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Mr. Tom Watson (West Bromwich, East) (Lab): Will the threat of prison for visiting Israeli politicians make it easier or harder for the UK Government to secure peace in the middle east?
Mr. Straw: I think that my hon. Friend is referring to the issue of arrest warrants and universal jurisdiction. Action on that is currently being considered by Government.
Mr. Philip Dunne (Ludlow) (Con): In response to a question from the right hon. Member for Rotherham (Mr. MacShane), the Minister of State, the right hon. Member for North Swindon (Mr. Wills), said that overseas voters were subject to the same registration requirements as domestic voters. If he is not aware that overseas voters have to re-register annually-whereas here, of course, only households have to register-perhaps it is no surprise that he has taken such small steps to increase overseas participation. What is he going to do about it?
Mr. Wills: The hon. Gentleman is well aware that we are introducing individual registration in this country. That is welcomed by his Front-Bench team, and I hope that he will welcome it too. We are doing a great deal to try to increase registration rates among overseas voters, and we have changed the requirements in all sorts of ways. He well knows that we are looking at how we can make attestation an easier process for overseas voters. We are not negligent about these matters. We are trying to do our best but, as I pointed out to my right hon. Friend the Member for Rotherham (Mr. MacShane), it is sometimes difficult when people choose to live overseas. They do not register their presence with our missions overseas, and so they can sometimes be very difficult to trace. That is the fundamental problem, as the hon. Gentleman ought to know.
Rob Marris (Wolverhampton, South-West) (Lab): When are the Government going to take steps to lessen markedly the use of these wretched super-injunctions, which hide from the public legal process even the fact that they have been obtained, let alone their content?
Mr. Straw: That is principally a matter for the courts. The recent judgment by Mr. Justice Tugendhat was important. It made clear the limitations on the so-called super-injunctions, as have other members of the senior judiciary. If my hon. Friend has in mind the case involving The Guardian , I can tell him that part of the problem was that the interpretation of the court order did not necessarily accord with the order's actual wording.
Miss Anne McIntosh (Vale of York) (Con): The Justice Secretary is aware of my concern about sentencing guidelines that allow shop theft offenders to be let off with a private notice penalty. Those offenders should be referred to court so that their substance abuse might be addressed. What progress has been made on that?
Mr. Straw: I am so well aware, and so is my Department, that there is an official who works virtually full time on the concerns of the hon. Lady, whom I commend for her assiduity. We have changed the guidelines significantly so that fixed penalty notices for shop theft are made available only for a first offence when there is no evidence of drug or other substance misuse. There are other restrictions, too, and we look to the police strictly to enforce those guidelines.
Sir Nicholas Winterton (Macclesfield) (Con): What advice would the Secretary of State give to my constituent Joanne Foster, whose partner was killed by a man who has committed a string of violent offences during his career-and who has been sentenced to what will turn out to be two years' imprisonment? Is that adequate? Is that justice?
Mr. Straw: First, may I express my profound sympathies and condolences to the family in respect of their loss? The hon. Gentleman will excuse me, but I cannot possibly comment on the detail of an offence without knowing a great deal more about it. If he cares to let me know about it, however, I shall write to him explaining the view of the court, which is independent, so that he can pass it on to the family.
Mr. Speaker: I do not want to cause friction in the Winterton household. I have called Sir Nicholas; I now call Ann Winterton.
Ann Winterton (Congleton) (Con): Jolly good! As we seek to reduce reoffending, why are young offenders not positively encouraged to take part in Duke of Edinburgh award schemes-not least because those schemes in turn encourage self-confidence and self-discipline and are very much favoured by employers, thereby leading, hopefully, to a job?
The Minister of State, Ministry of Justice (Maria Eagle): It is a great scheme, and there is no doubt that many schemes are available. I expect that some youngsters in youth offending institutions and in custody are so encouraged, and I hope that more will be in due course.
Philip Davies (Shipley) (Con): Over the Christmas recess, the chief constable of West Yorkshire police, Sir Norman Bettison, highlighted his concerns that burglars were being let out of prison early because there were not enough prison places, thereby causing an unnecessarily high burglary rate in West Yorkshire. What is the Secretary of State doing to address that outrageous state of affairs, which the chief constable of West Yorkshire police has highlighted?
Mr. Straw: The end-of-custody licence scheme is unsatisfactory, as I and the Minister of State, my hon. Friend the Member for Liverpool, Garston (Maria Eagle) have already said, and we wish to bring it to an end as quickly as possible. That said, there has been a dramatic reduction in burglary rates over the past dozen years throughout the country and a dramatic improvement in the number of prison places. That contrasts very sharply with the policy of the hon. and learned Member for Beaconsfield (Mr. Grieve), the shadow Justice Secretary, who is committed to reducing the prison population to its 1993 level, which would mean not an increase in prison places, but a cut to 43,000.
Christopher Fraser (South-West Norfolk) (Con): Further to the question that my hon. Friend the Member for Kettering (Mr. Hollobone) put, the independent monitoring board report on HM prison Wayland in my constituency found that the UK Border Agency routinely detains foreign nationals beyond their release date. The report says:
"This practice...is...poor use of a training prison to warehouse foreign nationals indefinitely."
Why have the Government not done anything about it? What are they going to do to engage the UK Border Agency to deal with that serious issue?
Mr. Straw: We are doing a great deal to ensure that time-served foreign national prisoners are deported. When we can, we transfer them during their sentence, but in many cases we have to deport them at the end of their sentence, and my right hon. Friend the Home Secretary and I are working very closely together. The result is a very significant increase in the number of deportations-particularly, if I may say, given the shambles of a situation over which the previous Conservative Government presided until 1997.
Mr. Peter Bone (Wellingborough) (Con): Does the Secretary of State and Lord High Chancellor believe that there should be a change in the law with regard to the wearing of the burqa in public places?
Mr. Straw: No I do not, and I would strongly recommend against a change in the law.
Maria Eagle: I think the hon. Gentleman would look quite good in one.
Mr. Straw: My hon. Friend the Minister is offering the hon. Gentleman some advice that I shall not pass on; it is equivalent to saying that he looks good on the radio.
All of us may have views about the wearing of the burqa, but I do not believe that the matter should be the subject of the criminal law-that would be expecting the police to remove these items of apparel from women who chose, for religious or cultural reasons, to wear them. That should have no part in the system of law in the United Kingdom.
Mr. Speaker: It is encouraging to see the House in such a good mood this afternoon.
Out-of-Hours GP Services
3.35 pm
The Minister of State, Department of Health (Mr. Mike O'Brien): With permission, Mr. Speaker, I should like to make a statement about out-of-hours primary care following the conclusion of the coroner's inquest last week into the care of Mr. David Gray, who died on 16 February 2008. First, and I am sure that I will be joined by the whole House in this, I should like to extend my sincere condolences to the family of Mr. Gray. This was a tragic case, and I am deeply sorry for their loss. I understand that litigation has arisen out of this issue and I shall therefore direct my remarks primarily to the wider policy issues.
Concerns about out-of-hours primary care were raised with me last summer. I then met primary care professionals to understand the issues in greater detail and to consider what action we might take to improve out-of-hours services for patients. The Care Quality Commission's interim report on out-of-hours care in Cambridgeshire, published on 1 October 2009, also expressed concerns over the quality of care provided. By that time, on 23 September, following discussions with them, I had formally asked Dr. David Colin-Thomé, the national director for primary care at the Department of Health, and Professor Steve Field, chairman of the council of the Royal College of General Practitioners, to lead jointly a review of the current arrangements for the local commissioning and provision of out-of-hours services.
The report, which I published last Thursday, considered the commissioning and performance management of out-of-hours services, the selection, induction, training and use of out-of-hours clinicians, and the management and operation of the medical performers lists on which doctors must register in order to practise in England. The report acknowledges the fact that there is an unacceptable variation in the quality of out-of- hours services across the country, and it sets out 24 recommendations, including that primary care trusts should review the performance management arrangements that they have in place for their out-of-hours services, to ensure that they are robust and fit for purpose; that the Department of Health should issue guidance to PCTs to help them decide whether a doctor has the necessary level of English to be added to their medical performers list; that the Department of Health should develop and introduce an improvement programme for PCTs to support the commissioning and performance management of out-of-hours services; that out-of-hours providers should consider their recruitment and selection processes for clinical staff to ensure that they are robust and follow best practice; and that strategic health authorities should monitor the actions taken by PCTs in response to the report and in carrying out appropriate performance management of out-of-hours providers.
The report's recommendations are an important reminder, to PCTs and providers, of their pre-existing obligations to provide patients with safe and effective out-of-hours services. We have accepted the recommendations in full, and we intend to go further still. I have announced additional improvements to out-of-hours GP services. We will review the existing national quality requirements, and introduce and mandate national minimum standards that all out-of-hours providers will be required to meet.
We will introduce a model contract based on these national minimum standards for out-of-hours provision that PCTs and the providers of out-of-hours services must use. The Department will work with national medical organisations to develop a national database and consider what data should be placed on it. We will tighten existing controls to ensure that PCTs meet their legal obligations and that providers employ competent clinicians to practise as out-of-hours GPs. SHAs must ensure that PCTs are meeting their obligations and we will, in turn, hold SHAs to account for this.
There is already a clear legal requirement under the National Health Service (Performers Lists) Regulations 2004 for PCTs to refuse a doctor's inclusion on their performers list if they are not satisfied with their level of English. We will direct PCTs to review their procedures and to make certain that they have a clear policy in place for assessing the English language skills of everyone applying to be added to their local performers list. Finally, we will require PCTs to involve local GPs in the design of out-of-hours services through local medical committees, RCGP groups and faculties, clinical executive groups and practice-based commissioning consortiums.
Officials in the Department of Health will continue to work with the NHS to implement these measures. The NHS chief executive, Sir David Nicholson, wrote to all NHS organisations last Thursday to bring Dr. Colin-Thomé's and Professor Field's report to their attention. Sir David sought assurances that they are meeting their obligations as highlighted in the report. Along with Sir David Nicholson's letter, the Department of Health has issued new interim guidance to PCTs to assist them in complying with their obligations to ensure that all doctors admitted to their performers list have the necessary English language skills.
It is clear that in some areas out-of-hours services are not as good as they could or should be. However, as Professor Field's and Dr. Colin-Thomé's report acknowledges, even when GPs were responsible for the care of their patients 24 hours a day, only 5 per cent. of them actually provided out-of-hours care for their own patients. Those GPs that did so were often left dangerously tired and exhausted. The system was unsafe. In fact, by early 2000, the level of complaints from the public was so great that the Government asked Dr. David Carson to conduct a comprehensive review of out-of-hours services in England. His recommendations formed the basis of our 2004 reforms, which have led to significant and independently verified improvements in out-of-hours care.
Most of our out-of-hours care is today provided by local GPs working on rotas for co-operatives or companies and, the case of Dr. Ubani notwithstanding, most of the service is good. A 2006 review of out-of-hours care by the National Audit Office said:
"England is at the forefront of thinking internationally"
on out-of-hours care. In 2008, a Healthcare Commission report on urgent and emergency care added:
"There have been significant improvements over recent years in the...number of out-of-hours GP services meeting national quality requirements."
Although it is clear that the quality of out-of-hours care for most people is better than it was in 2004, it is still not good enough. I hope that the recommendations set out in the report by Dr. Colin-Thomé and Professor
Field, along with the additional measures I have set out, will let Mr. Gray's family know that lessons will be learned, and I hope that we will give patients the level of out-of-hours primary care that they expect and deserve.
Mark Simmonds (Boston and Skegness) (Con): May I join the Minister in extending my sincere condolences to Mr. Gray's family?
I thank the Minister for the courtesy of giving me sight of his statement prior to his making it at the Dispatch Box. I suspect, however, that it is with great reluctance that he has come before the House today and that he has done so only because of significant pressure.
It needs to be said that good out-of-hours care is being provided in some parts of the country, but it is clear from the coroner's report into the terrible tragedy of David Gray in February last year, and from the additional report by Dr. Colin-Thomé and Professor Field released last Thursday, that there are significant failings in the provision of out-of-hours care in some parts of England, providing unsatisfactory levels of patient care and, ultimately, putting patients' lives at risk. There have been several tragic deaths, and we must all do everything we can to ensure that that never happens again.
The Government's decision to allow almost all GPs to opt out of involvement in out-of-hours care in 2004 was a significant and serious mistake. The current structure of out-of-hours care is at best patchy and has been described by the Public Accounts Committee as "shambolic". The Government were consistently warned that there were ongoing failures in the system, with reports not only by the PAC but by the National Audit Office and by the Select Committee on Health, twice, highlighting serious concerns and failings, yet no effective action was taken. All those reports, and the two released last Thursday, are critical of the patchy provision of out-of-hours care.
The list of defects and non-performance is extensive: increasing numbers of complaints about out-of hours care; primary care trusts failing to monitor the quality of care and not reviewing or assessing contracts; inadequate performance measurements; strategic health authorities not monitoring PCT performance, and in some cases not engaging in the process at all; out-of-hours care used too often as a holding bay; insufficient skills for commissioning out-of-hours services; some PCTs ignoring and shunning GPs' involvement and advice; a lack of clarity on responsibility between commissioners and providers; significant additional pressure and attendance at accident and emergency and pressure on ambulance services; little or no integration of out-of-hours care with urgent care; non-implementation of selection, induction and training of foreign doctors; very poor response times; and a lack of a coherent and consistent approach to the inclusion of doctors on the performers list.
It is clear that there were failures at SHA, PCT and provider level. There were failures to assess foreign doctors' language, communication and formulary skills, to involve GPs in the commissioning of services, to monitor, review and assess out-of-hours care, and to assess and learn from patient experience. In some parts of the country, that litany of failures has been detrimental not only to patient care but to patient safety, culminating in the shocking death of David Gray.
The Minister has said that he will implement all the recommendations of the Colin-Thomé and Field review. Will he do the same for the coroner's recommendations? What will be the time scale for the implementation of the recommendations of the review? In other words, what is the longstop date for its total implementation? What action will the Minister take to ensure that SHAs review PCTs' progress in that area? SHAs need to do more than just consider what action should be taken. How will he ensure that PCTs properly and regularly review out-of-hours contracts, involving local GPs and, I note with interest, including local GP consortiums? Rigorous monitoring should be taking place everywhere, looking at the quality of clinical decisions, the efficiency of call handling, the adequacy of staffing, doctors' training and patient outcomes.
The Minister will be aware that the General Medical Council is very concerned about the ability of foreign doctors from within the European economic area to practise in the UK. It believes that
"the current legal framework is unsatisfactory"
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