating that the Minister chose to override it. He was sensible to do so, but if he had used the triple lock in that first year, the gap between his uprating and the value of the basic state pension under the old method would now be almost £3 per week. So it is important in this debate to put on the record the extent to which the triple lock has delivered less than the long-established formula that was in place until the general election.

It is worth examining the history of the triple lock. In its first year, it was announced but not actually implemented, because it would have delivered a very small increase. So at its first outing, it failed.

Sir Robert Smith (West Aberdeenshire and Kincardine) (LD): Was it not, however, the long-established formula, over the long run, that had put pensioners so far behind those earning?

Stephen Timms: I think the hon. Gentleman is referring to the change made by Mrs Thatcher when she was Prime Minister, and he makes an entirely fair point. However, the point I am putting to him is that he and his party, particularly the Minister, frequently present the triple lock to us as somehow being extraordinarily generous, whereas in practice it has provided less than the formula he has just criticised—the one introduced by the former Conservative Prime Minister. If that formula had continued after the 2010 general election, the state pension amount we would be debating today would be more than £1 a week more than the figure in this order.

Mr Alan Reid (Argyll and Bute) (LD): The right hon. Gentleman will accept that the formula introduced by Mrs Thatcher was continued throughout the whole term of the previous Labour Government. As the economy

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is recovering, thanks to the coalition’s successful economic policies, will he not accept that linking pensions to earnings will mean higher pensions for people in the long run?

Stephen Timms: I certainly hope that that is the case, but in the short run, in the period since the general election, we are seeing a lower value for the basic state pension than if Mrs Thatcher’s formula had stayed in place. That point is not widely understood. I am sure that the hon. Gentleman understands it, but I want to put it on the record so that people are aware of the fact that the method that is currently in place has in fact delivered a lower value for the basic state pension than if Mrs Thatcher’s formula had continued to be used.

Mr Reid: Had the right hon. Gentleman’s party been in power, would the pension increases over the past three years have been at CPI or RPI?

Stephen Timms: If the arrangements in place before the last election had been maintained, the increases would have been at RPI. If they had been at RPI, we would be debating today a higher value for the basic state pension than the one in the order in front of us.

Dr Eilidh Whiteford (Banff and Buchan) (SNP): When we have debated such issues in the past, I have been quick to highlight the fact that both CPI and RPI are not particularly good methods of measuring inflation, especially its impact on low-income groups, including pensioners. Does the right hon. Gentleman agree that the real issue at stake here is that energy prices have increased by 37% in the past 10 years and that food inflation has grown ahead of inflation every year for the past eight years? We should be talking about the impact of inflation on low-income groups and not the technical measure. We should be finding technical measures that reflect that impact of inflation.

Stephen Timms: The hon. Lady makes an important point. I hope she will support Labour’s energy price freeze, which will have an important benefit for people on low incomes. She is also right to draw attention to the particular difficulties of pensioners on low incomes. It is for that reason that pension credit is so important. Pension credit, which is in the order in front of us—I believe that my hon. Friend the Member for Cumbernauld, Kilsyth and Kirkintilloch East (Gregg McClymont) will say more about that when he responds to the debate later—is being uprated at a significantly lower rate in percentage terms than the basic state pension.

I was talking about the history of the triple lock. In the first year, it was overridden, so it failed. In its second year, it was implemented and delivered an increase in line with CPI, along with working age benefits. Last year, it was applied again and, for the first time, it delivered something better than CPI, but that was only by 0.3 percentage points. This year, the Government propose to uprate the basic state pension by CPI, which, as of September last year, was 2.7%. That is only a 0.2 percentage point increase on the absolute bare minimum that would be possible under the triple lock. Had the previous uprating RPI mechanism been in place, there would have been a larger pension increase this year, and in the last two years, than has been delivered.

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It was in 2011 that the Government first uprated pensions by CPI rather than RPI. In the debate then I pointed out that this was a direct hit on the income of pensioners, and it still is. In 2011, a contributory deal, understood and signed up to by pensioners, was broken. That was compounded last year, and the Government want to do it again this year. On the other side of the coin, it is worth noting that RPI will continue to be used for the uprating of a great many other things. The Minister has correctly quoted my comments on that in the past. There could well have been a case to uprate by CPI as a deficit reducing measure for a period. However, we do not accept that Ministers should have tied themselves to CPI indefinitely, and that remains our view.

As announced in 2010, the Government have also made a permanent switch to CPI uprating. Thanks to the Welfare Benefits Up-rating Act 2013, most working age benefits were capped at 1%, with provisions for them also to be capped at 1% for the following two years, and so are outside the scope of this order. As we have said in previous years, there would have been a reasonable case for the Government to make a temporary change to the methodology, but unfortunately they went further.

Steve Webb: Sometimes we ask for a one-word answer. I want a three or possibly four-letter answer. Were the right hon. Gentleman introducing these motions today, which index would he use?

Stephen Timms: Sadly, I am not in the happy position that the Minister describes. I hope that I will be before very long, in which case I will gladly give him the answer that he seeks. However, I am not in that position today.

Mr Reid: If the right hon. Gentleman hopes to be in power some time in the future, will he tell us the formula that he would use for the long term?

Stephen Timms: I can well understand why the hon. Gentleman wants to know the answer to that question. If, as we have heard, he and his party are to be involved in the next Government, it will be in coalition with a party other than the one that they are in coalition with at the moment. I am afraid that he will have to be a little patient to get an answer to his question. None the less, I well understand why he wants to know the answer.

The Chancellor proudly told us in his autumn statement last year that the increase formula for regulated train fares was changing from RPI plus 1% to RPI plus 0%, which means that regulated rail fares would increase by no more than July 2013’s RPI of 3.1% . What is not clear is why the Government apply RPI in that case and CPI in this. The answer, as far as one can make sense of all this, is that the Government use CPI when it is useful to have a small number and RPI when they want a big number. That appears to be the principle that has been adopted. The result is that pensioners will see their state pension increased in line with CPI, but their train fares by RPI.

Part 7 of the order in front of us relates to universal credit. As the House well knows, this is becoming an appalling fiasco. The Secretary of State told us yesterday that he expected 6,000 people to be in receipt of universal credit during the current pathfinder. It was not clear by what date he expected that figure to be achieved. Will

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the Minister let us know? He will recall that I have been warning since November 2010 that the time scale announced by Ministers for universal credit was unachievable. Unfortunately I have been proved right. Indeed, the position is now a good deal worse than I feared when I wrote to the Secretary of State in November 2010. There is now a real danger that the entire project could collapse.

As I pointed out at the time, the time scale for the IT was always unachievable. That goes back to the July 2010 Green Paper, which included the absurd claim that the IT for universal credit would not amount to a major IT system. Replacing the whole of the benefit information technology can hardly amount to anything other than a major IT system. Ministers have failed to deliver any IT system. It now appears that, while they continue to develop late the IT system they started out with, they are also going to develop a second universal credit IT system, in the hope that they can get it right second time around. Goodness knows how many hundreds of millions of pounds that is going to end up costing. It is clear that the next Government will have a major job on their hands to salvage universal credit after May next year if, as all of us must hope, it can be salvaged.

Mr Elfyn Llwyd (Dwyfor Meirionnydd) (PC): Is the right hon. Gentleman at all reassured by the Secretary of State’s statement some time ago that universal credit would succeed because he believed that it would?

Stephen Timms: The hon. Gentleman correctly quotes the Secretary of State. He told us for a long time that universal credit was on track, then latterly he started to say that it was “essentially on track”. So one can be forgiven for not being entirely reassured.

I wonder whether the Minister can help us on another matter that has just come to light in connection with part 6 of the order on employment and support allowance. A freedom of information request by the advice service Benefits and Work revealed yesterday that the Department for Work and Pensions had issued an internal memo to staff on 20 January advising that, owing to a growing backlog at the assessment company Atos, all current ESA claimants would be left on the benefit without further medical checks until another company could be found to carry out repeat work capability assessments. The Minister of State, Department for Work and Pensions, the hon. Member for Hemel Hempstead (Mike Penning), frankly acknowledged in oral questions yesterday pressures and capacity problems at Atos and indicated that negotiations were taking place to find an alternative provider, but he made no mention of the suspension of repeat assessments in the meantime, which appears to have been introduced. The memo obtained by Benefits and Work suggests that DWP has deliberately chosen not to inform Members of the House or claimants about this change. Why has that been done? Can the Minister provide reassurances to the public about the scale of the difficulties—yet another emerging mess in his Department?

The decision by Ministers to take this action will confirm widespread scepticism about whether the system is fit for purpose. It certainly leaves an operational vacuum, apparently pending the appointment of a new provider. At this stage there is no indication of when such an appointment might be made. In the circumstances,

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it is surprising that the Minister did not take the opportunity to inform the House of the situation yesterday, when there was an extensive discussion on the matter and a number of questions were asked about the process for replacing Atos and the operation of the work capability assessment in the meantime. It appears that the operation has been significantly scaled back. Given that ESA is part of the order before us, I wonder whether the Minister can take this opportunity to provide us with the explanation that we were not provided with yesterday.

There is growing dismay in the country about the impact of the Government’s changes on growing numbers of people—with an extraordinary 750,000 people forced to go to food banks last year because they were unable to afford enough food for themselves and their families. The Cardinal Archbishop of Westminster expressed it powerfully last week when he said:

“Something is going seriously wrong when, in a country as affluent as ours people are left in that destitute situation and depend solely on the handouts of the charity of food banks”.

He is surely right. Something is going very badly wrong indeed, and it needs to be put right.

The increase of the state pension in line with the triple lock is worth having—I put it no stronger than that—but the Government have chosen to uprate state benefits and pensions permanently in a way that is meaner than the method used before. For that reason, we are unable to support the Government in the Lobby on the orders today.

1.14 pm

Katy Clark (North Ayrshire and Arran) (Lab): Thank you, Mr Speaker, for giving me the opportunity to say a few words. I will be speaking against the orders, but I am not suggesting that we should vote against them because of course, if we were to do so, the pitiful increases that some people will receive as a result of them would not be paid. I shall be arguing that the orders should be different.

The changes that the Government have introduced, some of which are in these orders, have huge significance for millions of the poorest in our country. Both motions are of vital importance, as restricting the uprating of benefits to these pitiful amounts, which in many cases represent a real-term cut, is one of the ways in which the coalition Government have attempted to balance the books on the back of the poor. The focus today is on the change from RPI to CPI and, as the Minister has said, other legislative methods have been used in relation to some of the other changes which yet again the Government are proceeding with this year.

Under the last Labour Government, most benefits were uprated every April in line with the RPI measure of inflation and based on the RPI of the previous September. Shortly after taking office, the coalition announced that it would be changing to CPI, which of course does not take into account housing costs and is almost always a lower measure than RPI. That is why I oppose it. The hon. Member for Banff and Buchan (Dr Whiteford) has already commented that another method of uprating should be found because neither CPI nor RPI is a good way of capturing the real cost of living for some of the groups affected by the orders. However, we do know that RPI is a more generous system than CPI and the Government should return to that way of looking at things unless a better way can be found.

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Steve Webb: I am listening with care to the hon. Lady. Just to set the record straight, one of her objections to the use of CPI is that it does not include housing costs. In fact, it does. It includes rents. Were we also to include owner-occupiers’ housing costs—the CPIH measure—we would have a lower measure than the one we are using.

Katy Clark: Obviously the Minister is aware that the range of factors taken into account has been smaller every year since the change was brought in. I oppose the orders not necessarily because they do or do not include housing costs—I understand the point he makes; he has made it before and we have debated it previously—but because the method does not reflect the real cost of living that people who rely on these benefits experience.

Every year since 2010 RPI has been higher than CPI and the gap between those figures has made a real difference to pensions and benefits. The danger with the change is the cumulative impact over many years. In 2010 the RPI figure was 4.6%. That went up to 5.6% in 2011, down to 2.6% in 2012, and was 3.2% last year. But the equivalent CPI figures were 3.1%, 5.2%, 2.2% and 2.7%. Every year there has been a gap, which has meant that some of the poorest and most vulnerable in our society have ended up with less money in their pocket.

The Prime Minister has made much of his decision to introduce a triple lock guarantee for the basic state pension. He has already pledged to retain it throughout the next Parliament should he have any success at the next general election. The guarantee ensures that the basic state pension will always rise in line with whatever is the greatest as between inflation, wages or 2.5%. The uncomfortable truth, however, as the Minister must accept, is that the triple lock was introduced alongside the change from RPI to CPI, so the basic state pension increases in 2012 and 2013 were lower than they would have been if the previous system had been used. By 2015, the basic state pension will therefore be £1.11 a week lower than it would have been if it had risen in line with RPI, so pensioners will be £106.60 worse off as a result.

That is how just one group is affected. If we look at other groups, such as carers, the situation is even worse. Next year, carer’s allowance will be £1.69 per week lower than it would have been under RPI, with carers £255.84 worse off by April 2015 as a result. Those receiving both the higher rate mobility and care components of disability living allowance will be £571.48 worse off by the same date.

Mr Reid: Does the hon. Lady accept that, with the triple lock, pensioners will benefit from an economic recovery by their pension going up in line with earnings, whereas when the economy was doing well in the early years of the Labour Government, pensioners did not share in the increased benefits, because their pension only went up in line with inflation and not in line with earnings?

Katy Clark: As the hon. Gentleman will appreciate, I am focusing on the change from RPI to CPI. He will be aware that in the last Parliament I strongly advocated a return to the link with earnings. However the reality, as he well knows, was that even though Labour did not reinstate that link, the increases every year were far higher than they would have been if that reinstatement had taken place. Therefore, I frankly did not understand why my Front Bench at the time would not make that change.

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I support the return to the link with earnings, but as I have said, the point I am making is about the change from RPI to CPI, which I understand is a long-term policy of this Government. Some of the poorest people in the hon. Gentleman’s constituency and mine will experience a cumulative long-term reduction in their incomes as a result of that change.

From April 2013, the coalition slashed the annual uplifts to a range of benefits to 1%; I appreciate that that issue is being dealt with in other legislation. Some of the disability benefits, such as carer’s allowance and disability living allowance, are exempt from that 1% cap, but employment and support allowance, which is the primary income replacement benefit for disabled people, is not. The Government have exempted from the cap the higher rate care component paid to the most severely disabled people, supposedly shielding the vulnerable from it. Unfortunately, however, this is a sleight of hand. ESA is paid in two parts—a basic rate, plus an additional component—and although the additional component of £35.75 is exempt from the 1% cap, the basic rate of £72.40 is not. Therefore, over-25s in receipt of the care component of ESA will receive £5.11 a week less than they would have received if it had increased in line with RPI. These cuts matter, because they are having a real impact on some of the poorest and most vulnerable people in our society.

Between 1997 and 2010, the Labour Government reduced the percentage of people living in absolute poverty from 28% of the population to 15%. During that time, 2.3 million children and 2 million pensioners were lifted out of poverty. Research from the Institute for Fiscal Studies suggests that investment in the social security system was the primary factor behind that reduction in poverty. By slashing social security benefits with these orders and the other legislation that we have considered previously, the Government risk putting some of the most vulnerable people in society back below the poverty line, and that is on top of the large number of people whose incomes have already been cut as a direct result of this Government’s policy. These orders are completely inadequate and the Government should come forward with something that protects the most vulnerable in our society.

1.24 pm

Gregg McClymont (Cumbernauld, Kilsyth and Kirkintilloch East) (Lab): I do not intend to detain the House for too long. I begin by thanking my hon. Friend the Member for North Ayrshire and Arran (Katy Clark) for a powerful speech. The final point that she made is an important one, and it is worth the House’s reflecting on it, because often when we discuss these kinds of issues there is a tendency to caricature the record of the last Labour Government, but anyone who looks closely at their changes to and improvements in social security will see a record of quite substantial progress. Of course, social progress often comes slowly; it is measured in inches as well as feet, and in centimetres as well as metres. However, there was significant social progress and that is part of the context within which this debate should be understood.

Mr Reid: The hon. Gentleman referred to enormous social progress, but why did the last Labour Government not increase pensions in line with earnings, as will now happen over the long term thanks to the triple lock?

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Gregg McClymont: I am pleased that the hon. Gentleman made that point, because to some degree it illuminates the difference between him and Labour; because what he discounts entirely by asking that question is the impact of pension credit. I do not know how aware he is of pension credit, but it took 1.3 million pensioners out of poverty. Is that not something that he welcomes? It reduced pensioner poverty in Scotland by two thirds, taking 200,000 pensioners out of poverty.

Mr Reid rose—

Gregg McClymont: I will give way to the hon. Gentleman again, but I hope he will recognise that achievement.

Mr Reid: The defect of the pension credit arrangements, when compared with the new pension arrangements that my hon. Friend the Minister has introduced, was that people had to apply for pension credit, and a lot of people were unaware that they had to do that, whereas under the new pension arrangements everyone will get the single-tier pension.

Gregg McClymont: I am afraid to say to the hon. Gentleman that, although I understand where he is coming from, it is not the case that everyone will receive the single-tier pension; people must have made contributions for 35 years. He should speak to his colleague, the Minister, who everyone recognises is an expert on the state pension. There will be poor pensioners who will not receive the new pension, and they will depend on pension credit.

I asked the hon. Member for Argyll and Bute (Mr Reid) to reflect on the reality of the difference that pension credit made, particularly in a period after 1997 when there was genuine absolute pensioner poverty.

Sheila Gilmore (Edinburgh East) (Lab): Is it not the case that if it had not been for the framework that was set up by the last Labour Government—particularly the introduction of pension credit, which is clearly already accounted for in budgets—it would have been far more difficult to move to the form of pension that the Minister has proposed?

Gregg McClymont: My hon. Friend makes an important point. The level at which the Minister appears set to place the new flat-rate state pension is just above pension credit. It is that framework, which was set for the poorest pensioners to ensure they would no longer live in poverty, that is so important. My argument is not that the hon. Member for Argyll and Bute is entirely wrong; it is that he must take account of the difference that pension credit made to the poorest pensioners in his constituency, my constituency and around the country.

That brings me to the question that I wanted to ask the Minister, which is about pension credit. Of course it is welcome that the basic state pension is rising by £2.95, and he was very clear that pension credit will also rise by £2.95, but of course as a percentage rise, the rise for pension credit is less. The danger is that those on pension credit will fall behind relative to those on the basic state pension.

The term that the Minister used was over-indexation. A little alarm goes off in my head when Ministers resort to using such terms. A more straightforward way to put things is to say that pension credit, which the poorest

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pensioners rely on, is not being uprated by the same percentage as the basic state pension. There may be an excellent reason for that, but I would like to hear it.

There is also a more fundamental point about the new pension system that the Minister and the Government are introducing, which relates to the point that my hon. Friend the Member for Edinburgh East (Sheila Gilmore) made. It is that, as the Pensions Bill proceeds, the new flat-rate state pension—as I understand it—is being set just above pension credit. If pension credit loses its value relative to the basic state pension in the run-up to the introduction of the new system, there is a danger that the flat-rate state pension will be pegged at a lower rate than would otherwise be the case. We must be clear not only about the implications for the poorest pensioners of a lag in the uprating of pension credit, but about the implications for the flat-rate state pension system for which the hon. Member for Argyll and Bute is such an enthusiast. We must ask these legitimate questions. If we are to have a reasonable debate, we need to recognise the progress that was made over the past decade—certainly until 2010—and consider how that will interact with the flat-rate state pension system that the Minister is so keen on creating.

Dame Anne Begg (Aberdeen South) (Lab): Following its pre-legislative scrutiny of the draft Pensions Bill, my Work and Pensions Committee thought that there should be a larger gap between the flat-rate state pension and pension credit to ensure that there would be a cut in means-testing, which the Government claim will be the effect of the flat-rate pension’s introduction. However, that will not happen if the two are kept together, or if one is lower than the other.

Gregg McClymont: My hon. Friend is widely acknowledged as an expert in this area, and questions arise when pension credit is not uprated by the same percentage as the basic state pension. As I said, I start to get worried when I hear the phrase “over-indexation” because the Minister is actually saying, “We have decided that pension credit will be uprated by earnings unless we decide otherwise, and we have decided otherwise, so it will be uprated by the cash equivalent of the uprating to the basic state pension.” However, that represents a smaller percentage increase, so we need to be aware of the wider implications of that.

I made it clear that I would not detain the House for too long. My right hon. Friend the Member for East Ham (Stephen Timms) asked the Minister a number of important questions, to which I shall add my own. First, does the Minister agree that pension credit made a real difference to millions of poor pensioners in this country? Secondly, does he agree that it provides the basis on which the flat-rate state pension will be pegged under his new system? If that is the case, it is important that we debate the lesser uprating of pension credit, and I hope that the Minister accepts that I ask my questions in the spirit of co-operation and inquiry.

1.32 pm

Steve Webb: With the leave of the House, I shall be grateful for the chance to respond to the three speeches that we have heard. I cannot help reflecting on the fact that we cannot manage to talk for even an hour about spending £3.3 billion, but I take it from that that the House thinks that we are doing a good job.

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Before I respond to the detailed points that have been raised, I want to be clear about what we mean by above inflation, real terms and all the rest of it. The April increase in the basic state pension will be in line with inflation at 2.7%. Of course, we now know that CPI is below 2%, so despite the population experiencing inflation at that rate, we are putting up the pension by 2.7%—

Sheila Gilmore: Will the Minister give way?

Steve Webb: In a second.

That explains the reference at the end of my speech to an above-inflation increase although, as we have discussed, there will be years in which the trend goes in the opposite direction.

Sheila Gilmore: The Minister anticipates the point I was about to make. The situation to which he refers could apply in any year. People suffered greatly in previous years because the uprating was set at a low point for inflation, yet they experienced real rising prices, so the increase is hardly a great virtue on the part of the Government.

Steve Webb: It is interesting to look at what has happened to benefit rates over the long run. In the seven years since the 2008 crash, the rate of jobseeker’s allowance has increased by more than the growth in earnings. While people with jobs—people would obviously far rather have jobs than not—have seen their wages grow over that period, the rate of JSA, which I still quaintly think of as unemployment benefit, has risen by more than that growth.

The hon. Member for North Ayrshire and Arran (Katy Clark) talked about pitiful increases and slashing benefits, but I can tell her that the Labour Government spent £181 billion on tax credits, benefits and pensions in their final year in office, yet in the first year of the next Parliament, we envisage spending not £181 billion, but £211 billion. Spending £30 billion more than six years previously is an odd definition of “slashing”, so we need to keep a bit of perspective in the debate. I respect the hon. Lady’s sincerity and clearly she wishes that the increases were greater but, as she well knows, her Front-Bench colleagues will not vote against the orders, and that is not because of a technicality, but because they would not allocate money for larger increases. I know that she disagrees with her Front Benchers. If she ruled the world, she would put in place greater increases—she would tax people more and spend more—but that is not her party’s position.

Stephen Timms: What is the Minister’s response to last week’s comments by the Cardinal Archbishop of Westminster about the significant number of people who find themselves in destitution as a result of the changes that have been made?

Steve Webb: I have great respect for the Cardinal Archbishop, whom I met some years ago, and I do not doubt his compassion for those in need, which is shared by Members on both sides of the House. However, I do not think that anyone believes that people were not in severe and urgent financial crisis before we saw the

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current network of food banks; they simply went somewhere else. The idea of urgent financial need has not suddenly arisen. As the right hon. Gentleman will know, people turned to charitable sources and churches. It was not uncommon for people to knock on a vicarage door to ask for a sandwich, and that is not very different from a food bank—it is a precursor to that. There were always people in urgent financial need, and we can debate the impact of a global economic downturn on the level of need. Church leaders who comment on such matters are sometimes briefed with partial information. It is sometimes suggested to them that there is a mad slash and burn on the welfare state, but I think that they would be surprised to learn that, at the start of the next Parliament, we will be spending £30 billion a year more on benefits, pensions and tax credits than in the final year of the previous Labour Government.

Stephen Timms: Surely the Minister accepts that comments such as those made by the Cardinal Archbishop of Westminster and in last week’s letter signed by 27 bishops are based on actual experience of what is happening in communities. Surely he cannot maintain, as he appeared to do, that nothing has changed and that things are carrying on as they were before—clearly that is not true.

Steve Webb: No one is suggesting that nothing has changed. The global economic downturn was far deeper than was originally thought, and we have had to recover from that. We had to make changes to the benefits system to try to balance the books, which the previous Government failed to do.

The hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East (Gregg McClymont) said that he felt uncomfortable when I talked about over-indexation. Let me make it clear that under the pensions legislation that the Labour Government put in force, there is a legal duty to uprate pension credit by earnings, but we are doing more than that. The hon. Gentleman implied that we were doing less and that we were somehow putting in place a worse increase, but we are paying a £2.95 increase on the basic state pension, and we do not want to follow Labour’s approach of making an earnings increase to the guarantee credit because that would give the poorest pensioners less than £2.95. In our jargon, we are passing through the full £2.95. Far from paying less than the law requires, we are paying more, because we put the biggest priority on the poorest pensioners.

Gregg McClymont: The Minister is well aware that earnings have been in decline, so setting out the Government’s approach as some sort of virtue is a bit like the argument that was made when he had to override the triple lock on its first day because it would have produced so little. However, does the Minister not accept that the situation has implications for the level at which the flat-rate state pension will be set?

Steve Webb: I would like to suggest that the colleague who just whispered in my ear was saying how much he was enjoying our debate on welfare and urging me to keep it going, but that may not have been the tenor of his remarks. What we are trying to do is ensure that we do the right thing by the poorest pensioners. Had we simply done what Labour required us to do by law, which was to index in line with the growth in average earnings—it was Labour’s law, not ours—the poorest

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pensioners would now be getting less. I assume that the hon. Gentleman is not suggesting that we should do that. We have therefore overridden Labour’s law and been more generous to the poorest pensioners. I do not know whether that is socialist enough for him, but it is what I think is the right thing to do.

Gregg McClymont: Let us be very clear that pension credit has been uprated by less than the basic state pension. That is a judgment the Minister can make, but let us be clear about what it means for the poorest pensioners: they are not getting the same increase as other pensioners. That is a judgment the Government can make, but they should at least be clear about what is happening.

Steve Webb: The hon. Gentleman is completely wrong, because they are getting exactly the same increase—£2.95—as in the basic state pension. He seems to want it both ways. If he is saying that the increase in pension credit should have been the 2.7% on the basic state pension, can he tell us where he would get the money from?

Gregg McClymont: The Minister is an intelligent man, and my point is a simple one: an increase of 2% is less than an increase of 2.7%. I think that we can all agree on that.

Steve Webb: I did not hear the hon. Gentleman say where the extra cash would come from—the bankers’ bonus tax, perhaps? Is he saying that it should be 2.7% or not? As a debating point he is saying that it should, but he has no idea where the money would come from. [Interruption.] He says from a sedentary position that he wants me to be straight about this. Being straight with the electorate means that if he stands up in Parliament and says that the increase should be bigger, which he has every right to do, he must say where the money would come from. That is the nature of choice in government.

The right hon. Member for East Ham (Stephen Timms) asked about tax credit. Tax credit rates will be set out in affirmative statutory instruments in the usual way and debated in the usual way, so there is no difference there. He talked about the triple lock, which we are very proud of. In fact, we understand that the Opposition are going to copy it. On one level he was mocking and deriding it, but when the Prime Minister said that he would continue it in the next Parliament if re-elected, the leader of the Labour party said that