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House of Commons

Tuesday 21 October 2014

The House met at half-past Eleven o’clock


[Mr Speaker in the Chair]

Oral Answers to Questions


The Secretary of State was asked—

Transatlantic Trade and Investment Partnership

1. Caroline Lucas (Brighton, Pavilion) (Green): What progress he has made on negotiations relating to the potential effect of the Transatlantic Trade and Investment Partnership on the NHS. [905538]

6. Mr Dave Watts (St Helens North) (Lab): What assessment he has made of the potential effect of the Transatlantic Trade and Investment Partnership on NHS services. [905543]

The Parliamentary Under-Secretary of State for Health (George Freeman): The Government’s aim and my central mission as the new Minister for life sciences is to accelerate access for NHS patients to the very latest diagnostic devices and drugs by making the UK the best place in the world in which to develop innovative treatments. The US is a world leader in medical technology and TTIP will help NHS patients get faster access to those innovations. Let me be clear: the treaty excludes the NHS from binding commitments. Parliament will retain sovereignty over how we organise and fund our health system and NHS England is free to decide how best to commission NHS services in the clinical interests of local patients, as it does today.

Caroline Lucas: I thank the Minister for his answer and I welcome him to his new post. If his assurances were remotely credible then surely the British Medical Association would not have called for health to be excluded from TTIP entirely. Will the Minister confirm that under the investor-state dispute mechanism, US corporations will be able to challenge our national health policy decisions for ad hoc arbitration tribunals and potentially sue us for millions of dollars in damages for loss of profit in the event of any moves to reverse the coalition’s privatisation agenda and bring the NHS back fully into public hands?

George Freeman: No, I will not confirm that, but the hon. Lady does not have to take it from me. She can take it from the people who are doing the negotiations.

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The US chief negotiator confirms that the United States has no provision in its trade agreements on health. The EU chief negotiator says:

“I wish… to stress that our approach to services negotiations excludes any commitment on public services, and the governments remain at any time free to decide that certain services should be provided by the public sector.”

Mr Watts: Before the election, there was a promise that there would be no top-down reorganisation of the NHS. Given the concern of the Opposition and the BMA, will the Minister meet the BMA to work out how we can get a cast iron assurance that these TTIP talks will not be used to privatise the NHS?

George Freeman: I will happily meet the BMA, but such a request is a bit rich coming from a Labour party that legislated to introduce competition in the health service and to pay private sector providers 11% more, which is now illegal under the Health and Social Care Act 2012. Let me be clear about this, and I can be no clearer than the Labour member of the all-party group for TTIP, who said that

“my direct discussions with the EU’s chief negotiator have helped produce an EU promise to fully protect our health service…TTIP could have no impact on the UK’s sovereign right to make changes to the NHS.”

Stephen Hammond (Wimbledon) (Con): I am grateful to the Minister for confirming that these negotiations will have no effect on NHS services and how they are provided. With his life sciences hat on, will the Minister also confirm that this treaty gives us a real advantage as UK companies will be able to compete in the American market?

George Freeman: My hon. Friend makes an excellent point. As well as providing a £10 billion boost to the economy, which I am surprised to see that the left is not in favour of, and securing 13 million jobs in the EU, this treaty also helps our NHS pioneers and innovators and our UK life science companies generate revenue for this country from our innovations in health care in the world’s biggest health care market.

Chris Heaton-Harris (Daventry) (Con): Is it not the case that free trade agreements have always grown the economies that have contracted within those agreements, and a growing economy can only benefit the NHS in the future?

George Freeman: My hon. Friend makes an important point. The truth is that we cannot have a strong economy without a strong NHS, and we cannot have a strong NHS without a strong economy. In a modern society, health and wealth go hand in hand, which is why this treaty, with the safeguards that we have secured, is good for Britain and good for NHS patients.

Keith Vaz (Leicester East) (Lab): Some 3 million people with diabetes have not received their full health checks, and 630,000 people have diabetes but do not know about it. Will the Minister give us an assurance that nothing in this deal will affect the ability of people to have free diabetes tests?

George Freeman: The last time I checked the TTIP negotiations do not make any specific provision for access to those services within the NHS. All I can do is remind the right hon. Gentleman that over the course

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of this Parliament, we have invested another £12 billion, hired more doctors and nurses and increased the provision of diagnostics in the NHS. This treaty does not affect that.

Sir Tony Baldry (Banbury) (Con): Will my hon. Friend confirm that there is absolutely no requirement in TTIP for this or any future Government to open NHS health care services to further competition and private sector provision, and that TTIP will have no effect on the ability of local NHS commissioners to decide who delivers services to patients?

George Freeman: I can absolutely provide that guarantee. UK sovereignty on health is not in any way threatened by TTIP. As I have already told the House, safeguards on this are being built in by both the American and the European negotiators. As my right hon. Friend points out, clinical commissioning decisions in the NHS will rightly remain with the clinical commissioning groups, which include the people who are closest to the patients.

Ms Margaret Ritchie (South Down) (SDLP): For the avoidance of any doubt, given that health is devolved to Northern Ireland, what assurances can the Minister give us that not just the UK Government, but the devolved Administrations, will be safeguarded from the investor-state dispute settlement mechanism?

George Freeman: The treaty’s provisions apply to the whole United Kingdom, so it will be for the delegated authority of the people of Ulster and their Administration to give effect to the treaty locally.

NHS Facilities (Contracting Out)

2. Tim Loughton (East Worthing and Shoreham) (Con): What safeguards are in place for the sustainability of NHS facilities when clinical commissioning groups contract out local services. [905539]

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): The previous Government introduced greater competition to the NHS. This Government have ensured that it is for local doctors and nurses through clinical commissioning groups, rather than bureaucrats, to decide how best to procure NHS services in the interests of their patients.

Tim Loughton: As the Minister is aware, Coastal West Sussex CCG is controversially proposing to award a major contract for musculo-skeletal services to a social enterprise consortium rather than Worthing hospital. While I welcome new ways of working in the NHS, as long as the quality of care for patients remains key, what safeguards are in place to ensure that existing NHS services such as trauma and accident and emergency, which we campaigned so hard to protect at Worthing hospital, are not compromised?

Dr Poulter: The Health and Social Care Act 2012 ensures that commissioners must also have regard to delivering integrated health care services. I reassure my hon. Friend that the West Sussex CCG has clearly stated:

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“The…CCG will continue to commission MSK related trauma from the current providers and the intention is for this to continue for the duration of this MSK…contract”.

23. [905562] Mr Jim Cunningham (Coventry South) (Lab): What is the Minister doing to retain GPs as there is considerable concern in Coventry about the number who are leaving practice?

Dr Poulter: I hope that I can reassure the hon. Gentleman that there are now 1,000 more GPs in training and working in the NHS under this Government than when we came to power in 2010. We are committed to training even more GPs to ensure that we can widen access to general practice services.

Andrew George (St Ives) (LD): In what circumstances can clinical commissioning groups treat the NHS as a preferred provider, and in what circumstances are they forced to contract out services?

Dr Poulter: As my hon. Friend will be aware, when commissioning services, it is important that regard is given not only to competition because, under the 2012 Act, we have ensured that there must be regard to delivering an integrated and joined-up approach for local services. That is an issue for local commissioners to decide in the best interests of the patients they look after.

John Cryer (Leyton and Wanstead) (Lab): Are not certain CCGs starting to merge decision-making processes, meaning that some important strategic decisions are removed even further from local communities and there is therefore a complete lack of accountability?

Dr Poulter: For some more specialist services, collaboration between various parts of the local NHS will always be needed. That is about good health care commissioning and ensuring that services are joined up in a collaborative way. Whereas day-to-day, bread-and-butter services will be commissioned by a local CCG, for more specialist services, clinical commissioners will of course need to work together to ensure that local centres of excellence are commissioned.

Steve Baker (Wycombe) (Con): The sustainability of NHS facilities is often prejudiced by the millstone of Labour’s private finance initiative deals. What is the Government’s expectation of how CCGs should make the best of the hand that they have been dealt?

Dr Poulter: My hon. Friend is absolutely right that PFI deals signed by the previous Government have crippled the finances of many hospital trusts, meaning that many of them are unable to invest as much in front-line patient care as they would like. It is important that the Government support the mitigation of PFI deals, when possible, and we have a group that is doing exactly that and supporting local commissioners to deal with the worst excesses of the previous Government’s mismanagement of the NHS finances.

A and E Waiting Times

3. Mr Gareth Thomas (Harrow West) (Lab/Co-op): How many patients waited longer than four hours in A and E departments in 2013-14. [905540]

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8. Karl Turner (Kingston upon Hull East) (Lab): How many patients waited longer than four hours in A and E departments in 2013-14. [905545]

The Secretary of State for Health (Mr Jeremy Hunt): Of the 21.7 million attendances at all A and E departments in England in 2013-14, 939,000 were not seen and treated within four hours, meaning that 95.7%—0.7% above the national target—were. I am pleased to inform the House that hospitals will have an extra 260 A and E doctors this winter, bringing emergency medics in the NHS to a record high.

Mr Thomas: The reason for the big rise in A and E admissions in my area is the weekday closure of the hugely popular Alexandra Avenue polyclinic. Will the Secretary of State look again at Harrow’s NHS funding formula to determine whether that popular service could be reopened?

Mr Hunt: I am happy to look at the point that the hon. Gentleman raises. I have visited the Northwick Park A and E department, where the clinicians on the front line are working incredibly hard. As he knows, the funding formula is decided independently—at arm’s length from politicians—but we have ensured that everyone gets a real-terms rise.

Karl Turner: Data published last Friday show that A and Es have missed their waiting targets for 64 weeks on the bounce. They are in a worse state now than they were last winter. What is going on?

Mr Hunt: First, I caution the hon. Gentleman on his use of statistics, because he is referring to a subset of A and Es, not all of them. Last year we hit our A and E target. I say gently to Labour Members that they need to be careful if they try to politicise operational issues, because people will note that in every year of this Parliament we have hit our A and E targets in England and Labour has missed its targets in Wales.

Andrew Bridgen (North West Leicestershire) (Con): Does the Secretary of State agree that the figures show that the average wait before assessment in A and Es in England is now down to 30 minutes, as opposed to 77 minutes under the previous Labour Government?

Mr Hunt: My hon. Friend makes an important point. I just say to the Labour party that the time people wait to be seen at A and Es has reduced while the number of people going to A and Es has increased, but in the end it will not be sustainable unless we invest in out-of-hospital care, which is why we need more personal care by GPs. That is why we have brought back named GPs and why we have 1,000 more GPs than we did four years ago.

Charlie Elphicke (Dover) (Con): May I welcome the outstanding treatment provided at the A and E at the William Harvey hospital—part of East Kent Hospitals University NHS Foundation Trust—which I attended on a family emergency during the summer, and note that the Care Quality Commission is getting striking improvements in East Kent, rather than the sort of cover-ups we used to see in the past?

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Mr Hunt: My hon. Friend is absolutely right. Under this Government, with the new inspection regime, we have had to take the difficult decision to put 18 hospitals into special measures, including East Kent. Six have now come out of special measures. We are tackling these problems in the NHS by being honest about them. I gently say to the Labour party that if it wants to be the party of the NHS, it has to give the country confidence that it will be honest about poor care when it comes across it.

Andrew Gwynne (Denton and Reddish) (Lab): On A and E, does the Secretary of State accept that we must do more to address the appalling statistic that one in four cancers is diagnosed in A and E departments? At the weekend, Labour outlined plans dramatically to reduce the wait for tests and results, paid for through a tobacco levy, which are supported by Macmillan, Cancer Research UK and the Royal College of Radiologists. Will he now back those plans?

Mr Hunt: I welcome the fact that Labour is thinking about how to improve our performance on cancer, because in 2010 we had the worst cancer survival rates in western Europe. I gently say to the Labour party that the issue is only partly about the amount of time it takes to get a hospital appointment when one has a referral; a much bigger issue is the fact that we are not spotting cancers early enough in the first place. That is why I hope that Labour will also welcome the fact that in this Parliament we are on track to treat nearly 1 million more people for cancer than we did in the previous Parliament. That is real progress of which the whole House can be proud.

Mr Philip Hollobone (Kettering) (Con): While it is working with one of the most outdated A and Es in the NHS, and one that will require fresh capital investment, does the Secretary of State recognise the tremendous improvement at Kettering general hospital’s A and E, which in the past year has gone from one of the worst performing to one of the best performing in the country?

Mr Hunt: I absolutely recognise that, and I congratulate my hon. Friend on the very close interest he takes in what is happening at Kettering hospital. I have visited the hospital, as he knows, and think that it is working very hard and that it offers a very good example of how, even when times are tough, finances are tough and there is increasing pressure from an ageing population, it is possible to increase and improve A and E performance. It has done a terrific job.

NHS Trusts (Deficit Forecasts)

4. Ian Austin (Dudley North) (Lab): What estimate he has made of the number of NHS trusts forecasting a deficit. [905541]

The Secretary of State for Health (Mr Jeremy Hunt): Eighty-six NHS trusts are forecasting a deficit this year.

Ian Austin: Jobs at Russells Hall hospital are at risk as managers battle with a £12 million deficit that the chief executive says is critical. Staff are working flat out, but people are still waiting too long in A and E, and too long for other treatment. What will the Secretary of

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State do to ensure that patients in Dudley and the hard-working staff at Russells Hall get the support they need?

Mr Hunt: I will tell the hon. Gentleman exactly what we are doing. The Dudley Group NHS Foundation Trust has 350 additional nurses this Parliament, and it has got them because this Government took the difficult decision to protect and increase the NHS budget, because those of us on the Government Benches know that a strong NHS needs a strong economy. We are taking measures, but there is more to do. I recognise that the staff on the front line are working very hard, but I think that he should also give credit when things are starting to move in the right direction.

Stephen Mosley (City of Chester) (Con): My right hon. Friend will be aware of the strains placed on the budgets of the Countess of Chester NHS Trust because of the need to treat thousands of patients every year who are fleeing the disastrous management of Labour in Wales. What action is my right hon. Friend taking to ensure that hospitals on the English side of the border get a fair share of resources?

Mr Hunt: My hon. Friend is right to talk about that intolerable pressure on hospitals on the England-Wales border. For every one English patient admitted for treatment in a Welsh hospital, five Welsh patients are admitted for treatment in an English hospital, which creates huge pressure for them. I have written to the Welsh Health Minister to say that the NHS is happy to treat more Welsh patients, but the trouble is that NHS Wales is not prepared to pay for it. That is why Welsh patients get a second-class health service. [Interruption.]

Mr Speaker: Order. The hon. Member for Caerphilly (Wayne David) is normally a very calm and reserved fellow—almost statesmanlike. This curious behaviour is quite out of character. He should take some sort of sedative. The hon. Member for Cardiff South and Penarth (Stephen Doughty) can probably advise him.

Liz Kendall (Leicester West) (Lab): With hospitals set to be £1 billion in the red this year, the Secretary of State should be getting a grip of NHS finances. Instead, he is starting on yet another reorganisation. First, he put NHS England in charge of commissioning primary and specialist care. Now, NHS England wants to hand this back to clinical commissioning groups. Ministers have already wasted three years and £3 billion of taxpayers’ money. How much will this Secretary of State’s second reorganisation cost?

Mr Hunt: It is lovely spin from the party that carried out nine reorganisations in 13 years. The difficult truth for the Labour party is that this reorganisation that they fought so hard against has been a success. We are saving this Parliament £5 billion. We have reduced the number of administrators by 19,000. We have hired 10,000 more doctors and nurses with the money, and the result is that our NHS, in very difficult circumstances, is doing nearly a million more operations every single year. That is something that we on both sides of the House should welcome and be proud of.

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Private Finance Initiative Costs

5. Jesse Norman (Hereford and South Herefordshire) (Con): What steps he is taking to encourage hospital trusts to manage their PFI costs more effectively. [905542]

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): PFI schemes have had their contracts reviewed for potential cost savings. A major data collection on the results is currently under way. In 2013, the Treasury launched a code of conduct for operational PFI contracts which contained a number of new guidelines for better working relations between the public and private sector parties.

Jesse Norman: Thanks to determined work with which I have been closely associated and with outside experts’ advice, Hereford hospital has managed to save several million pounds on its exorbitant PFI contract—money that is already being ploughed back into medicine and services for local people. My studies make it clear that there are hundreds of millions, if not billions, of pounds still to be saved on the PFI across other NHS hospital trusts. Will my hon. Friend press Monitor and the NHS Trust Development Authority to do everything they can to encourage hospitals to take on specialist PFI contract advisers to help them make these savings?

Several hon. Members rose

Mr Speaker: Order. Questions must be shorter. I say with the greatest courtesy to the hon. Member for Hereford and South Herefordshire (Jesse Norman) that to read out a prepared script and be too long is doubly bad, and it really is not excusable.

Dr Poulter: My hon. Friend is right to highlight the fact that the annual cost of PFI left by the previous Administration is £1.79 billion, which will rise to £2.7 billion. It is right that we do all we can to support hospitals to reduce the costs of PFI that have been inflicted upon them, and we will continue to do that and work with the Treasury to make sure that that specialist advice is available for the NHS to reduce the cost.

Mr Barry Sheerman (Huddersfield) (Lab/Co-op): I am worried that the members of the ministerial team are living in some sort of parallel universe. At the Calderdale and Huddersfield Trust we had a PFI. A hospital that has a long history of success is now struggling because it cannot get a management that works between the clinical commissioning groups and the trust. That is the truth—it is chaos.

Dr Poulter: There is nothing wrong with PFI schemes in principle; the point is the way in which they were put together by the previous Government. In 2011, the right hon. Member for Leigh (Andy Burnham) said:

“We made mistakes. I’m not defending every pen stroke of the PFI deals we signed”.

Those PFI contracts have damaged local hospitals and damaged local health care provision—

Mr Speaker: Order. I just said to a Back Bencher that his question was too long. I have said to the Minister several times that his answers are not just too long, but far too long, and if they do not get shorter I will have to ask him to resume his seat—which frankly, for a Minister, is a bit feeble.

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Nick de Bois (Enfield North) (Con): Will the Minister confirm that unlike the PFI agreements for my neighbouring hospitals in north Middlesex and Barnet, which were negotiated badly and ineffectively, the rebuild of Chase Farm hospital will be funded by proceeds from its own land sale and Treasury money, not PFI?

Dr Poulter: My hon. Friend makes an important point. Hospitals should always look to their own efficiencies first by improving procurement practices and freeing up surplus land to fund local schemes. His hospital has done that very effectively, and it has not pursued the policies of the previous Government, which have put so many trusts into difficulty.

Mr Nicholas Brown (Newcastle upon Tyne East) (Lab): Given the total forecast deficit across English hospital trusts, including PFI schemes, is it still the Government’s position that the situation can be dealt with by efficiency savings alone?

Dr Poulter: During this Parliament we are set to improve efficiency in the NHS and make £20 billion-worth of efficiency savings. There is much more that we can continue to do on improving hospital procurement practices, sharing business services across the NHS, and freeing up surplus land—which, as my hon. Friend the Member for Enfield North (Nick de Bois) outlined, is happening at his hospital. That is what we need to focus on in freeing up money for the front line.

Guy Opperman (Hexham) (Con): Hexham hospital is outstanding but was built under a very expensive Tony Blair PFI. Does the Minister welcome the fact that Northumbria NHS trust is the first in the country to buy out the PFI and put it into public ownership, thereby putting millions more into front-line care?

Dr Poulter: My hon. Friend makes an important point. The PFI schemes negotiated by the previous Government were, quite frankly, disastrous for many hospitals. His hospital has seen that the way forward is to buy out the PFI and free up more money for front-line patient care. We will support as many more hospitals in doing that as can be achieved, because this is about making sure that we deliver more money for NHS patients.

Kelvin Hopkins (Luton North) (Lab): I was fascinated by the question from the hon. Member for Hexham (Guy Opperman). Would not the simple solution be to take all PFI assets back into public ownership, reintegrate them with hospitals’ existing assets, and save millions of pounds for hospitals every year and billions of pounds for the public purse over time?

Dr Poulter: I understand that the hon. Gentleman is unhappy with the way in which the previous Government negotiated PFI contracts. We are unhappy with it as well, because it is costing the NHS almost £2 billion on current forecasts. We are making sure that we can put in place measures to support hospitals in mitigating the worst excesses of these poorly signed PFI deals.

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Ambulance Response Times (London)

7. Heidi Alexander (Lewisham East) (Lab): What recent assessment he has made of the adequacy of ambulance response times in London. [905544]

The Parliamentary Under-Secretary of State for Health (Jane Ellison): First, I praise the hard-working staff of the London ambulance service, who responded to 100,000 more calls last year. We know that the service is under some pressure, and that is why we are providing extra support to the NHS in London, including £15 million for the ambulance service to help to ensure that the trust meets standards in future.

Heidi Alexander: London ambulances are taking, on average, two minutes longer than they did three years ago to respond to the most serious call-outs. The chief executive of the service is quite open about the fact that she does not have enough staff on each shift every day. This is a service in chaos. Will the Minister be explicit about the support her Government are giving to ensure that my constituents, and Londoners, get the service they deserve?

[Official Report, 27 October 2014, Vol. 587, c. 1-2MC.]Jane Ellison: This affects my constituents too, as I am also a London MP and therefore take a very close interest in it. I think it is unfair to say that the trust is in chaos. It is taking urgent steps to address the situation, including recruiting extra paramedics, increasing overtime, and reducing the number of multiple vehicles attending each call. We are working with Health Education England to increase the pool of paramedics, with 240 being trained in 2014, going up to 700 in 2018. Urgent measures are being taken to address the problem right now. I have had those assurances directly from managers in the trust whom I met very recently.

Mr Jamie Reed (Copeland) (Lab): It is a fact that ambulances are taking longer to reach patients in the most critical condition. Today we are publishing figures regarding the increasing use of private ambulances. Nobody expects a private company to respond when they dial 999. Private ambulance usage has grown by 82% in the past two years nationally and by over 1,000% in London over the same period. Will the Secretary of State now admit that he sees no limit to the role of private companies in the national health service?

Jane Ellison: That is complete nonsense. The previous Government occasionally deployed private ambulances, which trusts use occasionally when they need to do so. This is another part of Labour’s myth of creeping privatisation, which is not true—it is absolute nonsense. It is important, however, in the interests of patient safety and as a short-term measure, that if that is what it takes, trusts must do it, as happened under the previous Government, because patient safety comes first.

Mental Health Nurses

9. Mike Kane (Wythenshawe and Sale East) (Lab): What estimate he has made of the number of mental health nurses working in the NHS in each of the last three years. [905546]

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The Minister of State, Department of Health (Norman Lamb): Mental health nurses are not identified in the NHS work force statistics. They work predominantly in psychiatric services, but also across a range of settings and the independent sector. The total number of full-time equivalent nurses working in psychiatric services was 39,472 in July 2012, 38,772 in July 2013, and 38,055 in July 2014. Since June, NHS organisations, including mental health trusts, have been required to report ward-level nursing numbers against safe staffing levels on NHS Choices.

Mike Kane: I am sure the Minister will join me in praising the hard work and dedication of all the staff at Laureate House mental health facility in Wythenshawe hospital in my constituency. The Government talk the talk, but do not walk the walk in terms of parity. Why has there been a decline in the number of mental health doctors over the past two years?

Norman Lamb: I also praise the work of the staff at the hon. Gentleman’s local trust. There has actually been an increase of more than 2,800 practitioners in psychological therapy since 2010 as part of the IAPT programme—increasing access to psychological therapies —which I am sure the hon. Gentleman will be very pleased to hear. For the first time, this Government are introducing access and waiting time standards in mental health, and that gives us the basis to achieve genuine equality for mental health for the first time ever.

Lorely Burt (Solihull) (LD): My local trust in Solihull tries to treat mentally ill patients out of hospital and at home whenever possible. That is commendable, but when a patient needs a bed they have to travel up to 200 miles because the trust operates at 100% capacity most of the time. Does my right hon. Friend agree that that is unacceptable and that more beds should be made available locally?

Norman Lamb: Yes, I agree that it is totally unacceptable for patients to be sent a long way away from home. In children’s services, we are investing £7 million extra this year to produce 50 more beds, and we are holding NHS organisations to account to ensure that they provide beds locally so that people do not have to travel long distances.

Luciana Berger (Liverpool, Wavertree) (Lab/Co-op): Research published yesterday by the Centre for Mental Health and the London School of Economics shows that perinatal mental illness is costing our economy more than £8 billion each year. Does the Minister think it is acceptable that half of mums do not have access to a service, are being separated from their babies, are being forced to travel hundreds of miles for a bed, or are not getting any help at all? What is he going to do about it?

Norman Lamb: The position has actually improved significantly. Last week, I visited a fantastic perinatal mental health service in Torbay where mums are getting support locally, as, indeed, they should be. I totally agree with the hon. Lady that it is unacceptable that people have to travel long distances, but across the country things are changing, and changing rapidly.

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NHS (North-East and Scotland)

10. Sir Alan Beith (Berwick-upon-Tweed) (LD): If he will take steps to encourage greater co-operation between the NHS in north-east England and in Scotland. [905547]

The Parliamentary Under-Secretary of State for Health (Jane Ellison): Of course, it is important that the national health services in all four parts of the UK work together. Good examples of that are happening at the moment on major public health issues, as my right hon. Friend can imagine. Providers in England can and do treat patients referred from Scotland, Wales and Northern Ireland. In England, we put emphasis on enabling patients to choose where they will be treated, not on restricting that choice to providers in England.

Sir Alan Beith: Does my hon. Friend agree that if someone’s nearest hospital or health centre is on the other side of the border, the health bureaucracy should not set up artificial barriers to access and any advice the Department gives should reflect that principle?

Jane Ellison: I am aware that this concern has been highlighted for my right hon. Friend by a very difficult constituency issue with regard to Northumberland clinical commissioning group. To be clear, the CCG is free to commission services from Scottish providers if it wishes to do so. No one instructs a CCG on where to commission services from—that is a decision for the CCG and one of the strengths of the system. Convenience may not be the most important factor in making that decision, but CCGs need to be assured of quality and standards. I am happy to talk to my right hon. Friend further about his particular case.

Leeds Children’s Heart Unit

11. Jason McCartney (Colne Valley) (Con): When the third stage of the review into the closure of surgery at Leeds children’s heart unit will be published. [905548]

The Parliamentary Under-Secretary of State for Health (George Freeman): Safe, compassionate care is an absolute priority for the Government. Publication of the Verita reports regarding the Leeds paediatric cardiac unit is a matter for NHS England. The reports are due to be published on 28 October, and copies will be placed on the NHS England website.

Jason McCartney: Constituents and clinicians continue to tell me that the children’s heart surgery unit goes from strength to strength, provides high-quality care, and has the full confidence of NHS England. Does the Minister sympathise with patients, families and clinicians who have faced uncertainty because of the delay of the third stage of the review?

George Freeman: Yes, I absolutely sympathise: I understand how important this is to local patients and their parents. As my hon. Friend knows, NHS England’s review of children’s heart surgery goes back a very long way—to the Bristol royal infirmary issues in the 1980s—and I know that Leeds and Newcastle Members are actively engaged on it. I can say that there is no immediate threat to any congenital heart surgery unit. NHS England

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has held a drop-in session with all MPs, and I encourage Members to make representations to the consultation on the national review.

Greg Mulholland (Leeds North West) (LD): The reality is that NHS England has made a mess of this. I hope that it will finally apologise when the third stage of the review is published. On the process that we have now, will my hon. Friend confirm that it is an open and fair process that will allow all units, including Leeds, to reach the important standards that we want for all our units?

George Freeman: My hon. Friend makes an important point. This is a matter for NHS England to deal with. I have made inquiries to ensure that the process is being followed as it should be. As I say, there is no immediate threat. The issues around the provision of congenital heart disease services are not limited to Leeds. NHS England is conducting a nationwide review of congenital heart services, which will look at the whole of life care pathways available across the country. The truth is that congenital heart diseases are often very serious illnesses affecting life expectancy and quality of life for patients, who will expect NHS England to put in place the very highest quality care and service available.

Rebalancing Project

12. Mr Graham Allen (Nottingham North) (Lab): What contribution his Department is making in support of the health objectives of the rebalancing project on dental checks for three-year-olds, foetal alcohol syndrome and lung screening for people over 60. [905549]

The Parliamentary Under-Secretary of State for Health (Jane Ellison): The hon. Gentleman and I have spoken a number of times about his valuable project. He knows that I am very interested in it and its outcomes. The Government are committed to improving oral health, with a particular focus on children, to reducing the incidence of foetal alcohol syndrome and to improving outcomes for all cancers. Results of major trials on lung cancer screening, including our own £2.4 million UK trial, are due in 2015. At that point, the UK national screening committee will review all the available evidence, looking towards a pilot.

Mr Allen: The rebalancing project, which covers my constituency, is I hope an innovative way of working that does not require additional money from the Government, but focuses on key health inequalities, such as a dental check for every three-year-old, the foetal alcohol syndrome prevalence study that we are trying to do and lung cancer screening for everyone over 60. Will the hon. Lady keep an eye on this work, use her reputation as a very committed Minister and visit us in Nottingham to see whether the work we are doing can be spread elsewhere in the UK?

Jane Ellison: All the issues that the hon. Gentleman outlines are extremely important. We, too, are very interested in the prevalence study on foetal alcohol syndrome. He may be aware that the World Health

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Organisation has just launched some work in that area, which will be of great interest to him. It would of course be a delight to visit the project.

Mr Speaker: These are splendidly succinct answers. Perhaps the Minister should issue her textbook to her colleagues. That would be extremely useful.

Bill Esterson (Sefton Central) (Lab): The Canadian Government say that foetal alcohol spectrum disorder is the most important preventable cause of severe childhood brain damage. The Minister told me in Westminster Hall last week that the chief medical officer’s review of the evidence is continuing. Is not the truth, however, that the evidence has been available for years, and that the time has come for the review to be published and for there to be much greater protection for the thousands of children who are damaged each year by women drinking in pregnancy?

Jane Ellison: We had a good debate last week in Westminster Hall. My reply remains what it was then: there is not complete clarity in clinical evidence on safe levels of drinking. That is exactly why the chief medical officer—[Interruption.] From the Opposition Front Bench, I hear cries of “Yes, there is.” I am sorry, but I am backing the UK’s chief medical officer over Opposition Front Benchers when it comes to the clinical basis for this. The review is important and is under way. I know that all Members will be interested in its outcome, and in how we can help to publicise good guidance to women on this very important issue.

Children’s Mental Health Services

13. Mr Russell Brown (Dumfries and Galloway) (Lab): What steps he is taking to improve access to and reduce waiting times for children’s mental health services. [905551]

The Minister of State, Department of Health (Norman Lamb): The taskforce on child and adolescent mental health is considering ways to improve access to children’s mental health services. The plan that we published earlier this month, “Achieving Better Access to Mental Health Services by 2020” sets out the ambition to extend waiting time standards across all mental health services by 2020. We are investing £7 million this year in providing an additional 50 beds.

Mr Brown: More and more children are being treated on adult psychiatric wards, with many having to travel hundreds of miles across the country for treatment, as has been said today. The chief executive of YoungMinds has said that the increase in the number of children being placed in adult wards was predictable, following the cuts to mental health services. Why did the Minister not see it coming and do something sooner?

Norman Lamb: We did see a problem emerging. That is why NHS England set up a taskforce to look at that precise problem. Its recommendation earlier this year was to add 50 beds, and that is what we are doing. The indication from October is that there is a significant increase in spare bed capacity within the system, so the problem is being addressed.

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Stephen Barclay (North East Cambridgeshire) (Con): I welcome the additional £7 million of investment. Given that 65% of children in Fenland wait more than 18 weeks for access to mental health services, will the Minister write to me to set out how the additional investment will help rural communities in particular?

Norman Lamb: I would be very happy to write to the hon. Gentleman. I am sure that he welcomes the fact that, for the first time, we are introducing access and waiting time standards in mental health, including in children’s mental health. Until now, there has been discrimination at the heart of the NHS. Labour introduced waiting time and access standards, but it left out mental health. That was completely unjustifiable and I am proud that the coalition is correcting it.

Seema Malhotra (Feltham and Heston) (Lab/Co-op): The cost of living crisis has had a huge impact on children’s well-being across Britain as families struggle. That issue has been raised with me by support workers in my constituency who have seen young people come forward with depression. That is compounded by the lack of mental health support services. Does the Minister recognise those issues? Is he happy with the data that he has available on the prevalence of young people’s mental health problems?

Norman Lamb: I absolutely recognise the problem. I have commissioned an up-to-date prevalence survey so that we have evidence that can help services around the country. If the hon. Lady wants to talk with me further about the problems in her area, I would be happy to do so.

Tim Farron (Westmorland and Lonsdale) (LD): A local report on mental health and emotional resilience among young people in South Lakeland found that the stigma surrounding mental health and the lack of sufficient resources over time mean that distressed and panic-stricken families often do not know how to begin to access the support that their children desperately need. How can my right hon. Friend help us get swift, clear and obvious access to mental health care for young people?

Norman Lamb: I welcome the study that has been undertaken in my hon. Friend’s area. The brilliant “time to change” campaign has done an awful lot to tackle stigma in mental health. We confirmed recently that the funding for that will continue in 2015-16. I accept that we need to do much more to improve access to children’s mental health services.

Cross-border Treatment (England/Wales)

14. David T. C. Davies (Monmouth) (Con): How many patients resident in England have written to him to request that they be treated in Wales. [905552]

The Secretary of State for Health (Mr Jeremy Hunt): Given the perilous state of the NHS in Labour-run Wales, my hon. Friend will not be surprised to know that not a single English patient has written to me asking for funding to be treated in Wales.

David T. C. Davies: My hon. Friend is correct. That will come as no surprise to anyone who has had dealings with the NHS in Wales. In the light of that, will he assure us that he will do everything possible to push

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ahead with the OECD comparison report into the health systems in Wales and England, on which the Welsh Assembly Government are disgracefully trying to obfuscate and cause delay because they are afraid of what might be discovered?

Mr Hunt: I am afraid that that says it all. Opposition Front Benchers tell us continually that they are not prepared to condemn what is happening in Wales and that the health service in Wales is performing well, yet here is an opportunity to prove it—an independent study by the OECD of the four NHS systems in the UK—and Labour is trying to block it. This issue matters, because the policies in Wales are what Labour wants to do in England.

Hywel Williams (Arfon) (PC): Will the Secretary of State concede that for many decades people from north Wales have had to travel to England for treatment? In that respect, both Government and Opposition Front Benchers are culpable.

Mr Hunt: The Government are happy for people to travel anywhere in the United Kingdom. My concern about health services in England is the pressure created, because for every patient that goes from England to Wales, five want to come from Wales to England.

17. [905555] Sir Oliver Heald (North East Hertfordshire) (Con): My right hon. Friend will be aware that his new website, My NHS, is providing much more openness and transparency for patients from England. To what extent does the extra information and ability to improve standards in hospitals as a result also apply to Wales?

Mr Hunt: This is the big lesson that we have learned after the tragedy of Mid Staffs. The Francis report said that the NHS had become over-dependent on a targets culture that was damaging for patients, and the Government think that the way to improve standards is through transparency, openness, and the pressure of peer review. We have embraced that lesson wholeheartedly, and it is such a shame that the Welsh Labour Government have taken a different tack.

Wayne David (Caerphilly) (Lab): Has the Secretary of State seen today’s Western Mail? If he has, he will know that the Western Mail, which is not a Labour supporting paper, totally condemns the scaremongering of the Conservative party.

Mr Hunt: When I started speaking out about poor care in England—one of the first things I did in this job—those on the Labour Front Bench said that I was running down the NHS. The result of my speaking out is that we are turning around failing hospitals and have 5,000 more nurses on our wards. The NHS in England is getting safer and better, and we want exactly the same thing for Wales.

Nurse Training

15. Barbara Keeley (Worsley and Eccles South) (Lab): How many training posts for nurses were commissioned in England in each of the last three years. [905553]

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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): Between 2010 and 2013, 52,528 new pre-registration nurse training places were filled, and this year Health Education England has made 19,206 new places available.

Barbara Keeley: It is interesting that the Secretary of State cannot follow his own advice about not making operational matters in the NHS political footballs. Perhaps we can try again. The number of nurse training places has been cut by thousands since 2010—a key issue given the need of hospitals to reach safe staffing levels. The Royal College of Nursing has said that Labour’s plans for 20,000 more nurses are absolutely necessary. Does the Minister agree?

Dr Poulter: It is right that hospitals respond when there are not enough staff working there, if that is affecting patient care. That is why under this Government 2,500 more nursing staff are working now than in 2010. That is progress to ensure that we are facing up to challenges in care where they exist at local hospitals.

Margot James (Stourbridge) (Con): Russells Hall hospital in the borough of Dudley has appointed 56 new nurses from overseas since the Keogh review last year. Will my hon. Friend join me in welcoming the graduate trainee programme for nursing that Russells Hall has put in place, which will provide for 100 trained nurses over future years?

Dr Poulter: That sounds like a commendable programme. It is good to hear that my hon. Friend’s local trust, where there was a shortage of nurses, is facing up to that and employing more nurses to ensure that patient care is as good as it can be.

Hospital Walk-in Centres

16. Mr Stephen Hepburn (Jarrow) (Lab): What recent representations he has received on hospital walk-in centres. [905554]

The Parliamentary Under-Secretary of State for Health (Jane Ellison): Ministers have received 34 representations regarding NHS walk-in centres.

Mr Hepburn: The NHS walk-in centre in Jarrow sees more than 27,000 people a year, yet the local management propose to close it to pay for the reorganisation that the Government have brought in. Will the Minister intervene on this occasion, overrule the manager and back the local people?

Jane Ellison: I find the hon. Gentleman’s question slightly mystifying. Responsibility for walk-in centres was passed to local commissioners in 2007, and as I understand, South Tyneside CCG is looking to improve urgent care in the area and reduce reliance on A and E. It reckons that 33,000 people did not need treatment in 2012-13 in the local A and E, so I quite see why it would want to review that. I urge the hon. Gentleman to engage with the consultation, and to get involved with some of the excellent north-east public health projects such as North East Better Health at Work, which is an award-winning scheme that would do a lot to relieve pressure on services.

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Topical Questions

T1. [905563] Heidi Alexander (Lewisham East) (Lab): If he will make a statement on his departmental responsibilities.

The Secretary of State for Health (Mr Jeremy Hunt): Last week, the Care Quality Commission published its “State of Care” report. This affirmed that the pace and scale of change to improve care in the NHS last year has been unprecedented, but it also contained some hard truths. It found that the variation in the quality of health in adult social care was too wide, and that too many hospitals have not got to grips with the basics of safety. This Government want every NHS patient to have confidence that their care will be both safe and compassionate. We have turned around six hospitals put into special measures, and people saying that their care is safe and compassionate are at record highs. We are determined to change the culture of the NHS away from secrecy towards transparency, and away from targets towards personal care where patients’ needs always come first.

Heidi Alexander: In August 2014, 10,616 patients had to wait longer than six weeks for a key cancer test. That is five times the number of people who had to wait that long in May 2010. If the Government do not support Labour’s commitment to a one-week cancer test guarantee, what action will they be taking to reduce waiting times?

Mr Hunt: As I said earlier, we welcome the fact that Labour is now interested in cancer policy. If we look at the reason for those delays, which we are working hard to address, it is because the number of cancer referrals—[Interruption.] Labour left this country with the worst cancer survival rate in western Europe; we are doing something about it. The reason for the delays is that the number of people being referred for cancer tests has gone up by 50% since 2010. We are treating record numbers of people with cancer because we want to do something about that survival rate.

T2. [905564] Philip Davies (Shipley) (Con): The Public Health Minister is pursuing a long list of nanny state proposals that we might have better expected from the Labour party, including plain packaging of tobacco, outlawing parents smoking in cars and having higher taxes on alcohol. Will she give us a list of which policies, if any, she is pursuing that have a Conservative flavour to them?

The Parliamentary Under-Secretary of State for Health (Jane Ellison): Following on from the Secretary of State’s previous answer, tobacco control is an integral part of tackling cancer. I am delighted to let the House know that smoking prevalence among adults in England fell to 18.4% in 2013. This is a record low, which means that the Government have hit their tobacco control plan target for 2015 two years early. I am sure that even my hon. Friend would welcome that news.

Andy Burnham (Leigh) (Lab): At their conference, the Tory party promised flat funding for the NHS in the next Parliament, but experts say that the service is at breaking point now and that the funding promised is

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not enough. Now, the Secretary of State’s own side are saying the same thing. The Chair of the Health Committee said last night:

“The Chancellor is going to have to write a bigger cheque”

or we will

“see reductions in services or waiting times increase”


“go down the route of top-ups and charges”.

Does the Secretary of State agree with her, and will he concede that a flat budget for the NHS in the next Parliament will not stop it tipping into a full-blown crisis?

Mr Jeremy Hunt: I am afraid that the shadow Health Secretary is misrepresenting what was said at the Conservative party conference. We promised not just to protect the NHS budget but to protect and continue to increase the NHS budget in real terms. I gently say to him that we have increased the NHS budget spend this Parliament by double the amount that Labour promised at its conference. We did that because on this side of the House we understand a simple truth: a strong NHS needs a strong economy.

Andy Burnham: The House will have noticed that the Secretary of State did not answer my question. There is a very simple reason why the Secretary of State cannot answer my question: his party has prioritised unfunded tax cuts for higher earners, leaving a large black hole in the public finances. There will be nothing left for the NHS if the Tories are re-elected. We on the Labour Benches, in contrast, have promised £2.5 billion over and above what they are committed to. Does that not make the choice on the NHS now clear: under Labour, more money for the NHS; under the Tories, tax cuts for some but an NHS crisis for all?

Mr Hunt: The right hon. Gentleman cannot have it both ways. The tax cuts the Government have prioritised are for lower-paid people, many of whom work in the NHS. When we had a strike last week, he was criticising the Government for not being more generous, but we have been generous—with the tax cuts he is now criticising. The NHS is facing the biggest financial squeeze in its history partly because of an ageing population but partly because the last Labour Government forgot about the deficit.

T3. [905566] Caroline Dinenage (Gosport) (Con): In my constituency, waiting times for GP appointments remain long and practices are struggling to recruit enough doctors. Will my right hon. Friend reassure me as to when the improvements he is making elsewhere in the country will take effect in Gosport, and will he meet me to discuss the matter?

Mr Hunt: I would be delighted to discuss it with my hon. Friend, who is right to focus on the role of GPs. If we are to transform the NHS by the end of the next Parliament, we need fundamentally to improve out-of-hospital care, and GPs are at the heart of that. We have recruited 1,000 more GPs during this Parliament, but we need many more, and that will definitely include her constituency.

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Derek Twigg (Halton) (Lab): We have a shortage of GPs in Halton. Constituents tell me it is more difficult to get an appointment, and in recent months, two GPs have told me that there are major problems with GP services in Halton and the country as a whole. Despite what the Secretary of State says about increased numbers of GPs, that is not happening in Halton. What is he doing to address the problem, particularly in areas of great deprivation, such as Halton?

Mr Hunt: There is pressure throughout the NHS because there are nearly 1 million more over-65s than there were four years ago, which puts pressure on GPs, as it does on any department or hospital providing elective care. However, this is not just about getting an appointment; it is also about ensuring that GPs have personal responsibility for the patients on their list and are accountable for the care of some of the most vulnerable people. We have brought back named GPs with personal responsibility for over-75s, and I hope the hon. Gentleman welcomes our going further and bringing it back for everyone.

T4. [905567] Neil Carmichael (Stroud) (Con): Meningitis Now, based in my constituency, is a keen supporter of the Men B vaccination for infants. Given the Joint Committee on Vaccination and Immunisation’s recommendation that it start, will the Minister update us on how the roll-out is progressing?

Jane Ellison: My hon. Friend is right to highlight this important issue. As he knows, the Department is negotiating with the manufacturer to purchase the vaccine at a cost-effective price, and he will understand that we need to ensure that NHS funds are used as effectively as possible. We are keen to see a positive conclusion to the negotiations as soon as possible so that plans for the Men B immunisation programme can be finalised.

Valerie Vaz (Walsall South) (Lab): Will the Secretary of State explain why NHS England has entered into a contract with a company based in Kent to provide GP services, when my constituents have just seen a string of locum GPs at a higher cost to the NHS?

Mr Jeremy Hunt: Wherever we can avoid it, we do not want to use locum GPs or nurses or agency doctors, because they are much more expensive—our spend on that is far too high—but sometimes when there are issues of patient safety we need a quick solution. That is what has happened in response to the Francis report: as well as recruiting 5,000 additional nurses on a permanent basis, we are using extra agency nurses. However, we hope to bring those numbers down.

T5. [905568] Simon Wright (Norwich South) (LD): I congratulate the Minister of State, Department of Health, my right hon. Friend the Member for North Norfolk (Norman Lamb), who has responsibility for care and support, on securing the introduction of NHS waiting times for mental health for the first time next year. How will he ensure that the resulting treatment is not only timely but evidence-based and effective?

The Minister of State, Department of Health (Norman Lamb): Last week, Mike Richards told me how waiting-time standards had transformed cancer care, and I think the

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same can happen for mental health. It is outrageous that somebody with a suspected cancer gets seen by a specialist within two weeks, but that if someone has a first episode of psychosis, who knows what will happen to them. That discrimination has to end, and we are delivering that.

Mr David Anderson (Blaydon) (Lab): The good people who work in the NHS have faced six years of pay restraint. How much longer must they carry the can for the failures of the people who got us into this mess—the moneylenders, the LIBOR fixers, the people who mis-sold mortgages? How much longer must front-line staff pay for the mistakes of capitalism?

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): Even in very difficult times this year, all NHS staff, either through their increments or through the 1% increase, will be getting a pay rise. Of course, we would like to do more, but the NHS finances are under pressure, and our priority is to ensure that we employ as many front-line staff as we can. We now have more than 13,000 more front-line staff working in the NHS than we did when we came into government.

T6. [905569] Charlie Elphicke (Dover) (Con): Can the Secretary of State confirm to the House whether there are any plans to sell off the NHS and will the NHS remain free at the point of delivery?

Mr Jeremy Hunt: I can confirm that there are no such plans and it will remain free at the point of delivery. Nor do we have any plans to pay private providers 11% more than NHS providers, as happened under the previous Labour Government.

Sheila Gilmore (Edinburgh East) (Lab): In response to my amendment to the Care Bill earlier this year about the portability of care packages to the countries of the UK, the Minister of State, Department of Health, the right hon. Member for North Norfolk (Norman Lamb), promised that a voluntary framework would be in place by November. It is 10 days until November, so how is progress going?

Norman Lamb: I thank the hon. Lady for that question. We have drawn up a statement of principles, we have been discussing them with the devolved Administrations and we hope very much that we will be able to achieve an agreed statement of principles in November. I cannot guarantee it, but that is absolutely our objective.

T7. [905570] Stephen Mosley (City of Chester) (Con): Healthwatch England recently released a report, “Suffering in silence”, that found that almost two thirds of people felt that their complaint about the NHS was not taken seriously and half ended up not receiving an apology or even hearing the word “sorry”. What action is my hon. Friend taking to ensure that complaints are taken seriously in the NHS?

The Parliamentary Under-Secretary of State for Health (George Freeman): My hon. Friend makes an excellent point. Following the appalling systemic abuse and neglect described in the Francis report, our response, set out in “Hard Truths”, focused relentlessly on hearing the patient voice, learning tough lessons on patient safety and care,

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and, in particular, the creation of the new independent chief inspector of hospitals, who is looking closely at all complaints. The health ombudsman has increased its caseload and we are also taking measures to display information on how to complain in every hospital and ward across the country.

Mrs Sharon Hodgson (Washington and Sunderland West) (Lab): Will the Secretary of State join me in paying tribute to Eilish Hoole, who sadly passed away in July from ovarian cancer. She was only 47 and the mother of five children. Following her diagnosis of late-stage ovarian cancer she campaigned tirelessly in Parliament with Target Ovarian Cancer, which led to the recent successful pilot of the awareness campaign in the north-west. Will the Secretary of State commit to roll that out to the rest of the country so that other women in her position get to see their children grow up?

Mr Jeremy Hunt: I am very happy to pay tribute to Eilish Hoole, to the many cancer campaigners and to the many people who have survived cancer and put their lives back together again. There is still a huge job to do in getting earlier diagnosis. I think there is agreement across the House about the need for much earlier cancer diagnosis, particularly for ovarian cancer, which makes a huge difference. I know that we would all like to pay tribute to her work.

Tim Farron (Westmorland and Lonsdale) (LD): NHS England has identified south Cumbria as one of just three places in England where travel times to receive radiotherapy are unacceptably and debilitatingly long. Will the Secretary of State meet me and NHS England to talk about how Kendal hospital can be the place for a new radiotherapy centre this autumn?

Jane Ellison: I would be happy to meet the hon. Gentleman and discuss this important issue for his constituents.

Kate Green (Stretford and Urmston) (Lab): The NHS Litigation Authority is piloting a new approach to improve feedback and learning in response to allegations of negligence. Will the Secretary of State say how patients can find out what feedback the NHSLA has given to individual trusts and how the trusts have responded?

Dr Poulter: The hon. Lady raises an important issue, which is that the NHS Litigation Authority often picks up on things when they do not go well and when the communication between patients and trusts has broken down. That is one of the things that need to be put right. I will look into the matter and write to her, because it is important that when things go wrong patients are supported in the right way and the lessons are learned.

T9. [905572] Annette Brooke (Mid Dorset and North Poole) (LD): Currently, there are no psychiatric intensive care unit beds for women in Dorset. One of my constituents was recently sent to a unit in Bradford. Will additional funding be available to address this appalling situation?

Norman Lamb: I am very happy to meet my right hon. Friend to discuss the concerns in her area. I heard similar concerns when I was in Devon last week and

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clearly the objective must be to have facilities close to where people live, rather than their having to travel long distances.

Fiona Mactaggart (Slough) (Lab): I assume that the Secretary of State has read the National Audit Office’s report on local funding for health care. In the 17 years for which I have been Member of Parliament for Slough, we have never reached our target for funding and now the gap between Slough’s target and our actual funding is greater than ever before. What is he going to do to ensure that areas get the funding they need to provide the health care their residents require?

Mr Jeremy Hunt: First, we have made the decision an independent one, taken at arm’s length from Ministers, to try to take the party politics out of it. Secondly, we protected the NHS budget. Thirdly, one of the most important and significant things for the hon. Lady’s constituents has been the way in which the Heatherwood and Wexham Park NHS Trust has been turned round from failing and being in special measures to being taken over and run by Frimley Park NHS Trust—the most successful trust in the country.

Several hon. Members rose

Mr Speaker: Order. We have overrun, principally because of long questions and answers earlier, but I am keen to accommodate a couple more colleagues.

Fiona Bruce (Congleton) (Con): Mitochondrial technique was last tried on humans in 2003 by John Zhang, resulting, I understand, in two still births and an abortion. Last week, one of the members of an expert panel of the Human Fertilisation and Embryology Authority said he had only just become aware of Zhang’s study. What action will Ministers take to ensure that this worrying study is properly examined before any steps are taken to bring this issue before the House?

Jane Ellison: My hon. Friend takes a great interest in this matter and led the Back-Bench business debate on 1 September. I will certainly ask the HFEA and the expert panel to look at the study to which she refers, but

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I can provide the reassurance I have given before—that the wide body of expertise and information out there about mitochondrial disease is regularly reviewed over a long period of time.

Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op): The Secretary of State makes great play of protecting the NHS budget, but NHS England, the Nuffield Trust and his hon. Friend the Chair of the Health Committee all agree that it needs another £30 billion investment, so how can he tell people that the NHS is safe under his watch?

Mr Jeremy Hunt: We have not just protected the NHS budget, but increased it in real terms, which I think is a huge achievement given the state of the economy we inherited. [Interruption.] I simply say to the hon. Lady that the way to protect and secure NHS funding for the future is by making sure that there is a strong economy to pay for it. That is the single most important thing of all.

Sir Nick Harvey (North Devon) (LD) rose—

Mr Speaker: Last but not least we shall hear from a Devon knight.

Sir Nick Harvey: Thank you, Mr Speaker.

Devon clinical commissioning group is embarking on a major programme of change next year, closing community hospital beds and replacing them with services at home. Do Ministers see that public and staff would have more confidence in the new services if they were being worked up first before getting rid of the existing services? Could the better care fund put money into the transition?

Norman Lamb: I thank my hon. Friend for that question. The better care fund is the biggest ever transfer of resources to preventive care and for integrated care. I saw last week in my hon. Friend’s own county fantastic integrated care in Torbay and Southern Devon NHS Trust, but I would be happy to discuss his particular concerns as soon as possible.

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Point of Order

12.37 pm

Sir Oliver Heald (North East Hertfordshire) (Con): On a point of order, Mr Speaker. I seek your guidance. Last Friday, at column 591 in Hansard, I intervened on the shadow Foreign Secretary to ask him to confirm that the German Government’s coalition agreement makes specific reference to EU treaty change. He denied this, and said that there was not a single reference in that document to it. However, at page 111, the document says:

“Wir werden die vertraglichen Grundlagen der Wirtschaft und Wahrungsunion anpassen”,

which means, “We will adapt the Treaty bases of the Economic and Monetary Union.” Should not the shadow Foreign Secretary, as a senior Privy Counsellor, come to the House and correct the record? He got it wrong; I got it right.

Mr Speaker: I am immensely grateful to the hon. and learned Gentleman, but whether his German accent would command the approval of the hon. Member for Birmingham, Edgbaston (Ms Stuart), I leave open to speculation and conjecture. I am sure that the hon. and learned Gentleman has done himself and those who think like him on this matter a service. I am asked whether the shadow Foreign Secretary should come to the House in these circumstances, I think my response—I am well advised on these matters—is that there is no need for that to happen. It is a matter of judgment for the individual Member concerned. In any case, the hon. and learned Gentleman has put his point very firmly, very clearly and, I hope, intelligently on the record. [Interruption.] It is true that there was a quotation in German, but I was exercising a generosity of spirit that I thought was appropriate. [Interruption.] I think we probably need to improve the tone somewhat.

Bill Presented

General Practitioner Surgeries (Rural Areas) Bill

Presentation and First Reading (Standing Order No. 57)

Tim Farron presented a Bill to require provision of General Practitioner surgeries in certain rural areas; and for connected purposes.

Bill read the First time; to be read a Second time on Friday 9 January 2015, and to be printed (Bill 105)

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Sex and Relationships Education (Curriculum)

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

12.39 pm

Diana Johnson (Kingston upon Hull North) (Lab): I beg to move,

That leave be given to bring in a Bill to require the Secretary of State to make provision to include education about sex and relationships, resilience against bullying and sexual abuse and ending violence against women and girls in the national curriculum; and for connected purposes.

I am very pleased to have the opportunity to present this Bill. I do so in view of the many disturbing cases of child abuse and exploitation that have come to light around the country recently. They include abuse in Derby, Telford, Peterborough and Rotherham and in north Wales care homes, and high-profile cases such as those of Jimmy Savile and Rolf Harris. There is also an ever-growing online threat. There are more opportunities for those who wish to harm our children to have unfettered online access to them. Tens of thousands of people are known to access child abuse images online, and I believe that we have reached a point at which we must think afresh about what more can be done to keep our children and young people as safe as possible from child sexual exploitation and abuse. One part of that will be ensuring that all children have access to effective, high-quality, evidence-based relationship and sex education in all schools.

I recently read Professor Jay’s report on the child exploitation scandal in Rotherham. Like all Members, I was shocked at what had happened to so many young people in the town, although we know that that was not an isolated incident. There are cases throughout the country of children being groomed and abused in towns and cities from Rochdale to Oxford. One particular instance in Professor Jay’s report caught my eye. Paragraph 8.13 states:

“The young people we met in the course of the Inquiry were scathing about the sex education they received at school. They complained that it only focused on contraception…They thought the sex education was out of touch and needed to be updated.”

What also caught my eye was that, according to the report, those young people had said that when a local organisation called Risky Business had arranged awareness-raising about child sexual exploitation, they had thought that it was very good, particularly when a survivor had spoken to them about their experience.

A clear recommendation in a recent report by the Children’s Commissioner on a national approach to safeguarding and protecting children was that, as part of the national strategy to tackle abuse, we need relationship education which explains what healthy relationships look like—answering questions such as “What is sexual exploitation?” and covering issues of consent and domestic abuse—and which is delivered in all schools by people with specialist expertise and knowledge.

Jane Lees, chair of the Sex Education Forum, has said:

“The details of the Harris and Savile cases have been shocking, in particular, the long periods of time during which victims suffered in silence and the wide range of ages of children and adults that were abused. The widespread publicity and information

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around the cases helpfully resulted in further victims coming forward. But we need to ensure that there is a better understanding of abuse so that children and young people are kept safe. It is for this reason we need a long lasting approach based on a guarantee that all schools teach children good quality SRE which includes learning to recognise and be able to talk about inappropriate sexual contact by others. Learning about what is and isn’t abusive behaviour is essential to help keep children safe from harm. We must respond to these cases by creating a legacy of guaranteed education for all children.”

For many years I have been convinced of the need to reform and overhaul the sex education that we provide for our young people, and to focus more widely on relationships and emotions. It is clear that the sex education that currently exists in schools is inadequate, just as the children in Rotherham said. It focuses on biology and what fits where, on sexual diseases, and on how not to get pregnant. We know that young people are often very savvy about the mechanics of sex, but lack any understanding of the potential dangers and threats that they face.

Ofsted has stated in recent reports that SRE requires improvements in nearly 50% of secondary schools. Students felt that there was too little teaching about relationships and too much emphasis on the mechanics of reproduction, and that lessons in personal, social, health and economic education had avoided discussions of sexual and emotional feelings and controversial issues such as abuse, homosexuality and pornography. Other recent evidence from Ofsted shows that, in some instances, SRE was limited to as little as two hours taught in the last year of primary school. Ofsted also found that younger pupils did not always learn the correct names for the sexual parts of their bodies. This can leave children muddled about their bodies and hampered by a lack of language to report sexual abuse. Plus, when the Sex Education Forum surveyed more than 800 young people, it found that one in three either did not know or were unsure about where to get help if they were sexually assaulted.

Now is the time to create a broad alliance of support for statutory sex and relationship education. A Mumsnet survey found that 92% parents wanted SRE to be compulsory at secondary school and that 69% wanted it to be compulsory at primary school, while 82% wanted it specifically to address sexual violence and bullying.

Of course we want parents and families to be part of the discussions with youngsters about relationships and keeping safe, but we cannot stand back and hope that all families will have those conversations when we know that it is often the most vulnerable children who do not have family support in this area. If we equip all our children with the tools to help them to keep safe, we will know that they have been taught how to identify abusive behaviour and the tactics of perpetrators and groomers, and that they will have learned what sexual consent actually means and what a loving and respectful relationship looks like.

We also know that there is huge support out there from charities and voluntary organisations. End Violence Against Women, the teaching unions, Brook, the Family Planning Association, the National Society for the Prevention of Cruelty to Children, the Terence Higgins Trust and many others are all calling for statutory SRE.

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At Hull’s recent Freedom festival in September, I came across a grooming prevention initiative that was being run by the Hull domestic abuse partnership team and the Soroptimists. It highlighted for young people the behaviours involved in acceptable and unacceptable relationships. It had cards with questions such as “If he really loves you, how does he treat you?” and answers “He respects and trusts you for what you are”; He is kind and makes you feel comfortable”; “He listens to you and tells you the truth”. Similarly, it asked what an abusive relationship might look like. The answers included “He frightens me”, “He gets violent”, “He bullies me”, “He teases me in public” and “He always blames me”. That is the type of work that needs to be done in all schools and taught to all children and young people.

The time has now come for the Government to act. They have been woeful in looking at new ways of ensuring that we keep our children safe in the light of what has happened in recent times. The previous Education Secretary agreed to make financial education part of the national curriculum as he was concerned about students’ financial literacy. We now need to be concerned about keeping our children safe, and that means that we need compulsory relationship and sex education in all our schools. We want to build up our children’s self-esteem and confidence so that they are clear about what good healthy relationships look like and what is acceptable, and so that they know who to go to, and when, if they are concerned about unwanted or unacceptable behaviour towards them.

Protecting children is everyone’s business, and schools and education have a vital part to play. This is about reinforcing good parenting, not replacing it. However, leaving it all to parents, which is the current approach and the approach of decades past, is not working. That approach is failing, and it is not fit to deal with the challenges of the future. In our free, open digital technology society, we cannot protect youngsters totally from every conceivable danger or from the increasing opportunities available to potential abusers. However, a modern education can equip young people with skills that can tilt the odds in their favour and firmly against those seeking to harm or exploit them. Why would we not want to give them those skills? Why would we not introduce compulsory relationship and sex education to keep all our children as safe as possible?

12.49 pm

Philip Davies (Shipley) (Con): I rise to oppose the Bill of the hon. Member for Kingston upon Hull North (Diana Johnson), but I should begin by congratulating her on the impressive doughnut she managed to arrange for herself, masking the fact that the people around the doughnut were the only Members on her side actually in the Chamber at the time. I give her full marks for her doughnut, which was better than her speech.

When a politician is faced with a problem—this is not necessarily a party political point—their solution always incorporates two ingredients. The first ingredient is that they have got to be seen to be doing something. I long for the day when a Minister stands up at the Dispatch Box and says, “Actually, that’s got nothing to do with the Government; that is for people to sort out for themselves.” They never do, however; politicians always want to highlight how important and powerful they are. The second ingredient in their solution is that what they

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propose does not really offend anybody. As long as they can come up with something that looks as if they are doing something and does not really offend anybody, that will be the solution they will go for, even if it will not make a blind bit of difference to the problem.


The hon. Lady’s speech today was a prime example of a politician who wants to be seen to be doing something with a proposal that does not really offend anybody, and which will make absolutely no difference at all to the problem she has rightly highlighted.


The hon. Lady talks about the importance of dealing—[Interruption.] I know that Opposition Members are so intolerant of other people’s opinions that they do not like to listen to them—

Mr Speaker: Order. The hon. Gentleman was, I think, being heard, because he rarely has any difficulty in making himself heard, but the hon. Gentleman must be heard.

Philip Davies: Thank you very much, Mr Speaker.

When the hon. Lady talks about the problems of child abuse, everybody agrees; of course we all agree that there is a massive problem with child abuse and it needs to be tackled. She highlighted the problems we found in Rotherham, but I am not sure most of my constituents would think the answer to that is to make sex education compulsory. Actually, I think what most people identified as the problem was the culture of political correctness that Labour councils up and down the country were cultivating, which prevented good people from speaking out about the disgusting things that were happening. If the hon. Lady had introduced an anti-political correctness Bill in Labour local authorities, it might have actually made some real difference. Trying to pretend that the solution to this problem is compulsory sex education is completely ludicrous.

We have been having sex education in our schools for more than 40 years, and it was supposedly going to solve things such as teenage pregnancies and unwanted pregnancies. Most of my constituents would probably conclude that the more sex education we have had since the early 1970s, the more teenage pregnancies and unwanted pregnancies we have had. [Interruption.] Perhaps somebody might look at the evidence—[Interruption.] I know Opposition Members do not want to hear this, but they might want to look at the evidence and then they might think that perhaps we should try less sex education in schools—or perhaps, even better, no sex education at all. That might be a better tactic.[Interruption.]

I will point out—[Interruption.]

Mr Speaker: Order. Fiona Mactaggart, you are an excessively excitable individual on occasion. Calm yourself and seek to behave with restraint, and as the aspiring stateswoman you should want to be.

Philip Davies: Thank you, Mr Speaker. The Labour party is known for its intolerance of other people’s opinions. I am just pleased Labour Members are highlighting that so effectively today.

The sex education fanatics always point to Holland, because in Holland they have lots of sex education at a very young age and they have very low levels of teenage pregnancy, but the sex education fanatics never mention

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Italy. Italy has equally low levels of teenage pregnancies and unwanted pregnancies, but has very little sex education. A few years ago I looked at what Holland and Italy had in common, because then we might find out the true solution. What they have in common—and have had in common for many years—is that they have much closer family units, where families are much more likely to do things such as eat meals together. They have also historically been spectacularly ungenerous to single mothers in the benefits system and the housing allocation system. If we want to tackle issues such as teenage pregnancies and unwanted pregnancies, it would be much better to look at the benefit systems and the housing allocation system. That would make much more of a difference than this ridiculous obsession with more and more sex education.

As sex education has failed, people like the hon. Member for Kingston upon Hull North have said, “Actually, what we need is more sex education.” As we have had more sex education, however, the problem has got worse, as she has highlighted. She then changes tack and says, “Actually, what we need is better sex education.” Actually, one day everybody will have to conclude that what we need is less sex education, or even better, none.

The hon. Lady spectacularly failed to mention the role of parents. The message we should be giving to parents is this: “Being a parent is a very responsible business. You should not enter into it lightly and there are things that only parents can do and are expected to do, because the state cannot fulfil the role of a parent for you.” We have got ourselves into a problem by saying, “If you’re a parent, don’t worry about what you do. Don’t worry about whether you’re doing a good job, because if you don’t do a good job of it—if you don’t care about it—the state will pick up the pieces for you.” That is an appalling message to send out to people. We should be saying, “This is a serious business and an important matter and there are certain things that are your responsibility alone, and the state cannot take those functions away.”

Some parents may well be bad at teaching sex education, but who is to say that all teachers are good at teaching sex education? It may well be that many teachers are not very good at teaching sex education and that the parent would have been the best person to teach it to the child. We should not forget that point.

My job as a parent is to bring up my children with my values and the values I think are important to instil in them. I do not want my children to have the teacher’s values instilled in them, whether or not I like or support them. These are things that should be done by parents and parents alone. Teachers should be there to teach children about things parents are not capable of teaching, not about the things that parents should be teaching if they were doing their job properly.

If we want to tackle the problem of child abuse—which we all want to do in this House—let us look at the root causes: the political correctness of the Labour party that caused the problems in Rotherham. Let us not go down the route of this nanny state version of a Bill which is a complete waste of time and will make absolutely no difference at all, but fulfils the role I mentioned at the start, of a politician who wants to look as if they are doing something proposing something that does not really offend anybody. It offends me, and it offends people out in the country.

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I will not delay the House by calling for a Division, as there is an important debate coming up and I would not want to highlight how silly some of the Labour Members are in the Lobby. So we will just leave it at that, but I hope this Bill goes absolutely nowhere.

Question put and agreed to.


That Diana Johnson, Simon Danczuk, Sarah Champion, Kevin Barron, John Healey, Mrs Sharon Hodgson, Lyn Brown, Barbara Keeley, Roberta Blackman-Woods, Andrew Gwynne and Wayne David present the Bill.

Diana Johnson accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 21 November, and to be printed (Bill 101).

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Recall of MPs Bill

[Relevant documents: First Report from the Political and Constitutional Reform Committee, Session 2012-13, Recall of MPs, HC 373, and the Government responses, HC 646 and Cm 8640.]

12.58 pm

The Minister of State, Cabinet Office (Greg Clark): I beg to move, That the Bill be now read a Second time.

The Recall of MPs Bill fulfils a commitment made by the three main parties in their 2010 manifestos and in the coalition’s programme for government to establish a recall mechanism for MPs who have been found guilty of wrongdoing or misconduct. Allow me to quote from my own party’s manifesto:

“at the moment, there is no way that local constituents can remove an MP found guilty of serious wrongdoing until there is a general election. That is why a Conservative government will introduce a power of ‘recall’ to allow electors to kick out MPs, a power that will be triggered by proven serious wrongdoing.”

That is the manifesto on which I stood at the last election and the one that I stand by today.

The Bill fulfils the commitment that we made in 2010, and, to put it candidly, seeks to reconcile differences within this legislature. Although we are agreed on the principle that MPs must be held to account when they have done something wrong, delivering on the practical detail of a recall mechanism has been more difficult. There is a wide range of views on how and whether it should be done.

Members will concede that we have not rushed into this reform. The Government opened the debate on recall when they published their White Paper and draft Recall of MPs Bill in 2011. I am grateful to the Political and Constitutional Reform Committee for its work. Its Chairman was in his place—I dare say he will be back.

Mr Frank Field (Birkenhead) (Lab): He has been recalled!

Greg Clark: I suspect that the hon. Member for Nottingham North (Mr Allen) would be robust in the face of such measures. The Committee has done considerable and painstaking work in conducting pre-legislative scrutiny of these proposals. It made some valuable recommendations, particularly on the recall petition process, most of which the Government have accepted and incorporated into the Bill.

As Members who follow this debate know, the Committee also concluded that there was no need for a recall system as it did not see a gap in the disciplinary arrangements for MPs. That view is shared by some Members, but not by the Government.

Mr Andrew Robathan (South Leicestershire) (Con): My right hon. Friend may know that I have recalled myself and that I am not standing again at the next general election, but I am struggling after 22 years in this House to understand the point of this Bill. I have seen people who have done wrong and have gone—quite rightly. Of the people caught up in the expenses scandal, several, quite rightly, have gone to prison. Denis MacShane went to prison and Patrick Mercer resigned his seat—quite rightly. But I can only think of two people who might have been affected by this Bill, and unless we make the

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powers retrospective to 2002, I do not see that it will affect the hon. Gentleman who sits on the Labour Benches whom I will not name because I have not mentioned it to him. Possibly, it might have affected one Member who was recently expelled from the Liberal Democrat party, but actually he has not committed a criminal offence as far as we know. So what exactly is the question that this Bill answers?

Greg Clark: First, let me say that we will miss my right hon. Friend in this House, and we are sorry that he has recalled himself. As he knows, MPs are disqualified from attending the House if they are sentenced to imprisonment for more than a year, but not below that. That is a gap, and this Bill puts forward a means of closing it. The other thing that this Bill does is enable the House to put before the electorate the question of whether an MP, who has been severely sanctioned by the Standards and Privileges Committee and suspended for more than 21 days, should continue in post. There are cases of Members who have been sentenced to terms of imprisonment for less than a year to whom this Bill would directly apply.

Mr Charles Walker (Broxbourne) (Con): My right hon. Friend has said that there are people who have been sentenced to prison to whom this Bill would directly apply. Who are those people?

Greg Clark: Clearly, this Bill would not apply retrospectively, but the two people who would have been caught are Chris Huhne and Eric Illsley.

Mr Robathan: They have gone.

Greg Clark: My right hon. Friend makes a reasonable point that those Members chose to resign. The fact that it was their choice rather than there being an element of compulsion is the loophole that this Bill seeks to close.

Mr Frank Field: Is the issue not somewhat different? It is about not how we feel, but how our constituents feel. We might be puzzled when people question our behaviour, but we are no longer in the world in which we can behave as we wish and for our constituents to push off. Our constituents will start defining what they think is acceptable behaviour by us. The key thing that we must ensure in this Bill, which I welcome, is that the threshold is such so that pernicious lobbies, such as the gun lobby in America if it were operating here, could not take Members out just because they disagree with their views.

Greg Clark: My right hon. Friend the Member for South Leicestershire (Mr Robathan) and the right hon. Gentleman make my case for me: there is not agreement across the House. I merely observe that this Bill was a commitment that we made in the manifesto on which we fought the last election, and that is true for the three main parties. It is reasonable to reflect that there is an expectation on parties that stood on such a commitment that they will bring forward such a Bill.

Robert Neill (Bromley and Chislehurst) (Con): My right hon. Friend is making a good case, and I shall certainly be supporting him. As the right hon. Member for Birkenhead (Mr Field) said, is not the key issue that if we are to have a greater degree of openness towards our constituents, there must none the less be something

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that triggers an objective finding of bad behaviour—be it by conviction or by some other form of sanction? Without that, there is a risk that campaigning MPs who take up unpopular causes could be subject to victimisation by various pressure groups.

Greg Clark: I am grateful to my hon. Friend for his point. He is taking up a popular cause, but there are occasions when Members should and will take up unpopular causes. It would be infinitely regrettable if they were to lose their seat in this House by a campaign that sought to silence them.

Mr David Winnick (Walsall North) (Lab) rose

Greg Clark: Let me make a bit of progress. The diametrically opposed view is that a recall system should be implemented to allow the recall of MPs on any grounds and at any time, including disagreements with an MP’s stance on a matter of policy. My hon. Friend the Member for Bromley and Chislehurst (Robert Neill) makes the counter argument, but my hon. Friend the Member for Richmond Park (Zac Goldsmith) takes the view that a policy disagreement between an MP and his or her constituents is such a ground. That is not the position of the Government, or the commitment that was made in the party manifestos.

Mr David Heath (Somerton and Frome) (LD): The right hon. Gentleman is explaining quite clearly the difference between what is misconduct and bad behaviour, which would get someone sacked from any other job in any other circumstances, and what is simply a disagreement over policy, where it would be possible for people to use a large amount of money effectively to remove an MP. But does he understand the concern that many members of the public have that the trigger for this at the moment is in a group of MPs in the form of the Standards and Privileges Committee? Does he understand that perhaps there needs to be an alternative mechanism that goes directly to the point of petition?

Greg Clark: I do understand both points that my hon. Friend makes. The question of a trigger is something that we will be debating both today and in Committee. Members who have served on Bill Committees with me will know that I have always taken a view that when experienced Members of Parliament debate a subject of great importance and interest—where the matters divide on party political lines—it is right and appropriate that the Government should reflect on the proposals, or amendments, put forward. I will confirm that we will do that and that we will take very seriously the views of the House.

Mr Winnick: Wrongdoing is always to be condemned. Is it not the case that MPs such as Sydney Silverman, who urged the abolition of capital punishment and who won the day after a long and hard campaign, and those who fought for the reform of homosexuality laws and for abortion and many other very unpopular issues, would have been in danger if this legislation had been in force?

Greg Clark: The drafting of the Bill reflects that undesirable risk that matters of conscience could result in the loss of a seat. A general election inevitably

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follows the MP’s selection. We all make policy arguments to our electorate each time, and the ability to do that is still in place.

Mr Stewart Jackson (Peterborough) (Con): Several of us have serious worries about undermining not just the sovereignty of Parliament, but the sanctity of the general election. My right hon. Friend will know that Edmund Burke said in the 18th century that he was a representative, not a delegate. It is noteworthy that he was removed by the electors of Bristol in a general election shortly thereafter.

Greg Clark: My hon. Friend is absolutely right. Many hon. Members will be familiar with what Edmund Burke said:

“Your representative owes you, not his industry only, but his judgment; and he betrays instead of serving you if he sacrifices it to your opinion.”

He made that point very strongly and was promptly thrown out by the electorate at the next election, which illustrates the point arising from the intervention made by the hon. Member for Walsall North (Mr Winnick).

Our early exchanges have made it clear that the opposing poles—I hesitate to call them extremes—in the debate have good intentions, and reasonable and serious points are being made. In developing the proposals, the Government have tried to steer a sensible and reasonable course. We believe that recall has a role in dealing with serious wrongdoing. If an MP has been found guilty of serious wrongdoing and clear lines have been crossed, the public must have their say about whether that Member should remain in office.

We have stopped short of enabling recall on any grounds so that we preserve the freedom of Members of Parliament to vote with their conscience and to take difficult decisions without facing constant challenges, at the public’s expense, from their political opponents. We have, of course, considered a range of recall models, including those used internationally, but there is no direct equivalent in a constitutional system such as ours anywhere in the world, so we are breaking new ground, and it is the tradition of the House and the country that we proceed with care when making constitutional change.

Mr Frank Roy (Motherwell and Wishaw) (Lab): I support the Bill, but I am sure that the Minister realises that it has serious flaws. For example, why would it not cover the MPs who took cash for questions in the 1990s?

Greg Clark: Clearly, like most legislation, the Bill will not apply retrospectively, but if the Standards Committee was to recommend that an MP be suspended for 21 or more sitting days due to precisely such a breach of the code, that Member would be liable for recall.

Richard Drax (South Dorset) (Con): I have been here long enough to know that Bills are all too often a huge sledgehammer to crack a nut. If the Bill goes through, I fear that it will be added to in time, as I know that many MPs and members of the public want to take things a lot further. That is why many Members are voicing their

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fears, which I share, that an MP’s position could be severely destabilised. I recommend caution and that we leave things as they are.

Greg Clark: I hope that hon. Members on both sides of the House will concede that we are proceeding with caution. We recognise that this is a novel constitutional step, and our traditions are that we exercise caution in such circumstances. The Prime Minister made it clear during last week’s Question Time that we regard the provisions as a minimum, and the various arguments that have been deployed today can be properly considered in Committee and on Report. Of course, whatever the House and the other place decide, it will be open to future Parliaments—one will begin next year—to consider whether to take things further still. That is the spirit in which we are proceeding.

Mr Charles Walker: I would take the Government’s position more seriously if, at the start of this Parliament in 2010, they had not made it almost impossible for this House to recall a Government.

Greg Clark: My hon. Friend takes us on to an area that could detain us for the rest of the day. He and I would prefer to be implementing all the Conservative party’s manifesto commitments, but the electorate did not give us a majority, so we formed a coalition, which I think has made great achievements, not least by turning around the economy through its effective, long-term economic plan.

Let me set out the provisions that will govern the debate not just today, but in Committee and on Report. There are two conditions under which a recall petition would be opened. The first trigger is if a Member of Parliament is convicted in the United Kingdom of an offence for which they receive a custodial sentence of 12 months or less. At present, any MP who is imprisoned for more than a year is automatically disqualified from Parliament, but if they receive a sentence of 12 months or less, they can keep their job until the next general election. The Bill will close that loophole.

The imprisonment of a Member of Parliament will, quite understandably, cause many constituents to question their faith in that MP. Incarceration not only indicates serious wrongdoing, but prevents that Member from doing their job effectively, so the Government believe that constituents should be able to decide whether there should be a by-election in such circumstances. Of course, it would remain open for the recalled Member of Parliament to stand as a candidate in that by-election, should they wish to justify the actions that led to that sentence of imprisonment.

Jacob Rees-Mogg (North East Somerset) (Con): I broadly support the Bill, but with regard to that point, is it strictly necessary? It is open to the House—this has been done in the past—to expel a Member who has been sentenced to prison. Is it not the failure to use our existing powers, rather than a need to create new powers, that is at issue?

Greg Clark: My hon. Friend, who is learned and reflective on these matters, is right that the power to expel a Member exists. However, constituents do not have the power to decide whether a seat should be vacated, but that would be available under the Bill.

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Jonathan Edwards (Carmarthen East and Dinefwr) (PC): What discussions has the Minister had with the devolved Governments about using the Bill to empower the devolved institutions, if they so wish, to introduce their own recall mechanism?

Greg Clark: I think I have made it clear that the Bill is not the last word on recall. It will apply specifically to Members of Parliament and it will govern simply the procedures of the House. It has been difficult enough to establish a consensus in this House, let alone in the devolved Administrations and beyond. However, as we heard from my hon. Friend the Member for South Dorset (Richard Drax), it will be open to future Parliaments to take a different view.

Lady Hermon (North Down) (Ind): The Minister will be well aware that five Sinn Fein Members do not take their seats in the House. Will he make it absolutely clear to those absentee Northern Ireland MPs—and to the House and the general public—that the Bill will apply equally to them?

Greg Clark: The hon. Lady makes an important point in the context of Northern Ireland. My understanding is that the Bill would not apply to those Members because they have not taken the Oath to sit in the House, but she will no doubt wish to raise that point in Committee.

Mr David Davis (Haltemprice and Howden) (Con): I favour a recall Bill and understand that my right hon. Friend has found it difficult to get an agreement, but might we at least have some logic in this process? Under the mechanism set out in the Bill, a Member of Parliament who was arrested at a demonstration and imprisoned would be forced to take part in a new election if 10% of his constituents disapproved of his position.

Greg Clark: My right hon. Friend clearly exposes one of the aspects of our debate. The decision would be in the hands of that Member’s constituents in two respects: a petition of 10% of the electorate would be required to occasion a recall by-election; and then that Member could stand in the by-election. My right hon. Friend has experience of standing in a by-election—not caused by any wrongdoing, I hasten to say, but because he was making a point—and he won the support of his constituents for his action, so his experience might provide some reassurance.

Mr Frank Field: It really comes back to the point—many Members have made it—about the threshold needing to be high enough. There are clearly two ways in which people view the electorate. I was under recall by the Trots for 10 years, and it was the electorate who saved me. It is possible to look to one’s voters as a bulwark of freedom, not as a group of people who wish to destroy us.

Greg Clark: The right hon. Gentleman makes an excellent point. None of us would be here today had we not had the endorsement of our constituents, and none of us should be afraid of that endorsement.

The second trigger is if an MP is suspended from the House for 21 sitting days or more. A suspension of such length indicates that the individual in question has

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done something seriously wrong, and constituents should be able to have their say about whether their MP deserves to keep his or her seat.

Frank Dobson (Holborn and St Pancras) (Lab): With the right hon. Gentleman give way?

Greg Clark: I will make some progress before giving way again.

Comparisons with the second trigger provisions published in the draft Bill will reveal changes that have arisen from fruitful discussions with the Standards Committee and others. The Bill’s proposals are designed to work alongside the existing arrangements and processes for investigating misconduct, and the changes that have been made ensure that recall petitions open automatically as a consequence of a substantial period of suspension. The Bill does not specify on what grounds the Committee, or indeed the House as a whole, would consider a suspension of that length to be appropriate, but I look forward to hearing the views of Members on both sides of the House, both today and in Committee, on the length of suspension proposed and on the operation of the second trigger more generally.

Some will say that the Bill still gives MPs too great a role in triggering recall, but we want to ensure that it complements the disciplinary procedures that already exist and the work of the independent commissioner and the Standards Committee. It is a long-standing principle of our political system that Parliament has sole jurisdiction over its own affairs and is free to operate without interference from the courts, the Crown or any other individual or body. The Standards Committee is currently undertaking a review to look at ways of improving its disciplinary procedure and so has an opportunity to consider these important matters. In other words, the decisions that that Committee will take, given the way that the Bill interfaces with its sanctions, allow whatever the Committee in this House decides should be the standards arrangements to link into the recall proposals. The Government do not wish to impose how the House chooses to govern its affairs and have drafted the Bill accordingly. That principle is of great importance to our parliamentary democracy, and it seems to me that we should exhaust all other avenues before casually setting it aside.

Duncan Hames (Chippenham) (LD): Surely the Minister realises that the reliance on the Standards Committee goes to the root of public dissatisfaction with the Bill. It might be the case, as he suggested earlier, that the Political and Constitutional Reform Committee has faith in the operation of the Standards Committee, but many members of the general public—our electors—simply do not.

Greg Clark: That is exactly why the Committee is reflecting upon its current arrangements and considering whether they should be amended.

I should also say—this is the earliest opportunity I have had—that I was wrongly advised in the answer I gave to the hon. Member for North Down (Lady Hermon). She will be reassured to know that the provisions would apply to Sinn Fein MPs.

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Stephen Mosley (City of Chester) (Con): I agree entirely with the two triggers that my right hon. Friend has outlined, but surely there is a third case: where a Member is not doing his duty. In local government there is a rule whereby councillors who do not attend meetings or vote for six months are automatically disqualified. Surely that, too, should be a trigger to allow a recall.

Greg Clark: As I have made clear, there are many views about the level of the recall and what the mechanism should be. I look forward to my hon. Friend’s contribution to the debate and think that all Members will understand the point he makes. One of the consequences of imprisonment, of course, is that an MP is prevented from attending, so at least part of that is covered by that provision.

Mr Andrew Lansley (South Cambridgeshire) (Con): Although the decision to suspend a Member is one for this House, the effective trigger for that process is a recommendation from the Standards Committee. Does my right hon. Friend therefore agree that it is important not only that we recognise that it results from an independent inquiry by the Parliamentary Commissioner for Standards, but that in the current review we strengthen the lay participation and voice in the Standards Committee? Does he agree not only that that should include an increase in the number of lay members, but that this House should hear directly from the lay members if in any respect they do not agree with the conclusion of the Standards Committee as a whole?

Greg Clark: That is exactly what I was alluding to when I said that the Standards Committee is considering ways to strengthen its credibility with members of the public. My right hon. Friend has substantial experience of those issues from his time as Leader of the House. I am sure that he will make an important and serious contribution to the debate.

I recognise that the creation of a recall mechanism for Members of Parliament clearly raises the question of how recall might fit with the disciplinary arrangements for other office holders in future. The triggers in the Bill have been carefully designed to fit with the particular rules of this House, and for that reason cannot be automatically applied to the recall of other elected office holders. This is not, and is not designed to be, a one-size-fits-all piece of legislation—that would be even more difficult to establish a consensus around—but we must of course learn the appropriate lessons from its implementation, which might in future be applied to other areas. I know that there will be debate, both today and later, on which other areas it might be appropriate to extend recall to. However, this Bill is narrowly about Members of Parliament.

Mr Stewart Jackson: Returning to the point made by our hon. Friend the Member for North East Somerset (Jacob Rees-Mogg) on the efficacy of primary legislation, the House might know that in 1947 the Labour MP Garry Allingham was expelled from the House for writing disobliging comments about fellow Members—not for any criminal offence—so there is a precedent for expelling a Member whose conduct falls below that which most electors would think suitable and appropriate.

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Greg Clark: I was not aware of that and so am intrigued by what my hon. Friend says. I see that the Government Whip is sending a note, perhaps recommending that to her colleagues in the Whips Office as an available sanction.

Several hon. Members rose

Greg Clark: I will make some progress, because many Members wish to speak.

I will turn briefly to the conduct of petitions once they are triggered by the provisions of the Bill. The Government’s priority has been to develop voting procedures that fit with what the public rightly expect from any official democratic election in this country. Safeguards must be in place to ensure that voting is robust, fair and open. I will not set out this process in detail here, but I look forward to debates in Committee on the clauses and schedules. Under the Bill’s proposals, 10% of eligible constituents would need to sign the petition for it to be successful. If at the end of the eight-week recall period the 10% threshold had been met, the MP would vacate his or her seat and a by-election would be held. There would be no legal barrier to the unseated individual standing in the by-election.

As I have described, we have made changes to the Bill as a result of pre-legislative scrutiny. I appreciate that there will be—there have been already—strong views on these proposals, and I welcome the House’s serious consideration and discussion of them. I remind the House that the transition to representative democracy did not take place in a single step, and nor will the progress we make towards more direct democracy—something I have always believed in. With the benefit of hindsight we can see that our predecessors were sometimes excessively cautious, not least in extending the franchise to women. Nevertheless, our country has gained more than it has lost from the British preference for evolutionary over revolutionary change. I believe that the Bill strikes the right balance between holding Members of Parliament to account while ensuring that they can do their job without facing frivolous or politically motivated petitions. We want a recall process that is fair, open and robust, and I commend the Bill to the House.

1.29 pm

Stephen Twigg (Liverpool, West Derby) (Lab/Co-op): I welcome the tone and tenor of the Minister’s opening speech and in particular the commitment that he has made seriously to consider amendments that will strengthen the Bill. I will come to that during my remarks.

This is a debate of critical importance to our politics and democracy. People feel more disconnected from Parliament and more disenchanted with the political process than possibly ever before. Polling and academic research reveal the pre-eminence of this distrust, but all of us know that the most vivid displays of antipathy are found on the doorstep when we meet voters while we are campaigning. People feel let down by politics, they feel angry, and they feel that too often their voice is not heard and that we politicians are out of touch.

Of course, politicians have never been the most popular people. It is in the nature of our job that we have to make unpopular decisions at times, as the Minister rightly said. But in 2009 the relationship between politics

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and the people reached a nadir during the scandal about MPs’ expenses. We can never be complacent or overestimate just how much damage was done to the standing of politics, politicians and this House with the public by what was revealed in 2009. In tough times, when families had been taking difficult decisions about their own household spending and with the economy in recession, revelations about the abuse of MPs’ expenses understandably left the public furious with the system and furious with the individuals involved.

Richard Drax: I am tired of this general slagging-off of people who work so hard for their constituencies. Like many of us here, I was not an MP then, but I admit that some dishonourable behaviour sadly occurred in this House. What we need to restore is honour; we do not need legislation for that.

Stephen Twigg: I partly agree with the hon. Gentleman. It is about how all of us do the job and about the culture of politics, but it is also about legislation. I will come to that now.

Mark Field (Cities of London and Westminster) (Con): I do not disagree with much of what the hon. Gentleman has said about the level of distrust, but does he accept that the lack of independence of many MPs is the biggest concern for many of our constituents? Does he not think that one of the concerns about a recall Bill broadly, which I support, is that it would largely undermine that sense of the independence of the individual MP?

Stephen Twigg: The hon. Gentleman makes a very important point. Later I shall refer to a distinction that others have made in interventions and which the Minister himself made between our conduct as Members of Parliament and the issues that we vote on, and how we are held to account for our voting. The hon. Gentleman makes a powerful point that although recall is, in my opinion, a correct mechanism for dealing with misconduct, it is a more questionable mechanism for dealing with issues to do with voting. One consequence of a particular model of recall could be to undermine the independence of MPs, for the reason that he gave.

In 2010 each of the main parties made proposals to change the system in response to the tide of distrust that I described. As the Minister said, each of us had a commitment to some form of recall in our manifesto. The Minister said that the Government have not rushed into this. That is an understatement: it is a shame that it has taken more than four years to have a Bill before the House. At one point both the Prime Minister and the Deputy Prime Minister promised to pursue a new politics of democracy and transparency. Well, it has taken them quite a while to get round to it, and now that they have, neither of them seems very pleased with the Bill before the House.

The Deputy Prime Minister, who led on the Bill that was published earlier in this Parliament, said this summer that he agreed with the critics of that Bill, and just yesterday he said he wished that the latest attempt—the Bill before us today—had gone further. The Prime Minister, at Prime Minister’s questions last Wednesday, four and a half years after declaring his intent to pursue a new politics, said that the current Bill is the minimum acceptable. Surely after four and a half years they could have come up with something better than this.