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House of Commons

Tuesday 10 June 2014

The House met at half-past Eleven o’clock


[Mr Speaker in the Chair]

Speaker’s Statement

Mr Speaker: I must draw Members’ attention to the fact that the book for entering the private Members’ Bill ballot is now open for Members to sign in the No Lobby. It will be open until the House rises today, and while the House is sitting on Wednesday 11 June. The ballot will be drawn on Thursday 12 June. An announcement setting out these arrangements, and the dates when ten-minute rule motions can be made and presentation Bills introduced, is published on the Order Paper.

Business before Questions

Spoliation Advisory Panel


That an humble Address be presented to Her Majesty, That she will be graciously pleased to give directions that there be laid before this House a Return of the Report from Sir Donnell Deeny, Chairman of the Spoliation Advisory Panel, dated 10 June 2014, in respect of three Meissen Figures, now in the possession of the Victoria and Albert Museum.—(John Penrose.)

Oral Answers to Questions


The Secretary of State was asked—

Challenge Fund

1. Mr Robin Walker (Worcester) (Con): What recent assessment he has made of the role of the Prime Minister’s challenge fund in improving access to GP services. [904103]

The Secretary of State for Health (Mr Jeremy Hunt): Mr Speaker, it is a pleasure to see you again so soon.

The Prime Minister’s challenge fund will be rolled out over 1,100 of the 8,300 GP surgeries in the country. It will improve access out of hours, at weekends and electronically, and it will benefit up to 7.5 million people.

Mr Walker: I am glad that this Government, unlike the previous one, whose disastrous contract negotiations led to a decline in GP access, is making sure that out-of-hours care is as widely available as possible. Will the Secretary of State assure me that he will do whatever he can to ensure that places, such as Worcester, that have not yet been reached by the challenge fund will also see the benefits of this approach?

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Mr Hunt: My hon. Friend is right to say that some bad changes were made. What will most benefit his constituents, whether or not they are part of the initial tranche of the Prime Minister’s challenge fund, is the reintroduction of named GPs for the over-75s. For people with complex long-term conditions, continuity of care is extremely important, and every single one of his constituents aged 75 or over will now get a named GP.

Kate Green (Stretford and Urmston) (Lab): We are very pleased in Old Trafford to have secured funding for 80 extra care beds for one of the most deprived parts of my community. We also hope to be able to bring health care services, including GP surgeries, on to the same sites, but we are experiencing difficulty in unblocking funding via the NHS area team. Will the Secretary of State meet me to discuss this issue and how we might be able to move forward?

Mr Hunt: Yes, I would be more than happy to meet the hon. Lady and see what I can do to help her to improve health care in her area.

Jessica Lee (Erewash) (Con): I thank my right hon. Friend the Secretary of State for his recent visit to Erewash. He has kindly offered to come back another time. We welcome the Prime Minister’s challenge fund being allocated to Erewash. May I reassure my right hon. Friend that our excellent GPs are working very hard to make sure that services and support are appropriately allocated in our community?

Mr Hunt: I thank my hon. Friend for her work to promote good health care in her area. I very much enjoyed meeting her local GPs. I was disappointed that it was only for about five minutes. I very much hope to go back and have a proper discussion. They were very enthusiastic about the Prime Minister’s challenge fund, and are making some very innovative changes.

Mr Barry Sheerman (Huddersfield) (Lab/Co-op): May I push the Secretary of State on this matter? What my constituents want is to be able to get to see a GP when they really need one; they do not want to turn up in A and E just because they cannot get an appointment for a week. Is not poor management of GP surgeries—poor management from top to bottom—at the heart of this problem?

Mr Hunt: Actually, I agree with the hon. Gentleman. I think that we do have a problem. We have some fantastically good GP surgeries and some brilliant GPs, but we have not in the past had structures in place to make sure that we deal quickly with underperforming GP surgeries and, indeed, underperforming GPs. We need to have much more transparency of data so that we can see where the problems are. We have introduced a rigorous new inspection regime, with a new chief inspector of general practice, and I hope that that will go some way to addressing the issues he raises.

Andy Burnham (Leigh) (Lab): People ringing their surgery this morning only to be told that no appointments are available for days will be listening to the Secretary of State’s answers today and thinking that he is living in a different world. People’s real experience is that it is

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getting harder and harder to get a GP appointment under this Government, but for some it could get much worse. I recently visited a practice in east London that faces closure in October because of this Health Secretary’s changes to GP funding. NHS England says that 97 other practices are in the same position, affecting thousands of patients. Will he today give a guarantee that no practice will have to close?

Mr Hunt: Let us address this issue head on. The right hon. Gentleman knows perfectly well that it is totally wrong to have a system in which two neighbouring GP practices can be paid different sums of money for doing the same amount of work. We must have an equitable funding formula for GP practices, which is why we are phasing out the minimum practice income guarantee. That is a sensible decision. We are also taking measures to ensure that we do not affect patient care in the process. Of course we are looking at the individual cases carefully, but I am sure that he would agree that we have to fund GP practices equitably.

Polypropylene Transvaginal Mesh Implants

2. Graeme Morrice (Livingston) (Lab): If he will commission a review of the safety of polypropylene transvaginal mesh implants. [904104]

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): The Department of Health, NHS England and the Medicines and Healthcare Products Regulatory Agency—the MHRA—have been working collaboratively with the clinical community to address the serious concerns that have been raised about transvaginal mesh implants. A working group, chaired by NHS England, has been set up to identify ways to address them. The group will also have patient representation.

Graeme Morrice: Last week, I attended the Scottish Parliament’s Public Petitions Committee to hear from and support women who have suffered from the horrific adverse effects of mesh implants. Women spoke from wheelchairs or on crutches and were in constant pain. They could not possibly have been told about the risks of TVM implants because there are simply no accurate data available. Will the Minister or the Secretary of State meet me and mesh campaigners from across the country, so that they can fully understand the urgency of the situation and the kind of action that is required to end this scandal once and for all?

Dr Poulter: I would be very happy to meet the hon. Gentleman. It is important to note that work is under way to collect better data on urogynaecological procedures generally and on mesh implants, because the complications that occur post-surgery are often multifactorial. An NHS England-funded audit on urogynaecological procedures for stress urinary incontinence is currently taking place, which covers all procedures, not just mesh implants. I am sure that we can discuss that and what the working group will do to review the procedures when we meet.

Care Costs

3. Andrew Bridgen (North West Leicestershire) (Con): What progress his Department has made in introducing a cap on care costs. [904105]

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The Minister of State, Department of Health (Norman Lamb): Everyone will be protected against catastrophic costs by the insurance the cap provides from April 2016, in line with the Dilnot commission’s recommendations. We are working through the detail of how it will operate in partnership with stakeholders. We will publish draft regulations and guidance for consultation towards the end of the year.

Andrew Bridgen: I thank the Minister for that statement. I have constituents who are very concerned about how they will continue to fund ongoing care costs in the interim period, when the proceeds of an asset or house sale have dissipated. What reassurance can my hon. Friend give my constituents?

Norman Lamb: I thank my hon. Friend for that question. Another reform that we are introducing is universal access to a deferred payment agreement for everyone who would otherwise be forced to sell their home to pay for care—something of which we should be very proud. That will be introduced in April 2015 and it will mean that no one has to sell their home during their lifetime to pay for their care.

Meg Munn (Sheffield, Heeley) (Lab/Co-op): For the avoidance of doubt, will the Minister list the care costs that will not be included?

Norman Lamb: The amount that will count towards the clock running to reach the cap will be based on what the local authority determines will be the cost of meeting a person’s eligible care needs. That is exactly the model that Andrew Dilnot recommended, and we are implementing it as he recommended.

Keith Vaz (Leicester East) (Lab): Last Thursday, the first ever care home diabetes audit was published. It showed a significant lack of support for the 37,000 people with diabetes who live in care homes. Will the Minister confirm that when a person in a care home has diabetes, there will be no lack of funding to help them?

Norman Lamb: I pay tribute to the right hon. Gentleman for his tireless campaigning on diabetes. He has played an essential role in ensuring that it is brought to public attention. It is critical that people who require care for diabetes get access to the care they need, whether they are living in a care home or in their own home.

One-year Cancer Survival Rates

4. Mr John Baron (Basildon and Billericay) (Con): What assessment he has made of the role of the comprehensive delivery dashboard in holding clinical commissioning groups accountable for their one-year cancer survival rates. [904106]

The Parliamentary Under-Secretary of State for Health (Jane Ellison): NHS England uses a range of data, as my hon. Friend will know, including data from the delivery dashboard, to assess the performance of CCGs. That includes the data from the composite cancer one-year survival indicators. NHS England will take action— it has quarterly assurance meetings between area teams and CCGs—if there are concerns about CCGs’ performance.

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Mr Baron: May I suggest to the Minister that if the Government are to meet their target of saving an additional 5,000 lives a year and to promote diagnosis, we need to hold underperforming CCGs to account. Why is it, then, that the one-year survival rates, which are designed to promote earlier diagnosis, are not in the delivery dashboard, which, unlike the outcomes indicator set, has teeth, particularly given that CCG chief executives have said that they see no reason why the one-year figures could not be included in the dashboard?

Jane Ellison: We will certainly look at that, but I emphasise that all those things are important as part of the conversation between area teams and CCGs. I remind the House that the CCG outcome indicators set for 2014-15 include a range of important indicators for cancer, including one-year survival for all cancers, one-year survival for breast, lung and colorectal cancers combined, cancers diagnosed via emergency routes, and cancers diagnosed at an early stage—something I know my hon. Friend has, quite rightly, championed consistently in this House.

Jim Shannon (Strangford) (DUP): Does the Minister agree that the inclusion of more innovative drugs in the NHS medicine cabinet is essential for improvements in one-year cancer survival rates? Does she also agree that information shared between the devolved Assemblies, such as the Northern Ireland Assembly, is a vital part of that process of improvement?

Jane Ellison: We want people in England to have the best cancer outcomes, and to bring those outcomes up to the best in Europe. We know we are not there yet, but we have done a range of things to try to make that happen, including putting a lot of money into early diagnostics. In my area of public health there are award-winning public campaigns such as Be Clear on Cancer, and I know that the cancer drugs fund has been appreciated by many people. I hear what the hon. Gentleman says about the Northern Ireland example.

Dr Sarah Wollaston (Totnes) (Con): High-quality data will play an essential role in improving cancer outcomes. Will the Minister confirm that NHS England has addressed the concerns raised about the care.data programme, and that we are on track for a successful roll-out?

Jane Ellison: I confirm that we are.

Mr Jamie Reed (Copeland) (Lab): Last month, for the first time ever the NHS missed a target for beginning cancer treatment within 62 days of patients being urgently referred. Cancer Research UK stated:

“This isn’t just a missed target—some patients are being failed,”.

We know that the key to ensuring that more people survive cancer is to start treatment as soon as possible after diagnosis. Is it not shocking that cancer charities, including Macmillan Cancer Support and Cancer Research UK, now say that cancer is being overlooked in this Prime Minister’s national health service?

Jane Ellison: We all appreciate the wonderful work done by cancer charities such as Macmillan Cancer Support and Cancer Research UK, and the Department

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works closely with those charities. We want outcomes for cancer patients in England to be among the best in Europe. As I said, we know we are not there yet, but a great deal of effort and money is going into getting there. The NHS is treating more cancer patients than ever. Since 2009, we have seen numbers rise by 15%—that is 1,000 more patients with suspected cancer referred to a specialist every day. That is the success of some of the early diagnosis and awareness raising activity. Of course we want any local dips in performance to be addressed, but let us give credit where it is due to clinicians who are diagnosing more cancers and catching them earlier, because that is the key to treating cancer successfully.

Accident and Emergency Units

5. Ms Margaret Ritchie (South Down) (SDLP): If he will meet the chair of the College of Emergency Medicine to discuss A and E units. [904107]

The Secretary of State for Health (Mr Jeremy Hunt): I met the chair of the College of Emergency Medicine four times in the last six months and I will meet him again next week.

Ms Ritchie: I thank the Secretary of State for his answer. Will he tell the House what progress has been made by Health Education England, along with the College of Emergency Medicine, to recruit trainee doctors from India in an attempt to address the serious staffing shortages in emergency medicines departments? Will he work with Ministers from other devolved regions to address the serious shortage in A and E doctors, which is having an impact on waiting lists in hospitals the length and breadth of the UK?

Mr Hunt: The hon. Lady is right that operational pressures on A and E are happening throughout the United Kingdom. We have made good progress in recruiting 50 A and E doctors to help relieve pressure this year in A and E departments, but that is a short-term measure. The long-term issue is to get more doctors going into A and E from training, and we are looking at contract structures and at what we can do with training schedules to make that more attractive. We will certainly work with colleagues in devolved Administrations and tell them what we have learned.

Chloe Smith (Norwich North) (Con): I welcome the fact that waiting times have halved under this Government, but the Norwich walk-in centre should stay in its city centre location to continue to move people away from A and E when they do not need to go there. Will the Secretary of State meet me to discuss urgent and primary care provision in Norwich?

Mr Hunt: I would be delighted to meet my hon. Friend, and she is right to say that the long-term solution to pressures in A and E is to find alternatives in out-of-hospital care that are easy for people to find. That means improving GP access and any other alternatives, and I am sure we can find a good solution in Norwich.

Mrs Linda Riordan (Halifax) (Lab/Co-op): There is not one person in my constituency who does not want to see the accident and emergency unit stay open. If this

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is made clear in any consultation, will the Secretary of State commit today to scrapping the callous closure proposals?

Mr Hunt: As the hon. Lady knows, local service changes are the responsibility of the local NHS, but when they get referred to me, through local authorities, I will never take a decision that is against the interests of patients, including her constituents. Were such a proposal to come to me, I would indeed listen to any representations that she makes.

David Tredinnick (Bosworth) (Con): Does my right hon. Friend agree that a critical problem that A and E units will face in the future is antibiotic resistance? Is he aware that the Science and Technology Committee, of which I am a member, has been looking at this issue, and it also interests the Health Committee, of which I am also a member? Can he assure me that he is talking to the Prime Minister about how to stimulate new antibiotic research, and will he also remember that nature has its own remedies, such as tea tree oil?

Mr Hunt: My hon. Friend is right about the seriousness of the issue of antimicrobial resistance. Some 25,000 people die in Europe every year as a result of the failure of antibiotics—more than die in road traffic accidents. I raised the issue at the World Health Assembly and I have discussed it closely with the Prime Minister.

John Woodcock (Barrow and Furness) (Lab/Co-op): The Health Secretary will be aware that the chair of Morecambe Bay trust has stood down today, ahead of what is expected to be another critical report from the Care Quality Commission about services. What guarantees can the Health Secretary give the worried people who are served by the Furness general hospital that its A and E department will be protected and the vital national industries that depend on its services will continue to be able to rely on them?

Mr Hunt: First, I thank the hon. Gentleman for the work that he does locally, in particular with people such as James Titcombe, who has campaigned extensively to improve the quality of care at Morecambe Bay. I assure the hon. Gentleman that whatever the problems are at Morecambe Bay, we will be transparent and open, and we will make sure that we deal with them promptly. That is why we have had these independent inquiries. We will look closely at what the report says and make sure that we act quickly.

Liz Kendall (Leicester West) (Lab): The College of Emergency Medicine says that the use of agency doctors has become endemic in the NHS, and that hospitals are increasingly relying on more expensive agency nurses, just as Labour warned when jobs and training places were cut. It is clear that NHS finances are going backwards under this Government. Will the Minister now confirm Monitor’s latest figures, which show that annual spending on agency staff in foundation trusts has soared to £1.4 billion, a staggering 150% higher than trusts planned at the beginning of the year, and will he explain how that makes any financial sense?

Mr Hunt: Let us look at why the number of agency nurses has increased. It is because trusts have responded to the Francis report, published just over a year ago, and are seeking to end the shocking under-staffing of

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wards that was endemic under the last Labour Government. Of course we want people to recruit full-time nurses on proper contracts, and that is happening. That is why we have 3,000 more nurses—not agency nurses, but proper full-time nurses on proper NHS contracts—than when the hon. Lady’s Government were in power, and we will continue to make progress.

Kettering General Hospital (A and E Department)

6. Mr Philip Hollobone (Kettering) (Con): What recent assessment he has made of the performance of the A and E department at Kettering general hospital. [904108]

The Parliamentary Under-Secretary of State for Health (Jane Ellison): We are aware that the trust did not meet the four-hour standard for a period, and obviously Monitor took action and worked with the trust. In the week ending 1 June 2014—the most recent period for which data are available—99.7% of patients who attended Kettering A and E were treated, admitted or discharged within four hours, continuing a recent improvement in performance. I am sure that the staff are justly proud of that, and I know their local Member of Parliament will want to champion it.

Mr Hollobone: In April 2013, Kettering general hospital was one of the worst performing acute hospitals in England on the A and E target, admitting only 74% of patients within the four-hour A and E target time. Now, as the Minister has said, it is almost 100% and the hospital is one of the best performing trusts in the country. Will the Minister congratulate all involved at the hospital on that rapid turnaround, and tell the House how the lessons learned at Kettering might be applied elsewhere?

Jane Ellison: I absolutely join my hon. Friend in congratulating everyone involved in turning that performance around—it is really, really impressive. He is right to say there are lessons to be learnt everywhere from people innovating, joining up services and the various things that have gone on in the background. I know that the local Members have been involved and engaged in the process and I congratulate them on that. That is really valuable and I urge everyone to get involved. We should congratulate A and E staff everywhere on dealing with the pressures they are under. We know they are considerable, but they do a great job.

Mr Peter Bone (Wellingborough) (Con): May I congratulate my hon. Friend the Member for Kettering (Mr Hollobone) on the work he has done to help with this amazing turnaround? The Minister is aware of the plans to have a community urgent care centre at Isebrook hospital in my constituency, which will mean that my constituents will not have to go to Kettering hospital. Is this not another way forward to improve A and E results?

Jane Ellison: My hon. Friend highlights that there are a lot of different approaches to reducing the pressures on A and E. The great thing is that we are seeing real innovation from local clinicians, supported by local Members of Parliament. That shows what can be done when we address these problems with an innovative

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approach, and think about how we can reduce these pressures and ensure that as many people as possible are served in the right way and treated outside A and E, if that is not the place they should be.

Cancer Drugs Fund

7. Grahame M. Morris (Easington) (Lab): What discussions he has had with NHS England on the future of the cancer drugs fund. [904109]

The Minister of State, Department of Health (Norman Lamb): We have committed to continuing the cancer drugs fund until the end of March 2016. We will consider carefully with NHS England how, in the longer term, we can support patients in accessing cancer drugs that could benefit them, at a cost that represents value to the NHS.

Grahame M. Morris: I thank the Minister for that answer, but is it not true that last year the cancer drugs fund was again underspent—funds that could be used to pay for advanced radio therapy? Every MP has received a letter from the England rugby legend Lawrence Dallaglio asking for a meeting to highlight this problem. Why is the Secretary of State refusing to meet Mr Dallaglio, along with top cancer clinicians in Cancer Research UK?

Norman Lamb: First, if only it was underspent. More than 50,000 patients have now benefited from the fund, which is fully spent. More than £1 billion will have been committed in the full period of the fund. I have confirmation from the Secretary of State that he has already met Lawrence Dallaglio. I hope that will reassure the hon. Gentleman.

Dental Care

8. Jason McCartney (Colne Valley) (Con): What steps his Department is taking to improve access to and standards of dental care. [904110]

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): Between May 2010 and December 2013, 1.5 million more patients were able to see an NHS dentist. We are committed to reforming the current contractual arrangements to promote improvement in oral health and to increase access to dentistry services.

Jason McCartney: What specific advice would the Minister give to my constituents who are trying really hard to access good quality, local dental care on the NHS?

Dr Poulter: A recent HealthWatch report highlighted this issue in west Yorkshire, where access to dental services has been a long-standing challenge. NHS England is looking at the financial arrangements in west Yorkshire and will report back soon. I am happy to meet my hon. Friend and representatives from the local NHS to take this issue further forward and ensure that local patients get the service they deserve.

NHS Whistleblowers

9. Michael Fabricant (Lichfield) (Con): What steps he is taking to ensure that whistleblowers in the NHS are protected from (a) dismissal and (b) other punitive measures by their employers. [904111]

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The Secretary of State for Health (Mr Jeremy Hunt) rose—

Mr Speaker: Go ahead.

Mr Hunt: Thank you, Mr Speaker. I like to wait until you give me the word.

Mr Speaker: If the Secretary of State needs encouragement I am happy to give it to him.

Mr Hunt: I am most grateful for any encouragement I can get.

The NHS needs to change its culture to be much more open to whistleblowers. That is why we have banned gagging orders in contracts and funded a whistleblowing helpline and website, and why we are working with brave whistleblowers, such as Helene Donnelly from Mid Staffs, to reform the training of NHS clinicians to make it easier.

Michael Fabricant: I am grateful for that answer. About 10 years ago, two people, a nurse and a consultant surgeon from the same hospital, came to my surgery and showed me evidence of filth—mouse droppings—in even consulting rooms and the operating theatre. They were frightened to leave the documentation with me, because they thought they would be sacked if it was found that they were the whistleblowers. Will they now have the assurance that they could give me or others evidence without fear of retribution?

Mr Hunt: I hope so, but I want to be honest with the House. It takes time to change a culture, and that is the big change we have to make. Whistleblowers are now coming forward from Coventry, Cambridge, Ealing and all over the country. That is why I am afraid that I profoundly disagree with the shadow Health Secretary, who said that the lessons of the Francis report were about a local failure. This is about a systemic problem and we have to change it across the NHS.

Charlotte Leslie (Bristol North West) (Con): Given there are so many emerging cases of whistleblowers—both current and historic—being treated with injustice, a precedent will not be set for accountability until these injustices are actually faced. Will the Secretary of State set up a truth and reconciliation committee to look at historic and current cases so that accountability becomes a reality?

Mr Hunt: First, I commend my hon. Friend for her campaigning on this issue in the House and on the Health Committee. We have not done everything we need to do to change the culture within the NHS, and we are looking at what more needs to be done to get a culture change profound enough to make it easier for people to speak out. This is not just about whistleblowing. If it is whistleblowing, we have failed because it means that someone has had to go to the press or outside their organisation when they were worried. We need an NHS where people within their own organisation are listened to when they have concerns, and we are looking at what we need to do to take that forward.

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Alcohol Consumption in Pregnancy

10. Kelvin Hopkins (Luton North) (Lab): What statistics his Department keeps on babies damaged by alcohol consumed in pregnancy; and if he will make a statement. [904112]

The Parliamentary Under-Secretary of State for Health (Jane Ellison): Hospital episode statistics include finished admission episodes where there was either a primary or secondary diagnosis of a foetus or newborn affected by maternal use of alcohol or foetal alcohol syndrome. I have supplied some detail on that in parliamentary answers this week. These records cover both patients treated in NHS hospitals in England and by independent providers whose services are commissioned by the NHS.

Kelvin Hopkins: The Minister has confirmed that thousands of babies are born every year damaged by alcohol, and yet there is still no statutory requirement for all alcoholic drinks containers to display specific health warnings about the dangers of drinking in pregnancy. When will the Government introduce the necessary legislation?

Jane Ellison: Before I respond to the substantive point, it is worth saying that there is a spectrum of disorders and some of the diagnoses on certain parts of the spectrum are quite difficult. We have statistics on foetal alcohol syndrome and there is no evidence that that is increasing, although we seem to be diagnosing more in younger children. Also, the women to whom this tends to happen are extremely difficult to reach through public education campaigns as many are subject to additional, complex factors.

On bottling, through the responsibility deal, there was a commitment to get 80% of alcoholic drinks on the market labelled. That is being independently audited and is something we champion, not just with messages about drinking in pregnancy, but through guidance from the chief medical officer on drinking generally.

Henry Smith (Crawley) (Con): Prevention is of course better than cure. What is my hon. Friend’s Department doing on better guidance and support for midwives and other groups such as the National Childbirth Trust to discourage expectant mothers from drinking alcohol?

Jane Ellison: One of the slight challenges in this area is that quite a lot of pregnancies are unplanned and people have sometimes been drinking alcohol before they know they are pregnant. However, a lot of advice is available. Along with health visitors and midwives—we are putting more resource into those areas—Public Health England’s “start for life” campaign provides advice to pregnant women. There are National Institute for Health and Care Excellence guidelines, including for those women to whom I referred earlier with complex social factors. A lot of information is available, and the chief medical officers are reviewing the guidance to people generally. The simple message to women who are hoping to conceive or who are pregnant is that it is best to avoid alcohol.

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Minimum Practice Income Guarantee

11. Paul Blomfield (Sheffield Central) (Lab): What assessment he has made of the potential effect on health outcomes of phasing out minimum practice income guarantee funding from GP practices in England. [904114]

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): The minimum practice income guarantee payment is unfair because practices serving very similar populations are paid very different amounts per patient. The payments are being phased out over a seven-year period to allow practices time to adjust. The money released by doing this will be reinvested in the basic payments made to all general medical services practices, which are based on numbers of patients and key determinants of practice workload, such as the age and health needs of patients.

Paul Blomfield: The minimum practice income guarantee was introduced to meet the specific needs of specific practices. Those needs have not changed. NHS England has drawn up a list of 100 practices across the country that will be threatened by its withdrawal. Five are in Sheffield and two are in my constituency. Will the Minister give a guarantee that no practice will close as a result of the withdrawal of the minimum practice income guarantee, and will he provide the funding to achieve that?

Dr Poulter: The point is this: the funding system set up by the previous Government was based on historical funding and did not necessarily recognise the needs of patients. One practice might have been paid more for historical reasons than another practice next door that might have been treating more patients. That was unfair; we have changed it. NHS England is working at local level with practices that are, for whatever reason, in financial difficulties to make sure that it can help them get to the right place.

George Freeman (Mid Norfolk) (Con): The GP practice in Watton in my constituency is struggling with the recruitment of GPs and is now two short, which is putting pressure on services. Today I heard of the proposal from NHS England to deregister 1,500 patients and transfer them to neighbouring practices in the constituency, raising a whole series of issues. Will the Minister agree to meet me to talk about what should happen, including whether NHS England could fund some sort of locum service?

Dr Poulter: Yes, I would be delighted to meet my hon. Friend. It is important to see, where possible, collaboration between GP practices on back-office services and other savings that could be made—something the public sector needs to do more generally so that more money can be invested in patients. The Government are training more GPs; in future, we will see 50% of postgraduate medical training taking place in general practice, leading to a big increase in the number of GPs.

Mr Andy Slaughter (Hammersmith) (Lab): Will the Minister look at the decision by clinical commissioning groups in north-west London to move funding away—contrary to what NHS England has proposed—from

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GP practices and primary care in deprived areas such as Hammersmith to areas that have much better health outcomes?

Dr Poulter: I do not believe that that is the case. In looking at the changes, we need to factor in the point that the minimum practice income guarantee, which was a historical payment and not based on patient need or patient demand, is being phased out in order to achieve a more equitable solution. As a result, we can see that the global sum payments to GPs have risen from £66.25 per patient in 2013-14 to £73.56 per patient in 2014-15. Clearly, the global sum payment to GPs per patient has increased, which is a good thing for patients and the equitability of services.

Miss Anne McIntosh (Thirsk and Malton) (Con): Historically, there used to be a payment for the distance GPs or their patients travelled. The removal of minimum practice income guarantee funding may make certain rural practices unviable. Will the Government address that issue, and will the Minister look particularly at rurality and sparsity in order to address what is a very real issue for rural GPs?

Dr Poulter: My hon. Friend makes a very good point, and we know that rural practices have unique challenges. The point is that because the money from the minimum practice income guarantee is going to be reinvested in a global sum payment, and because the global sum payment per practice is increasing, one of the key determinants of that payment is, in fact, rurality, so that should be of benefit to many rural practices.

Andrew Gwynne (Denton and Reddish) (Lab): The situation is far more urgent than the Minister’s complacent answer suggests. One practice in a deprived part of London has said that it is weeks away from laying off staff and just months away from closure. The Royal College of General Practitioners says that 1,700 practices could be affected, with over 12 million patients potentially facing even longer waits for appointments. Is it not the case that until we have a Labour Government, GP services are going to be marginalised and patients are going to face ever-longer waits?

Dr Poulter: I am afraid that the distance between the real world out there for patients and the Labour Government’s record is very clear. Under the Labour Government’s record on general practice, 20% of patients were routinely unable to get a GP appointment within 48 hours, and a quarter of patients who wanted to book an appointment more than 48 hours in advance could not get one. That was what happened under Labour; that is Labour’s commitment to general practice and GP patients. Under this Government, we are making sure that there is equality of finance per patient according to patient need, and that is how health care decisions should be made.

Mr Speaker: Order. I encourage the Minister to learn to provide more succinct answers. They are always too long.

Congenital Heart Disease

12. Stuart Andrew (Pudsey) (Con): What the planned timetable is for his Department’s congenital heart disease review. [904115]

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The Parliamentary Under-Secretary of State for Health (Jane Ellison): The review is being undertaken by NHS England, which has been engaging with a wide range of stakeholders, of whom my hon. Friend is one. He is a doughty champion for his city, and for these services. I understand that NHS England will consult on draft service standards later this year, but will not do so in July as was previously expected. All information relating to the review can be found on the organisation’s website, which is updated fortnightly. I spoke to officials yesterday in order to update myself, and I know they will post another update very soon, if not today.

Stuart Andrew: According to the mortality case section of the Secretary of State’s review of the closure of services at Leeds, many of the recommendations could apply more widely to other units throughout the NHS. Given that no other unit has received anything like as much scrutiny as Leeds, will my hon. Friend ensure that any continuing audits take place in the other units as well, so that standards can be maximised?

Jane Ellison: That is a very good point. This Government and this Secretary of State have championed transparency more generally, because we all believe that it is essential to our ability to build on the success of the health service and maximise its service to patients.

Mr Nicholas Brown (Newcastle upon Tyne East) (Lab): Am I right in understanding that the Minister has just announced a further delay? The key recommendation to the Government on children’s heart surgery, which was made in 2001, was that fewer units should be centres of excellence, because that was in the best interests of patients. Now, 13 years later, none of that has actually happened. Do the Government still accept the premise that fewer units should be centres of excellence, and will the Minister tell us what accounts for the delay?

Jane Ellison: I understand the right hon. Gentleman’s frustration, but the review is very important. NHS England has confirmed that it will not be able to consult quite as early as it had wished, but it should be appreciated that this review is more comprehensive than the last one. For example, NHS England has developed a comprehensive set of commissioning standards which have never existed before. For the first time, the whole patient pathway will be covered, from foetal detection through childhood, into adult services and all the way to palliative care—on which one of my hon. Friends led a debate relatively recently—and bereavement.

It is always frustrating when things do not happen according to schedule, but what really matters is getting this right and being as transparent as possible. The level of engagement with stakeholders has been much more satisfactory than before, and we continue to make progress.

Community Hospitals

13. Sir Alan Beith (Berwick-upon-Tweed) (LD): If he will bring forward proposals to widen the range of services and treatments available in community hospitals in rural areas. [904116]

The Minister of State, Department of Health (Norman Lamb): Responsibility for the commissioning of local NHS services lies with clinical commissioning groups.

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Community hospitals have an important role in achieving more integrated care across health and social care services in rural areas by providing better out-of-hospital care, particularly for frail older people and those with long-term conditions.

Sir Alan Beith: A new community hospital is to be built in Berwick, which is 50 miles from major hospitals. Will it be free to offer a wider range of services, along the lines envisaged by the NHS chief executive in his recent comments?

Norman Lamb: I know that my right hon. Friend has been campaigning for that hospital. I welcomed the comments of the chief executive of NHS England, who has argued for a much more flexible and adaptable NHS, and for ensuring that GPs locally, working with community services, can offer the maximum range of health services to the local community as close to them as possible.

Sir Edward Garnier (Harborough) (Con): Two and a half years ago, my right hon. Friend the Member for Chelmsford (Mr Burns), then Minister of State, opened the St Luke’s hospital day care unit in Market Harborough, which serves a large rural area in my constituency. During those two and a half years it has been open for only 131 days, which is a huge waste of public money. I wrote to the Secretary of State yesterday. He will not have had a chance to read my letter yet, but will my hon. Friend and his colleagues look into the matter, and ensure that we do not waste public money on opening hospitals that do not provide a service?

Norman Lamb: My hon. and learned Friend has raised an extremely important point. It is essential that the maximum possible use be made of investment. I know that the Secretary of State will look into this issue when he has received the letter, but we must ensure that all such facilities are properly used.

Health Services (East Midlands)

14. Sir Edward Leigh (Gainsborough) (Con): What steps he plans to take to improve the provision of health services in the east midlands. [904117]

The Minister of State, Department of Health (Norman Lamb): Decisions about local services should be made as close to patients as possible, by those who are best placed to work with patients and the public to understand their needs. Clinical commissioning groups commission the majority of health services, working with health and care professionals to design services for local populations.

Sir Edward Leigh: In large rural areas like Lincolnshire, the air ambulance can make the difference between life and death, particularly for car crashes where roads are blocked. What plans does the Minister have to strengthen the services of the East Midlands air ambulance service?

Norman Lamb: I will be very happy to discuss the issue with my hon. Friend, if he would like to do so. I pay tribute to the extraordinary work the air ambulance services undertake across our country. I have witnessed

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that in my own community and I would be very happy to talk further about what more can be done to strengthen the work they do.

Child and Adolescent Mental Health Services

15. Heidi Alexander (Lewisham East) (Lab): What recent assessment he has made of the adequacy of child and adolescent mental health services. [904118]

The Minister of State, Department of Health (Norman Lamb): We know that there is a varied picture of services across the country, where decisions on spend and allocation of resources are made by local commissioners. NHS England is preparing to publish a report based on its recent analysis of tier 4 child and adolescent mental health services, along with a service improvement plan. We expect these to be published in the coming weeks.

Heidi Alexander: A recent survey conducted by the Royal College of Psychiatrists found that over a quarter of trainee psychiatrists have had to send a child or young person more than 200 miles away from their family in order to access an appropriate bed. What is the Minister going to do about this totally unacceptable situation?

Norman Lamb: I agree, and that is why NHS England undertook the work to analyse exactly what the position is across the country. In fact it is very varied. There are some regions where it is fine, and others where it is not acceptable. I think we would all agree that it is completely unacceptable for children to be sent sometimes hundreds of miles away from home. When it publishes its report, it—[Interruption.] If the right hon. Member for Leigh (Andy Burnham) would just listen, when it publishes its report, it will be publishing an action plan of the steps it will take very soon to meet any shortfalls in provision.

Dr Phillip Lee (Bracknell) (Con): Although I supported the Health and Social Care Bill at every stage, I have always harboured some concerns about the ability of GPs to commission mental health services. Mental health is a fast-growing problem and a challenge to the NHS for the future. What assurances can the Minister give me that GPs will receive the appropriate specialist guidance, if required?

Norman Lamb: I thank my hon. Friend for that question, and it is a legitimate one. A lot of work is being undertaken by NHS England and the national clinical director Geraldine Strathdee, a highly regarded individual, to strengthen the quality of commissioning of mental health services. It falls short in many areas at the moment and it is essential that it is improved.

Luciana Berger (Liverpool, Wavertree) (Lab/Co-op): Ministers say that they are committed to parity of esteem between mental and physical health, yet we have already learned from an NHS England report that three quarters of children with anxiety or a diagnosable depression are not receiving the treatment they need. This is plainly unacceptable. It would not happen to children presenting with a broken arm or asthma, so can the Minister please tell the House when he will translate his rhetoric into reality?

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Norman Lamb: Absolutely, and we are doing it. One of the problems we are having to confront is that when the Labour Government introduced the 18-week waiting standard, unbelievably they left out mental health. When mental health is left out from a standard of that sort, that determines where the money goes, and ever since then mental health has lost out. We are committed to changing that.

Topical Questions

T1. [904093] Mr John Baron (Basildon and Billericay) (Con): If he will make a statement on his departmental responsibilities.

The Secretary of State for Health (Mr Jeremy Hunt): Almost a year ago, following the Keogh report, we put 11 NHS trusts into special measures, the first time such a large number of trusts have been put into special measures. Yesterday I was pleased to report to the House that the first trust, Basildon, has come out of special measures. I am pleased to tell the House today that across all the trusts in special measures, an additional 1,202 nurses and an additional 118 doctors have been recruited. The programme is making good progress, and the whole House will want to commend the efforts of all the staff in those hospitals on the tremendous efforts they are making.

Mr Baron: I join the Secretary of State in commending the management and all the staff of Basildon hospital for their excellent work and a great team effort. The hospital is now no doubt on an upward trajectory. I should like to raise with him the matter of the human papilloma virus vaccination programme for young women. It has been a success, and there is mounting evidence that is should be extended to young men. Will the Government now look into the feasibility of doing that?

Mr Hunt: My hon. Friend is right, and I am grateful to him for mentioning how proud we are of the HPV vaccination programme for girls and women. It is one of the best in the world, and we are getting an 86% take-up rate among eligible 12 to 13-year-old girls. He is also right to say that we now need to look at whether the programme should be extended to men and boys. A decision was taken at the time that it did not need to be, but we are now reviewing that decision. We will shortly be getting advice from the Joint Committee on Vaccination and Immunisation—which, as he will know, gives us independent advice on these matters—and we will take its advice seriously.

Andy Burnham (Leigh) (Lab): I am sure that, like me, the Secretary of State will have been shocked to the core by the serious case review into the Orchid View care home. It spoke of institutionalised abuse and of residents dying of sheer neglect. This is just the latest case of appalling abuse in care homes, following that of Winterbourne View and the recent “Panorama” programme on Oban House. People are asking how many more times we must see abuse of this kind in our care homes before we take decisive action to stop it. Will the Secretary of State give serious consideration to the central finding of yesterday’s review, which was that the same principles of patient safety that apply in the NHS should now be applied to the care home sector?

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Mr Hunt: I thank the right hon. Gentleman for that question. He is absolutely right to suggest that the lessons of Francis need to be applied to the care home sector, to general practice and to all out-of-hospital care every bit as much as they are applied to NHS hospitals. That is why we have legislated in the Care Act 2014 not only for a chief inspector of general practice but for a chief inspector of adult social care, Andrea Sutcliffe, who has made an excellent start. She is going around all the care homes, and she is bringing back the rigorous Ofsted-style analysis that was unfortunately taken away by the last Government. That will mean that we have proper transparency in standards. Going back to an earlier question from my hon. Friend the Member for Lichfield (Michael Fabricant), we also need to do more to help whistleblowers working in care homes. Because there are so many care homes, we cannot depend solely on the inspectors to get this right. We have also introduced the ability to prosecute offenders, which did not exist before.

T3. [904095] Mr Nigel Evans (Ribble Valley) (Con): The fears of the people of the Ribble valley that the old Clitheroe hospital would be closed and not replaced were allayed when the new hospital was built. It recently opened with 32 in-patient beds, radiology, diagnostics and other facilities. Will the Secretary of State come to Clitheroe to have a look at this brand-spanking-new hospital, which is being welcomed by the local community, and to say thank you to the staff there for all they do? If he does so, I promise to take him for a pint of healthy real ale afterwards in the Campaign for Real Ale pub of the year in Pendleton in the Ribble valley, to celebrate the opening of the new hospital.

Mr Speaker: What a generous fellow the hon. Gentleman is!

Mr Hunt: Well, I must say that that sounds like a pretty irresistible offer, and I will give it careful consideration. Local community hospitals have an important role to play in our NHS because of the high standard of compassionate care that they deliver, and because they are easy for relatives to get to. I am delighted to see my hon. Friend campaigning for his local hospital, and delighted that it is doing so well.

T2. [904094] Steve McCabe (Birmingham, Selly Oak) (Lab): A Birmingham trust has recently announced that it will be possible to cut 1,000 beds across the city by setting a maximum stay of seven days for most patients. Not surprisingly, this has caused some alarm. Are Ministers aware of that proposal? What guidance, if any, can they offer in regard to such proposals?

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): As the hon. Gentleman will be aware, patients need to be treated according to clinical need, and bed stays should not be determined by anything other than that. So if what he describes is actually the case, it would be very disturbing. If he would like to raise the issue further with me, I would be happy to look into it for him.

T5. [904097] Jesse Norman (Hereford and South Herefordshire) (Con): Like other rural communities, Herefordshire has long suffered from chronic underfunding in health care. Does the Secretary of

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State share my view that setting clinical commissioning group allocations should be an evidence-based process that takes into account factors including sparsity and old age? Also, will he ignore the calls from the shadow Health Secretary, who was seeking to cut the previous NHS allocations in areas such as Herefordshire?

Mr Jeremy Hunt: I agree with my hon. Friend that it has to be done on the basis of evidence. Part of that is an important change that the Government have made, which the Labour party criticised a great deal. We have depoliticised the process by giving it to NHS England, where it is decided at arm’s length from Ministers on the basis of need. It is challenging to do it fairly. There are some historical imbalances, and we have to do what we can to address them, but we have to do it in a way that is fair and is not tarnished by party politics.

T4. [904096] Alex Cunningham (Stockton North) (Lab): Health inequality on Teesside is a major issue, but the Government axed plans for our new hospital four years ago. I am told that Ministers now accept that a new hospital to replace the two hospitals at North Tees and Hartlepool is the right way forward. When will they remove the barriers to the project and give the support that is needed?

The Parliamentary Under-Secretary of State for Health (Jane Ellison): That is certainly something that we will look into.

T6. [904098] Sir Alan Beith (Berwick-upon-Tweed) (LD): The new specialist emergency hospital is nearly 60 miles from Berwick. Given the serious delays in ambulance attendance in recent cases in Northumbria, how can we be sure that serious cases will get paramedic attendance and delivery to the hospital within the critical hour?

The Minister of State, Department of Health (Norman Lamb): My right hon. Friend is right to raise concern. The North East ambulance service has traditionally been a good performer, but any deterioration that has been identified needs to be addressed very speedily. I urge him to monitor this closely, and if he wants to talk about it further with me, I will be happy to do so.

T10. [904102] Mr Andy Slaughter (Hammersmith) (Lab): Last October the Secretary of State said that Hammersmith accident and emergency would be closed when it was safe to do so. Imperial proposes to close it on 10 September, when on its own admission there is insufficient capacity at St Mary’s and it is not safe to do so. Will he keep his promise and ensure that Hammersmith A and E does not close, especially when there is not sufficient capacity in the system?

Mr Jeremy Hunt: I keep my promises, but may I point out to the hon. Gentleman that the way in which he has campaigned on those issues has been totally irresponsible? He put out leaflets in the local election campaign saying that Charing Cross hospital would be demolished. He failed to mention that it was going to be rebuilt as a brand-new hospital with an A and E department. I hope that he will not be invited to it when it is reopened unless he apologises to his constituents for the way he has presented this issue.

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T7. [904099] Andrew Bridgen (North West Leicestershire) (Con): The Government can be rightly proud that there are fewer managers and more doctors in the NHS than in 2010. However, recent research by the TaxPayers Alliance shows that in the Greater East Midlands commissioning support unit more than £1 million a year is being spent on 26 administrative jobs of dubious value such as communications managers, communications officers, three communications and engagement leads, and two equality and diversity managers. The list goes on, Mr Speaker, but I will not. What further steps can my right hon. Friend take to ensure that the NHS budget is spent on front-line medical services?

Dr Poulter: My hon. Friend is right to highlight the fact that as much money as possible always needs to be put into front-line patient care. Under the previous Government, spending on managers and administrators more than doubled from £3 billion to £7 billion, and we have seen the number of administrators fall by 20,000. There is clearly work to do in his area, because as much money needs to go on front-line patient care as possible, and I hope that local commissioners will be looking to share back-office services as much as possible with other commissioning groups to reduce costs and put money into front-line patient care.

Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op): Earlier the Secretary of State and his Minister said that the minimum practice income guarantee was unfair. What is unfair is that so many practices in Hackney and east London are set to close, in an area where there is great deprivation. What are they going to do to make sure that patients still have practices to go to?

Dr Poulter: We have had this discussion. A payments system that is almost 20 years out of date and is not funding patients according to clinical need or is not per head of population will not deliver good care. The payments system needs to be changed and NHS England is working with practices that are facing challenges to address those challenges and ensure that high-quality patient care can still be delivered locally.

T8. [904100] David Rutley (Macclesfield) (Con): Following the recent speech by the new NHS England chief executive Simon Stevens about the important role of local hospitals, can my right hon. Friend confirm that district general hospitals such as Macclesfield will continue to play a vital role in delivering local health services in the years to come?

Mr Jeremy Hunt: I can confirm that. What my hon. Friend said was profoundly important. There is not an automatic link between size and quality. We know that for certain types of treatment, there is huge benefit in centralising services, as has happened for stroke services in London, but other services can be delivered extremely well at smaller units, and we will continue to support those.

Barbara Keeley (Worsley and Eccles South) (Lab): The Minister has just talked rather piously about spending NHS money on front-line services, but the NHS is

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spending £300,000 on a university secondment for a staff member who has left. How does he justify that sort of abuse?

Mr Hunt: I just point out to the hon. Lady that in the Queen’s Speech we made it clear that we are cracking down on inappropriate payments to people who leave the NHS, many of which are the result of contracts set up by her Government.

T9. [904101] Ian Swales (Redcar) (LD): My constituent, Beth Charlton, recently lost her father to pancreatic cancer and notes that patients have only a 3% chance of surviving five years. That is much lower than the survival rates for other cancers and has not improved in 40 years. Will the Minister invest more in early detection and diagnosis of this silent killer?

Dr Poulter: Spending on health care research, including cancer research, has considerably increased under this Government, and much of that funding is allocated independently. It is important to note that pancreatic cancer is, as the hon. Gentleman says, a silent killer, because presentation is often very late in the disease process. Patients can present suddenly with painless jaundice and are often only three months away from death. It is therefore important that we look at the causes of pancreatic cancer and focus on primary prevention and on helping people to develop a healthy attitude to alcohol.

Mr Dennis Skinner (Bolsover) (Lab): In the last hour I have heard the Secretary of State and his Ministers complain about the problems with A and Es; I have heard them talk about the problems with GPs; now we hear that they have lost control of care of the elderly. Instead of continuing to blame the last Labour Government of four years ago, why does the right hon. Gentleman not admit that the NHS is not safe in his hands? Let us have an election and get a Labour Government.

Mr Jeremy Hunt: Because we are making the NHS safe. We are taking action to deal with the issues that the hon. Gentleman’s Government swept under the carpet. The NHS is getting safer and more compassionate. It is delivering more care to more people than ever happened under the Labour Government. We are proud of our record on the NHS, and we will not make the NHS better by pretending that problems do not exist when they do.

Sir Andrew Stunell (Hazel Grove) (LD): Stockport Mind reports that it takes on average 12 months to receive the first appointment for cognitive behavioural therapy after diagnosis. What action can be taken to improve that standard in Greater Manchester?

Norman Lamb: I mentioned earlier that when the last Labour Government introduced the 18-week waiting time standard they left out mental health. That is at the heart of the problem. We are committed to changing that and to introducing access standards in mental health, and we plan to start next year.

Kerry McCarthy (Bristol East) (Lab): The Stitch project in Bristol has contacted me with concerns about the number of overdoses by people on prescription medication

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and suggested that allowing medication to be dispensed in instalments would be a better way of handling those vulnerable patients. I was disappointed in the response that I got from the Department, and I urge the Minister to think again on this issue.

Dr Poulter: I am very happy to meet the hon. Lady to discuss this further and see what we can do because it is important that the vulnerable patient groups she highlighted are looked after in the right way.

Charlotte Leslie (Bristol North West) (Con): As he heralds an era of transparency, can the Secretary of State update us on what steps he has taken to ensure that private providers in the NHS are every bit as transparent and accountable as public ones?

Mr Jeremy Hunt: I think they absolutely should be, and the changes that we introduced in the Care Act 2014 relating to the transparency of the inspection regimes apply to private providers supplying services to the NHS just as they do to NHS providers. Let us be absolutely clear: poor care is poor, whether it happens in the public sector or the private sector, and we must clamp down on it wherever it happens.

Bill Esterson (Sefton Central) (Lab): The Minister said that he was dealing with the chronic shortage of staff who help vulnerable children and young people, who cannot get access to mental health services. Will he tell us when there will be enough staff delivering those services to that important group?

Norman Lamb: I mentioned that NHS England will very soon publish a report following its analysis of existing facilities across the country, so the hon. Gentleman will get the answer in the next few weeks.

Duncan Hames (Chippenham) (LD): When will the public health Minister publish the regulations for the plain packaging of tobacco products, on which she proposes to consult?

Jane Ellison: As my hon. Friend knows, Parliament has already granted us the regulation-making powers in the Children and Families Act 2014 and we have said that we are minded to proceed with those. We are still committed to consult. The regulations are being drafted. I had hoped to publish them before the end of April. We were caught by the pre-election purdah period, but I hope to publish them soon.

Several hon. Members rose—

Mr Speaker: Order. We are very pressed for time, but I want to accommodate a couple of remaining colleagues.

Barry Gardiner (Brent North) (Lab): I am grateful, Mr Speaker. In Brent we have the highest incidence of TB and of type 2 diabetes in the country. We have just received a cut of £450 million in the money allocated to the CCG. The Secretary of State says that this is fair, but my constituents want to know whether it is in accordance with need.

Jane Ellison: The hon. Gentleman is right to draw attention to the problem of TB in London. As a London Member myself, I know what he is talking about. I encourage him to participate in the current consultation

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on Public Health England’s comprehensive TB strategy. It is a very important document which marks a step change in the way we confront the problem. That will help us to allocate resources to need and to address serious problems.

Mr Speaker: Last but not least, I call Sir Kevin Barron.

Kevin Barron (Rother Valley) (Lab): Will the Minister give us an update on the proposed licensing of e-cigarettes

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by the Medicines and Healthcare Products Regulatory Agency? Does her Department believe that e-cigarettes could be used in smoking cessation programmes?

Jane Ellison: When I brought the regulations before Parliament, we were clear that those e-cigarettes for which a medicinal claim is made must be subjected to medicinal licensing arrangements. Once they are licensed as medicine, they can be prescribed as part of NHS smoking cessation services.

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Point of Order

12.36 pm

Mr Gareth Thomas (Harrow West) (Lab/Co-op): On a point of order, Mr Speaker. Many will think it odd that the Prime Minister’s choice for Britain’s next EU Commissioner will be scrutinised by the European Parliament, but that there appear to be no plans to allow the British people, through this House, to examine their suitability. Have you had any indication that Ministers might support such parliamentary scrutiny on this occasion?

Mr Speaker: I am grateful to the hon. Gentleman for his point of order, of which I did not have advance notice. The short answer is that I am not aware of any intention for arrangements to be different on this occasion from those which have applied in the past. However, the point has been aired. It will have been heard at any rate by the Government Chief Whip, who sits impassively and in languid fashion on the Treasury Bench, but I feel sure that it can be the subject of a private conversation between the hon. Gentleman and the Government Chief Whip if both are so minded. The latter part of that sentence is at least as important as the former.

Michael Connarty (Linlithgow and East Falkirk) (Lab): Further to that point of order, Mr Speaker.

Mr Speaker: I do not think there is a “further”, but because I am a generous soul and the hon. Gentleman’s brow is more than usually furrowed, we will give it a go.

Michael Connarty: As I understand it from the last meeting of the European Scrutiny Committee, it is the Committee’s intention to write to the Government on that very point and to suggest that the Committee might be given the facility to do that interview before the appointment is made.

Mr Speaker: That is a helpful observation. Whether it is a point of order I do not know, but it is a helpful observation from somebody who is familiar with the workings of the Committee. I had better leave it there. There has been a kind of conversation through attempted points of order. Where it will end I know not.

bill presented

Modern Slavery Bill

Presentation and First Reading (Standing Order No. 57)

Secretary Theresa May, supported by the Prime Minister, the Deputy Prime Minister, Mr Chancellor of the Exchequer, Secretary Iain Duncan Smith, Secretary Chris Grayling and Karen Bradley, presented a Bill to make provision about slavery, servitude and forced or compulsory labour; to make provision about human trafficking; to make provision for an Anti-slavery Commissioner; and for connected purposes.

Bill read the First time; to be read a Second time tomorrow; and to be printed (Bill 8) with explanatory notes (Bill 8-EN).

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Debate on the Address

[4th Day]

Debate resumed (Order, 9 June).

Question again proposed,

That an Humble Address be presented to Her Majesty, as follows:

Most Gracious Sovereign,

We, Your Majesty’s most dutiful and loyal subjects, the Commons of the United Kingdom of Great Britain and Northern Ireland in Parliament assembled, beg leave to offer our humble thanks to Your Majesty for the Gracious Speech which Your Majesty has addressed to both Houses of Parliament.

Home Affairs

12.39 pm

The Secretary of State for the Home Department (Mrs Theresa May): The Gracious Speech that we heard last week included a comprehensive programme of legislation on home affairs and justice. Since coming to power, this Government have implemented far-reaching reforms of which they can be proud. We have introduced a programme of radical police reform, and crime has continued to fall—it is down more than 10% since the last election. We have reformed the immigration system, and net migration from outside the EU is down by almost a third since its peak under the last Government. We are transforming the criminal justice system, improving support for victims, rehabilitating offenders and making prisons more effective, while reducing the burden on the taxpayer. On counter-terrorism, the police and security agencies continue to rise to tough new challenges, working tirelessly to keep us safe. Our reforms and our legislative changes are working.

Mr Brian H. Donohoe (Central Ayrshire) (Lab): One of the major problems facing my constituents is the time spent trying to get their passports. I have heard the right hon. Lady say that she is reforming the Passport Office, but she has reduced the number of staff to such an extent that those that are left are not able to perform as they should. What is the turnaround period for a passport application now?

Mrs May: The hon. Gentleman’s intervention gives me an opportunity to tell the House that it is not true that the number of staff at the Passport Office has gone down; the number has gone up. In the first few months of this year, we saw a significant increase in the number of applications for passports, both renewals and new passports, and I am pleased to say that even given the unprecedented levels of applications, we are still meeting the service standards of 97% of straightforward applications being returned within three weeks, and 99% being returned within four weeks. We are not complacent. We continue to consider whether further contingency measures need to be put in place, should the significant increase in applications that we saw in the first few months of this year continue. I recognise the importance of this issue for the hon. Gentleman’s constituents and for mine.

Mark Lazarowicz (Edinburgh North and Leith) (Lab/Co-op): Surely the Home Secretary will know from her own constituency experience that there has been a big increase in such problems in the last few weeks. Has she not seen that in her constituency?

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Mrs May: All Members of the House will have had comments and inquiries from constituents on this matter. That is why during the last few months we have been increasing the resource that is available in the Passport Office to deal with applications, and increasing the resource available to deal with queries from Members of Parliament on this issue. As I just said in my response to the hon. Member for Central Ayrshire (Mr Donohoe), we continue to ensure that the resource available will be sufficient to deliver the service that we require, and that the public require when they are renewing or applying for a passport.

Kate Green (Stretford and Urmston) (Lab): I am surprised that the rising number of renewals took the Passport Office by surprise. Surely renewals at least are something that could be reasonably reliably predicted. Will the right hon. Lady assure the House that as we approach the busy summer holiday season, there will be sufficient resources to ensure that applications can be turned round in time for families to go on their annual holidays?

Mrs May: I can absolutely assure the hon. Lady that we are very aware of the major period of summer holidays coming up and the need for us to ensure that the facilities and resources are there in the Passport Office to deal with this matter. I do not know whether it is appropriate to give a plug for a debate that is due to take place in the House, but tonight’s Adjournment debate will be on this matter. My hon. Friend the Minister for Security and Immigration will be responding, and he will be able to go into some of these matters in more detail.

Michael Connarty (Linlithgow and East Falkirk) (Lab): On a very simple point, I have many cases similar to those of my colleagues, but people are being told that the target cannot be met, so if they want a passport they should pay £70 to have it express delivered. Will those people now be given their money back? If the Passport Office has failed to meet the standard set by the Department, those people should not be charged for that service.

Mrs May: I have indicated that even given the unprecedented levels of demand during the first few months of this year, we have been able to meet our service standards. People can pay for the premium service, but there has been good news in relation to passport fees: the Government were able to reduce the regular fee for passports, partly owing to changes in the Passport Office that resulted from our decision to scrap the identity card proposal of the last Government.

Overall, we see that our reforms and legislative changes are working. Now, in the fourth and final Session of this Parliament, we are bringing forward legislation to ensure that more organised criminals can be brought to justice, and to further the significant and far-reaching reforms of our criminal justice system.

The Gracious Speech included a Modern Slavery Bill to tackle the appalling crime of modern slavery. In few other crimes are the effects of organised criminals and gangs more pernicious than in the trade of human beings for profit. In towns and cities across the country, behind closed doors and hidden from plain sight, there are men, women and children who endure a horrendous

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existence of servitude and abuse. forced to work inhumane hours in terrible conditions, forced to live a life of crime and forced into degrading sexual exploitation. The misery and trauma experienced by victims are immense. Held against their will and with no means of escape, they often endure rape, violence and psychological torture.

In 2013, 1,746 potential victims of trafficking were referred to the national referral mechanism, but modern slavery is largely a hidden crime, so in reality this figure most likely does not represent or reflect the true number of people enduring slavery in Britain today. Slavery is a crime that includes not only those trafficked into the UK but vulnerable British nationals who are preyed upon and exploited by people living here.

Andrew Jones (Harrogate and Knaresborough) (Con): My constituents, in particular the voluntary organisations and charities, will welcome the Modern Slavery Bill. Will my right hon. Friend outline in more detail how it will stop the exploitation of so many innocent people?

Mrs May: I am grateful to my hon. Friend for his intervention. I am sure he is right that his constituents will welcome this Bill; indeed, I hope that it will be welcomed, as it has been in the Joint Scrutiny Committee, by Members of all parties. If he will indulge me, I will say a little bit about what is in the Bill, which will explain to him how we are going to deal with this crime, particularly by toughening up sentencing and enabling the law enforcement agencies to be in an even better position to deal with it.

Michael Connarty: There have been many criticisms of how the national referral mechanism works, and the Government promised six months ago that there would be a review of it. Will there be detail of how this review has been carried out or how it will be carried out? What will we do with people when they leave the NRM? Once they have been in it for a certain time, they are pitched out into what would appear to be oblivion.

Mrs May: The hon. Gentleman makes a point that is often made about people coming to the end of their permitted period within the NRM. In fact, a lot of work is done with other providers to ensure that people are able to move on to other facilities at the end of that time, but crucially that will be one of the issues that of course the review of the NRM will look at. That review is ongoing. Yesterday, I saw the individual who is undertaking it. He said that he is getting on well with it; and of course we will bring the results of the review into the public domain, so that we can show what issues have been identified and what our response to them will be.

I said that I would come on to exactly what is in the Bill. If we are to stamp out this crime and expunge it from this country, we must arrest, prosecute and imprison the criminals and organised groups that systematically exploit people and that lie behind the majority of the modern-day slave trade.

Mr Stewart Jackson (Peterborough) (Con): Yesterday my hon. Friend the Member for North East Cambridgeshire (Stephen Barclay) facilitated a meeting with the Lithuanian ambassador. Does my right hon. Friend the Secretary of State agree that it is extremely important that we

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have cross-country and pan-EU working on this issue, because criminals from overseas are prevalent in this particular area?

Mrs May: Yes, it is absolutely crucial that we both work across borders and countries to deal with the organised crime groups. There are issues with how those who are being trafficked from source countries are dealt with, and trying to ensure that they do not become victims of this particular crime. We can also look at how other countries deal with this issue and with people being returned to their countries.

The Under-Secretary of State for the Home Department, my hon. Friend the Member for Staffordshire Moorlands (Karen Bradley), who is the Minister with responsibility for modern slavery and organised crime, has already visited Albania to talk to people there about how they deal with this crime. I was able to appoint Anthony Steen, a former Member of this House, as my special envoy in this regard; he was the chairman of the all-party group on this issue and has done a lot of work on human trafficking. He visited a number of countries, including Albania, and others such as Israel, to see how they were dealing with these issues. That work will inform the action plan that we will produce in due course alongside the legislation, because this process is not just about a legislative response; it is about some wider issues too.

Ian Lucas (Wrexham) (Lab): We all support action on modern slavery, but unfortunately within the past two months the Home Secretary has withdrawn face-to-face advice for asylum seekers in my constituency, which is a dispersal area, so victims of modern slavery now have to call a phone helpline in order to seek advice. Actions speak louder than words. Why has she withdrawn that advice?

Mrs May: The hon. Gentleman is right that the service provided is now under a new contract. A greater range of facilities is now available to individuals— for example, the advice phone line.

Of course, one of the key issues in dealing with modern slavery is being able to identify those who have been subject to it or to human trafficking. That is why it is so important to train our Border Force officials to spot people who may have been trafficked when they enter the country, and it is why the national referral mechanism review will crucially look at identification. At the moment we know, in a formal sense, who is referred to the NRM, but we fear that there are many more victims of slavery and/or trafficking, as I said earlier.

Crucially, more arrests and more prosecutions will mean more victims released from slavery, and more prevented from ever entering it in the first place. At the same time, we must improve and enhance protection for victims and give them the support they need to recover from their ordeal. The Modern Slavery Bill—the first of its kind in Europe—will substantially strengthen our powers to tackle this crime. It will do so by doing three things. First, it will ensure that measures are in place so that law enforcement agencies and the judiciary can crack down on offenders and give them the punishments they deserve. Secondly, it will provide vital new policing tools to help prevent further cases of modern slavery.

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Thirdly, it will ensure that victims receive the protection and support they deserve during the judicial process and in accessing vital victim support services.

Currently, modern slavery and human trafficking offences are spread across a number of different Acts. The Bill fixes that by consolidating and simplifying existing offences in one single piece of legislation, providing much needed clarity and focus and making the law easier to apply. Punishments will now fit the crime, with the maximum sentence available increased to life imprisonment. Slave-drivers and traffickers will have their illicit gains seized and, wherever possible, used to make reparations to victims. A new anti-slavery commissioner will drive an improved and co-ordinated response. The Bill will also introduce a statutory defence for victims who are compelled to commit a crime as a direct consequence of their slavery, alongside other measures to enhance protection and support for victims.

The Bill has benefited considerably from pre-legislative scrutiny and the detailed evidence heard during that process. I am enormously grateful to the right hon. Member for Birkenhead (Mr Field) and other members of the Committee for their unstinting dedication and I share with them a determination to see an end to modern slavery. We have listened to the Committee’s findings and, where practicable, have put forward proposals to address its key concerns. A detailed response to its work has been published today. However, as I indicated earlier, stamping out modern slavery in Britain will require more than legislation alone. Law enforcement must play a robust and effective role in tracking down, arresting and prosecuting offenders. That is why I have made tackling modern slavery a priority for the National Crime Agency, and at our borders I have established specialist teams to help identify and protect victims being trafficked into the country.

Victims must be at the heart of everything we do, so I have ordered a review of the national referral mechanism, as I indicated in response to the hon. Member for Linlithgow and East Falkirk (Michael Connarty). Recognising the particular needs and vulnerabilities of child victims, I am putting in place trials for child advocates. The Bill gives those advocates a statutory basis and the status they need to support and represent the child effectively. We are also encouraging businesses to look at their supply chains and ensure that they are free from trafficking and exploitation.

Yvette Cooper (Normanton, Pontefract and Castleford) (Lab): Will the Home Secretary clarify that point about child guardians? Will the Bill include statutory provision to bring in child guardians, or simply the permissive power to do so depending on the trials, the length of which we do not know?

Mrs May: The Bill will provide the enabling legislation that we undertook to provide when the Immigration Act 2014 was going through this House, following an amendment made in another place. We are doing it that way because we want to see what the best model is for child advocates; there are differences of opinion over which model will work best. We are therefore including an enabling power to ensure that we adopt the best model when that becomes clear from the trials.

Michael Connarty: Is the Home Secretary proposing a separate and more serious crime of trafficking or exploiting children? She has not made that clear.

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Mrs May: The hon. Gentleman raises a point that the pre-legislative scrutiny Committee looked at. It was keen that we should change our approach to the whole question of offences in the Bill by having a wider offence of exploitation. We have decided not to go down that route because we believe that such a broad and wide-ranging offence could make it more difficult for law enforcement agencies and that it could, through the law of unintended consequences, encompass behaviour that is otherwise entirely innocent. We have changed some of the definitions in the offences in order to make it absolutely clear that where they involve a child, which might make it harder to identify when coercion is taking place, there is specific reference to that in the overall offences of slavery, servitude and labour exploitation.

Taken together, the Modern Slavery Bill and these measures provide a comprehensive programme of action that will help to make a real difference to the lives of some of the most vulnerable people in our society.

Jim Shannon (Strangford) (DUP): Has the Home Secretary had any discussions with the devolved Assemblies, particularly the Scottish Parliament and the Northern Ireland Assembly, which have both brought in anti-trafficking legislation that relates specifically to Scotland and Northern Ireland respectively, as I understand that that legislation takes care of the point about specific child exploitation and guardianship?

Mrs May: The hon. Gentleman makes an important point. We have had considerable discussions with the Scottish Parliament and the Northern Ireland Assembly. We have also had discussions with the Welsh Assembly, because most of the Bill’s provisions cover England and Wales. We are still in discussions with the Scottish Government and the Northern Ireland Executive. The Scottish Government made it clear a few months ago that they wanted to introduce their own legislation in this area. As he says, there are also legislative proposals in the Northern Ireland Assembly. We are talking about how we can ensure that they all mesh together so that we have a comprehensive approach. As a result of further discussions, it is possible that I might wish to bring forward amendments relating to Scotland and Northern Ireland, but detailed discussions are still ongoing on what legislative arrangements will work best.

Moving on from the Modern Slavery Bill—

Michael Connarty rose—

Mrs May: I have been generous to the hon. Gentleman.

Michael Connarty: I think that the Home Secretary might have mentioned the fact that the biggest problem in Scotland—I am sure that the same is true in Northern Ireland—as has been said in public by the Justice Minister, Kenny MacAskill, is the criminalisation of victims by the UK Border Agency, which treats people as criminals because they have broken immigration laws. Rather than being treated as victims, they are taken to court for breaching immigration laws. Will that be resolved? Will the UK Border Agency stop victimising people by criminalising them for breaches of immigration laws?

Mrs May: I have to tell the hon. Gentleman that the UK Border Agency will not be doing anything, because I abolished it over a year ago. He has taken a great

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interest in the issue over the years and has developed a great understanding of it, so he will know that one of the issues raised about the national referral mechanism is precisely the operation of immigration officials in relation to it. However, I think that the largest numbers of referrals made to the NRM still come from people within the immigration system who have spotted people who might have been trafficked. This is not an either/or issue; it is one that we have to explore very carefully, to ensure that all those who come into contact with people who might have been enslaved or trafficked can spot the signs and know how to refer, so that a case can be dealt with appropriately. Indeed, the Bill will include a clause about a duty on first responders to report a case when they see someone who has been the victim of slavery or trafficking.

For justice to be done, we must have a criminal justice system that properly punishes offenders and protects the public. The Criminal Justice and Courts Bill, carried over from the third Session, is the next stage in the Government’s significant reforms to the justice system to make sure that offenders receive suitable sentences, to improve court processes and to reduce the financial burden on the taxpayer. It includes a package of sentencing and criminal law reforms aimed at ensuring that the public are kept safe from serious and repeat offenders.

Once this Bill gets Royal Assent, no one convicted of certain serious violent and sexual offences, such as the rape of a child or a serious terrorism offence, will be entitled to automatic release at the halfway point of their sentence, and they will get early release only if they no longer present a risk to the public. The Bill will ensure that when offenders are released on licence we can properly monitor their whereabouts using modern technology. It will also crack down on those who abscond after being recalled to custody by creating a new offence of being unlawfully at large. In addition, it will ensure that anyone who murders a police or prison officer in the course of their duty faces a whole life sentence, and it will introduce tougher sentences for those who cause death or serious injury by driving while disqualified.

While the proper punishment of offences is important, so too is rehabilitation. This is particularly true of young offenders. We are therefore putting education at the heart of youth custody and ensuring that young offenders are given an opportunity to turn their lives around. The Bill will provide for secure colleges to be created, so that we can trial a new approach to youth custody that gives young offenders the skills, support and qualifications that they need to turn their backs on crime and become productive, hard-working members of society.

Kate Green: Has the Home Secretary had any discussions with ministerial colleagues about provision for young women and girls in these secure training colleges?

Mrs May: Over the past few years, I have had a number of discussions with colleagues in the Ministry of Justice about how women are dealt with in the whole prison estate and in the criminal justice system in terms of custodial sentences. The Ministry of Justice is still looking at the issue, aware that there may well be particular concerns that need to be taken into account.

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Mr David Blunkett (Sheffield, Brightside and Hillsborough) (Lab): Would the Home Secretary be prepared to revisit the report produced by Baroness Jean Corston, and perhaps talk to her, about the crucial issue of how we treat people in our communities, as well those coming into them, in relation to the conditions they live in?

Mrs May: The report by Baroness Corston was indeed significant in its findings on the treatment of women and girls, particularly in the criminal justice system in relation to custodial sentences. I have had a number of discussions with Baroness Corston on this matter in the past, especially when I held the women’s brief, when I was considering it particularly. I have also had discussions with the prisons Minister, my hon. Friend the Member for Kenilworth and Southam (Jeremy Wright). I can assure the right hon. Gentleman that the Ministry of Justice is aware that the matter needs to be considered. I am sure that it will be looking at Baroness Corston’s report—although it was done a few years ago, of course—to see what she proposed.

We must ensure that modern courts run efficiently and effectively without undue costs to the taxpayer. We are therefore introducing criminal court charges to ensure that criminals contribute to the cost of their cases being heard through the courts system. It is only right that criminals who give rise to those costs in the first place should carry some of the burden placed on the taxpayer. We will also introduce reforms to judicial review to ensure that it is used for the right reasons and not merely to cause unnecessary delays or to court publicity. Judicial review is vital in holding authorities and others to account, but this must be balanced to avoid costly and time-wasting applications and abuse of the system.

The Modern Slavery Bill will ensure that law enforcement and the judiciary have effective powers available to put slave drivers and traffickers behind bars, where they belong.

Jim Shannon: Can the Secretary of State confirm that the Government will introduce a non-criminalisation and detention clause, so that children who are prosecuted for crimes that they were compelled to carry out by their traffickers have some flexibility in the system to ensure that they are not penalised for that?

Mrs May: We will absolutely do that. The Bill includes a statutory defence that an individual who has been coerced into committing a crime will be able to rely on, except for certain very serious crimes that will be excluded, where, however, the Crown Prosecution Service guidance will still require that prosecutors consider the circumstances of the individual when the crime was committed.

We are determined to disrupt all those who engage, support and profit from all forms of organised crime. Organised crime costs the UK at least £24 billion a year. The financial sector spends about £10 billion a year on protecting itself from serious and organised crime, and the cost to the UK from organised fraud is thought to be around £9 billion. The impacts of organised crime reach deep into our communities, shattering lives, inflicting violence, corroding society, damaging businesses, stealing people’s money, robbing people of their security and causing untold harm in the sexual exploitation of children. To deal with this threat, the Government are taking comprehensive, wide-ranging action. The powerful new

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crime-fighting body, the National Crime Agency, has been launched to ensure the effective and relentless pursuit and disruption of serious and organised criminality. On the same day as it was launched, we published our serious and organised crime strategy to drive our collective and relentless response. We have legislated to break down barriers to information sharing between law enforcement agencies and toughen up penalties for those trading in illegal firearms.

Keith Vaz (Leicester East) (Lab): I apologise for missing the earlier part of the Home Secretary’s speech. I warmly welcome what the Government propose in respect of organised crime. As she knows, half a billion pounds remains unpaid by the Mr Bigs and Mrs Bigs who manage to finish their sentence but then leave the country without paying their fines. Will she consider the strongest possible measures to ensure that they pay up before they leave the country?

Mrs May: The right hon. Gentleman makes an important point. I am about to come to the provisions on asset recovery.

Organised crime evolves, and we need to keep pace. Under this Government, approximately £746 million of criminal assets has been recovered. However, the Proceeds of Crime Act 2002 is under sustained legal challenge from criminals who are constantly seeking new ways to avoid its reach and frustrate asset recovery, as the right hon. Gentleman said. The Serious Crime Bill referred to in the Gracious Speech will close loopholes used by criminals to get round confiscation orders—for example, through attempts to hide money with spouses, associates and other third parties. The Bill will ensure that assets can be frozen more quickly and earlier on in investigations and reduce the time that the courts can give offenders to pay. It will also significantly increase the time in prison faced by criminals who fail to pay confiscation orders, to deter offenders from choosing to serve time in custody rather than paying up.

Targeting and convicting those in the wider criminal group, such as corrupt and complicit professionals, can prove difficult under current legislation. The Bill will close this gap by creating a new offence of participation in an organised crime group. That will allow the National Crime Agency and the police to go after those who knowingly turn a blind eye to organised crime from which they profit, and it will send out a strong signal that no one should be beyond the reach of the law. Those convicted could face up to five years in prison and be subject to further civil measures.

The Bill will also close a gap in our current legislation in relation to terrorism, which is particularly pertinent in the light of the ongoing crisis in Syria. The UK faces the very serious threat that British nationals travelling to Syria are exposed to terrorist groups there, become radicalised, and on returning may be prepared to radicalise others or carry out an attack here. The Bill will therefore extend extra-territorial jurisdiction to offences under the Terrorism Act 2006, so enabling the UK to prosecute individuals who prepare for terrorist acts and train for terrorism abroad in the same way as though they had carried out those activities in the UK.

Those who act for the good of society and for the benefit of others play a valuable and often largely unrecognised role in this country. Good works and

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good deeds are to be encouraged. There is some evidence, however, that people are put off from volunteering or going to help in an emergency owing to fears of being held liable if something goes wrong.

The social action, responsibility and heroism Bill will reassure the public that if they act for the benefit of society and demonstrate a generally responsible approach towards the safety of others during an activity or when assisting someone in an emergency, the courts will always consider the context of their actions in the event they are sued for negligence.

Dr Julian Huppert (Cambridge) (LD): When I used to do voluntary work, my understanding was that, essentially, that was already the case. Could the Secretary of State explain whether the Bill will change what the law means or how confident people can be in terms of how they act, or will it change both?

Mrs May: The hon. Gentleman is right that there has always been an understanding, but the problem is that, sadly, people do not see enough clarity in legislation to give them the confidence that that is the case. Indeed, they sometimes see reports of cases where the opposite has been the case. It is, therefore, important to give greater clarity in the law and that is what the Bill will do.

Andrew Percy (Brigg and Goole) (Con): I spend a lot of my time as a community first responder with the ambulance service in Yorkshire, and when I turn up at emergencies, I often find that people are unwilling to involve themselves because, although the law may well protect them, they do not feel that it will do so. Therefore, I wholeheartedly welcome the Bill and offer the Home Secretary my experience as an example of why more clarity is needed.

Mrs May: I am very grateful to my hon. Friend, who has hit the nail on the head. The social action, responsibility and heroism Bill will, I hope, send a very clear message to everyone that they should have the confidence of knowing that they can go to help others and not fear the consequences for themselves.

Although not specifically referenced in the Gracious Speech last week, the Government intend to introduce a draft Bill to modernise the way in which compensation is paid to individuals and businesses that experience loss or damage to property caused by riots. The Riot (Damages) Act 1886 has not been updated since it was introduced. Consequently, it does not properly reflect modern society—for example, it does not cover damage to cars.

The precise detail of the draft Bill will be determined following the public consultation that I launched last week. This will build on the findings of the independent review of the Act, which was published in November 2013 and is part of our substantial work since the riots of August 2011 to ensure that compensation arrangements keep pace with modern life. It is right that we continue to protect vulnerable people and businesses from the financial impact of riots.

This Government can be proud of the reforms and legislation that we have put in place. These Bills will build on that work. They will ensure that we can hunt,

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prosecute and lock up the criminals behind the appalling crime of modern slavery; that we have a criminal justice system that properly punishes offenders, while being fair to the taxpayer; that we can better disrupt those who support and benefit from all forms of organised crime; and that we continue to encourage good works and good deeds.

On crime and on justice, this Government’s legislative programme is working to ensure a safe and secure Britain in which honest, hard-working people can prosper. I commend it to the House.

1.13 pm

Yvette Cooper (Normanton, Pontefract and Castleford) (Lab): The Home Secretary has set out the Bills and measures announced in the Queen’s Speech, including measures on modern slavery and on tackling organised crime and helping, we hope, pay back the profits of crime—which we have called for before—as well as action on female genital mutilation, child neglect and terrorism abroad. All of those measures will have strong cross-party support and I want to address some of them. I also want to talk about what is missing from the Queen’s Speech, because the Home Secretary’s proposals are not sufficient to address some of the challenges that Britain faces for the future.

I will start with the Bill that we welcome most—the Modern Slavery Bill. I pay tribute, as the Home Secretary has done, to the members of the cross-party Joint Committee, including my right hon. Friend the Member for Birkenhead (Mr Field) and my hon. Friends the Members for Slough (Fiona Mactaggart) and for Linlithgow and East Falkirk (Michael Connarty), who have argued for changes and improvements to the Bill.

The Home Secretary was right to talk about the torture, rape and persecution of those who see no way out. The gangmasters, traffickers and slave drivers are not just stealing vulnerable people’s money; they are stealing their freedom and stealing their lives. Tougher laws and penalties are needed, and I also hope the Bill will go further in providing more support for victims by making sure they are not punished in the immigration system or sent back to those who sold them in the first place. It also needs to make sure that there are child guardians, which we have been calling for since 2010, because it is chilling that two thirds of children rescued from trafficking in Britain just disappear. They are betrayed by their abusers only to be betrayed for a second time by the authorities, which fail to protect them when their abusers and traffickers steal their lives and freedom all over again.

The Home Secretary also needs to look again at the domestic workers visa and the risks to those forced into domestic slavery, unable to escape. The charity Kalayaan has found that since the Home Secretary changed the visas, 60% of those on the new visa were paid no salary at all, compared with 14% on the original visa. That is slavery, and the evidence suggests that the Home Secretary’s visa reforms have made it worse. We will also press her to support joint action on supply chains, as the Joint Committee has suggested.

I am glad that the Home Secretary is doing more to recover the proceeds of crime. She will know that less has been recovered in recent years. The amount collected by the police and the volume of confiscation orders

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have fallen, yet we know there is still £1.5 billion-worth of outstanding orders—ill-gotten gains that criminals are still stashing away. We have already called on the Home Secretary to end early release with regard to default sentences where organised criminals refuse to pay, and to stop loopholes whereby criminals transfer assets to families. I hope those measures will be in the Bill.

We welcome further action on organised crime and those aiding and abetting criminals, and we certainly need stronger action against those who are mutilating the bodies of girls and young women. It is a stain on our country that so many young women are at risk and no one has yet been successfully prosecuted.

More action is also needed against online child abuse. We are glad that the Home Secretary is looking at new offences, but what is she doing to reverse the fall in Child Exploitation and Online Protection Centre arrests and the drop in the number of chid abusers being caught?

I am also glad that the Home Secretary is looking at terrorist offences overseas, but after all the noise yesterday about the Prevent programme she needs also to recognise that there is a significant gap in her policies on preventing terrorism and extremism. She claimed yesterday that it was okay for the Home Office to narrow the work it does and to stop funding work by communities themselves to prevent extremism, because, she said, the Department for Communities and Local Government is doing that instead—but it is not.

The reality is that neither the Home Secretary nor the Communities Secretary—nor even the Education Secretary—are taking seriously enough the need to work with communities on preventing young people from being seduced into going to Syria. Some of the strongest voices and most effective people in counteracting the ideology of the jihad are those within the communities, in faith groups and friends in social media, yet not enough work is being done with those communities or to give them support. I hope the Home Secretary will make sure that that happens.

Keith Vaz: May I endorse what my right hon. Friend the shadow Home Secretary has said? In my constituency, 52% of the people are from ethnic minority communities and there are more than 27 mosques, 35 Hindu temples and five gurdwaras in Leicester. It is important to bring communities with us. Of course, a tough strategy is very important. We did not get it absolutely right under the previous Government and Prevent had to be modernised, but without those communities we cannot make change.

Yvette Cooper: The Home Affairs Committee has done some important work on this issue and my right hon. Friend is right that we will always have to keep reforming the programmes and learning from things that do not work, because preventing extremism is a difficult area. However, experts in countering extremism and preventing terrorism have raised concerns with me that some of the work done previously with the Somali community to ensure that it got the support it needed to prevent people from going to Somalia to fight is not being replicated to prevent people from going to Syria.

Kate Green: I also represent a constituency with a highly diverse population and many families from minority communities. They tell me of a deep sense of bubbling

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anger and that they are no longer being made to feel welcome or respected in the community as a whole. Does my right hon. Friend agree that it is important that the broader strategy engages the whole community and respects and honours everyone’s contribution as members of our country?

Yvette Cooper: My hon. Friend is right. She knows that many of the strongest advocates of fighting extremism or preventing extremism—for example, preventing Islamist extremism—are those in the Muslim communities themselves, such as Muslim community leaders who have done excellent work on preventing extremism. The Government should do more to support those communities in the work that such communities are often better at leading.

A lot is missing from this Queen’s Speech. There is no serious action to tackle domestic violence or rape, of which reported cases are going up, but prosecutions and convictions are going down on the Home Secretary’s watch. There are no national standards, and no commissioner on violence against women to make sure that such standards are enforced. I still fail to understand why the Government will not do more to prevent violent relationships among young people. Where is the proposal for the compulsory sex and relationship education that all our children should get to ensure that they are taught zero tolerance of violence in relationships from the start?

What about immigration? The Home Secretary’s approach is failing. She set a net migration target, and the Prime Minister promised—no ifs, no buts—that he would get immigration down to the tens of thousands. The Home Secretary said that she would meet the target by the end of the Parliament. Yet net migration is now at 212,000, which is hardly less than the 222,000 at the time of the last election. Despite all her rhetoric and four years’ worth of legislation, the public are more worried about immigration now than when she started as Home Secretary. However, universities and businesses are concerned that they cannot attract the best international talent, which they need. In the past year alone, the number of people saying that immigration is their biggest concern has doubled. It is the worst of all worlds, so why does she not stop pretending about meeting her failed target and act to address some of the practical concerns that people have about the impact of immigration on wages and jobs?

Pete Wishart (Perth and North Perthshire) (SNP): Will the right hon. Lady tell me what the Labour party is going to do? It seems to me that there are only two ways to deal with UKIP’s agenda: either to accommodate and pander to it, or to challenge the very assumptions on which it is based. Labour cannot look two ways on this matter—will it challenge or pander?

Yvette Cooper: UKIP is exploiting people’s fears and concerns, and it needs to be challenged every step of the way. We need to set out the practical reforms that would address people’s concerns about the impact of immigration on their wages and jobs when employers exploit immigration to undercut local wages and jobs. I do not understand why the Home Secretary will not take such measures—we could support them—in a new immigration Bill.

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Andrew Percy: The shadow Secretary of State came to my constituency recently. She did not give me notice of her visit, but she may have heard from residents in Goole of their concerns about immigration. The visit did no good: the Labour vote completely collapsed in the Euro elections. Will she now take this opportunity to apologise to residents in Goole for what happened in 2007, which led massive numbers of immigrants to come to our town and put huge pressure on schools, housing and our public services?

Yvette Cooper: I must tell the hon. Gentleman that, unfortunately, public concern about immigration is much higher now than it was at the time of the general election. I hope that he will apologise to his constituents for backing a net migration target and promising that it would be met by the time of the next general election, but utterly failing to meet it.

The Government are not setting out the practical things that they could do. For example, they could stop agencies recruiting only from abroad, close loopholes in the minimum wage, go much further on unfair zero-hours contracts and make serious exploitation a crime. All those are things that the Government could do.

In response to my hon. Friends’ questions, the Home Secretary commented about the Passport Office, but I must say that her answers were incredibly complacent and simply do not reflect the experience of MPs right across the country. She claimed that all the targets are being met. From what she said, we would think that everything was absolutely fine. Tell that to James Bowness from Cumbria, who nearly missed his chance to qualify for the Commonwealth games because his passport did not arrive in time; pensioner Eileen Shepherd from Darlington, who missed her dream cruise because her passport did not arrive; or the Vernon family from Coventry, who missed their first family holiday abroad. They all applied in time, but the Passport Office let them down.

Mr Donohoe: One of the problems faced by Members of Parliament and their staff is that when they phone the ministerial hotlines, they do not get an answer for two or three days, and when they do it is incomprehensible and does not help them with the particular case.

Yvette Cooper: My hon. Friend is right. Many of us have had the experience of trying to ensure that our constituents get their passports in time to go on the holiday that they have put all their savings into, or to go on a business trip abroad. We are told that there is a backlog of 500,000 cases. We all know that people are now in a state of panic and, for fear of losing their money, are putting extra money in to pay for fast-track services or rushing across the country to Durham or elsewhere to pick up their passport.

Keith Vaz: For my right hon. Friend’s information, the Home Affairs Committee has called the head of the Passport Office to appear before us on Tuesday. We have heard that the real problem is that 80 members of staff have been moved off passport fraud duties to help with the backlog, meaning that they are not doing the very important work of checking fraud that they are required to do.

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Yvette Cooper: My right hon. Friend is exactly right. I know that he and the Committee will scrutinise this matter in great detail. It is deeply troubling if important security measures have been dropped simply because there is a crisis in the Passport Office and the Home Secretary has taken her eye off the ball.

We know that the delays are even longer for Brits living abroad, such as the family who cannot come home from Qatar with their baby because they cannot get him a passport to fly. With expats stuck abroad and unable to come home, keeping Brits out of the country seems to be the Government’s only chance of meeting the net migration target. This is a shambles.

There are some sensible measures in this Queen’s Speech, but too much that is not in it. Frankly, from our debates over the past week, people would not have known even about the measures that are in it. The Home Secretary was not talking about them on the day of the Queen’s Speech. In fact, no one was talking about them, and even the fainting page-boy struggled to get a look in. We had the headlines, “Cabinet at war over extremists in schools”, “Angry Cameron rebukes rivals as Tory rift widens”, and “Tory bloodbath over Muslim schools fiasco”. We had to pity the poor Prime Minister, who was standing on the sidelines and desperate to talk about pensions or fracking, and even the Deputy Prime Minister, who was trying to get noticed and madly waving his plastic bags. No one heard about the slavery Bill or the crime Bill on Queen’s Speech day, because the Home Secretary had started her own plot to cause a parliamentary explosion on the day the Queen came to Parliament.

Yesterday, the Home Secretary told the House that she did not authorise the publication of the letter on the website or in the media. Presumably, she woke up on Wednesday morning to be as shocked by the headlines as everyone else. Presumably, she was as horrified as the Prime Minister that the Gracious Speech we should have been talking about was overshadowed. Presumably, she rushed into the Department and said, “Oh, Fiona, what on earth have you done? Take it down. Quick—rush across and make nice to the Education Secretary. Get me the Prime Minister on the phone, and I’ll apologise for this dreadful departmental mistake on such an important day.” Except that she did not; there was no contrition, no rush to limit the violence and no punishment for the culprit in her Department.

Yesterday, the Home Secretary got terribly touchy about the ministerial code. She said that she had not breached it, but let us see what it says. Under section 2.1, ministerial correspondence should be confidential. Yet she kept the letter on her website for three days. Under section 3.3, she has responsibility for her special adviser. Is that why she will not tell us who leaked the letter? These are blatant breaches of the ministerial code and she knows it. If she wants those charges against her to be dropped, she should answer these questions. Who agreed to put the letter on the website? Who agreed to give it to the press? Why did she write it after she had heard about the briefing from The Times, and did she write it knowing that it would be leaked? When did she find out it was on the website, and why did she not take it down?

The Home Secretary launched a sabotage attack on the Queen’s Speech, even though her own Department had some perfectly reasonable measures that she should

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have wanted to include. The Queen’s Speech just does not do enough to tackle the serious problems in the country. There is not enough on crime, immigration or violence against women, and the Home Secretary has taken her eye off the ball. She has been too busy in briefing wars with the Education Secretary to keep her own house in order, and too busy worrying about her next job to get her day job right, and the country is being let down.

1.29 pm

Sir Paul Beresford (Mole Valley) (Con): That was quite an extraordinary speech. It did not focus on the Queen’s Speech. It did not focus on the Bills that were listed. Incidentally, the right hon. Member for Normanton, Pontefract and Castleford (Yvette Cooper) should recognise that the Child Exploitation and Online Protection Centre does not arrest—it passes information to individual police forces to deal with.

I was impressed with the list, and the Home Secretary, for the sake of the rest of us who want to speak, went through it quickly. She did not touch on everything; there is more there than she mentioned. I am here to say a personal thank you to the Ministers—

John Robertson (Glasgow North West) (Lab): You are grovelling.

Sir Paul Beresford: No, I do not grovel; the hon. Gentleman knows that.

John Robertson: That is what it sounds like.

Sir Paul Beresford: I will meet him on the rugby field and we will see.

I am coming to the point. After 12 or 14 years of working to try to bring legislative changes, with considerable success on, among other things, dealing with paedophiles, there is a tiny element—that last element, which has taken me 14 years—included in the Serious Crime Bill. It is little. The Home Secretary did not mention it. My specific interest is in part 5, clause 63. It has not been noticed by many. It is a change to help prosecute child sex abusers. The clause is headed simply, “Possession of paedophile manual”, and as I read the measure, the definition is broader than the sort of straight manual that one would see on car repair. That said, in the past much of this kind of material has been similar to a repair manual.

Two of my ten-minute rule Bills have effectively been on the same subject—I was supported by Paul Goggins, whose name has been mentioned several times. Such material has also been the subject of my continual pressure on Ministers of the previous Labour Government—including one who is present—and of this Government. The problem was first highlighted by the Home Office taskforce of which I was a member in 2001-02, which preceded the Sexual Offences Act 2003. Along with a few senior Met officers—particularly retired DCI Dave Marshall, who is highly respected in this area—I have persistently raised the issue ever since. Recently, CEOP has swung heavily behind the need for legal changes.

The existence of real manuals and their effect came to the fore when BBC 2 broadcast a three-part programme called “The Hunt for Britain’s Paedophiles” in 2002. It involved Bob Long of the BBC following the Metropolitan

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police paedophile unit for two years. The first of the three parts involved hunting down a group of individuals who, if my memory is correct, were members of a paedophile ring that had been abusing children in London since 1957—not quite 50 years. One of the more active members was a Julian Levene, who produced a manual on the grooming and abuse of children for the use of the members of the ring, and any others who were interested.

Many paedophiles write, either in hard copy or on a computer, guidance or descriptions of their abuse activities, whether real or imaginary. They are, in effect, manuals, and can clearly be seen as guidance. The Bill looks broad enough to catch such material. For many, the written word is more effective than child pornographic photographs, pseudo-photographs and so on.

I would like to give a simple example from CEOP. A man from Kent recently wrote describing his wish to kidnap an early-teenage girl, strip her, sexually abuse her and then, in an appalling way that I will not detail, slowly kill her. It is horrific, especially as his writings inspired him to carry it out. He is now in prison, hopefully for ever, but the teenager is lost. With this legislation, perhaps the early discovery of the writings could have helped, especially given that the police will have the power to act.

Having pondered, with legal help, over quite how to phrase legislation to cover this problem, I congratulate the Secretary of State and her Ministers on the ingenious approach that they have taken. It is broad, it is clever, it will do the job, and lessons have been learned from the Terrorism Act 2006. I also congratulate Ministers on following the approach of much of the child protection legislation. The change will be able to be used actively, proactively and retrospectively. I thank the Ministers again.

1.34 pm

Mr David Blunkett (Sheffield, Brightside and Hillsborough) (Lab): I have a declared interest that relates to higher education, which might crop up in my speech.

I thank the hon. Member for Mole Valley (Sir Paul Beresford) for his reference to the work of my late friend, Paul Goggins, who was referred to by the Prime Minister and the Leader of the Opposition on the day of the Queen’s Speech. I appreciate that reference, because Paul would have been proud that his work, like that of so many in this House, has borne fruit in the form of legislation.