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Mr. Cook: I see that I carry the hon. Member for North Cornwall (Mr. Tyler) in my caution on this point. I will be coming to Cardiff soon and I shall sample Brain's beer and consider whether it possibly reaches equivalence with the excellent McEwans beer that is brewed in my native country.
Mr. Andrew Turner (Isle of Wight): Many of us will remember with nostalgia and affection the silver jubilee celebrations in the days of our youth. Will the Government make a statement on how the new generation can similarly enjoy the golden jubilee celebrations of Her Majesty the Queen's reign this year, by lifting the absurd threat of administration charges for traffic orders, risk assessments and health and safety inspections, which have been quoted as £800 for a street party; and similarly, by ending the demands for absurd levels of third party
insurance? Would it not be nice to read a headline that says, "Cook calls for common sense. Bring out the bunting!"?
Mr. Cook: I regret that I cannot write these headlines, but the hon. Gentleman makes an attractive suggestion which I enjoin on all newspaper editors. We hope that the golden jubilee will be a success. The hon. Gentleman will be aware that my colleagues at the Department for Culture, Media and Sport are working hard to do all we can to support it. There is no requirement for third party insurance for street parties. We hope that local authorities will apply common sense with regard to the other charges that he mentioned and will want to work with local people to make a success of local celebrations. That is why we welcome the decision of some local authorities to reduce or remove these charges.
NHS Cuts
1.23 pm
Mr. David Lidington (Aylesbury): I beg to ask leave to move the Adjournment of the House, under Standing Order No. 24, for the purpose of discussing a specific and important matter that should have urgent consideration, namely,
- the decision by the south east regional executive of the NHS to instruct every health authority and NHS trust in that region to implement cuts in planned expenditure and services by the end of the current financial year.
Ministers have made no public announcement so far, but it is now clear that the matter is urgent. A leaked letter to health authorities and trusts from the chief executive of the NHS south-east region, dated 14 January, demands immediate action to implement the savings required:
- "Proposals need to be capable of being actioned to deliver savings before 31st March. I do not want reasons as to why savings cannot be achieved but proposals on what could be actioned. I recognise that this will mean reductions in areas that do not contribute to national imperatives . . . You should revisit all revenue and capital spending plans for the remainder of the year".
Mr. Speaker: I have listened carefully to what the hon. Gentleman has said and I have to give my decision without stating any reasons. I am afraid that I do not consider that the matter that he has raised appropriate for discussion under Standing Order No. 24, and I cannot therefore submit the application to the House.
Points of Order
1.26 pm
Jeremy Corbyn (Islington, North): On a point of order, Mr. Speaker. You will recall that at 11.30 this morning the Chairman of Ways and Means moved that the City of London (Ward Elections) Bill be set down for debate, and in the business statement the Leader of the House said that it would be debated at 7 o'clock on Monday evening. Would you consider some means by which the time for tabling amendments can be extended? Under the procedure, amendments to be considered for selection on Monday would have to be on the Order Paper by tomorrow morning or this evening, which means that there are only seven and a half hours in which to table such amendments. Do you not think that that is a wholly inadequate time for what is, after all, a deeply controversial and, many of us believe, wholly unnecessary piece of legislation?
Mr. Speaker: The hon. Gentleman might realise that I cannot make an exception for one Bill. It would be very difficult for me to do so.
Mr. Julian Brazier (Canterbury): On a point of order, Mr. Speaker. I of course fully accept the ruling that you gave my hon. Friend the Member for Aylesbury (Mr. Lidington), but I seek your advice as to how to raise the ghastly case of my constituent, 83-year-old Arnhem veteran Bill Holman, whose surgeon telephoned me a few minutes ago to say that Mr. Holman spent 36 hours waiting among 40 other people on trolleys in casualty, with really severe stomach pains. I could not get into business questions because I was telephoning Mr. Holman. He told me that at one point he was considering suicide. The place was so overcrowded and
the staff were so over-stressed that he had his coat instead of a pillow under his head at one stage. How much longer will this go on in our hospitals in Kent?
Mr. Speaker: The hon. Gentleman has already used his ingenuity to help his Arnhem veteran. The hon. Gentleman knows his way around the Order Paper and knows how to get in touch with Ministers.
Dr. Evan Harris (Oxford, West and Abingdon): On a point of order, Mr. Speaker. Following exchanges in the House yesterday at Prime Minister's questions, Members of Parliament will be aware that they are not, unlike medical staff, under a duty of confidentiality. Does that not nevertheless place a responsibility on MPs, given parliamentary privilege, to recognise, first, that best practice involves seeking the permission of a patient, where a patient is competent to give consent, before raising their case publicly; and, secondly, that medical staff are not in a position to respond to allegations made against them by patients' relatives, other third parties, the media or MPs without risking employment sanctions or being reported to their professional regulatory body?
Would you consider, therefore, Mr. Speaker, some guidelines to Members of Parliament, similar to our self-denying ordinance on the question of sub judice, that will show best practice and recognise patients' right to confidentiality and the difficulty that medical staff have in responding to allegations made, because of the risk that they will be reported to their professional bodies for breach of confidentiality? I should be grateful if you would consider issuing such guidance.
Mr. Speaker: The hon. Gentleman gave me notice of this point of order, and I understand that, in doing so, he said that he would write to me. The best course of action is for him to write to me, so that I can consider this matter.
Public Accounts
1.30 pm
Mr. Edward Leigh (Gainsborough): I beg to move,
- That this House takes note of the 38th to 47th Reports of the Committee of Public Accounts of Session 1999–2000, of the 1st to 16th Reports of Session 2000–01, and of the Treasury Minutes on these Reports (Cm 5021, 5071, 5078, 5127, 5201 and 5261).
I pay tribute to my immediate predecessor. He asked me to pass on his good wishes to the Committee, but, ever scrupulous about our impartiality, he thought it better for the chairman of the Conservative party not to attend today.
My right hon. Friend often said that his challenge as Chairman of the Committee was to make audit exciting. Did he succeed? He certainly raised the Committee's profile during his four years as its Chairman, and it was—almost to coin a phrase—a profile with a purpose. That higher profile caused the Committee's work to be taken more seriously and resulted in it having a greater impact. His drive and intellect were matched by an appreciation of the Committee's impartiality, and he was quick to condemn failure in our public services, regardless of political sensitivities. Even in his first two years as Chairman he was prepared to put his name to reports that were very critical of the previous Conservative Government. He was utterly impartial. He had a very clear agenda as the Committee's Chairman and understood that its work could make a real difference to the quality of people's lives across the spectrum of Government policy.
My right hon. Friend took a particular interest in the Committee's work on hospital-acquired infection, which affects thousands of people each year at a staggering cost that is measurable financially and in lives lost. The Committee's work raised the profile of that issue and led to the first concerted programme of action to make hospitals cleaner and safer places.
My right hon. Friend became increasingly frustrated by the fact that the Committee would see the same errors repeated time and again, so he commissioned three reports—on privatisations, the private finance initiative and information technology projects—that identified those recurring themes and made practical suggestions for improvement. The IT report that he commissioned has had a particular impact. It drew on 25 reports, spanning 10 years, and contained a wealth of experience gained from studying IT projects. Its objective was to look forward and to identify lessons from the past that would be relevant to future IT projects. The Government's response to it was positive, and I hope that its impact will continue to be felt for many years to come.
My right hon. Friend was a very keen advocate of the need for Parliament to have the power and the information to hold the Government properly to account. He intervened on numerous occasions to ensure that the powers of the Comptroller and Auditor General were
strengthened. In particular, he played a leading part in the debate on the Government Resources and Accounts Act 2000, as well as in the ensuing review, led by Lord Sharman, of audit and central Government accountability arrangements. That review recommended a significant extension of the CAG's powers, on which I hope the Treasury will respond in the very near future.My right hon. Friend inherited a Committee steeped in a long tradition, spanning 140 years of thorough and worthwhile work. During his chairmanship, he raised the profile of the Committee's work and focused its energies more rigorously on issues of importance to people's day-to-day lives. I am sure that the House will join me in commending his contribution to the Committee's work, and we wish him well in his new role. [Hon. Members: "Hear, hear."]
Other significant changes have been made. In the past year, the Committee has lost a number of valuable members. I pay tribute to my hon. Friend the Member for West Chelmsford (Mr. Burns) and to the hon. Members for Tynemouth (Mr. Campbell), for Edmonton (Mr. Love) and for Eastwood (Mr. Murphy). It gives me great pleasure, however, to welcome to the Committee the hon. Members for Tamworth (Mr. Jenkins) and for Hemsworth (Jon Trickett), my hon. Friend the Member for Bognor Regis and Littlehampton (Mr. Gibb) and—two new additions to the House—my hon. Friends the Members for South Norfolk (Mr. Bacon) and for Tatton (Mr. Osborne).
Membership of the Committee is not an easy ride. The subject matter varies widely across the range of government and it is often very technical and difficult to master. Members have to work hard in preparing to dissect two entirely different topics every week that Parliament sits. No other Select Committee has anything like our work load. Members of the Committee work with energy, commitment and enthusiasm and I am indebted to them for their support. I pay tribute to them, and I am sure that some of them will wish to catch your eye later in the debate, Mr. Deputy Speaker.
I also pay tribute to the former Committee Clerk, Mr. Ken Brown OBE. He retired in December after serving the Committee for six gruelling years and after 40 years' service to the House. Ken will be known to many Members, and he will be remembered for his good humour, sound advice and his ability to get things done. He served three successive Chairmen of the Committee and we all came to rely on his sure-footed approach. He understood perfectly the dynamics of the Committee and was able to find appropriate ways to push at the boundaries of the conventions within which we operate, of which there are many, but he was careful never to breach them. I thank the other Committee staff for the sterling service that they provide and welcome Mr. Nick Wright, our new Clerk, to his work.
I look forward to working closely with the new Financial Secretary, the right hon. Member for Brent, South (Mr. Boateng). We have always had a very good working relationship in the past and he is, uniquely, a member of the Committee. I understand that the convention is that he makes a formal appearance, and we look forward to seeing him at some time in the near future.
The Committee's work would be pointless if it did not have an impact. Much of its impact is the result of the expertise of the Comptroller and Auditor General and his
staff at the National Audit Office. The Committee is so strong because it is serviced by the NAO, which employs 700 people. Between us, we have generated savings of £1.4 billion over the past three years. We have produced 30 reports over the past year alone on matters as diverse as the National Blood Service and the refinancing of the Fazakerley private finance initiative prison contract. We have ranged right across government.Those considering possible reforms of the Select Committee system should look at the Public Accounts Committee—at the way in which it is so expertly serviced, at the care with which the reports on which we base our deliberations are prepared and at the impact that they have every week of the year.
We cover many issues, but when we first considered taking evidence about obesity—just one of the subjects that caused contention—some members questioned whether the issue was within the locus of a financial scrutiny Committee. It was suggested that, surely, people had a right to choose to be fat. One of my Committee, the hon. Member for City of Durham (Mr. Steinberg)—who is in his place—said that
- "the vast majority of people eat too much, they indulge, they do not do any exercise and basically it is their own fault."
Our evidence session revealed that obesity is very much a public policy issue; the public purse, in the form of NHS care and benefit payments, certainly picks up much of the cost. Obesity contributes to 30,000 premature deaths each year and costs the economy £2.5 billion a year.
Before our deliberations, the NAO helpfully provided a body mass index dial, which the hon. Member for City of Durham viewed with incredulity. How could it be that he—a finely honed athlete—should be uncomfortably close to the obese category? Indeed, so strongly did he feel that he stood up before witnesses—permanent secretaries from five Departments—and gave them full sight of his muscular physique, toned by many years actively gracing these Benches. "Could you describe me as obese?", he challenged. The assembled mandarins flinched or blanched and, with an aplomb of which Sir Humphrey would have been proud, they ducked the question. The issues that surfaced, however, were real, and the costs, in terms of cash and human lives, enormous. I mention the subject because it was the first time that the PAC considered a subject that involved so many Departments, and it was a good and useful exercise.
Our work encompasses all central Government spending. It covers a staggering breadth of activity, with a level of complexity to match. Hard-pressed public servants in our hospitals, schools and armed forces, to name just a few, work to deliver ever-more complicated services against a backdrop of rising public expectation. All their work is carried out in the glare of publicity in a media often interested only in failure. It is true that some public servants might see my Committee in the same light—interested only in failure. That is not true, and to do so would be to misunderstand our purpose and approach. I want dwell for a moment or two on what I believe to be the central purpose of the Committee. At the start of this Parliament, it is right that we should ask ourselves why we are here and what we are going do with the powers given to us for the next four or five years.
In brief, the members of my Committee—I think that I speak for them when I say this—represent the interests of the taxpayer. That is why we are here as Members of
Parliament, and our priorities reflect those of our constituents. We want to be sure that taxpayers' money is spent properly on what Parliament has approved, and we want to be sure that the services delivered to the public are of good quality and achieve the outcome intended. By bringing our constituency and personal perspectives to the issues that we consider, we speak for the layman—indeed, we are laymen—but we do so with much more authority because our deliberations are informed by the detailed work and expert analysis provided by the NAO. We, with our experience, can speak for our constituents.It is well known that we do not interrogate Ministers. We normally interrogate permanent secretaries and are unique in that respect. As a Committee and the mouthpiece of Parliament, we have a unique relationship with the British civil service. It is renowned for its honesty and integrity. I believe, however, that my Committee has a role to play in ensuring that it also develops a reputation for successfully delivering public services. It is no longer good enough to have a worldwide reputation for honesty and integrity.
The British civil service has to deliver successful public services. We have an important part to play in understanding why projects and programmes have not delivered what was expected, but we seek also to identify the elements of success when we find them and to suggest solutions. We do not want to be negative all the time. We do not want to be just an undertaker. We do, however, want to be a practical force for good, trying to suggest how things can be done better.
We do not get involved in policy, which is our key to success. It is why we are a united Committee and why we hunt as a pack. No one can put a piece of paper between any member of the Committee because we focus our attention on the civil service, not on policy, and on trying to get things done.
Our task is to ensure that the learning points from our work are not lost, but crystallised and acted on. The fact that more than 90 per cent. of our recommendations are accepted by the Government clearly shows that our concerns are well founded and our suggestions well grounded. If anyone says that Parliament means nothing, that Back Benchers have no power and that Select Committees mean nothing, here is one Select Committee—meeting twice a week, producing up to 50 reports a year—that has 90 per cent. of its recommendations accepted by the Government. That is not a bad track record.
We are also sometimes criticised for focusing on relatively small bodies that spend relatively little. My response to such criticism is that if we constantly target very large spending Departments, there is a danger that those in the smaller bodies will feel free from the discipline that parliamentary scrutiny provides. In our experience, the smaller spending areas are most vulnerable to fraud, mismanagement and impropriety because often there are fewer controls. We believe that each public pound is as important as the next, and we take an interest in them all.
In summarising our work for the past year there are four themes of particular interest: the quality of financial management, improving public service, innovation and risk, and accountability. First, monitoring the quality of financial management is central to our role and it is a fundamental part of our work. The past year has seen a
major change in the way in which the Government account for public expenditure. After 140 years, the wholly cash-based system by which Parliament approved Government expenditure has been replaced with one in which Parliament votes on expenditure in terms of resources, reflecting when liabilities are entered into, rather than when cash is paid out. For Departments, the challenge of changing systems has been immense, and I pay tribute to Sir Andrew Likierman and his team in the Treasury and their personal contributions in driving through this very difficult work. It has often been a uphill struggle.What next? As a result of the shift to resource accounting, we have a wealth of information that was not available to us before. We need now to play our part, and we owe it to the taxpayer to devote more of our time to understanding and interpreting the information that is now available. That in itself is a massive task for Parliament and a huge challenge for us if we are to hold the Government to account day by day. We intend to do our best.
Reliable and timely accounts are essential if we are to grasp the potential of resource accounts. We can make progress only if those accounts are delivered well and on time and they are accurate. Last November, we reviewed the progress that Departments have made as they move from the old system to the new. I accept that the transition to the new commercial-style accounts, which are complicated, has caused many Departments headaches and difficulties, but it has been largely successful, with many Departments making substantial efforts to improve the quality of their resource accounts.
We were disappointed, however, that far too many Departments had qualified opinions on their accounts. That position must improve. Departments must also address the widespread and persistent lack of timeliness in delivering their accounts to the Comptroller and Auditor General. Delays in submitting accounts suggest a more disturbing malaise, and we must ask whether senior staff in Departments, including permanent secretaries, are sufficiently engaged in the process, although I am sure they understand it. It is essential that senior staff in public bodies take seriously their personal responsibility for the public funds with which they are entrusted.
As I said, the propriety of the British civil service is not in doubt. My concerns, and the three examples that I shall briefly give, are about the need for sound systems of control and early warning signs before things go badly wrong. The first example in which my Committee recently played an part, and acted particularly strongly, concerns the Public Trust Office, which existed to protect the financial interests of the mentally incapacitated and was therefore responsible for one of the most vulnerable sections of the community. The Committee first reported on the very poor service provided in 1994, and we were dismayed to find in 1999 that the improvements we had been promised had still not materialised—indeed, performance had declined.
A further dimension to the PTO's problems emerged when we considered the management of unclaimed balances in court funds, weaknesses in its financial reporting and bonus arrangements for the agency's former chief executive. The Lord Chancellor's Department had responsibility for the PTO, but its approach was woefully
hands off. It had ignored the warning signs so clearly heralded in our earlier report. For example, despite the PTO's worsening performance, the Department allowed its chief executive to continue to receive her full performance bonus. In the course of our subsequent work, the Department acknowledged that its oversight should have been a lot better; supervision should have been more rigorous and greater leadership should have been shown to help the agency think more imaginatively about its operations. In accepting our recommendations, the Lord Chancellor's Department took the radical step of closing the PTO and creating a new system to protect the interests of those vulnerable people. Clearly, we have to keep a close eye on that in future, but it is an example of the PAC's work and the way in which we have acted.Failure to act on warning signs was a factor in our report on the corruption case involving Focus housing association. Two former Focus employees and a property dealer were convicted after the two employees took bribes from the dealer in connection with a purchase by Focus of 47 houses between 1991 and 1995, many at inflated prices. The case illustrated the failure of the Housing Corporation, which oversees housing associations, to act with sufficient urgency and improve their regulation of them. The Housing Corporation acknowledged to the Committee that there were inadequacies in its regulation of housing associations in the early 1990s, particularly in assessing their internal controls; those weaknesses may have made it easier for the corruption to occur. While the corporation began to improve its regulation, following a PAC report in 1994, it took until 1998, long after the discovery of corruption at Focus, to complete those improvements, which was far too slow.
Suspected impropriety at whatever level in government should be investigated properly and thoroughly to protect public funds. The corruption was discovered as a result of an investigation prompted by allegations received by Focus, but only after it and the Housing Corporation had received between them no fewer than six earlier warnings of possible impropriety. The case reinforces the need for allegations of impropriety to be swiftly and fully investigated.
It is outrageous that the Comptroller and Auditor General did not have the right of automatic access to the housing association, but had to negotiate with it for six months before gaining access to the information that he needed to bring the matter to our attention. Parliament has had a central role in such matters throughout history, but in that clear case of impropriety it took six months for the CAG to gain access, which is not good enough. We shall soon have the Government's response to Lord Sharman; I hope that they accept his recommendation that the CAG should have automatic access so that people working in that sector are aware that they are answerable to Parliament for the way in which they use public money.
Further education is another sector with which there are problems. It is a large sector and receives about £3 billion a year. Most colleges manage their financial affairs successfully, but our ninth report found that 72 FE colleges—some 17 per cent. of the total—were in financial difficulty. Financial problems on that scale give rise to serious questions about the funding, organisation, governance and management of the sector, and unnecessarily divert management from its primary role of delivering quality and successful education. We found that the Further Education Funding Council focused too
much on trying to help colleges once they had got into difficulty, rather than spotting the warning signs and taking early preventive action.We urge the Learning and Skills Council, which now has responsibility for the sector, to take a more pro-active approach than its predecessor. It must identify problems earlier and take preventive measures sooner if the sector is to meet the targets for widening participation and improving quality. That illustrates a wider problem that has vexed other committees. There is a danger that bodies with responsibility for oversight of a sector confuse their support and regulatory functions. Instead of policing a sector, they are captured by it. We recently looked at the Charity Commissioners; they are a notable example in which there is confusion about the role that they play.
I shall say a bit about better public service delivery, which is now at the heart of the political agenda. That reflects the genuine concern and belief across the political divide that there is enormous scope for improvement. The issue must, therefore, be central to the Committee's remit.
I want to focus on one element of public service delivery that has become something of a recurring theme for the Committee—equity. I hope that we can emphasise equity in our work in the next few years. It is the principle that access to and quality of the services that a citizen receives should not vary according to one's postcode.
For example, in the Committee's 43rd report of 1999-2000, we considered hip replacements. Total hip replacement is a highly effective procedure that reduces pain and increases mobility in almost all cases. In England, the NHS performs more than 30,000 replacements each year, at a cost of about £140 million. Most patients who have a hip operation receive an excellent service, but we expressed concern about variations in access to treatment and the quality of care that people were receiving. Believe it or not, patients can wait for an operation for anything between two and 16 months, although the average is eight months. Clearly, waiting 16 months for a hip operation is completely unacceptable. Integrated pathways for hip patients reduce their length of stay in hospital and improve outcomes, but what do phrases such as "integrated care pathways", which are used by the bureaucracy, mean? This particular term means people talking to each other in the NHS. Less than a third of trusts use pathways for all hip replacements. We hear much about joined-up government, but our role in the Committee in this matter and indeed all others is to ensure that we have joined-up management as well as joined-up government. There is no point in all the Ministers in the world ensuring that we have joined-up government—if they can do such a thing—if we still do not have joined-up management.
Sticking with health, I mentioned the terrible blight that hospital-acquired infection represents for patients. It kills about 5,000 people a year and costs the NHS about £1 billion a year. I am pleased that, since the Committee worked on it, the issue's profile has been raised considerably, but I still remember being staggered by the differences in how trusts were handling the problem. Again, there were enormous differences throughout the country. Infection control nurses have been shown to be vital in reducing the level of hospital-acquired infections. At the time of the National Audit Office investigation, the number of beds that one of these crucial nurses had to cover varied from about 150 in some trusts, which is fine, to an impossible-to-manage 1,800 in the very worst cases.
Such a difference may mean that a patient's chances of picking up an infection and dying—that is what we are talking about—depends on which hospital they are lucky or unlucky enough to end up in.More recently, and again on health, the Committee took evidence on another example of poor-quality service following our recent investigation of NHS waiting lists. Drawing on the CAG's report, we noted that there were sharp disparities in patient waiting times across the country. For example, 37 per cent. of people in west Sussex wait more than six months for admission, but in Dorset, less than 1 per cent. wait six months. That is a huge disparity on a central issue of political concern. It is also a concern for our constituents and it simply cannot be right. Indeed, these wide variations can occur in adjacent areas. I know that that is the case. They occur between Lincolnshire and Humberside in my constituency.
Variations in patient care are not confined to waiting lists and hip replacements. The Committee found the same problem in the previous Parliament when we examined cataract surgery and cervical screening. Although politicians spend a lot of time arguing party political points about health, there is a huge amount of detailed management work to be done that makes a real difference to people's lives, irrespective of views on the future of the NHS. We intend to pursue those problems. Almost 6 million people a year are admitted to hospital in England for at least one night, so good information systems that provide real information on current and planned uses of resources are essential.
We highlighted the Royal Shrewsbury hospitals NHS trust because it has a good system, which has dramatically reduced the number of operations cancelled for non-medical reasons. Sadly, that is rare.
Too many trusts continue to have inadequate information systems. In the 21st century, bed managers in 90 per cent. of hospitals can find out whether beds are vacant only by physically inspecting them or telephoning wards. It is disappointing that the NHS executive has not done more to build on the success of systems such as those developed in Shrewsbury. Although the new NHS information technology strategy aims to tackle that, many trusts will continue to operate without the information that they need until new systems are available nationwide. That is a simple matter, but it could make so much difference to people's lives.
I have already considered some of the disparities in waiting times. Why should patients, who may have waited many months for an operation, face the disappointment of a last-minute cancellation simply because the trust in their area—they have no choice about where they are being sent—does not adopt the good practice that already exists in other parts of the country?
I am pleased to say that our criticism has not fallen on deaf ears. When questioned, the Department of Health acknowledged that such variations need to be tackled, and is taking action. Distributing resources more fairly and targeting them to remove variations is an important first step. Setting national standards through the National Institute for Clinical Excellence and a national service framework, and testing compliance with the Commission for Health Improvement, are also crucial. We shall keep an eye on all those matters. We were told that differences
in management processes were a factor in the variations. It is therefore imperative that best practice is quickly rolled out to ensure consistency of service.The autumn of 2000 provided a grim reminder of the misery that serious flooding can cause.
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