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House of Commons

Tuesday 7 December 2010

The House met at half-past Two o'clock


[Mr Speaker in the Chair]

Oral Answers to Questions


The Secretary of State was asked-

Interim Cancer Drugs Fund

1. Nigel Adams (Selby and Ainsty) (Con): What recent assessment he has made of the effectiveness of the operation of the interim cancer drugs fund; and if he will make a statement. [28698]

12. Alun Cairns (Vale of Glamorgan) (Con): What recent representations he has received on the operation of the interim cancer drugs fund; and if he will make a statement. [28709]

The Secretary of State for Health (Mr Andrew Lansley): Clinically led arrangements are in place in all strategic health authorities for determining the best use of the additional funds that we have made available for cancer drugs from 1 October 2010. Information provided by SHAs shows that, as of 15 November, funding had been agreed for the treatment of more than 250 patients in England. I have received representations from hon. Members, noble Lords, and members of the public on how the interim arrangements for cancer drugs funding are operating. Many of those representations have welcomed the additional support we are giving to cancer patients in need.

Nigel Adams: I am grateful to the Secretary of State for his response. Last week, my constituent, Trudy Cusworth, received the news that she is to be given the cancer drug Avastin, despite the panel at St James's university hospital, Leeds initially refusing to do so. In this case, the emergency cancer drugs fund has done its job, but what can the Secretary of State say to assure other cancer patients in North Yorkshire who are also in desperate need of such life-prolonging drugs and who are currently being denied access to them?

Mr Lansley: I am grateful to my hon. Friend for his question. Indeed, I want to thank him for the support he has given to Trudy Cusworth. I am very pleased that she was able to take her case, with her clinicians, to the panel and that it has been approved. There are a number of people in the York and Selby area for whom that is true. The panels are working across the country to ensure additional access to cancer drug treatments where a clinical case is made for that.

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Alun Cairns: My constituents are pretty angry and disappointed that the cancer drugs fund will not apply to them because health matters have been devolved to the National Assembly for Wales. Will the Secretary of State give an assurance that he will champion the merits of the policy in the hope of convincing the Welsh Assembly Government to follow the lead that he is offering?

Mr Lansley: I agree with my hon. Friend, who is obviously an advocate for his constituents to the Welsh Assembly Government. These are matters for the devolved Administrations and they must decide how to allocate their resources. In this instance we have shared with the devolved Administrations the consultation on the cancer drugs fund, which will start next April, although the policy proposed will apply in England alone.

Preventive Health Care

2. Toby Perkins (Chesterfield) (Lab): What recent representations he has received on the effect of the abolition of primary care trusts on the co-ordination of preventive health care. [28699]

The Minister of State, Department of Health (Paul Burstow): The Government have set out a number of proposals to support integrated working and preventive action, including ensuring that local councils take a key role in joining up local NHS services, social care and health improvement. There is a strong preventive focus in the NHS public health and social care outcome frameworks, and an additional £1 billion will be provided by 2014-15 for the NHS to support social care. Some of that money will be spent on preventive services. The public health White Paper sets out the Government's plans to return the leadership of public health to local government. That proposal has been widely welcomed.

Toby Perkins: Before the Secretary of State and the Minister embarked upon the biggest reorganisation of the NHS in the past 60 years, what consideration did they give to the impact that such changes will have on the co-ordination of services? Primary care trusts are being described as in meltdown at the moment. PCT staff whom I meet are deeply worried about the co-ordination of services, as linking such services is about so much more than the work of GPs.

Paul Burstow: Let me start with the point of agreement: this is about more than just the work of GPs. That is why the Government are proposing the establishment of health and well-being boards in local authorities to drive the integration that was never delivered under the Labour party. Services were not integrated and, for many people, services did not fit around their lives as a consequence. This Government will change that. It seems that the hon. Gentleman is putting forward the campaign slogan, "Save the PCT; don't trust your GP." That is not a good campaign slogan.

Nadine Dorries (Mid Bedfordshire) (Con): Will there be £2 billion going into two pots-one for public health and one for social care? What element of that budget will local authorities be able to use for preventive care? Some reports say that the budget is ring-fenced and some say that it is not, so some clarity would be appreciated.

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Paul Burstow: In fact, there is a further pot of money, which relates to the proposals for a ring-fenced budget in respect of public health. One of the problems has been the NHS's raiding that pot to spend on other things. We believe that public health is a priority, and we will therefore ring-fence those resources in future. The £1 billion that will go into social care directly through the local government settlement will be available for local government to support social care services. The £1 billion that will go in via the NHS will also be there to support social care, but it will particularly address issues such as reablement and preventive services.

Liz Kendall (Leicester West) (Lab): The Government are abolishing all PCTs and handing £80 billion to GP consortiums that do not yet exist for services including the co-ordination of care. Is not this reorganisation a huge gamble for patients and taxpayers, which is why No. 10 and the Treasury are so concerned, as we see in today's edition of The Independent? Will the Minister finally agree to publish details about the financial assurance regime for GP consortiums, and will he guarantee that under his plans £80 billion of public money will be accountable to Parliament in the same way that it is today?

Paul Burstow: Of course the money will be accountable to Parliament, as it is now. The hon. Lady's comments reflect an interesting campaign that the Labour party has dreamed up, which is very much to ally itself with the interests of primary care trusts rather than those of patients and ensuring that we improve public services. This Government's proposals will improve the way in which services are commissioned, deliver better outcomes for patients up and down the country, and deliver the integration across health and social care that the previous Government failed to deliver.

GP-led Commissioning Consortiums

3. Henry Smith (Crawley) (Con): What recent progress he has made on the introduction of GP-led commissioning consortiums. [28700]

13. Mark Lancaster (Milton Keynes North) (Con): What recent progress he has made on the introduction of GP-led commissioning consortiums. [28710]

The Secretary of State for Health (Mr Andrew Lansley): On 21 October, I invited general practice-led commissioning consortiums to put themselves forward as pathfinders, and I have been absolutely delighted by the response. The pathfinder consortiums will be announced shortly. They have formed in response to the needs of local communities, and there is, sensibly, variation around the country to take account of those differing needs. Some consortiums map on to local authority boundaries; others organise themselves around catchments for hospitals or smaller populations. This bottom-up, locally determined approach is exactly in line with what we envisaged in the policy framework.

Henry Smith: Under the previous Government, Crawley hospital saw the removal of services such as accident and emergency and maternity. Can my right hon. Friend explain how, under the new GP-led consortiums, doctors
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will have the freedom and the flexibility to be able to refer their patients to local services if they so choose, as well as to new services?

Mr Lansley: That is exactly what our reforms will allow. We are putting not only the freedom to refer in the hands of general practices but choice in the hands of patients, and allying that to the power on the part of commissioners to commission services that meet the needs of their local community. That is precisely the change that will empower front-line clinicians and patients.

Mark Lancaster: Having consulted widely in Milton Keynes, I am pleased to say that the Government's plans have been broadly welcomed. However, one area of concern that has been raised with me by patients, in particular, is the amount of time that they will get to spend face to face with their GP. Can the Secretary of State reassure my constituents and outline the administrative support that GPs will get in fulfilling their new functions?

Mr Lansley: I am grateful to my hon. Friend. In Milton Keynes, GP Healthcare MK and Premier MK consortiums are shaping their services in order to be able to deliver better services for their patients and improve services for patients. We do not intend that all GPs individually should become managers, by any means; there will be clinical leadership, but the consortiums should have commissioning support. The primary care trust in Milton Keynes has had some good commissioning support arrangements, as I know from having visited it in the past. It is open to the new commissioning consortiums to take teams from the primary care trust into their new consortium support arrangements, but they can go elsewhere. They can look to the local authority and to the independent sector to provide them with the commissioning support that they need so that clinicians provide leadership but continue to be responsible for clinical care.

Mr Ben Bradshaw (Exeter) (Lab): What impact does the Secretary of State think that this change and the rest of the upheaval that he is inflicting on the health service will have on hospital waiting times?

Mr Lansley: I think that the reforms will have a positive impact on performance right across the NHS, because they will enable patients who want to exercise choice to see the quality and standard of services, including waiting times. Unlike in the past, they will be able to see waiting times for individual hospitals, rather than just a single target. They will be able to make choices based on information about the quality of services.

Derek Twigg (Halton) (Lab): If the reforms are so good, why have they been criticised by the chairman of the Royal College of General Practitioners, Dr Clare Gerada? She said:

The British Medical Association has expressed concerns about competition, and we hear in this morning's edition of The Independent from an unnamed "ally" of the Secretary of State that

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obviously a very brave ally. Why has the Prime Minister asked the Cabinet Office Minister who is in charge of Government policy to review the plans? Is it because the Secretary of State is the only one who believes in them?

Mr Lansley: The hon. Gentleman should not believe all that he reads in the newspapers. The curious thing is that the Minister with responsibility for Government policy is engaged with Government policy. That is a good and positive thing. The hon. Gentleman referred to the Royal College of General Practitioners and to Dr Gerada. In response to the White Paper, the RCGP said:

Dr Gerada said:

Mr Stephen Dorrell (Charnwood) (Con): I very much welcome the steps that my right hon. Friend is taking to encourage the early emergence of pathfinder consortiums, so that the shape of the new commissioning structure is made clear as quickly as possible. Given the nature of the quality, innovation, productivity and prevention challenge-QIPP-that the health service faces, does he agree that the process must be carried forward as quickly as possible so that the new framework is clear for all concerned as quickly as possible?

Mr Lansley: Yes, I do. I was delighted by the response of general practice to the emerging consortiums, because one of the central reasons it wants to make progress quickly is to shape clinical service redesign, which is at the heart of delivering the efficiency savings that will enable us all to improve outcomes.

David Miliband (South Shields) (Lab): The Secretary of State has said that GPs are the best people to manage the health service. Will he confirm that in the eight years of GP training, not a single hour is dedicated to the commissioning work that he has described?

Mr Lansley: The right hon. Gentleman should understand that what I said was that GPs are the best people to commission services. Commissioning and management are not the same thing. GPs are already responsible for commissioning most services in the NHS, but they have no power over resources and contracting. I intend to ally clinical leadership and commissioning decisions with commissioning support that involves management. The people who should determine the shape of local services to meet the needs of patients are those who are already at the heart of designing services and referring patients.

NHS Administration

4. Andrew Stephenson (Pendle) (Con): What recent representations he has received on management and administration costs in the NHS; and if he will make a statement. [28701]

The Minister of State, Department of Health (Mr Simon Burns): Administration costs across the health sector will reduce by a third in real terms over the spending
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review period. That is a £1.4 billion cash reduction and a £1.9 billion real-terms reduction, from a baseline of £5.1 billion. Every penny of the savings will be reinvested in front-line services.

Andrew Stephenson: I thank my hon. Friend for that answer. Will he give me and my constituents examples of how the billions that are saved will make a difference on the front line when invested in patient care?

Mr Burns: I am extremely grateful to my hon. Friend and I will certainly give such examples. Every penny that is saved by cutting excessive management and bureaucracy will be spent on providing health care and drugs for his and other hon. Members' constituents, and on ensuring that we have proper front-line services that provide the best quality care for all the people of England.

Nick Smith (Blaenau Gwent) (Lab): Due to the snow, many falls and fractures have been reported in my constituency and around the country in the last few days. What plans are there to cope with such winter pressures?

Mr Burns: I fully appreciate the hon. Gentleman's concern, because particularly at this time of the year and throughout the winter months there is both an extra duty on the NHS and an increased problem. I can assure him that for over a month now, as is the custom, the NHS has been meeting regularly to plan for the winter and ensure that we have the services in place to help those who suffer falls or illnesses due to the inclement weather.

Contaminated Blood Products

5. Simon Kirby (Brighton, Kemptown) (Con): On what date he expects to make an announcement on compensation for those infected by contaminated blood products supplied by the NHS. [28702]

The Minister of State, Department of Health (Paul Burstow): In October we announced a review of a number of aspects of Lord Archer's recommendations, including the level of ex gratia payments and the mechanism by which they are made, access to insurance, prescriptions charges and access to nursing and other care services. The Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), expects to report the outcomes of the review by the end of the year.

Simon Kirby: I thank the Minister for his answer. Does he believe that after all the years of inaction, that will draw a line under the matter?

Paul Burstow: The hon. Gentleman is absolutely right to indicate that the matter has not been dealt with thoroughly for many years, and that is why the Government have launched the review. Obviously I cannot pre-empt its outcomes, but we will bring it to the House as soon as we can.

Ms Diane Abbott (Hackney North and Stoke Newington) (Lab): The Minister will be aware that no past Government have anything to be proud of in the way in which the
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matter was dealt with, and that Members on both sides of the House have campaigned on the issue. People hope that the Government will be able to live up to the promise in the October debate of producing a review before Christmas. Thousands of sufferers of HIV and hepatitis C, and thousands of dependants, are waiting for the announcement.

Paul Burstow: The hon. Lady makes some very important points. As she rightly says, the matter was debated in the House only recently, and the Government are determined to ensure that we are in a position to report back on the review before Christmas.

Andrea Leadsom (South Northamptonshire) (Con): I know that the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), has done a lot of work on the review and is keen to see a fair settlement. May I urge Ministers to take into account the fact that this is perhaps one of the worst tragedies to have befallen the NHS in this country? Many people have suffered terribly, and I hope that Ministers will make every effort to ensure that those sufferers can at last receive closure.

Paul Burstow: I am grateful to the hon. Lady for her comments and will ensure that they are reported back to my hon. Friend the Under-Secretary for her consideration in the review.

Hospital Energy Consumption

6. Paul Goggins (Wythenshawe and Sale East) (Lab): What steps he is taking to reduce energy consumption in hospitals. [28703]

The Minister of State, Department of Health (Mr Simon Burns): The NHS continues to improve its energy efficiency. The Department provides guidance to the NHS and supports the NHS sustainable development unit, which promotes energy awareness and carbon management across health care providers. Hospitals are working with the Department for Business, Innovation and Skills to engage with suppliers who provide innovative solutions.

Paul Goggins: I thank the Minister for his answer and invite him to join me in congratulating all the staff at Wythenshawe hospital in my constituency, which was recently named overall winner this year in The Guardian public services award as the country's greenest hospital and for reducing energy emissions by 26%. What further pressure is he putting on other hospitals and health service providers to ensure that they follow that fine example?

Mr Burns: I am happy to join the right hon. Gentleman in congratulating the university hospital of south Manchester on its fantastic achievement and the award that it has won. As he knows, his local hospital did that by reducing its energy consumption and carbon emissions by 26% over the past three years in ways such as the greater use of biomass fuels. It is a fantastic achievement and the staff should be justifiably proud of it. They are a beacon for other hospitals to follow to reach the same level of sustainability, and I am delighted that a number of hospitals throughout the country are striving to reach the position of the one in his area. I am confident
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that through greater sharing of information and work, more and more hospitals will make their contribution to reducing carbon levels.

Miss Anne McIntosh (Thirsk and Malton) (Con): The Minister will be aware of the extreme weather conditions and extremely low temperatures of minus 17° C in and around Thirsk and in other parts of North Yorkshire where we have community hospitals and trust hospitals. Has he reviewed the impact on their funds of heating costs when low temperatures come so early in the winter and will carry on for such a long period?

Mr Burns: I can reassure my hon. Friend. She is absolutely right that the winter period and harsh weather impose extra costs, but I am pleased to tell her that partly through winter planning and partly through the experience of past years, hospitals are aware of that. They take into their planning and financial budgeting the possibility of weeks and perhaps longer-depending on the weather-when their costs will increase, and adjust to meet those demands. I am confident that bad weather will not impact on front-line services because of the work that hospitals do to account for it over the 52 weeks of the year.


7. Annette Brooke (Mid Dorset and North Poole) (LD): What assessment he has made of the Health Protection Agency's recent report on the incidence of tuberculosis. [28704]

The Secretary of State for Health (Mr Andrew Lansley): I welcome the Health Protection Agency's recent report on tuberculosis in the UK. There were 8,286 cases of TB in England in 2009, an increase of 4.3% on 2008. The rise has occurred mainly in people infected in countries where TB is common, who go on to develop active TB disease later in life.

Annette Brooke: I understand that that is a 30-year high. Evidence from New York shows that a co-ordinated approach across the city has made a real impact in controlling TB. How will the Secretary of State ensure that such co-ordination takes place, especially in cities, when GP-led commissioning is introduced?

Mr Lansley: The treatment services for individual patients will be commissioned through GP consortiums, but the identification and preventive work on TB is a public health responsibility. To that extent, I believe that we will be better placed to deal with it in future. Many local authorities-for example, in Birmingham, Manchester or Leeds-will be well placed as cities to respond to any incidence or outbreaks of TB on a preventive basis, using their powers as public health authorities.

Ms Gisela Stuart (Birmingham, Edgbaston) (Lab): In response to my question on the publication of the White Paper about the more than 500 TB cases in Birmingham the Secretary of State confirmed that there would be no changes to what such cities could do to control TB outbreaks. Will he elaborate on his answer? What more can Birmingham do under the new arrangements to prevent such exceedingly high numbers?

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Mr Lansley: We can do a number of things. For example, the Department has funded TB Alert, which is the UK's national TB charity, to raise awareness of TB among public and primary health care professionals, which will help. In London, we have supported a find-and-treat outreach service. In a similar vein, that could happen in cities where there is a rising prevalence of TB. TB is not general across the country, but likely to occur in particular areas. Those kind of initiatives enable us to identify TB outbreaks, and we can then structure services around that.

End-of-Life Care

8. Penny Mordaunt (Portsmouth North) (Con): What assessment he has made of the merits of steps to increase the standard of end-of-life care in an acute setting; and if he will make a statement. [28705]

The Minister of State, Department of Health (Paul Burstow): The Government are committed to increasing choice for people at the end of life, which will result in fewer people dying in hospital. However, there will always be a need for hospital-based end-of-life care. The national end-of-life care programme has published a guide for achieving quality in acute hospitals, which includes recommendations on holistic assessment, advance care planning, training, and improved multi-disciplinary working. The guide has been widely welcomed as a blueprint for improving the quality of end-of-life care.

Penny Mordaunt: Ministers will be aware of the Queen Alexandra hospital's withdrawal of its G5 service to create a mobile model of end-of-life care. That will extend services across the hospital, but my constituents and I have grave concerns at the number of quiet and appropriate beds that will be left. Will Ministers agree to meet me to discuss what can be done to encourage the QA to meet the public's concerns?

Paul Burstow: I am grateful to the hon. Lady for her question and I know that she has campaigned on that issue. She will know that on 25 October, the Secretary of State asked the independent reconfiguration panel to consider the issue that was raised by the Portsmouth health overview and scrutiny committee regarding a referral of ward G5. The advice has now been tendered, and the Secretary of State has asked the panel to undertake a full review of the case. He expects that report by March of next year and I am sure that during that period, conversations at ministerial level will be helpful.

Emily Thornberry (Islington South and Finsbury) (Lab): Most people want to die at home, but they are prevented from doing so by the lack of out-of-hours support. Also, 24/7 community nursing is popular with the National Audit Office because it saves money. Even the Government say it is crucial, so why do they not use some of the £3 billion they are wasting on top-down reorganisation to ensure that everybody gets a community nurse at the end of their life, if they want one? How can the Government guarantee care for the dying if they abolish primary care trusts?

Paul Burstow: Perhaps a little humility might have been a necessary preface to that question, including, not least, an acknowledgment that the hon. Lady's question is based on the failings of the previous
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Administration to deliver the necessary improvements in end-of-life care. On GP commissioning, there is undoubtedly an opportunity to integrate health and social care to deliver more timely and appropriate community-based end-of-life care, and we intend to deliver it.

Patient Information

9. Jonathan Lord (Woking) (Con): What steps he is taking to improve the information provided to patients on their diagnosis and treatment. [28706]

The Minister of State, Department of Health (Mr Simon Burns): As part of our White Paper reforms, a wide-ranging review of the information required to empower patients is in progress. Related current initiatives include the information standard scheme, information prescriptions and quality standards produced by the National Institute for Health and Clinical Excellence.

Jonathan Lord: I am grateful to the Minister for his reply. Currently good comparative data on the individual performance of doctors and surgeons are not readily available. How does he envisage compiling that data in a way that does not create too much bureaucracy or use up too much of doctors' valuable clinical time?

Mr Burns: My hon. Friend is absolutely right: if we are to put patients at the heart of an NHS in which it is their care and views that are important and drive the provision of health care, we must empower them by giving them information that is consistently accurate, unbiased and easily understandable. We are currently consulting on our information revolution papers, and we await a chance to study the responses. However, we are determined to empower patients by giving them far more information, so that they can exercise their right of choice to get what they deserve, which is the very best health care.

Keith Vaz (Leicester East) (Lab): I would like to declare an interest and remind the Minister that we currently spend £1 million an hour dealing with diabetes-related illnesses. One key way of helping to reduce that cost is giving patients diabetes tests and ensuring they get as much information as possible so that they can change their lifestyles.

Mr Burns: The right hon. Gentleman is absolutely right. We have to supply all patients, including those suffering from diabetes as well as other conditions, with as much information that they can understand as possible, so that they can make the choices about the health care they need. They also need to be backed up with advice from their GPs, community pharmacists and others in the health sector, because that will empower them to take decisions in their best interests to manage their medical condition.

Mr John Baron (Basildon and Billericay) (Con): The Government have rightly announced, in the consultation document on patient choice, that all patients with long-term conditions will be offered a care plan. May I urge the Minister to ensure that that will apply also to cancer patients?

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Mr Burns: As my hon. Friend is aware, we are still consulting on that document and will consider the results of the consultation process before making any final decisions. On his specific point, however, my understanding is that that will be case.

Specialist Children's Hospitals

10. Mr David Blunkett (Sheffield, Brightside and Hillsborough) (Lab): What decisions he has reached in respect of additional funding for the purpose of the tariff applying to specialist children's hospitals. [28707]

The Secretary of State for Health (Mr Andrew Lansley): Following a very constructive meeting with the specialist children's hospitals on Friday 3 December, I am pleased to be able to tell the House that we are working on a proposal to set the top-up payment for specialised services for children at 60%, over and above tariff prices. In addition, I intend to help the trusts by extending the number of procedures that will attract the top-up payment in 2011-12. I believe that the children's hospitals will find that entirely acceptable.

Mr Blunkett: I would like-uniquely-to thank the Secretary of State for signing off the technical agreement from last Friday, and to say that the specialist children's hospitals will welcome his announcement this afternoon. Is it not time to take the uncertainty away from the children's hospitals and have a system that allows them to put in place a forward plan that does not result in this annual farrago? Would it not also be nice to congratulate the staff of the children's hospitals on their terrific work, not least the dedicated way in which they will be working with these children over Christmas?

Mr Lansley: Yes, I am very glad to do so. I have visited Sheffield children's hospital, and I very much applaud the work that it does. I am sure that those at the hospital are grateful to the right hon. Gentleman, as I am, for the way in which he has represented their interests. I entirely agree with him: the purpose of developing the payment-by-results system is to arrive at a point where it is predictable and delivers a relevant payment, related to the costs that are genuinely incurred in the provision of that treatment. We are not in that position yet. The specialist top-up was put in place to reflect that, but I hope that it is temporary rather than permanent.

Neuromuscular Conditions

11. Mr John Leech (Manchester, Withington) (LD): What progress has been made on improving the provision of specialist neuromuscular physiotherapy for people with muscular dystrophy and related neuromuscular conditions; and if he will make a statement. [28708]

The Minister of State, Department of Health (Paul Burstow): Physiotherapy can help to manage the physical deterioration associated with muscular dystrophy and other neuromuscular conditions. Physiotherapists have a key role to play in reducing waiting times, improving access and choice, and providing more personalised services closer to home, thereby improving the quality
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of life of their patients. It is for local NHS organisations to decide how best to use the funds allocated to meet health needs.

Mr Leech: I thank my hon. Friend for his answer. Will he meet me and campaigners from the North West Muscle Group to discuss what actions need to be taken to ensure ongoing physiotherapy for patients with neuromuscular diseases?

Paul Burstow: I am grateful to my hon. Friend for that question, and I know that he plays an active part in the all-party muscular dystrophy group. He was involved in ensuring that we had a report from that body on access to specialist neuromuscular care-the Walton report, an important report that mapped out many of the deficiencies in the current service. I would be happy to meet him and his friends to discuss the matter further.

IVF Treatment

14. Gareth Johnson (Dartford) (Con): What recent assessment he has made of the adequacy of provision of IVF treatment across the country. [28711]

The Secretary of State for Health (Mr Andrew Lansley): Many primary care trusts have made good progress towards meeting NICE guidance recommendations on the provision of IVF treatment. However, I am aware that a small number of PCTs with historical funding problems have temporarily suspended local NHS provision of IVF services. I have already expressed my concerns about that approach. I expect all PCTs to have regard to the current NICE guidance and to recognise fully the significant distress and impact that infertility has on people's lives.

Gareth Johnson: I am grateful to my right hon. Friend for his answer. He will be aware that Robert Edwards, the British inventor of IVF treatment, is due to receive the Nobel prize this week for his work. I am sure that Professor Edwards would be dismayed that PCTs have suspended their IVF provision, so would my right hon. Friend join me in urging those PCTs that have taken that step to reconsider their decision on this important issue?

Mr Lansley: Yes, I am indeed aware of that, not least because the Bourn Hall clinic, where Robert Edwards and Patrick Steptoe did their groundbreaking work, is in my constituency. As a former vice-chair of the all-party infertility group, I feel strongly that the reason the NICE guidance was written as it was, way back in 2004, was to recognise both the distress and the extent of the difficulties that couples face, and the need for them to be assured not only of good quality investigation, but of good quality follow-up provision in fertility services throughout the NHS. I urge PCTs to have regard to the NICE guidance in their commissioning decisions.

Mr Kevin Barron (Rother Valley) (Lab): If this unfair situation in the commissioning of infertility services continues, and if the reconfiguration goes ahead, would it be the responsibility of the national commissioning board to address it?

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Mr Lansley: Beyond 2012 it would indeed. The reason we are in this position is not least because when NICE produced its guidance, my predecessor, John Reid, in effect told PCTs that they should not feel obliged to have regard to it and arbitrarily changed it. It is precisely that kind of political interference with what should be a clinically-led decision about the appropriate structure of commissioning services that I am proposing to do away with.

Adult Social Care

15. Chris White (Warwick and Leamington) (Con): What support his Department plans to provide for front-line services in adult social care. [28712]

The Minister of State, Department of Health (Paul Burstow): Protecting adult social care services is a clear priority for this Government. The spending review fully protects all existing grant funding for social care, and by 2014 an additional £2 billion a year will be available to support social care. Along with a programme of efficiency, those additional funds will enable councils to maintain access to social care while meeting demographic and other cost pressures and delivering new approaches to improve quality and outcomes over the next four years.

Chris White: I am grateful to the Minister for his response. In my constituency, residents of Whitnash are trying to set up a social enterprise to take over the running of a local care home. Will the Government encourage and support councils such as Warwickshire to respond positively to such initiatives, and will he meet residents of Whitnash to understand some of the issues that they face?

Paul Burstow: In our vision for adult social care, we very much argued the case for the greater use of social enterprises and the involvement of voluntary organisations as a way in which we can better deliver more personalised and appropriate public services of the very sort that the hon. Gentleman is talking about to our local communities.

Ann Coffey (Stockport) (Lab): From April 2011, district nurses, health visitors and other specialist nurses working in the community in Stockport will be employed and managed by the Ashton, Leigh and Wigan Community Healthcare NHS Trust, and from April 2011, nurses providing community health services in Tameside will be employed and managed by the Stockport NHS Foundation Trust. Can the Minister tell me how that reorganisation will improve the delivery of front-line services to local people?

Paul Burstow: First and foremost, the hon. Lady should welcome the fact that this will provide opportunities for the greater integration of services, and that is a key way in which we can deliver better outcomes for her constituents and others up and down the country.

Psychiatric Care (Deaths)

16. Paul Maynard (Blackpool North and Cleveleys) (Con): How many patients in psychiatric care died of natural causes in the last five years. [28713]

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The Minister of State, Department of Health (Paul Burstow): Information on the number of people in psychiatric care who died of natural causes is not available. However, information about patients detained under the Mental Health Act is collected by the Care Quality Commission. The most recent information, covering the period 2005 to 2008, shows that there were 1,392 deaths of detained patients, of which 1,123 were ascribed to natural causes.

Paul Maynard: I thank the Minister for that reply. Does he share my concern that, almost uniquely, in psychiatric care, the state has a large degree of control over an individual's circumstances, yet, unlike in prison or police custody, deaths from natural causes do not have to be reported to the coroner or be the subject of an inquest? Does he not think that the time has now come to end that disparity and to shed some light on to the real reasons behind many of the deaths from natural causes in psychiatric care?

Paul Burstow: My hon. Friend might be interested to know that the Ministry of Justice is reviewing sections of the Coroners and Justice Act 2009 and how they will be implemented. That review will include the subject of how deaths are reported to coroners. In fact, the statutory requirements to report deaths of mental health patients to coroners are the same as those for other patients, and NHS providers must report deaths of service users that occur during, or as a result of, care or treatment that they are providing.

NHS Administration

17. Richard Graham (Gloucester) (Con): What recent representations he has received on the management and administration costs of the NHS; and if he will make a statement. [28714]

The Minister of State, Department of Health (Mr Simon Burns): As I said to my hon. Friend the Member for Pendle (Andrew Stephenson) earlier, administration costs across the whole health sector will reduce by a third in real terms over the spending review period. This is a £1.4 billion cash reduction and a £1.9 billion real-terms reduction, from a baseline of £5.1 billion. Every penny of the savings will be reinvested in front-line services.

Richard Graham: I am grateful to the Minister for his reply. Can he reassure my constituents in Gloucester that this is broadly the degree of savings that we should expect from NHS Gloucestershire's expenditure on management, and that those savings will be spent on the rising demand for front-line services, including in the new, soon-to-be-opened women's centre?

Mr Burns: Yes, I can give my hon. Friend the assurance that he seeks. We have made it quite clear that we will reduce management costs throughout the NHS by more than 45% over the next four years, and establishing GP consortiums will allow us to strip out the costly top-down bureaucracy that now exists. All the money that will be saved through these initiatives will be reinvested in front-line services, which will benefit the constituents of my hon. Friend and those of every other right hon. and hon. Member throughout England.

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Rushanara Ali (Bethnal Green and Bow) (Lab): I am concerned about the quality of services that patients and their families receive. In my constituency, 100 jobs are already going, and I am worried that the cuts in staffing will have an effect on the services that are available. Can the Minister guarantee that front-line services will be protected, because the reality is that, in constituencies such as mine, staffing is crucial to ensuring that decent services are available?

Mr Burns: I have to tell the hon. Lady that, in this very difficult financial situation, which we inherited from her Government, it is only by making efficiency savings and getting rid of excess bureaucracy that we can generate the income to reinvest to save front-line services- [ Interruption. ] She and the Greek chorus in front of her must understand that, if we had not been left in this mess in which £43 billion a year is being spent on the interest on the debt that we inherited, we would not have the problems that we now have-

Mr Speaker: Order. I think we understand what the Minister is trying to get at.

Mr Graham Stuart (Beverley and Holderness) (Con): I welcome the Minister's responses and his firm proposals to reduce administration costs. However, it is not just a matter of management costs rising massively under the last Government, as productivity fell. The last time productivity increased in the NHS was under the last Conservative Government in the early 1990s. What plans do the Government have to ensure that productivity is increased, because only by doing can we deliver better health?

Mr Speaker: Let us have the answer.

Mr Burns: My hon. Friend is absolutely right. Although the last Government significantly increased health spending -I do not dispute that; it is a self-evident fact-the trouble is that we did see increases in productivity pro rata. That is the challenge that we face; that is what we are addressing; that is what we are going to achieve through QIPP-quality, innovation, productivity and prevention-by cutting out inefficiency, cutting out excess management and administration so that every single penny can be reinvested in improving front-line services and giving our constituents the finest health they-

Mr Speaker: Order. The Minister will resume his seat. His answers have been excessively long-winded and repetitive-and it must not happen again. I have made the position clear and I hope that the Minister will learn from that.

Waiting Times

18. Mr Russell Brown (Dumfries and Galloway) (Lab): What estimate he has made of the change in average waiting times for patients waiting for diagnostic tests since May 2010. [28715]

The Minister of State, Department of Health (Mr Simon Burns): Patients are continuing to receive timely access to diagnostic tests. In September 2010, the median waiting time for 15 key diagnostic tests was 1.7 weeks, compared with 1.8 weeks in May.

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Mr Brown: I thank the Minister. Does he expect waiting times to stay down now that they have been scrapped or will they simply be ignored by no longer being performance-managed?

Mr Burns: I suggest that the hon. Gentleman studies the response given earlier by my right hon. Friend the Secretary of State to the right hon. Member for Exeter (Mr Bradshaw). By concentrating resources and reforming the system to improve outcomes, we will provide enhanced health care for all our constituents in England.

Topical Questions

T1. [28723] Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op): If he will make a statement on his departmental responsibilities.

The Secretary of State for Health (Mr Andrew Lansley): My responsibility is to lead the NHS in delivering improved health outcomes in England, to lead a public health service that improves the health of the nation and reduces health inequalities and to lead the reform of adult social care, which supports and protects vulnerable people.

Jonathan Reynolds: The Secretary of State will be aware that primary care trusts across the country are being asked to cut between 35% and 50% from their management costs. This inevitably leads to job losses, but can he confirm that he is confident that the jobs being lost as a result of this policy are purely management roles and that there are no losses of jobs that combine some management role with front-line clinical responsibilities?

Mr Lansley: We have been very clear that we are asking the whole of the NHS administration-we are applying the same discipline inside the Department, to arm's length bodies and across the whole of government-to secure a reduction by a third of real-terms administration costs over four years. In the NHS in particular, I am looking for a reduction in management costs of 45% in cash terms. By that, I mean specifically the costs of managers and senior managers. By definition, that does not include clinical staffing.

T3. [28725] Ian Swales (Redcar) (LD): In the light of the recent damning report by the Care Quality Commission into Redcar and Cleveland council's adult social care services, what steps is the Secretary of State taking to improve adult social care and will he meet me to address the issues raised in the report?

The Minister of State, Department of Health (Paul Burstow): I am grateful to my hon. Friend for his question. I know of his concerns, which he has raised for some time. I understand that an improvement plan has been developed by Redcar and Cleveland and that it has been shared and agreed with the Care Quality Commission. The plan has a strong focus around ensuring a rigorous approach to improving the safeguarding of vulnerable people, and a peer review process is being established with the Local Government Group and the Association of Directors of Adult Social Services. I would, of course, be happy to meet my hon. Friend to discuss the matter further.

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John Healey (Wentworth and Dearne) (Lab): May I welcome the Secretary of State's sensible rethink and change of mind on the funding of specialist children's hospitals after Labour Members raised concerns during the previous Health questions? During those questions he also got his NHS funding figures in a twist, so what has he got to say about the updated inflation forecasts on page 83 of last week's Office for Budget Responsibility report? They show that for the next four years the inflation increase will be bigger than the cash increase in the NHS-in other words, the NHS will get a real cut in funding, not a real increase. Does he accept the OBR figures? Does he accept that they are hard proof that the Government are breaking their promise to protect NHS funding?

Mr Lansley: Let me tell the right hon. Gentleman that it is not a change on specialist children's hospitals. The previous Government initiated a study by York university, which reported. I made it clear, when we discussed it last, that we were examining the results of that together with the specialist children's hospitals. We have reached what I regard, as I hope they do, as a very acceptable outcome.

The spending review gave a real-terms increase in NHS funding. That was the commitment we gave and it was set out in the spending review, and it remains true that revenue funding for the NHS continues to rise in real terms.

John Healey: Perhaps I should have asked the Secretary of State whether he has even seen the OBR report. Let me try to help him. The OBR's inflation figures mean that the NHS will not get the 0.4% real increase that he bragged about and that was stated in the spending review; the NHS will get a 0.25% decrease-a cut-in funding, as has been confirmed today for me by the House of Commons Library. No wonder the Prime Minister is rattled and is asking what on earth the Health Secretary is doing with the NHS. Does the Health Secretary accept that this confirms that the coalition's pledge to guarantee that health spending rises

is being broken? How does he explain that to the Prime Minister and how does he explain it to the public?

Mr Lansley: No, I do not accept that for a minute. At the spending review we set out what met our commitment. I am very clear that, as I just told the right hon. Gentleman, revenue funding for the NHS will increase in real terms. It will do so because we did not listen to the advice of the Labour party in the run-up to the spending review, which was to cut the NHS budget. We did not do that and we were committed at the spending review to an increase in real terms. The gross domestic product deflator will move from time to time, but the commitment that we set out was clear and will continue.

Mr Speaker: Just as the answers from the Minister of State, the hon. Member for West Chelmsford, were too long, those questions were too long as well.

Mr Burns: Chelmsford.

Mr Speaker: Order. I do not require any assistance from the hon. Gentleman. We must speed up from now on. That is the situation.

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T6. [28729] Michael Ellis (Northampton North) (Con): Every day, ambulance service staff in my constituency and around the country deliver life-saving care to our constituents, but they are themselves occasionally put in harm's way. What steps are Her Majesty's Government taking to ensure that the protection that our ambulance staff get in my constituency and around the country is the best that we can provide?

Mr Lansley: I join my hon. Friend in paying tribute to the staff in ambulance service-in the current circumstances, with the winter pressures being what they are, we should especially do so. But those staff can come under particular threat from time to time and we have to prepare for all eventualities. For example, if an attack involving firearms takes place, as it did recently in Cumbria, it is possible that ambulance staff would be working alongside other emergency services in responding to it. It is only right, therefore, that they are offered as much training and equipment as possible to carry out that work.

T2. [28724] Paul Goggins (Wythenshawe and Sale East) (Lab): This morning, the Justice Secretary said that he was working with the Health Secretary on plans to divert more mentally ill offenders away from prison. I broadly welcome that, but could the Health Secretary tell us how much new money will be made available for that initiative, especially given the comments made by my right hon. Friend the Member for Wentworth and Dearne (John Healey) about the cut in the real value of health spending?

Mr Lansley: The right hon. Gentleman is in no position to make that point, given that his party wanted to cut the NHS budget. What my right hon. and learned Friend said this morning about our working together is indeed true. However, this is not a case of our diverting patients; it is about ensuring that people who have mental health problems are dealt with appropriately rather than there being a failure to deal with them. That applies whether they are in prison or in hospital. We are working together on that, and I know that my right hon. and learned Friend will be making a statement shortly.

T8. [28731] Richard Graham (Gloucester) (Con): Can Ministers reassure me that, given the relative health deprivation in Gloucester, the ring-fenced funding promised in the White Paper on public health will in fact benefit people there?

Mr Burns: Yes, I can certainly give my hon. Friend that assurance. The money will be ring-fenced to ensure that local communities can enhance the quality of public health for all constituents both in Gloucestershire and throughout the country.

T4. [28726] Mrs Mary Glindon (North Tyneside) (Lab): The north of England cancer network has been working since 2007 to improve cancer commissioning across primary and secondary care and to improve standards of cancer care for my constituents. Can the Secretary of State confirm that it will continue to play that role after the introduction of GP commissioning?

Paul Burstow: In the not-too-distant future, we will publish the refresh of the cancer reform strategy. That will demonstrate how the Government will continue to
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build on past success while ensuring that we reduce and improve the survival rates for cancer. One of the real problems in this country is that we have some of the poorest survival rates for cancer. We will ensure that the networks' expertise is incorporated into the way in which the reformed system will work.

David Tredinnick (Bosworth) (Con): Is my right hon. Friend aware of the rally being held here in Westminster tomorrow by qualified herbalists who are coming to lobby for statutory regulation, which my right hon. Friend is obliged to provide under European law? When will he do that, please?

Mr Lansley: I am indeed aware of that, as my hon. Friend would expect. He will know that we are considering how we can give effect to the proper regulation of herbal practitioners and we will make an announcement shortly.

T5. [28727] John Mann (Bassetlaw) (Lab): If a hospital service's reconfiguration is demonstrably and overwhelmingly rejected by a local population, what notice will the Secretary of State take of the patients' voice?

Mr Lansley: It was only under this Government, after the election, that tests were set out that such reconfigurations should meet. Those tests clearly included recognition of the voice of the public and of the local authority as well as current and prospective patient choice. To that extent, for the very first time, reconfigurations are not being dictated by an NHS administration but are responding to the views of patients and clinicians.

Duncan Hames (Chippenham) (LD): The NHS Litigation Authority estimates an outstanding liability for clinical negligence claims of £15 billion, a sum that increased by £2 billion in the last year alone. How will the Minister bring that spiralling cost to the NHS to a halt?

Mr Lansley: I understand exactly my hon. Friend's point. The increase in liabilities was, in part, an expression of the change in the discount rate rather than necessarily an increase in the number of cases coming through. It is a worrying figure and costs the NHS not far short of £1 billion a year through contributions to the clinical negligence scheme for trusts. My noble Friend Lord Young, in the course of his review of health and safety and other issues, made recommendations on dealing with conditional fee arrangements and clinical negligence. It set out that we would consider, for example, how we implement NHS redress arrangements, including whether there should be a fact-finding phase before any question of legal intervention. We will do that and report back to the House.

T7. [28730] Pat Glass (North West Durham) (Lab): My local hospital, Shotley Bridge hospital in Consett, has faced a degree of certainty over its future in recent years. However, with the demise of the local PCT, which owns the hospital and the land, uncertainty has returned. Is the Minister prepared to meet me and a delegation from the hospital to consider the future?

Mr Lansley: I am sure that I or one of my hon. Friends will be happy to meet the hon. Lady. I do not know why she thinks that the abolition of the PCT will
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make that change. We have yet to set out how PCT assets will be dealt with when they are abolished. She must talk to her local GPs as I know that GPs in Durham have come together in a consortium and they will be well placed to give precisely the kind of assurance about the security of services in the future that she is looking for.

Nick de Bois (Enfield North) (Con): The Secretary of State will be aware that the Barnet, Enfield and Haringey clinical review has been concluded. It notes that the Secretary of State's four tests have been passed, despite health scrutiny establishing that they have not. In addition, the majority of Enfield GPs do not support the proposals. Will the Secretary of State therefore conclude that the four tests have not been passed?

Mr Lansley: My hon. Friend will know that all that has not yet come to me, so I will not prejudge this issue. However, I have made it clear, not least in a letter I recently sent to Baroness Margaret Wall, who is the chair of the Barnet and Chase Farm Hospitals NHS Trust, that I expect us to examine not only the Barnet, Enfield and Haringey proposals, but any other proposals that the trust might put forward about the level of acute services provided through Chase Farm.

T9. [28732] Toby Perkins (Chesterfield) (Lab): The Secretary of State seemed to suggest, in his answer to the shadow Secretary of State, that his definition of a real-terms increase includes changes in inflation. If he does not accept the Office for Budget Responsibility verdict that the increase in inflation means a real-terms cut in 2012, which definition of inflation is he using?

Mr Lansley: What I said to the shadow Secretary of State was entirely accurate.

Gordon Birtwistle (Burnley) (LD): Does the Secretary of State agree that the abolition of unelected quangos such as primary care trusts and strategic health authorities will bring an end to the decisions they are taking to remove services from local hospitals against the wishes of GPs and local residents?

Mr Lansley: The reforms we propose will bring far greater accountability not only through local authorities but through patient choice and through front-line clinicians being able to commission services.

Let me also tell my hon. Friend that I have today referred to the independent reconfiguration panel, for initial appraisal, the question referred to me by Lancashire county council about the children's ward at Burnley hospital.

Steve McCabe (Birmingham, Selly Oak) (Lab): Will the Secretary of State join me in deprecating the outrageous behaviour of the Prime Minister's aides who told the Financial Times that the Secretary of State, on his reorganisation, has all the answers-unfortunately to all the wrong questions?

Mr Lansley: The hon. Gentleman should not believe what he reads in the papers and when he is trying to quote from them, he should do so accurately.

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Caroline Dinenage (Gosport) (Con): Blake maternity unit in Gosport is temporarily shut and its long-term future is by no means 100% secure. In conversations with local health care bosses, I have learned that it is not because of cost but because of a national shortage of midwives. Are there any policies or plans to address this issue?

Mr Lansley: I do not know the particular circumstances in Gosport, but I shall happily write to my hon. Friend. Nationally, we have more midwives than we have ever had- [ Interruption. ] I am being provoked by those on the Opposition Front Bench. There was a 16% increase in the number of live births in this country, but only a 4.5% increase in the number of midwives. That is the point I was about to make. The Government of whom the hon. Member for Halton (Derek Twigg) was a member failed to invest in midwifery when there was an increase in live births. That is why hospitals across the country have too few midwives, and that is why we are putting the investment in-because we did not listen to the Labour party when it said, "Cut the NHS budget."

Fiona Mactaggart (Slough) (Lab): Will waiting times for in-patient treatment in hospital increase or decrease next year?

Mr Lansley: They will respond positively to patient choice and GP referral.

Joseph Johnson (Orpington) (Con): I am grateful to the Secretary of State for agreeing to visit Queen Mary's, Sidcup, tomorrow, recognising the strength of local
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opinion there about the closure of accident and emergency and maternity services temporarily over the winter period. I hope that on his return he will reassure my constituents in Orpington that the closure will not mean that the review of reconfiguration of local NHS services will be prejudged and will not put neighbouring hospitals such as those in my constituency under undue pressure.

Mr Lansley: I am grateful. Tomorrow, I hope to assure myself, among other things, that the closure is temporarily demanded by virtue of the inability to secure enough staff to maintain a safe service for the time being and that it will not and does not pre-empt the question of availability of services at Queen Mary's, Sidcup, on which a decision has not yet been reached locally or referred to me.

Mr Dennis Skinner (Bolsover) (Lab): On the NHS campaign against obesity, does the Secretary of State welcome the magnificent support of the thousands of schoolchildren who have come down to demonstrate for school sports funding outside No. 10 Downing street? Will he fight in the Cabinet against the Education Secretary's silly proposal, which will damage children's health?

Mr Lansley: The Secretary of State for Education rightly believes in schools making decisions about how they should best use their resources, including for school sport. I hope the hon. Gentleman will welcome the fact that through my Department we have supported school sports clubs under Change4Life and intend to expand them.

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Rehabilitation and Sentencing

3.34 pm

The Lord Chancellor and Secretary of State for Justice (Mr Kenneth Clarke): With permission, Mr Speaker, I would like to make a statement. On 12 May, we said in our programme for government that we would conduct a full assessment of rehabilitation and sentencing policy to pave the way for radical reforms to the criminal justice system. I have laid before Parliament today the Green Paper entitled "Breaking the Cycle: Effective Punishment, Rehabilitation and Sentencing of Offenders." This sets out our initial conclusions from this work, on which we will be consulting widely over the next 12 weeks.

Despite record spending we are not delivering what really matters. Society has a right to expect the criminal justice system to protect them. Prison will always be the right place for serious and dangerous offenders. Criminals should be properly punished. Prisons should be places of hard work and industry, and community sentences must be credible and robust. Criminals must also be reformed so that when they finish their sentence they do not simply return to their life of crime, creating more misery for victims.

The present criminal justice system falls short of what is required. Around half of offenders released from prison reoffend within a year. Reoffending rates for young offenders sentenced to custodial or community sentences are even worse. It is not acceptable that three quarters of offenders sentenced to youth custody reoffend within a year. If we do not stop offending by young people, the young offenders of today will become the prolific career criminals of tomorrow.

Solving these problems requires a radically different approach. Of course, criminals must face robust and demanding punishments. This means making them work hard both in prison and in the community. More prisoners will face the tough discipline of regular working hours. This has been lacking in most prison regimes for too long. Community sentences will be more credible, with more demanding work and greater use of tough curfew requirements. There will be greater reparation to victims through increased use of restorative justice and by implementing the Prisoners' Earnings Act 1996. We will bring forward other changes to make sure that more offenders directly compensate the victims of crime.

But we will take a new approach to the reform of offenders. I regard prison first and foremost as a place of punishment where people lose their liberty as reparation for what they have done, but on top of that, prison cannot continue to be simply an expensive way of giving communities a break. We must give higher priority to ensuring that more prisoners go straight on release.

Offenders will face a tough and co-ordinated response from the police, probation and other services. It will mean that they must either address the problems that fuel their criminal activity or be caught and punished again. It will mean taking action to get offenders off drugs. It will mean reducing the abuse of alcohol. It will mean improving the treatment available to those suffering mental illness. It will mean getting more of them off benefits and into honest employment so that they can pay their own way.

We will bring forward a revolutionary shift in the way that rehabilitation is financed and delivered. We will begin by commissioning a range of providers to administer
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at least six new projects over the next two years. They will be paid for the results that they achieve. I intend to apply the principles of that approach across the whole system by the end of the Parliament. We will also test this payment by results approach with young offenders, and devolve more responsibility for preventing and tackling youth offending to local communities. We will introduce more competition across offender management services to drive up standards and deliver value for money for the taxpayer. We will increase discretion for public sector providers and front-line professionals.

The sentencing framework must provide courts with a range of options to punish and rehabilitate criminals and keep the public safe. The sentencing framework has developed in an ad hoc fashion recently, with over 20 Acts of Parliament changing sentencing in the past 10 years. This has left it overly complex, difficult to interpret and administer, and hard for the public to understand. We need to make better use of prison and community sentences to punish offenders and improve public safety, while ensuring that sentencing supports our aims of improved rehabilitation and increased reparation to victims and society. We will therefore simplify the sentencing framework in order to make it more comprehensible to the public and to enhance judicial independence. We will reform community orders to give providers more discretion, and we will encourage greater use of financial penalties and improve their collection.

We will bring forward reforms to the indeterminate sentence of imprisonment for public protection. This sentence has been much more widely used than was ever intended by Parliament since its introduction in the Criminal Justice Act 2003. Indeed the last Government had already tried to change it once since its introduction. We will reserve IPP sentences for the most serious offenders and focus indefinite punishment on those who most clearly pose a very serious risk of future harm. Of course, prisoners who in future do not receive an IPP sentence will instead receive long determinate sentences. This will enable us to restore clarity in sentencing, plan rehabilitation and target punishment more effectively to protect the public.

Let me assure the House that public safety remains our first priority. We will continue to ensure that serious and dangerous offenders are managed effectively and their risk is reduced through appropriate use of prison and then through the multi-agency public protection arrangements. Let me also assure the House that we will also ensure effective responses to knife crime. Knife crime is wholly unacceptable. It causes misery for victims and is often connected to the kind of gang violence that can wreck whole communities. The Government's position is clear. Any adult who commits a crime using a knife can expect to be sent to prison, and serious offenders can expect a long sentence. For juveniles, imprisonment is always available and will also be appropriate for serious offenders.

The Green Paper is an important change of direction in penal policy, which will put more emphasis on reducing reoffending without reducing the punishment of offenders. By reforming criminals and turning them away from a life of crime we will break the cycle. This should mean fewer crimes, fewer victims and safer communities. The Government will make a further statement to the House when they publish their response to the consultation. I commend the statement to the House.

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Sadiq Khan (Tooting) (Lab): I thank the Secretary of State for advance sight of his statement on sentencing policy. The Ministry of Justice's four-year plan on its vision page declares:

I have no quarrel with that. It seems to me a perfectly sensible vision for a sentencing policy, entirely in keeping with the emphasis on punishment and reform that Labour followed in government, and which helped to cut crime by 43% between 1997 and 2010, both in times of growth and recession-the only Administration since the second world war who can boast such an enviable record.

I have a number of questions for the Secretary of State. First, will he confirm that he accepts that crime went down, as I have just said? So, on the core principle we are in agreement, and where the Government propose sensible measures to punish and reform offenders, we will support them. However, the statement that we have just heard and the Green Paper give rise to a number of questions and concerns. Will he confirm that the entirety of the Conservative party's manifesto on law and order has been put in the bin? Before the election, the Prime Minister promised that there would be tougher sentences for knife crime. People caught in possession of a knife would face a presumption of prison. Does the Secretary of State accept that he has now made a humiliating U-turn on that policy? The Prime Minister promised that there would be "honesty in sentencing". Judges would read out a maximum and a minimum sentence to offenders in court. Does the Secretary of State accept that there has been a U-turn on that also? The Prime Minister promised increased prison capacity-another U-turn?

Let us be absolutely clear. Every one of those pre-election promises to be tough on crime has been abandoned. They have been revealed for what they are: a bluff. A bluff on crime and a bluff on the causes of crime. Like so many of the heavily trailed announcements that we have seen in the past six months, this sentencing review is a wasted opportunity. Sentencing policy should be about dealing with offenders in the right way in order to protect the public, but this review has been about trying to reduce the prison population in order to cut costs.

When the comprehensive spending review was published recently, the Justice Secretary outlined his central aim, which was

The prison population is about 85,000 today, so that would mean it being 82,000 in four years. In practice, however, because many people serve less than one year in prison, meeting that target would mean 10,000 fewer offenders in jail each year. That is what the sentencing review is all about.

Given the Government's big claims about transparency, can the Secretary of State confirm that he will publish the detailed assumptions that his officials and the Home Office have made about crime trends to justify that target of 82,000? I do not subscribe to the view that there is a direct link between prisons and crime, but nor do I share the Justice Secretary's belief that there is no link at all. Under Labour, more serious and persistent criminals went to prison for longer, and crime fell. The relationship between those two things might not have
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been simple and straightforward, and other factors, including an increase in police numbers, were at play, but there was a relationship.

The Justice Secretary, to justify his view that there is no link, is fond of saying that crime rates also declined internationally during that time, but that prison rates in many countries went down. Well, he is wrong. I have checked the figures for OECD countries, and prison populations rose almost everywhere. Although prison should always be the outcome for serious and persistent offenders, we believe that alternatives to custody should be used when they are a more appropriate form of punishment and reform. We accept that prison is not always the best place for offenders, and community sentences can be a better alternative in order to cut reoffending, but does he accept that, as a result of the changes that we introduced, the number of women in custody went down, and that reoffending rates for women, young men and first-time offenders also went down in recent years?

I welcome the announcement that the Government are seeking to build on important Labour innovations, such as the expansion of community payback. Further action on drug addiction is clearly welcome, and the steps outlined to deal more effectively with offenders with mental health problems, one of our society's most pressing issues, are a vindication of the decision of my right hon. Friend the Member for Blackburn (Mr Straw) to set up and start to implement the important Bradley review.

The current Justice Secretary aims at some of the right goals, but his total eagerness to please the Treasury by cutting the Ministry of Justice budget by 23% will make it very difficult and risky to turn those aspirations into reality. With the Home Secretary having also caved in to a 23% cut, the obvious question voters will ask is, how can the right hon. and learned Gentleman's party ever again claim to be the party of law and order?

The Secretary of State will recall the old care in the community model for mental health in the 1990s. As a former Health Secretary, he presided over it and will be aware of some of the real problems that it created. If proper resources are not invested in dealing with offenders outside prison, we could be in for care in the community mark 2-this time with criminals.

Will the Justice Secretary explain, in particular, what assessments are being made of the likelihood that prisoners on indeterminate sentences, whom he wants to release, are no longer a risk to the public? What procedures will be put in place to monitor such people in the community?

Mr Speaker: Order. I am loth to interrupt the shadow Secretary of State, but he is getting towards the point where his questioning has been longer than the Secretary of State's pithy statement, so he really does now need to bring it to an end. He can have another sentence, but he must then bring it to an end.

Sadiq Khan: As ever, Mr Speaker, I am grateful.

When the Justice Secretary was recently asked on BBC's "Newsnight" how he would judge the success of his penal policy, his first response was that he "hadn't the first idea". That was a more revealing answer than he perhaps intended, because it exposed a certain complacency that is becoming the hallmark of this Government.

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In conclusion, let me offer the Lord Chancellor advice on how to judge the success of his policy. Will it make communities up and down the country more or less safe? Will it result in crime going up or down? I tell the Lord Chancellor and those who support him that it is against those criteria that we will be holding him, his proposals and his Government to account.

Several hon. Members rose -

Mr Speaker: I do not want to be corny about it, but in this context I should surely be able to appeal from now on for shorter sentences-and preferably fewer of them.

Mr Clarke: I was about to congratulate the Opposition spokesman on his statesman-like performance in a difficult situation. He managed to go on for exactly the same length of time as I took to make my statement. I listened carefully, and he did not criticise a single proposal that I had made. He did not disagree at all. I should have realised that he would do that, because when he was asked, by Decca Aitkenhead in The Guardian of 29 November, whether Ken Clarke had said anything that he disagreed with, he said, "No, he hasn't." He took eight minutes to give that reply today, but the conclusion was the same.

The right hon. Gentleman said that we had abandoned our whole manifesto and pre-election commitment. We are in a coalition Government and have inherited a financial crisis. The principal argument that we had when in opposition was about the rehabilitation revolution. I commend to the right hon. Gentleman the work done by my right hon. Friend the Minister for Policing and Criminal Justice and my hon. and learned Friend the Solicitor-General on a pamphlet called "Prisons with a purpose". In the manifesto, we said:

That remains the core proposal that we are putting forward, and I am glad to be able to build on it.

The right hon. Gentleman talks about the reduction in the number of people in prison. Eighty-two thousand is not a target; I asked people to produce an estimate of what the whole package-there are a lot of things in the package-was likely to do to the prison population over the next few years, and their estimate, and it is only an estimate, is that that population will reduce by about 3,000. It would be quite something to stop the explosion of the prison population that has been going on in recent years. Reducing it by 3,000 is quite modest, but that is an estimate. We are aiming to do something to ease the pressure on the system-above all, to ease the pressure on victims-by rehabilitation and by tackling the root causes of crime.

The right hon. Gentleman talks about numbers. He tried to praise-he did his best-the record of the Government of whom he was a member. The real nadir of the publicity-seeking policies of the last Government came when they had succeeded in getting so many people sentenced to prison that they could not accommodate them. Eventually, they had to release 80,000 prisoners from jail, before they had finished their sentences, under an early-release scheme. That was a debacle of a policy that we will not repeat.

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The right hon. Gentleman talked about this being against a background of a 23% reduction in my budget. Half of that, of course, is going to come from administration and a great bulk of it from legal aid savings, which he supports. Much less will come from the Prison Service and the probation service.

Does that comment mean that the right hon. Gentleman would spend more? I am waiting to hear what the Labour party says about the financial background to policy. Apparently, the reduction is too much. Will he consult the shadow Chancellor and let us know how much more a new Labour Government would spend on keeping up the prison population, keeping the criminal justice system as it is and continuing the failed policies of the last Government?

Several hon. Members rose -

Mr Speaker: Order. Thirty-seven years of service in the House should make the right hon. Member for Berwick-upon-Tweed (Sir Alan Beith) an exemplar of brevity.

Sir Alan Beith (Berwick-upon-Tweed) (LD): I remind the Lord Chancellor that Members from all three parties on the Justice Committee unanimously recommended a shift from expanding prison places to rehabilitation, drug and alcohol treatment, mental health provision and early intervention to stop young people from getting into crime. Would he not be failing to keep the public safe if he did not follow that recommendation?

Mr Clarke: I entirely agree with the right hon. Gentleman. A lot of people in all three parties welcome this shift of policy. It is not particularly myself and my colleagues who believe this; it is quite obvious that it is a direction in which we should go. I look forward to having the assistance of the Select Committee and making sure that we get the details right and keep going in the right direction.

Several hon. Members rose -

Mr Speaker: Order. I would love to try to get everyone in, but I appeal to right hon. and hon. Members to help me to help them.

Mr Jack Straw (Blackburn) (Lab): Why is the Secretary of State so unwilling even to utter the words that would acknowledge that, in the past 15 years-the last two years of his Government, from 1995, and through the 13 years of the previous Labour Government-crime fell by a record 50%? Why does he not acknowledge that and also accept that the cost-cutting led programme that he has announced today may put crime levels at risk?

Mr Clarke: Of course I acknowledge that crime fell during that period, as it did throughout most of the western world. I have always acknowledged that. Where we will not agree is on the simple cause and effect that the right hon. Gentleman puts forward. Let me quote from source that it would be unexpected for me to quote with total favour: Mr Newt Gingrich. A recent article he published in an American magazine about the situation in the state of South Carolina states:

This morning, I was put on Alastair Campbell's blog. Newt Gingrich seems to agree with the direction we are taking, Alastair Campbell appears to believe that we are going in the right direction, and Members from all three parties, including the Chairman of the Select Committee, agree. The right hon. Gentleman is the representative of a failed past.

Philip Davies (Shipley) (Con): Last year, 3,000 burglars and 4,500 violent criminals with 15 or more previous convictions were not sent to jail, and people with more than 100 previous convictions who came before the courts were more likely not to be sent to jail. They reoffended not because they went to prison, but because they did not go to prison. How on earth can my right hon. and learned Friend accept the figures that his Department has issued and say that too many people are going to prison? Most people would look at those figures and conclude that too few people are going to prison.

Mr Clarke: A court has to look at the nature of the offence and the individual offender and give the right sentence. For serious criminals, that means going to prison; for recidivist offenders, that means going to prison; for others, it might be more appropriate for a strong community sentence to be made available. It is not possible to generalise in such a way. At the heart of what we are doing is ensuring that judges give the right punishment and that they give us a rest while people are in prison. The system is simply failing to prevent people reoffending. That is what the policy focus has to be and that is what will reduce crime if it is successful.

Mr David Blunkett (Sheffield, Brightside and Hillsborough) (Lab): Perhaps the Secretary of State will remember that, back in 2001, there was something called the Halliday review of sentencing. In July of that year, I talked-much as the Secretary of State has done this afternoon-about avoiding reoffending. Does he acknowledge that a £40 million cut in the South Yorkshire police budget, more prisoners on the street, more offenders reoffending because the police are not available to protect the public and the victims is not a charter for common sense; it is a charter for criminals to get on with the job that they have been doing and from which we have been trying to protect the public?

Mr Clarke: The budget for the Prison Service and the probation service in my Department increased by roughly 50% in real terms over the past seven years. The idea that the only approach to criminal justice policy-as with other policies-is simply to spend and borrow more and more is what got the previous Government into the sorry state in which they eventually collapsed. We must now do things more intelligently and sensibly, and address the problem of reoffending. I am afraid that the right hon. Gentleman was unsuccessful when he turned to that in 2001.

Claire Perry (Devizes) (Con): Will the Secretary of State talk specifically about the issue of foreign offenders in the prison system and what he proposes to do to free up prison places by a change of policy in that area?

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Mr Clarke: The number of foreign prisoners in our prisons roughly doubled in the past 10 years, during the period of office of the previous Government who rather went backwards and forwards at various times about whether they were releasing people who might have been deported or keeping them here because they could not be deported. It is difficult to get large numbers out, but we are determined to make an effort to do it. We are looking at ways in which, in suitable cases, conditional cautioning could get people out of the country and diverted out of our criminal justice system altogether on the basis that they never come back. We are also looking at how we can encourage other countries to take back prisoners who are eligible for deportation to ensure that this extraordinary burden, which has grown in the past few years, is eased, because there are better things we can do in the whole system with the money we are spending on foreign prisoners.

Alun Michael (Cardiff South and Penarth) (Lab/Co-op): I am pleased that the Justice Secretary intends to build on the success of the youth offending teams, which I introduced in 1998. Will he ensure that the youth courts, and indeed the courts generally, follow the central recommendations of the justice reinvestment report by focusing clearly on what works in reducing reoffending and incentivising those outside the criminal justice system who can help to bring down crime?

Mr Clarke: The answer is yes. One thing on which I totally agree with the right hon. Gentleman is that we have to concentrate our resources on what works. By that I mean, from the point of view of the potential victims and society at large, what gets down the level of crime committed by young offenders, in particular.

Mr Edward Leigh (Gainsborough) (Con): I notice that my Conservative Secretary of State says: "Prison cannot continue to be simply an expensive way of giving communities a break." I am sorry, but communities deserve a break-they deserve a break from being burgled. Will my right hon. and learned Friend assure me that on his watch, people who cause absolute misery by thieving from people's homes, particularly those of elderly people, can expect to go to prison, where they deserve to be?

Mr Clarke: The answer to the last part of the question is obviously yes. Burglars should usually go to prison-nobody has ever suggested that they should not. I have read extraordinary suggestions that we are letting out burglars, robbers and all kinds of people. They are the core population of a prison and should remain so. The main purpose of prison is that it is the best form of punishment: it is a way of exacting some reparation from somebody for the crime they have committed. It also, of course, gives us a break from their offences while they are in prison. However, if we concentrate on that aspect of imprisonment, it is a very expensive way of giving people temporary relief from the crimes of those incarcerated. Prison should be producing people most of whom, on release, will not go back to a life of crime. Unfortunately, it has been the case over a period of years that three quarters of them eventually commit further crime. That is the failure and weakness in the system, and that is where the concentration now has to be.

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Paul Goggins (Wythenshawe and Sale East) (Lab): Earlier, in Health questions, the Health Secretary confirmed that he has been working with the Justice Secretary on plans to divert mentally ill offenders from prison-something that I broadly welcome. When I pressed him on how much additional funding was being made available for this, he was unable to tell me, but referred me to this statement, so can the Justice Secretary tell me how much additional money will be made available?

Mr Clarke: This is about both our budgets, so I had better not pre-empt my discussions with my right hon. Friend. I hope that he gave a helpful response to the question, because the two of us, together with our Departments and our officials, are working very seriously on trying to improve the situation for mentally ill people who ought not to be in prison or ought to be better treated in prison. It is not an easy subject. The reason we have so many people in prison who obviously ought not to be there because they are suffering from mental illness is that it is difficult to devise services that will not only help them but improve their behaviour and make them less of a risk to the community at large. At this stage, we are consulting on it. However, I can assure the right hon. Gentleman that there is a genuine commitment on the part of my right hon. Friend and me to ensure that the Department of Health, the NHS, the National Offender Management Service and the Prison Service work together properly so that people are dealt with in a more suitable and civilised fashion. The main benefit one can give to the public regarding those whose main problem is mental illness is to help them to cope with the behavioural problems that are causing the crime.

Tom Brake (Carshalton and Wallington) (LD): Can the Secretary of State confirm by how much he expects the number of vulnerable women and women with babies in prison to reduce as a result of these very sensible proposals?

Mr Clarke: I will not go into another precise estimate, but we need to reduce the number of women in prison. The previous Government worked on that. It is important to realise that women who go to prison-many fewer do so than men-tend to have a particular combination of problems. Compared with men, a much higher proportion of women in prison have a history of drug abuse, alcohol abuse, domestic violence and a disordered life, in all kinds of ways. Focusing on that is likely to reduce the women prison population, and we will do that. Of course, as with men, there is a hard core of women who are hardened criminals or antisocial people, and they must be incarcerated for long sentences when they do something that deserves it.

Keith Vaz (Leicester East) (Lab): I have no quarrel with the vision set out by the Secretary of State for Justice. It is in keeping with many recommendations made by the Home Affairs Committee over many years. I do have a quarrel with the detail, however. Last year, there were 4,600 hospital admissions as a result of knife crime. Will he confirm that it is still the policy of the Government that those who are caught carrying knives will be sent to jail?

Mr Clarke: I am grateful that the right hon. Gentleman does not differ in principle. I do not think that Opposition Front Benchers do either; they certainly do not have an
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alternative to put forward. Knife crime is a very serious matter. We are clear that the use of a knife in crime is serious. Anybody who stabs somebody else will go to prison-they usually do and they always should. Anybody who uses a knife in a threatening way in the course of a crime should go to prison. Anybody who carries a knife in circumstances in which its imminent use is likely should go to prison.

However, we have to avoid absolute tariffs that set in statute what the punishment should be for every particular offence. That was a mistake made by the previous Government. To fill up more than 20 criminal justice Acts, they produced ever more complicated and prescriptive rules, which judges sometimes find incomprehensible and which sometimes are in danger of flying in the face of the obvious justice of an individual case or the long-term interests of society.

Anna Soubry (Broxtowe) (Con): The majority of the people I represented who were burglars were addicted to drugs or alcohol. Does the Secretary of State agree that residential rehabilitation is usually far more effective at stopping such people reoffending than long custodial sentences?

Mr Clarke: I entirely agree with my hon. Friend. She has long experience, and much more recent experience than I have, of dealing with such problems in the courts. What we must do through, among other things, the payment by results approach and bringing in more private, independent and not-for-profit providers, working in co-operation and partnership with statutory providers, is find better ways of achieving better results in drug rehabilitation, the ending of alcohol abuse and the treatment of mental illness.

Kerry McCarthy (Bristol East) (Lab): Following on from the previous question, will the Secretary of State confirm that he will lobby for drugs funding, not just in his Department and the Home Office, but in the Department of Health? Unless drug treatment programmes are funded, we will not be able to treat drug addicts and prevent them moving into the criminal justice system.

Mr Clarke: I will. My right hon. Friend the Home Secretary takes the lead in the Government in tackling drug problems and the Minister of State, Cabinet Office, my right hon. Friend the Member for West Dorset (Mr Letwin), is heavily involved too. We will use payment by results widely across the piece, not just with regard to offenders, to find out what works. We will put more emphasis on genuine rehabilitation, not just keeping people dependent on methadone, for as long as happens in far too many cases in prison and in the community.

Dr Julian Huppert (Cambridge) (LD): I welcome the reference to the Rehabilitation of Offenders Act 1974 in the Green Paper "Breaking the Cycle", although that reference did not make it into the statement. It follows on from the excellent report by Lord Falconer, "Breaking the Circle", which unfortunately the Labour Government did not have the courage to do anything about. Will the Secretary of State assure me that this matter will be an important priority, particularly in ensuring that cautions become spent extremely quickly?

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Mr Clarke: I can confirm that we are proposing to reform that matter. We are consulting on it, so I look forward to having the hon. Gentleman's representations on what level of offence should never be excluded from disclosure, how long it should take for cautions for other offences to be spent and what we should do about juvenile offences, which are sometimes held against people for far too long in what has become a law-abiding adult life. We will not duck the issue, we will reform the system and I look forward to hearing his views.

Mr Chuka Umunna (Streatham) (Lab): HMP Brixton is in my constituency, and 80% of the prisoners there are on short-term sentences of less than four weeks. I will look at the Green Paper to see what it will do to address the fact that it is difficult to rehabilitate within that time frame. I was e-mailed last week by the prison's independent monitoring board, which made it clear that there should be absolutely no cuts to the prison. What guarantee can the Secretary of State give me that the Green Paper will not be used to impose cuts on my local prison?

Mr Clarke: I realise the difficulties of a prison such a Brixton, with such a high proportion of its population being short-term prisoners. We cannot get rid of all short-term prison sentences. I have never believed that that was possible, because magistrates face people who have come before them frequently, and they have tried everything else. In such cases, there is absolutely no way of dealing with their recidivist behaviour other than to send them to prison, or sometimes back to prison yet again. I hope that some of the payment by results providers will be able to start providing rehabilitation for such people, for whom no provision is currently made once they are put out of the door.

As far as spending on the Prison Service is concerned, we are affected, as in every other service, by the financial constraints we are under. It is not true that it is not possible to make any savings in how we run the prison estate. Spending on the Prison Service will depend in large part on what burdens are imposed on the system in future years by the level of crime and sentencing patterns, because it is partly a demand-led service. I cannot simply give an undertaking that nothing will be changed. We intend to follow on from the last Government's policy of using competition, among other things, to test costs and ensure that we have the most cost-effective way of providing the quality of service that we want to provide.

Rehman Chishti (Gillingham and Rainham) (Con): As someone who both prosecuted and defended in criminal courts before coming to this place, I wish to mention the possession of knives. Does the Secretary of State have an assessment of the effect of the Violent Crime Reduction Act 2006, which increased the sentence from two years to four years? Does he agree that the best way to deal with knife crime is to deal with the gang culture that leads to the possession of knives?

Mr Clarke: Yes, I think the possession of knives is a scourge on society, particularly when it is associated with gang culture and all the other problems that it causes in many communities. I repeat, however, that judges and magistrates are in the best position to decide what the circumstances of a particular offence were,
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what the circumstances of the offender are and what is the best way of imposing a penalty that protects the public.

We have to get away from the habit of the past few years of leaping in with a tariff that takes discretion away from the courts in each and every category of case. The tariff works in some cases but then, the next thing we know, the people who campaigned for it are campaigning like mad against some obvious injustice because it is inflexibly applied to some person who would be better dealt with in other ways.

Mr David Crausby (Bolton North East) (Lab): Earlier this year in my constituency, a driver who had been drinking crashed into a group of teenagers on the pavement, seriously and permanently injuring them. At the trial, the judge bitterly complained that he could give him only the maximum two-year sentence for dangerous driving. Will the right hon. and learned Gentleman join me in supporting the Drive for Justice campaign to give judges more flexibility in sentencing dangerous drivers?

Mr Clarke: I shall have a word with my right hon. and learned Friend the Attorney-General, because that is a perfectly valid point that we will consider. There is, of course, a higher penalty for causing death by dangerous driving, but the hon. Gentleman describes someone who behaved equally reprehensibly but happens not to have killed any of the victims. As I am arguing for discretion, we will look to see whether the constraint is too tight.

In the case of ordinary dangerous driving without any serious consequences, although I deplore all dangerous driving we cannot start imposing heavy prison sentences on everybody who might otherwise be a blameless citizen and then behaves in an absolutely reprehensible way when driving his car. Some cases, such as the one described, make the case for having a look at the two-year maximum.

Mr Robert Buckland (South Swindon) (Con): I welcome the proposal in the Green Paper to expand the principle of restorative justice, but will my right hon. and learned Friend assure me that any moves to expand that approach will be victim-led rather than offender-led?

Mr Clarke: The answer to that is yes, I will. Restorative justice is proving to be remarkably successful, but I take my hon. Friend's point that it does not work if victims are not in the leading role. We have ensured very high levels of victim satisfaction in most of our experience so far of steadily spreading restorative justice.

Mrs Jenny Chapman (Darlington) (Lab): I welcome the Secretary of State's road-to-Damascus conversion to rehabilitation. I made a note of some of the promises that he makes in the Green Paper, which include regular working hours, restorative justice, custody diversion, and drug, alcohol and mental health services. What bothers me is that if those things are to be effective, they cannot be done on the cheap. It is wrong of him to promise such investment in rehabilitation, because the 23% cut to the Ministry of Justice and cuts in probation mean that those promises are completely undeliverable.

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Mr Clarke: I make the point again: the hon. Lady does not appear to disagree with any of those proposals, but they were not priorities of the Labour party when it was in office. That is not where the money went. The Labour Government spent money on a colossal scale, but it did not go into the objectives that this Government now advocate.

Otherwise, to be fair, the hon. Lady makes a valid point. The House should understand that achieving the results that we want will take time. We are dealing with difficult problems, such as mentally ill prisoners, which are incapable of instant, overnight solution- [ Interruption. ] It is no good her making gestures about spending money, because simply spending money on mentally ill prisoners will not get us very far. We must spend money intelligently.

We are talking about a whole Parliament, but I emphasise that payment by results does not involve putting money up front. It avoids the danger of giving grants to this or that hopeful-sounding idea or project. Sadly, some of those projects do not work. Paying by results means that we will pay for what works. The projects that succeed will spread more rapidly.

Mark Reckless (Rochester and Strood) (Con): The secure training centre in my constituency protects the community when young people are locked up there, and often teaches them to read for the first time. Yet, as it costs more than £100,000 a year for that, what will the Secretary of State do to ensure that those benefits carry over when those young people are released?

Mr Clarke: It costs about £170,000 a year to keep somebody in a young offenders institution. Those who think that the numbers being detained are inadequate might reflect upon that. I agree strongly with my hon. Friend that what matters is the rehabilitative supervision that is in place after detention, with the support to deal with whatever the young person's problems are in addition to his bad behaviour. In that way, we ensure that we reduce to the absolute minimum the risk of his reoffending and getting back into the system.

Luciana Berger (Liverpool, Wavertree) (Lab/Co-op): Further to the questions asked by my right hon. Friend the Member for Wythenshawe and Sale East (Paul Goggins), and my hon. Friends the Members for Bristol East (Kerry McCarthy) and for Darlington (Mrs Chapman), can the Secretary of State confirm whether extra cash will be made available by either the Ministry of Justice or the Department of Health to support all the rehabilitation measures that he outlined today?

Mr Clarke: I realise that the hon. Lady is a new Member of the House- [ Interruption. ] If the Labour party cannot move on from reacting to every social problem by saying that there must be more public expenditure and borrowing-Labour Members think that if we demonstrate that, we are tackling the problem effectively-it has no role in the government of this country for many years to come.

Dr Thérèse Coffey (Suffolk Coastal) (Con): I very much welcome my right hon. and learned Friend's announcement that those who commit a crime using a knife can expect to be sent to prison. However, will he elaborate on another part of his statement? He mentioned having a sentencing framework that is comprehensible
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to the public, which I hope also applies to victims. I found during the general election that a number of my constituents do not understand why, when somebody is sentenced to six years, they automatically go home after three.

Mr Clarke: I have no anecdotal recollection of anybody who has stabbed somebody not going to prison. Actually, people who do not stab someone because they are stopped in time should go to prison too. A serious knife crime justifies a prison sentence, and I think that we can rely on judges to give serious prison sentences. They do not have to be told that the use of a knife in a crime deserves a serious sentence. However, if they want to be told, I and my hon. Friends will tell them.

Public understanding of the system is important. We will consider how sentences can be expressed in terms that the public understand. People do not understand that when someone is sentenced to a certain number of years in prison, they serve the first half in prison and the other half on licence, which means that they will be recalled to prison if they start falling down in their behaviour. There are many other aspects of our incomprehensible sentencing arrangements that are difficult to get across to the public. The rules given to judges for explaining sentences are a hopeless mess and need to be simplified, and I agree with my hon. Friend that we need to make it more transparent and clearly available to the public.

Mr Speaker: Order. May I remind the Secretary of State that I am always keen to hear his answers? I know that his natural courtesy inclines his head backwards, but I would like him to look at the House.

Kevin Brennan (Cardiff West) (Lab): Instead of giving prisoners the vote, why does the Secretary of State not incorporate the withdrawal of that civic right in a prison sentence? If he does not do that, will people not think that he actually wants to give prisoners the vote?

Mr Clarke: The hon. Gentleman was a Minister in the last Government for-I think-the last five years. For five years, the last Government accepted that they had to give some prisoners the vote. They consulted on it every now and then, but they did nothing. He should have come forward with his helpful suggestions when he was in office. We are about to produce our proposals on how to comply with the relevant judgment, but that will not involve giving all prisoners the vote. We will consider some of his points and then get on with it. The Government led by the previous Prime Minister were often incapable of taking a decision and getting on with anything.

Priti Patel (Witham) (Con): Will the Secretary of State reassure my constituents and guarantee that dangerous criminals, such as paedophiles, will receive demanding and robust punishment in prison so that our streets are kept safe for our children?

Mr Clarke: Yes. It is sometimes difficult to debate law and order in this country. Occasionally, I have to listen to a kind of looney-tunes debate about whether I am starting by releasing murderers, rapists, burglars or paedophiles. I believe that serious criminals should be in prison. I have never met a sane person who wishes to disturb that. I believe in long and severe sentences for people guilty of such a serious crime as paedophilia.

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Clive Efford (Eltham) (Lab): May I suggest that the Secretary of State visit, as I did recently, the Isis centre at Belmarsh prison, which is taking some innovative steps towards rehabilitating young offenders? With that in mind, I think that young offenders sometimes need custodial sentences to turn their lives around. Will he confirm therefore that judges will not have the discretion to give anything other than a custodial sentence to someone who uses a knife in a criminal act?

Mr Clarke: I think I can, although I do not think we need to put it in statute. I would be utterly astonished if a judge did not give a custodial sentence to anybody who used a knife in a criminal act. I approve of prison sentences in such cases, but I do not think we need to legislate on it. It is the nuances of far less serious cases that will get us into difficulty. However, if a person stabs somebody, they should go to prison, and I would be quite shocked if somebody did not go to prison in such circumstances.

Paul Uppal (Wolverhampton South West) (Con): In September, I met an ex-prisoner who told me that a continual stream of custodial sentences was broken only when he swapped a life of crime for a life as a conscientious father. What measures can we consider to ensure that the families of offenders, and not just the offenders in isolation, are supported on the road to rehabilitation?

Mr Clarke: We would like to give professionals every possible encouragement to follow that advice. People who are criminal for a part of their lives and then stop often do so because family responsibilities and a secure family environment have taken them back into a more sensible and decent way of life. We intend to give the professionals more discretion in how they do that. The last Government were prone to setting targets, prescribing methods and setting down rules for community sentencing.

Mr Jack Straw (Blackburn) (Lab): It worked.

Mr Clarke: It did not work, despite what the right hon. Gentleman says. Over and over again, the professionals complained they spent half their lives in an office ticking boxes confirming that they had taken the prescribed course, rather than being able to tackle in an individual way the kind of problems my hon. Friend heard about when he met his constituent.

Fiona O'Donnell (East Lothian) (Lab): Let me begin by telling the Secretary of State that my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) and I may be new, but we are not daft. He said that prison could not be just an expensive way of giving communities a break. For victims of domestic violence, that break can be priceless or even life-saving. What reassurances can the Secretary of State give to victims about the criteria that he will use in deciding which IPP prisoners-those sentenced to imprisonment for public protection-who have completed their minimum tariffs will be released?

Mr Clarke: We are not just going to let IPP prisoners out-any of them. Release will be by the Parole Board. The Parole Board is currently experiencing considerable difficulty in evaluating whether prisoners can prove that they are a minimal risk when they are released, because it is very difficult to demonstrate that when the prisoner is in prison. We are going to readdress IPPs, to try to make them work as they were originally intended, for a
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comparatively small number of very dangerous offenders who pose a continuing risk, and look at the test that the Parole Board can apply. However, no one will be released until someone has assessed whether the level of risk is acceptable. It is impossible to guarantee no risk: there is nobody in prison about whom anybody could ever say, "This person is never going to be at risk of offending again." I am afraid that, in the real world, there is nothing we can do about human nature. Quite a number of the people in prison will inevitably commit crimes when they come out, but the number who reoffend has to be reduced, the IPP ones have to handled very carefully, and the Parole Board has to be given a proper test to apply.

Mr David Nuttall (Bury North) (Con): Further to the reply that the Secretary of State gave to my hon. Friend the Member for Suffolk Coastal (Dr Coffey), does he agree that if we are to restore the public's trust in the criminal justice system, there must be honesty in sentencing and that convicted criminals should serve the full length of any sentence of imprisonment handed down by the court?

Mr Clarke: I agree with honesty in sentencing-I have always supported that idea-and we will certainly be addressing the way in which it is explained by a judge in court, so that it is clear and comprehensible to the public. That includes explaining the term of imprisonment and the term of licence that follows-what is currently called "serving half the sentence". The first half is in prison; the second half is subject to recall to prison, but it is served on licence out in the community. To turn the full term into imprisonment, which no one has ever done, would merely involve doubling the sentence for every prisoner. The financial objections to that are only the first ones that I would raise.

Steve McCabe (Birmingham, Selly Oak) (Lab): Surely the courts must always determine when a custodial sentence is required. The public will not understand what sounds like the Secretary of State saying that he or the Treasury is setting out to constrain that decision making.

Mr Clarke: With great respect, I am obviously being particularly obscure today, because I agree with the hon. Gentleman; indeed, I was saying precisely the opposite of what he described. We have spent the last 10 years or so believing that sections of statute-some of which read rather like local government circulars-are required in order to tell the judges what to do in individual cases, and that we should prescribe exactly what they do, according to some careful analysis. The judges complain like mad about the incomprehensibility of the legislation they are supposed to be applying. I firmly agree with the hon. Gentleman that, by and large, judges are in the best position to judge the appropriate way of dealing with each case and each offender, just as juries are the right people to decide guilt or innocence in serious cases. Parliament must stop trying to second-guess and introduce rules that we believe, with the best of intentions, cover all cases but which will not cover the absolutely amazing variety of circumstances that tend to accompany any particular category of crime.

Paul Maynard (Blackpool North and Cleveleys) (Con): I congratulate the Secretary of State on avoiding the siren calls of populism that I have been so disappointed
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to hear on both sides of the House today. Will he reassure me that when a prisoner is in prison, not only does he have a duty to make reparations but the state also has a duty, to offer him the opportunity of redemption, so that when he leaves that place of incarceration he has a chance to lead a useful and meaningful life-a life that is not reduced to one of stigmatisation or described, as I heard from the Opposition Benches, as that of a prisoner on the streets?

Mr Clarke: I agree with my hon. Friend entirely. We should give those who have the backbone to go straight, with help, a chance to do so because that will protect the public. Those who do not, and who commit crime again, will be punished again. It is just hopeless to suggest that giving extra emphasis to reforming criminals who want to be reformed is somehow weakening in the context of law and order; it is not. It would improve the protection of the public if we did it, and, as my hon. Friend says, it is a perfectly sensible way for a civilised state to behave.

John Mann (Bassetlaw) (Lab): Bassetlaw has the largest drug treatment programme in the country by far. We have reduced crime further by locking up repeat offenders. The Secretary of State is trying to get rid of the courts, he is getting rid of 300 front-line police officers, and now he is conducting this social experiment. Can my community, which is totally against this idea, please have an exemption? We could then compare and contrast the results to find out what works best.

Mr Clarke: One day I will convert the hon. Gentleman. With great respect, I think that he has been a great leader in his community in tackling the problem of drugs in Bassetlaw, and it is partly down to his efforts that it has been tackled in that part of Nottinghamshire much more forcefully than ever before. We are going to send repeat offenders to prison; no one is going to stop punishing people who keep offending. It is not a key part of the legal system in north Nottinghamshire that we should keep redundant courts, although we are still consulting on the two courts in his constituency. The foresight that he has shown on the problems of drugs will not be frustrated by our attempts to improve yet further the drug rehabilitation programmes that young
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people get in his constituency. This is not all about money, and that has not actually been the way he has approached this issue in the past few years either.

Mr Philip Hollobone (Kettering) (Con): Last year, more than 20,000 offenders with 15 or more previous convictions or cautions, and more than 2,500 offenders with more than 50 prosecutions or cautions, avoided a jail sentence. Will my right hon. and learned Friend's proposals not simply make that matter worse?

Mr Clarke: I do not think that they will make any difference, really- [ Interruption. ] No, do not start misquoting me. If the right hon. Member for Tooting (Sadiq Khan) cannot find anything that I have actually said to disagree with, I hope that he will not start misquoting me in order to find something to disagree with. I would need to work through those 2,000 cases, and my first question would be to ask what the further offence was that they were up for. I am sure it was not parking. People who have previously committed a crime do not always get sent to prison again, and the first thing we have to ask is how serious is the matter for which they are now before the courts again. I hate to cast doubt on my hon. Friend's statistics, but a lot of the statistics used across this whole field as the basis for these arguments are hopelessly unreliable. We are not reducing punishment for serious crime, and we are not letting anybody out of prison. We are using prison as a punishment, and trying to prevent the kind of people that he has described from reoffending over and over again, because that is in the public interest.

Mr Rob Wilson (Reading East) (Con): My right hon. and learned Friend will know that education is key to rehabilitation in prisons. What facilities are there for young people in prisons such as the Reading young offenders institution, where big central contracts have failed and more local provision is needed under the guidance of the governor of the prison?

Mr Clarke: We will of course continue to try to improve the level of education available to people, particularly in young offenders institutions. We are reviewing the educational service, and I agree that in many cases a more localised approach is likely to produce a better standard of education services than attempts to impose some kind of centralised system.

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