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29 Apr 2008 : Column 58WH—continued
The Minister for Borders and Immigration (Mr. Liam Byrne) indicated assent.
1.18 pm
Ms Diane Abbott (Hackney, North and Stoke Newington) (Lab): The Government pride themselves, particularly under their brilliant new phalanx of Home Office Ministers, on firm and effective immigration control. However, for such control to be acceptable, it has to be fair—and, specifically, it must not be race-based. My hon. Friend the Member for Great Grimsby (Mr. Mitchell)—he is an hon. Friend—said that we have always had ancestral rights. We have not. I remember with some clarity the patriality clause being introduced, mainly because I used to work for the Home Office. It was brought in when the Government sought to bear down on Commonwealth immigration.
It seems to me that the sweeping away of the clause is long overdue. I do not believe that it would survive legal challenge. If we look at the figures, we will see that in 2004, out of 9,397 visas issued, more than 8,000 were to people from the white Commonwealth, and most of the rest were from Zimbabwe. In 2005, out of 10,143 visas issued, nearly 10,000 were to people from the white Commonwealth; in 2006, out of 9,741 visas, more than 9,000 were to people from the white Commonwealth; and the most recent figures show that out of 8,380 visas issued, 8,083 went to people from the white Commonwealth.
The clause has provided a route by which members of the white Commonwealth gain rights and access that are denied to members of the non-white Commonwealth. It is archaic, but not in the sense that it goes back hundreds of years—it is one of the many indefensible and incoherent aspects of immigration control. I welcome the fact that Ministers, in seeking to revise, improve and make immigration control more coherent, are eliminating the clause. I believe that if persons from the rest of the Commonwealth—Africa, the Caribbean and Asia—realise how disproportionate the figures for the handing out of the visas are, they would understand the nature of the clause.
1.20 pm
The Minister for Borders and Immigration (Mr. Liam Byrne): I should begin by expressing my gratitude to my hon. Friend the Member for Great Grimsby (Mr. Mitchell) for securing this debate this afternoon. This is the first debate that we have had on one part of the Green Paper, “The Path to Citizenship”, which the Home Office published earlier in the year.
The House knows that 2008 is a big year for immigration reform. We are comprehensively changing how the system is policed and how we judge who has the right to come to this country and who has not—we debated the points system at length in the House last week. As those two sets of changes will come into force this year, I personally felt that it was time that the House turned its attention to the unfinished business of migration reform in the past 30 or 40 years.
Any student of immigration legislation since the second world war will know that the busiest periods of change in legislation for immigration reform were, first, in response to decolonisation in the 1950s and 1960s and, secondly, in response to the asylum crisis that we inherited from the Conservatives in the late 1990s. Since 1945,
Governments and the House have never applied themselves systematically to thinking from first principles about who should be able to come and stay, and what we should ask of people to whom we grant the great privilege of British citizenship. The Green Paper attempts to do just that. Many of the ideas will be wrong or will need to be revised, and plenty of them will benefit from the House’s attention, which is why they were published in a Green Paper.
Before I deal with the detail of my hon. Friend’s remarks, I should put on record my thanks and gratitude to my right hon. Friend the Member for Warley (Mr. Spellar), who has bent my ear for some weeks and months about some of the proposals on immigration reform and more generally. My hon. Friend the Member for Great Grimsby touched on some of the changes that we are proposing for tourist visas. That is part of the proposed reform to how we judge who is allowed to come to the UK in the first place—I shall not detain the House with another discursion into the iniquities of the points system because my hon. Friend raised the point about how we are changing short-term visas.
My starting point for that reform is an analysis that says that the visa system was invented for the 1970s, which was a different era, and I do not believe that it works any more, so it should be changed. It does not work for business people who want to come to do business in the UK, or for family visitors, many of whom come to see me at my advice bureau in Birmingham each month. There is a strong argument for reforming how we offer tourist visas to the world, simply because something like 1.1 per cent. of people who apply for such visas stay for longer than three months.
We cannot think about the question in isolation from the changes that we want to make to youth exchange and youth mobility schemes. That has been an issue on which there have been enormously important exchanges between Britain and Australasia. I should declare my first interest at this stage: when I finished my A-levels, I spent four or five months working my way around Australia. At the tender age of 18, it taught me a great deal about life, and it certainly gave me an enormous love for Australia. When the Government publish some of the changes to the youth mobility schemes under the points system later this year, the House will see how clearly determined we are to ensure that there is a continued opportunity for people from Commonwealth countries, but in particular from Australia and New Zealand, to come to the UK and spend a bit of time learning about the country from which many of their ancestors came.
Mr. Spellar: Will the Minister assure us that he will give serious consideration to any representations from the Governments of our friends in Australia and New Zealand?
Mr. Byrne:
I am delighted to give my right hon. Friend that absolute assurance. I was able to meet the Australian high commissioner shortly before he returned to Canberra recently. Such people are important friends of the United Kingdom; we have enormous regard for, and pay attention to, their advice and counsel. I urge my hon. Friend the Member for Great Grimsby not to see changes to the tourist visa system in isolation from the wider changes that we are making on youth mobility,
but the picture will become clearer in the next month or two when we publish relevant proposals.
My hon. Friend’s second point, which I believe was the substance of his remarks, was about Commonwealth visas. Again, I welcome his comments. By publishing the Green Paper, the Government were attempting to go back to first principles and to set out a coherent story on the values and attributes that we want newcomers to sign up to if they want to become British citizens for the long term. I could not profess to have many of the answers to those questions, so I spent three or four months going around the United Kingdom to talk to people from all over the country about what values we think are important in the country, what values we want newcomers to sign up to, and what is the British deal that we want migrants to buy into if they want to make the United Kingdom their long-term home. Four values or standards were paramount across the United Kingdom: the ability to speak English to a certain level, the aptitude and attitude of hard work and paying tax, obeying the law, and making an effort to integrate with the wider community.
Some values, such as those of blood and history that my hon. Friend highlighted, would not necessarily have emerged from that survey of British citizens, but there is a good argument for putting them centre stage in immigration reform, which is the point at which I should declare my second interest: I am the great-great-grandson of someone who was born in Australia—they were born in Kulpara in South Australia. My other
grandparents are Irish, so I would be able to apply for Irish citizenship in due course. There is a good case for saying that when we revise the values that we want to put centre stage in immigration and citizenship reform, those values, ties and historic bonds that my hon. Friend talked about should be part of the deal. I listened carefully to what he said this afternoon.
My hon. Friend the Member for Hackney, North and Stoke Newington (Ms Abbott) was absolutely right to say that the policy dates back to 1971. If one reads Hansard reports of the debates on the Immigration Act 1971, one will see that they were contentious and, in parts, coloured by the language of race. It is true that, overwhelmingly, people who take that route to settlement are from Australia, New Zealand, South Africa and Canada—something like 80 or 90 per cent. Our ambition is to listen to the debate on the Green Paper before bringing back a comprehensive Bill to consolidate all immigration reform back to 1971. That will involve a lengthy debate in the House and in Committee, and provide an opportunity to fix a number of historical wrongs in our immigration system. However, I hope that it will also provide a chance to reinforce and ensure that the values that my hon. Friend the Member for Great Grimsby talked about are part and parcel of the wider set of values that we have heard about from the British public, which we will seek to consolidate in the form of citizenship.
As I said, this is unfinished business, and it is down to this Government to finish the job. I hope that we will be able to do so in the next 18 months.
Bromley Hospitals NHS Trust
1.30 pm
Mr. John Horam (Orpington) (Con): I raised the issue of Bromley Hospitals NHS Trust in a debate last July, and I want, through the Minister, to thank the Secretary of State—it is the same Secretary of State—for his written response to the points that I made. I make no apology, however, for returning to the subject today, because the issue is of great importance to my constituents, as the Minister will appreciate. The situation remains extremely unsatisfactory, and important decisions will be taken soon, so it is vital that the Government make the right decisions and have the appropriate input. What I have to say, however, is no reflection on the trust’s clinical staff, who do a heroic job of keeping the ship afloat. I continuously hear that much good medicine is being practised in the trust, but the situation in which staff have to work is very difficult.
The trust consists of two hospitals, both of which, as it happens, are in my constituency. The Princess Royal university hospital at Farnborough is a district general hospital with full accident and emergency facilities. It was built under the private finance initiative and is now seven years old. Orpington hospital is an older and smaller hospital, but it, too, received an infusion of capital five years ago, with £8.8 million being spent on new theatres and wards for elective surgery—hips, knees and that kind of thing. As hon. Members will understand, Bromley residents thought themselves lucky to have such excellent new facilities available to them, but serious problems have emerged.
The first problem is financial. The trust has operated at a loss every year. It now has debts totalling £100 million and it will lose more than £18 million in this financial year—2007-08—despite a cost-cutting regime. The interim chief executive forecasts that the trust will break even next year, but that is extremely unlikely given the present lack of progress, so the debt will continue to mount. Under the PFI scheme, payments of about £25 million a year are made to the owners of facilities, and that includes not only interest on private finance initiative borrowings, but payments for building maintenance and supply and support services. The trust’s financial performance is among the worst in the whole of England and Wales. The other day, the local newspaper—the News Shopper—quoted the interim chief executive as saying that repaying the debt would take between 50 and 100 years, which is quite an astonishing admission.
There are also problems on the medical side. The Healthcare Commission served the Princess Royal university hospital with an improvement notice after an inspection found blood stains on the walls and dust on the surfaces. According to the commission, the hospital is now off the sick list, but these events were a warning. Infection rates for methicillin-resistant Staphylococcus aureus and clostridium difficile are also a problem. Recent figures show an improvement, but the fact is that we are talking about a new hospital where there are still problems with cleanliness and infection.
The performance with audiology is among the worst in the country. I have had a succession of agonised letters from constituents over many years complaining of their inability to get a digital hearing aid in less than
two, three and often four years, which is quite astonishing. Many of these people are in their 70s. In addition, the hospital’s maternity ward came out badly in a recent survey, and the hospital has had problems meeting its waiting time targets—both the four-hour accident and emergency target and the 18-week referral-to-treatment target.
The Minister might also be aware of the disgraceful treatment of local fundraisers, who, led by Mrs. Mary Spinks, have collected £500,000 for the Primrose centre for breast cancer care. I shall write to him shortly about that separate issue.
Another important point is that the management at the top level seems always to be interim, acting or short term. The present CEO is there for only six months and will leave in June. His predecessor was there for a year, while his predecessor’s predecessor was there for only a few weeks, which is ridiculous. Needless to say, all these people are on vast salaries.
In addition, there has been a positive frenzy of reorganisations, reports and consultations. The previous chief executive, who was there for only a year, has been taken away to head an interim executive team for the four local hospitals in outer south-east London. The team has been set up to see whether co-operation between the four hospitals could achieve economies of scale. Many people suspect—indeed, this has been talked about officially and privately—that this is a precursor to a merger between all four hospitals or between two or three of them.
The trust’s chief executive is heading a reorganisation exercise in south-east London called “A picture of health”—the Minister may be familiar with the consultation document. It is not easy to consult on such difficult issues, and anyone would have difficulty drawing up such a document. None the less, many of the options were pretty banally stated, with no real attempt to define the costs or alternatives. In the case of Bromley, it was almost pointless to answer the consultation, because all the options related to the hospital in Lewisham, not to the Princess Royal university hospital or the Orpington hospital in Bromley, where the options seemed to be taken as given. On top of that, of course, we have “Healthcare for London”, the document produced by Lord Darzi, who is now a Minister at the Department of Health, which has had a big impact in London. The situation is therefore not only bad financially, but dizzyingly complex, which makes it far more difficult for the trust’s management to make decisions. As a result, confusion is widespread and morale is low. The suspicion throughout is that decisions are financially, not medically driven.
What should be done? First, the primary and overall driving objective should be to put the medical staff in a position where they can deliver the quality of health care that I am sure they can. Secondly, a management team should be put in place that is committed to the trust and which can at least take a five-year view. I appreciate that it is difficult to attract people to management in the trust because of the uncertainties surrounding the positive plethora of consultations and rumours about mergers. However, the Government have helped to create the situation with their endless plans and should assist in resolving the issues so that committed, longer-term managers can be put in place. In that respect, we should also say no to mergers. In my experience as a former business man, mergers are often a distraction
for management. It would be much more sensible for managers to focus on putting right what is wrong in the trust.
Thirdly—this is the point that I particularly want to address to the Minister—not only should there be a management that is committed to the hospital and to making it work, but that management should be given a workable financial situation. Here the Government have a plain responsibility. They signed off a bad PFI deal, which has now clearly come unstuck. The Government acknowledged that when they gave the trust a £6 million a year subsidy. They have now withdrawn that, admittedly step by step and not all at once; but the fact that they ever gave it shows that they were concerned that the PFI deal was a poor one. Now that the subsidy has been withdrawn, the costs of the PFI are coming home to roost. The situation is still bad. The PFI charge for the hospital is 10.4 per cent. of its annual income, which is nearly double the average charge of 5.8 per cent. That is the handicap under which the hospital starts.
The Government also precipitated the crisis that is affecting the hospital. They changed the regime governing all hospital trusts, away from the old-fashioned borrow and broker, by which hospital trusts could at the end of the year broker an arrangement so that even if they made a loss it would be worked out with surpluses from other trusts and so on. Two years ago, when there was a deficit in NHS funds nationwide, that was scrapped, and we now have a transparent and accountable system. I welcome that, but it led to the exposure of the difficulties into which the trust had fallen, and the Government precipitated that.
The Government have in addition brought in a national payment-by-results scheme. The problem with it is that the tariffs are based on average costs throughout the country, whereas the trust, because of its difficult PFI agreement, has higher than average costs. It is reckoned that the gap between the high-cost trust and an average-cost trust is between £7 million and £12 million a year, and that is a further disadvantage for the operation of the hospitals trust in Bromley.
The Government have some money: as a result of the tightening of the regime for all NHS trusts throughout the country, compared with two years ago, when there was a £500 million deficit, they now boast of a £1.8 billion surplus. Therefore there is money to deal with such difficulties, which are fallout from the action taken by them. Whenever I talk to the people who run the London NHS, they always say money is not a problem. The Government should take that into account.
If the interim chief executive officer of a hospitals trust can say quite openly that it will take between 50 and 100 years to pay off its debt, that is a ludicrous situation. Clearly, something must be done before then, and quickly; otherwise there will be an overhang that will destroy the hospital’s morale and ability to act. I therefore want a debt write-off in some form. That is necessary so that the hospital can be placed in a position where it can take decisions on medical grounds, not purely driven by financial requirements.
A fourth matter that I should like taken into account in the discussions that relate to the Bromley hospitals trust and all the reviews and consultations is the idea that we should use the facilities that we already have. There are proposals in the document “A picture of health” to move elective surgery from Orpington, and
day surgery from the Princess Royal university hospital, somewhere else. However, both those facilities are new and work well. Why spend money to close them and move them elsewhere? That does not seem economically sensible. As the trust said in its evidence in relation to the document, with respect to the day surgery unit:
“The DSU at the PRUH consists of 6 operating theatres that are supported by 40 patient spaces. This is therefore the largest stand-alone DSU in OSEL”—
outer south-east London. The evidence continued:
“Indicative figures for a proposed ISTC at QMS quoted costs of £30 million...In addition...we consider that expanding the PRU DSU to 3 lists per day would mean that all the population could be treated without any added capital expenditure”.
That is the view of the hospitals trust, and I support it. It seems stupid to spend money when facilities exist and work well.
On the waste front, let us not waste money on big ideas that do not work locally. Lord Darzi’s health care for London strategy would mean, if applied to Bromley, that having spent £120 million on new hospital facilities, we would take income from them by diverting business to specialist hospitals and polyclinics. Of course, neither the specialist hospitals nor the polyclinics exist; it will cost money to build them. Therefore, we would be reducing the chances for the district general hospital to make money; it would make further losses and the Government would spend taxpayers’ money on building new facilities. As Professor Harrison of the King’s Fund said:
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