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House of Commons

Tuesday 7 June 2011

The House met at half-past Two o’clock


[Mr Speakerin the Chair]

Oral Answers to Questions


The Secretary of State was asked—

NHS Financial Performance

2. Nigel Adams (Selby and Ainsty) (Con): What assessment he has made of the financial performance of the NHS in 2010-11; and if he will make a statement. [57812]

The Secretary of State for Health (Mr Andrew Lansley): Financial performance in the NHS in the last year has been strong. As at quarter three of financial year 2010-11, the strategic health authorities and primary care trusts were forecasting an overall surplus of £1,269 million, and the NHS trust sector was forecasting an overall surplus of £132 million. I expect the 2010-11 final year-end surplus to be no less than this forecast, representing about 1% of the budget, broadly in line with plans.

Nigel Adams: I am grateful to the Secretary of State for his response. My constituents will be pleased that the NHS performed on a sound financial basis nationally. What increases will the NHS receive in my local area of north Yorkshire in 2011-12, and can my right hon. Friend confirm that those increases are the result of the Government’s decision to protect the NHS?

Mr Lansley: In 2011-12, NorthYorkshire and York primary care trust will receive £1,207.3 million. That represents a cash increase over last year of £34.7 million, or 3%. That exactly represents our coalition Government’s commitment to protect the NHS and to increase its budget in real terms, and it is in stark contrast to what we were told we should do by the Labour party and what the Labour Government in Wales have done, which is to impose a 5% real cut in NHS spending in Wales.

David Miliband (South Shields) (Lab): Can the Secretary of State confirm my figures that over £20 million has been spent in the north-east of England sacking PCT staff, that that money has come from funds previously earmarked for hospitals, and that there will be at least as many commissioning groups under his arrangements as there are currently PCTs employing managers in those roles? Does not that show that his plans are lunacy not reform, and that they should be taken away and put in the dustbin, not given a simple pause?

Mr Lansley: I can tell the right hon. Gentleman that in contrast to the last Labour Government it is our intention to increase the front-line staffing of the NHS relative to the staffing of the administration in the NHS. That is why, since the general election, there are 3,800 fewer managers in the NHS and 2,500 more doctors.

Mr Stephen Dorrell (Charnwood) (Con): Can my right hon. Friend confirm that it is a key priority of the Government to reverse a decade of declining productivity in the health service in order to ensure that the resources that are committed by the Government deliver improved access and improved quality of patient care?

Mr Lansley: Yes, I can. My right hon. Friend is absolutely right about that. Over the last year in hospitals in particular we saw what was approaching a 15% reduction

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in productivity. That is why we are proceeding with ensuring that across the NHS we recognise not only that there are increasing demands on the NHS, which is why we are increasing the NHS budget by £ll.5 billion over four years, but that that money must be used increasingly effectively to deliver efficiency savings in excess of 4% each year so that we can improve the quality of services for patients.

John Healey (Wentworth and Dearne) (Lab): The Secretary of State spoke in glowing terms of the last year, but the last year has been a catalogue of confusion, incompetence and broken promises. So will he now accept that the Government’s massive mishandled NHS reorganisation is piling extra pressure on NHS services, with nearly £2 billion promised for patient care being wasted on the internal changes? Will he admit that it is patients who will suffer as front-line NHS staff lose their jobs, treatments are cut back and waiting times start to rise again under the Tories?

Mr Lansley: The right hon. Gentleman asked about performance last year. I told him what the financial performance was. Let me also make it clear that, for example, for hospital in-patients, referral to treatment waiting time has gone down from 8.4 weeks in May 2010 to 7.9 weeks in the latest figures in March, and for out-patients the figure has gone down from 4.3 weeks in May 2010 to 3.7 weeks in the latest figures, so waiting times have improved. We have established the cancer drugs fund, with more than 2,500 patients benefiting from that. We have published and driven down the number of breaches of the single sex accommodation rules: a 77% reduction in those breaches, which Labour never achieved. In the last year we have reduced the number of MRSA infections in hospitals by 22% and C. difficile infections by 15%. I applaud the NHS—

Mr Speaker: Order. I think we have got the thrust of it and are most grateful.

John Healey: The Secretary of State mentioned a lot of things, but I notice that he did not mention the Prime Minister’s five new guarantees. [ Interruption. ] The Secretary of State shakes his head as if they do not matter, but perhaps he was not consulted on them. People have seen the Prime Minister make and then break promises on the NHS before, but this time he is breaking his pledges as he is making them. The King’s Fund says that waiting times are going up and the Nuffield Trust says that health funding is being cut in real terms. Privatisation, the break-up of integrated care and the removal of national standards at the heart of the health service are exactly what his health Bill is designed to do. Is that not why MORI shows public concern about the NHS rising rapidly and why people are right to conclude that they cannot trust the Tories on the NHS?

Mr Lansley: My right hon. Friend the Prime Minister has made it very clear that we will not let waiting times rise and that we will improve performance in the NHS right across the board, which was what I was illustrating. I remind the right hon. Gentleman again that waiting times in hospitals are down from 8.4 weeks to 7.9 weeks for in-patients and from 4.3 weeks to 3.7 weeks for out-patients. That is what we are committed to. Chris Ham of the Kings Fund was on the “Today”programme this morning and said on waiting times, “There hasn’t

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been a great deal of change since the election.” What has changed since the election is that we are improving performance, driving down the number of breaches of the single-sex rules, increasing access to dentistry, cutting the number of managers and increasing the number of doctors. Those are the things we are doing in the NHS, and it is to the benefit of patients that we do.

Integrated Cancer Services

3. Mr John Baron (Basildon and Billericay) (Con): What steps he is taking to enable GP consortia to commission integrated cancer services. [57813]

The Minister of State, Department of Health (Paul Burstow): “Improving Outcomes: A Strategy for Cancer” set out our plans to support GP consortia to commission high-quality cancer services that deliver improved outcomes. The strategy confirmed the importance of cancer networks and we have recently confirmed that the NHS commissioning board will continue to support strengthened cancer networks.

Mr Baron: I thank the Minister and the Secretary of State for extending the guaranteed funding for cancer networks to 2013 and their commitment to support them thereafter, because the cancer networks’ expertise will be much valued by consortia. How will the authorisation process for GP consortia ensure effective commissioning of those cancer services that span consortia boundaries, such as radiotherapy?

Paul Burstow: What we are doing at the moment with the pause is making sure that we revise the proposals in ways that ensure that we deliver the outcomes set out in the White Paper last year. One of the things we said in the White Paper, and which the Bill currently provides for, is that GP commissioning consortia can collaborate where they need to commission for larger populations.

Ms Diane Abbott (Hackney North and Stoke Newington) (Lab): On GP commissioning consortia, one of the concerns that the Minister will have heard during his pause is the public’s concern about the possible role of the private sector in GP commissioning. Although we all agree that the private sector has always had, and will always have, a role in the NHS, does the Southern Cross Healthcare disaster not show the dangers of leaving health and social care to the short-term decisions of private equity bosses?

Paul Burstow rose

Mr Speaker: Order. The Minister will want to focus on GP commissioning of integrated cancer services.

Paul Burstow: I am grateful for that advice, Mr Speaker. The hon. Lady’s remark was one that she might have made from the Back Benches when the Labour party was in power, but which it never listened to when in government. On GP commissioning consortia, we believe that it is important that consortia have access to the right expertise to be able to commission effectively both clinicians from other parts of the health economy and other expertise from the voluntary sector. That should be possible and we think that it is how we can improve commissioning in the NHS.

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David Tredinnick (Bosworth) (Con): Will commissioners be able to approach specialist integrated cancer services, such as the Penny Brohn cancer clinic in Bristol, and will that clinic and others be represented on health and wellbeing boards in future?

Paul Burstow: The membership of health and wellbeing boards will be a matter for the local authorities that will set them up. The Bill provides de minimis provisions for involving local councillors, representatives from commissioning consortia, public health directors, social services and children’s services, but I am sure that many of the pilots that are currently going on across the country are looking at innovative ways of involving others as well.

Southern Cross Healthcare

4. Alex Cunningham (Stockton North) (Lab): What steps he is considering in relation to Southern Cross Healthcare; and if he will make a statement. [57815]

5. Nick Smith (Blaenau Gwent) (Lab): What steps he is considering in relation to Southern Cross Healthcare; and if he will make a statement. [57816]

8. Sheila Gilmore (Edinburgh East) (Lab): What steps he is considering in relation to Southern Cross Healthcare; and if he will make a statement. [57819]

The Minister of State, Department of Health (Paul Burstow): Southern Cross has plans in place to restructure its business and is keeping the Government updated on progress. We will continue to keep in close touch with the situation and work with local authorities, the Care Quality Commission and others to ensure that there is an effective response which delivers to everyone the protection that we should want for all in those residential homes.

Alex Cunningham: I am grateful for that answer, but Southern Cross will not win any medals for managing its self-made crisis or for the anxiety caused to thousands of residents and their families, including 200 in five homes in my constituency. If organisations such as Southern Cross fail to get the investment that they need and end up going bust, will the Government guarantee those older people that decisive Government action will be taken to safeguard them in the places that they now call home?

Paul Burstow: Let me make it absolutely clear to the hon. Gentleman and to hon. Members on both sides of the House who have legitimate concerns about the welfare of residents in those homes: that is the Government’s paramount concern, and we will ensure that every step necessary is taken to safeguard those interests. The responsibility for providing care rests with local authorities, and that is why we as a Government have been working so closely with the Local Government Association and the Association of Directors of Adult Social Services to ensure that such arrangements are in place in the event of any need. The key thing at the moment, however, is to ensure that the company continues to restructure and continues to be in business.

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Nick Smith: Uncertainty about Southern Cross is troubling for the 74 residents of the two homes in Blaenau Gwent, and I commend my local authority on contacting their relatives to explain that it is monitoring the situation. If Southern Cross cuts its running costs, what measures will the Government put in place to ensure that the standards of care are closely monitored? Will the Government investigate the financial management of the company, described by my constituent Mr Hooper, whose mam is a Southern Cross resident, as

“greedy chancers who gamble with crazy business plans”?

Paul Burstow: The Government continue to maintain very close contact with the devolved Administrations on those issues to ensure that we co-ordinate in that way, and the hon. Gentleman is right that we need to make sure that the standards of care provided in all those homes are maintained. That is a role that the CQC has been discharging and will continue to discharge.

Sheila Gilmore: Housing associations have regulatory control over financial management and viability in order to protect tenants’ homes. Will the Minister consider putting in place a similar regime to protect the homes of care home residents?

Paul Burstow: Within the current legal framework established in the Health and Social Care Act 2008, there are requirements on financial viability, but we will undoubtedly want to look at those issues when we come to publish a White Paper on social care reform later this year.

John Pugh (Southport) (LD): Does the Minister agree that to avoid similar issues we need to build consensus throughout the House on the future of social care—and its financial governance?

Paul Burstow: I could simply say yes to my hon. Friend, but I agree entirely, and that is why last year we acted quickly to establish an independent commission, led by Andrew Dilnot, to undertake a review of how we fund social care. His report will be coming forward shortly, and I would certainly welcome all necessary discussions to ensure that we deliver effective reform.

Margot James (Stourbridge) (Con): We have six homes in Dudley borough managed and owned by Southern Cross, and I am pleased to hear the Minister’s assurance that he will work with local authorities to ensure that no resident is left in need. Questions must be asked, however, about the conduct of the former directors of Southern Cross, and about how they acted in terms of the duty of care to their company and to residents. Will my hon. Friend consider investigating the conduct of those former directors should the company’s situation worsen?

Paul Burstow: Those matters would more appropriately be dealt with by colleagues in the Department for Business, Innovation and Skills, but those points are fairly made by my hon. Friend. As a Government, we continue to maintain close dialogue with the company, the landlords and all other interested parties to make clear to them their responsibilities to secure the ongoing care of the individuals in those homes.

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Mr David Ward (Bradford East) (LD): I welcome the Minister’s response to the issue, which I acknowledge is the responsibility of local authorities, but they face many other difficulties, not only with nursing care but with residential care and the increased demand for it. What effective support will there be, other than additional words of support?

Paul Burstow: I am grateful to my hon. Friend for that question. Over many months, we have been in discussions with colleagues at the Local Government Association, and the Association of Directors of Adult Social Services recently produced new guidance on maintaining continuity and quality of care for individuals in homes that may be in difficulties. That is the appropriate way for us to proceed. We continue to work with them to ensure that all the necessary arrangements are in place. However, I remain focused, as all Members in this House should be, on ensuring that the company has the best possible opportunity to get itself on a stable footing so that it can continue to provide the care that people want.

Ian Paisley (North Antrim) (DUP): The Minister will be aware that 25 care homes in Northern Ireland operate under the Southern Cross banner. What is he going to do to ensure that there is a consistent approach across the entirety of the United Kingdom? Will he have discussions with the Health Minister in Northern Ireland and other concerned parties to ensure that patients and residents in those homes are treated equitably and fairly?

Paul Burstow: The hon. Gentleman makes a fair point that relates to the earlier question where I indicated that we are in constant contact with the devolved Administrations and will continue to have that dialogue—if necessary, at ministerial level.

Emily Thornberry (Islington South and Finsbury) (Lab): Although we welcome the Government’s statement today that whatever the outcome of the restructuring of Southern Cross, they will not allow anyone to find themselves homeless, may I cast the Minister’s mind back to a week ago? Where was he? Why was he not visiting Southern Cross homes and speaking to residents, families and carers, as I was? Does he not now regret hiding in his bunker and allowing No. 10 to attempt to answer the questions that were put to the Government on behalf of these very vulnerable people?

Paul Burstow: I was about to say that I was grateful to the hon. Lady for the question, but clearly I am not. I have been following this as a Minister throughout, and I continue to follow it closely and to give the necessary instructions to officials to secure the future and the fate of the residents in these care homes. We have to be cautious and careful about the language we use on this particular endeavour. That is what I am doing, and I would urge the hon. Lady to do the same.

Emily Thornberry: The Minister can be assured that I am careful in the language that I use, and the words that I wish to use are these: does he agree that it is simply wrong that financiers and some of Southern Cross’s previous directors have creamed off millions of pounds while putting at risk the care of 31,000 elderly people who seem to have been used merely as commodities?

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Now that this has come to light, will the Government look urgently at whether regulation should be extended to ensure the financial stability of organisations that we entrust with the care of our most vulnerable?

Paul Burstow: That question has already been asked, and I have already indicated the approach that we intend to take with regard to the White Paper. I also point out that the establishment of the business model that Southern Cross operates of separating out provision from the ownership of the homes took place not under this Government’s watch but under her Government’s watch.

Patient Outcomes

6. Chris Heaton-Harris (Daventry) (Con): What assessment he has made of trends in outcomes for NHS patients since May 2010. [57817]

The Secretary of State for Health (Mr Andrew Lansley): I am determined to focus on the results that matter most to patients. For example, in the year ending March 2011, the number of MRSA bloodstream infections decreased by 22% and C. difficile infections decreased by 15% on the year before. These are key outcomes in the drive to protect patients from avoidable harm. We also want to see continuous improvements in patients’ experience of their care. For example, between December last year and April this year, we took action on breaches of the single sex accommodation rules, and the number of breaches reduced by 77%. The NHS outcomes framework will drive up quality across services as well as providing evidence of the overall progress of the NHS.

Chris Heaton-Harris: I thank the Secretary of State for his answer. He has rightly identified patient experience as a key outcome that has improved over the past year. Given that tens of millions of patients every year experience accident and emergency as their first point of contact with the NHS, what steps has he taken to improve the quality of care that patients receive in A and E wards?

Mr Lansley: In the past, the only measure of activity and performance in A and E departments was whether patients had been discharged from the department within four hours. That meant, for example, that the emergency department at Stafford hospital was able to tick the box marked “Four-hour target met” in circumstances where patients were discharged completely inappropriately and patients suffered and died. We have now published, for the first time, quality indicators agreed with clinical professionals across emergency services that indicate what A and E quality should look like regarding not only time waited but the time before patients are seen by a qualified professional, re-attendance rates for the same problems, and mortality and related outcomes.

Mr Ben Bradshaw (Exeter) (Lab): The Secretary of State is using a highly selective reading of waiting times. Will he confirm that breaches of the four hour target for A and E waits and the 18 week target for operations have increased massively in the past year? If they have not, why did the Prime Minister today confirm his support for those Labour targets?

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Mr Lansley: The Prime Minister made it clear that we will focus on outcomes for patients, not just on individual targets. In 2010-11, the financial year that has just ended, only 2.6% of people who attended at A and E waited for more than four hours, despite an additional 870,000 people attending A and E departments.

Speech Therapy Services

7. Mr Gary Streeter (South West Devon) (Con): What plans he has for access to NHS speech therapy services for children. [57818]

The Parliamentary Under-Secretary of State for Health (Anne Milton): As my hon. Friend knows, speech and language therapy services are critical for children and young people who need help to develop their speech, language and communication skills, and who have conditions such as swallowing difficulties. We have published a Green Paper on special educational needs and disability, which includes proposals to develop a new co-ordinated assessment for education, health and care plans by 2014 and for the option of a personal budget for all families with such plans. That will offer families more choice and ensure that children get the support that they need.

Mr Streeter: Does my hon. Friend agree that when a child needs to access speech therapy, often it is to unlock vital early years education and is therefore time critical? The west country has known waiting times of three, six or even nine months. Will she assure me that the coalition Government can do better than that?

Anne Milton: We most certainly can do better than that. I agree with my hon. Friend that such problems are often a barrier, and that therapy can unlock so much more. I refer him to service redesigns that have happened, such as at the Cambridgeshire Community Services NHS Trust, which redesigned its clinical pathways with the result that the number of children waiting longer than 18 weeks from referral to treatment fell from 409 in May 2010 to eight at the end of January 2011. That is a fantastic improvement in the service. This is not all about money, but about the way in which services are designed.

Mr Kevin Barron (Rother Valley) (Lab): The Minister will know that more than 60% of inmates in young offender institutions have speech and communication problems. Can we ensure that the Green Paper addresses this matter not just within the national health service, but in education and wider, so that we can begin to tackle this problem, which has lain dormant in this country for decades?

Anne Milton: The right hon. Gentleman is right that we are not talking just about children. A number of people have languished and failed to achieve their potential, particularly their educational potential, for the lack of speech and language therapies. I take this opportunity to commend the work of Jean Gross, the communication champion, in raising and highlighting these issues.

NHS Blood and Transplant

10. Annette Brooke (Mid Dorset and North Poole) (LD): What recent representations he has received on the future of NHS Blood and Transplant; and if he will make a statement. [57821]

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The Parliamentary Under-Secretary of State for Health (Anne Milton): Since February 2011, we have received about 60 representations on the future of NHS Blood and Transplant, including from MPs, Unison and the public. Representations continue to come in. I am happy to meet the hon. Lady if she would like. I should make it clear that the current review is not considering the sale of any part of NHSBT.

Annette Brooke: I wonder whether the Minister can give further assurances to address the great concern that voluntary donations of blood and organs might be put at risk if it is perceived that profits are being made in any part of the operation.

Anne Milton: My hon. Friend is right. The altruistic donor system is one of the rocks on which the NHS is built, and we will do nothing to jeopardise public confidence in it. I am alarmed at some of the scare stories that have been circulating. They serve nobody any good, least of all those who need the necessary donations that are made.

Cancer Drugs Fund

11. Andrew Stephenson (Pendle) (Con): What recent representations he has received on the operation of the cancer drugs fund. [57822]

16. Stephen Hammond (Wimbledon) (Con): What recent assessment he has made of the operation of the cancer drugs fund; and if he will make a statement. [57827]

The Secretary of State for Health (Mr Andrew Lansley): I have received representations from hon. Members, noble Lords and members of the public on how the fund has operated. A number have welcomed the additional support that we are giving to cancer patients in need. More than 2,500 patients have already benefited from the additional funding provided up to the start of April 2011, and the further £600 million that we have committed for next three years will improve the lives of thousands more cancer sufferers.

Andrew Stephenson: Can my right hon. Friend confirm that the cancer drugs fund is helping cancer specialists tailor treatment regimes to patients in areas including my constituency, and helping to provide a more personal and responsive cancer service?

Mr Lansley: Yes, I can reassure my hon. Friend on that point. Indeed, I cannot do better than to quote Mike Hobday, head of policy at Macmillan Cancer Support, who said:

“The £200 million Cancer Drugs Fund will make sure every cancer patient has a better chance to get the drugs their doctor prescribes for them. This is particularly important for those with a rarer cancer, who have historically lost out on getting drugs on the NHS.”

Stephen Hammond: I am sure the whole House will welcome my right hon. Friend’s announcement today that 2,500 people have already benefited from the interim cancer drugs fund. Can he give the House some indication of whether people with the more difficult types of cancer will benefit from it?

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Mr Lansley: My hon. Friend will be aware that in the run-up to the election and since, the Rarer Cancers Forum has mentioned the number of applications to the exceptional cases panels of primary care trusts that have been turned down, and pointed out how often patients in this country have not got access to new cancer medicines that are regularly available to patients in other European countries. That was the basis on which we estimated the level of demand for the cancer drugs fund, and it has actually turned out to be a very good predictor of demand. Patients are now receiving second-line or new medicines for a range of cancers, including prostate and bowel cancer. People with common cancers as well as rarer ones are getting access to new medicines that are increasing their quality of life or life expectancy.

Liz Kendall (Leicester West) (Lab): Today the Prime Minister pledged to increase NHS funding, protect universal coverage and keep waiting times low, but his promises are already being broken on cancer care. Three quarters of the cancer drugs fund is not additional money, as the Secretary of State claims, but money taken from other patients, and half as many new cancer drugs are available in some parts of the country as in others. Whatever he claims, can he now confirm that the number of patients waiting more than six weeks for their diagnostic test, including for cancer, has doubled since this time last year?

Mr Lansley: The hon. Lady seems to have forgotten that we were very clear at the time of the election that we would establish the cancer drugs fund not least on the basis that under this Government, the NHS would not have to pay the additional employer’s national insurance contributions that it otherwise would. The money available for the NHS is being used for the benefit of patients, and it represents additional resources.

I might also remind the hon. Lady that before the election, her party was not committed to protecting the NHS budget. The Leader of the Opposition was completely wrong today when he said that Labour was going to protect NHS spending, as we did. That is not true. Actually, it was committed to only 95% of NHS funding, which was that for the PCTs. It was going to cut the rest, and centrally funded budgets such as the cancer drugs fund are precisely what would have disappeared.

The hon. Lady asked about diagnostic tests. The figures show that a year ago, the average waiting time was 1.7 weeks, whereas the latest figure is 1.8 weeks.

Foundation Trusts

12. Pat Glass (North West Durham) (Lab): What recent assessment he has made of the ability of all NHS hospital trusts to become foundation trusts by 2014. [57823]

The Minister of State, Department of Health (Mr Simon Burns): The Department is currently in the process of working with strategic health authorities to establish timetables for every NHS trust to achieve foundation trust status by April 2014, and to agree the actions that are required to achieve that. That work is ongoing, and once plans are finalised, they will be published locally.

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Pat Glass: The Minister will have to make some difficult decisions very soon about specialist children’s heart provision. In my part of the world, the choice will be between the NHS trusts in Newcastle and Leeds. Can he confirm that those decisions will be based on clinical outcomes, not political expediency?

Mr Burns: I can give the hon. Lady a categorical assurance that they will be based on clinical outcomes, not political considerations. I hope she will accept that it would be inappropriate for me to say anything further at this point in the proceedings, because we are in the middle of a consultation process at arm’s length from Ministers.

Mr Stewart Jackson (Peterborough) (Con): Over the past 12 months, the Peterborough and Stamford Hospitals Foundation Trust has spent thousands of pounds of public money in connection with a vacant site—the former Peterborough district hospital site— and has yet to take it to market, despite having a £38 million deficit this year. Will my right hon. Friend ask Monitor to ensure that trusts make use of, and dispose of, valuable public assets in a timely way, in the best interests of both the taxpayer and the local health economy?

Mr Burns: I hope that I can reassure my hon. Friend by giving him a straightforward yes in answer to that question.

Paul Goggins (Wythenshawe and Sale East) (Lab): Will the Minister look urgently at what is happening in Trafford? The Trafford Healthcare NHS Trust has decided not to seek foundation status and is looking to transfer its acute services to another local provider. One difficulty with that is the projected funding shortfall of £55 million. Will he take a close interest in that, and seek to resolve the current uncertainty?

Mr Burns: I am grateful to the right hon. Gentleman for that question. I am aware of that situation and of the problems at that hospital. My understanding is that the strategic health authority is working hard with the trust to seek a solution. That work will continue until a viable solution is found.

GP Pathfinder Consortia

13. Nick de Bois (Enfield North) (Con): What recent assessment he has made of progress by GP pathfinder consortia in delivering improvements in NHS services. [57824]

The Secretary of State for Health (Mr Andrew Lansley): We have taken time to pause, to listen and to reflect on our reforms; none the less I am pleased to report that there remain 220 pathfinder consortia, covering nearly 90% of England. In my hon. Friend’s constituency, the Enfield consortium group is established and is focusing on quality and productivity improvements to local health care services. I have been greatly encouraged by the initiative that clinicians have taken to improve patient services, and examples are available at the pathfinder learning network, a forum through which we are supporting their development.

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Nick de Bois: My right hon. Friend the Secretary of State knows my view on the need to ensure that there is a comprehensive network of commissioning consortia across the whole country by April 2013. Does he share my view that that essential requirement will not only improve patient choice but ensure that we can pass a further £5 billion in savings back into front-line services?

Mr Lansley: Yes, I think my hon. Friend is absolutely right about that. What has been interesting in the listening exercise is the clear expression—on the part of front-line clinicians, general practitioners, doctors, nurses and other health professionals—of a desire to take greater responsibility for commissioning. They are only too aware of a decade of decline in productivity in the NHS, in which administration costs and staffing ballooned while front-line staffing did not increase to anything like the same extent. They want to deliver better clinical services for their patients, and to have the responsibility to do so. We are determined to give that to them.

Breast Screening Programme

14. Mr Steve Brine (Winchester) (Con): Whether his Department has considered the merits of introducing a supplemental ultrasound breast screening examination as part of the NHS breast screening programme. [57825]

The Minister of State, Department of Health (Paul Burstow): The answer is no. Mammography is the only screening modality that has been proven to reduce mortality from breast cancer, and is supported and promoted by the World Health Organisation’s international agency for research on cancer. Ultrasound screening may be used within the breast screening programme as part of the triple assessment process.

Mr Brine: The Minister will be aware that forms of cancer such as lobular breast cancer are far more difficult to detect with a mammogram than other types of breast cancer. Will he perhaps clarify exactly what guidance his Department issues to primary care trusts on the use of ultrasound screening as part of the triple assessment process? Sadly, in the case of my constituent Lindsay Jackson, mammography failed to detect that form of lobular breast cancer.

Paul Burstow: I am grateful to the hon. Gentleman for his question. The Department does not issue guidance, but the National Institute for Health and Clinical Excellence does. Its guidance on improving outcomes in breast cancer states that mammography and ultrasound imaging should be available in breast clinics as part of the triple assessment of women with suspected breast cancer. In addition, the guidance states that ultrasound is useful in predicting tumour size and in planning surgery, and that it can complement mammography in differentiating malignant and benign disease. That guidance is the key tool used in making such decisions.

Foundation Trusts

15. Gavin Barwell (Croydon Central) (Con): What recent progress he has made in establishing foundation trusts in London. [57826]

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The Secretary of State for Health (Mr Andrew Lansley): The Department is currently in the process of working with NHS London to establish timetables for each NHS trust and agree the actions required to achieve foundation trust status by April 2014. This work is ongoing; once it is finalised, plans will be published locally.

Gavin Barwell: In 2010-11 Croydon Health Services NHS Trust delivered an operating surplus of £4.5 million. May I commend its FT application to my right hon. Friend in the hope that in future years, that money can be reinvested in local health services in my borough?

Mr Lansley: Yes, I understand and entirely sympathise with my hon. Friend’s desire to see Croydon Health Services NHS Trust achieve foundation trust status. He will know that the trust was recently the subject of a responsive review visit by the Care Quality Commission, which revealed areas in which further assurance will be needed ahead of its foundation trust application going forward. He will appreciate, as I do, that in the past foundation trust status did not depend sufficiently on the achievement of high-quality services, rather than merely viable services. We intend that in future, foundation trust status will depend on both.

Mental Health Services

17. Nicky Morgan (Loughborough) (Con): What steps he is taking to improve mental health services. [57828]

The Minister of State, Department of Health (Paul Burstow): Mental health is a cross-government priority. Earlier this year we published our mental health outcomes strategy document “No health without mental health”, to drive up standards in services and improve the nation’s mental health. But this cannot just be a problem for the Government, which is why we are working in partnership with the voluntary sector and the wider community.

Nicky Morgan: I thank the Minister for his reply, and I am pleased to hear about the emphasis on mental health. During the recess, I met members of the Charnwood health forum, including Leicestershire’s public health lead for mental health matters. He is concerned that there will be no place for him to advise or work with GP commissioning consortia. Can my hon. Friend reassure him that he will be able to advise GPs?

Paul Burstow: Yes, I believe that I can. Directors of public health will be the local leaders for public health in their communities. For example, local authorities and GP commissioning consortia will be required to undertake joint strategic needs assessments and produce joint health and well-being strategies for their areas, through health and well-being boards. The directors of public health will be directly engaged in that process and will therefore be able to influence the commissioning not only of health care services but of social care. They will be directly involved in the commissioning of public health locally.

Tony Lloyd (Manchester Central) (Lab): The Minister will be aware of the proposal to close the Edale unit in central Manchester and open a different facility in north Manchester. Can he give the House, and the country, a guarantee that if that were to take place,

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financial consideration would be given to the total NHS economy and not simply to the mental health trusts, and that there would be clear benefits for mental health patients?

Paul Burstow: The key point that I take from the hon. Gentleman’s question is the importance of ensuring that there are clear benefits for those who rely on mental health services. Obviously, I cannot prejudge any decisions that are being made locally, because they may well come to a Minister for a decision in the future. I will, however, undertake to consider further the point that the hon. Gentleman has raised, and if necessary to write to him with more detail.

NHS (Competition and Co-operation)

18. Lilian Greenwood (Nottingham South) (Lab): What assessment he has made of the potential role of (a) competition and (b) co-operation and collaboration in the NHS. [57829]

The Minister of State, Department of Health (Mr Simon Burns): Co-operation and competition both have important roles to play in improving services for patients. We want to see better integration of services to improve quality and increase choice for patients. Following the listening exercise, we are awaiting the report on the best way forward.

Lilian Greenwood: The Deputy Prime Minister says that he wants Monitor to promote co-operation and collaboration, while the Secretary of State says that competition can lead to a far greater degree of integration. It is good that the Deputy Prime Minister has finally caught up with the views of the public and health professionals—but which of those fundamentally contradictory views will end up in the Bill?

Mr Burns: First, we all want co-operation and competition based on quality. We have had a listening event, and we are awaiting the recommendations of the forum set up under Professor Steve Field. Until we see that report, we cannot comment. I can tell the hon. Lady, however, that we do not want the kind of system of competition in the health service that leads to an independent sector treatment centre in Nottingham being paid 18% more than the NHS for the services provided, and getting £5.6 million for not doing a single operation.

Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con): Does my right hon. Friend agree that a key focus for improving collaboration in the NHS must be to break down the silo working that occurs between adult social services and the NHS? That will be particularly pertinent in improving elderly care services and mental health care services, and in providing a community focus for that care.

Mr Burns: Yes—and it is always refreshing to get a question from someone who has had experience of working in the NHS and actually knows what he is talking about. My hon. Friend is absolutely right; greater integration of services is crucial if we are to break down the barriers and get improved, high-quality care for all patients.

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Kate Green (Stretford and Urmston) (Lab): I was interested to hear the Minister’s earlier answer to my right hon. Friend the Member for Wythenshawe and Sale East (Paul Goggins) about the situation in Trafford. Will he confirm that he will encourage a collaborative approach, involving the strategic health authority, the primary care trust, the existing foundation trust and the potential bidding foundation trust, to secure the best possible clinical and financial outcome for patients?

Mr Burns: Yes, I can tell the hon. Lady that it will be up to the SHA, the trust and officials at the Department—[Interruption.] The SHA is the strategic health authority in the north-west. It is for them to work together to produce a tripartite formal agreement—when agreed, it will be published for the local community to see—as the best way forward to seek solutions and to help trusts achieve foundation trust status. It is in their interest and the interest of patients to bring about improved, high-quality patient care.

Mental Health Services

19. Henry Smith (Crawley) (Con): What steps he is taking to improve mental health services. [57830]

The Minister of State, Department of Health (Paul Burstow): May I refer the hon. Gentleman to the answer that I gave to the hon. Member for Loughborough (Nicky Morgan)?

Henry Smith: I am grateful for the Minister’s answer to that earlier question. Will he explain more fully exactly how services for those with eating disorders can be enhanced, particularly in the Sussex Partnership NHS Foundation Trust area?

Paul Burstow: Yes, the National Institute for Health and Clinical Excellence will update its guidance on eating disorders later this year. The plans already set out in the Health and Social Care Bill mean that eating disorders will be subject to specialised commissioning in future by the NHS Commissioning Board. We believe that, because of the consolidated expertise in matching needs, this will help to drive up standards and enhance quality and consistency across the country. In the hon. Gentleman’s own patch, the assessment service run by Sussex Partnership NHS Foundation Trust is certainly an impressive one.

Topical Questions

T1. [57836] Karl McCartney (Lincoln) (Con): 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.

Karl McCartney: I thank the Secretary of State for that answer. Will my right hon. Friend reassure me, and my Lincoln constituents, that whatever the outcome of the Government’s consultation, our NHS still requires

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some measure of reform—and that if a provider is qualified to deliver NHS standards at NHS costs, and if patients, with the support of their doctor, want to be treated there, this Government should do nothing to stand in their way, regardless of any political posturing by our flip-flopping coalition partners? [Hon. Members: “ Ooh!”] And further to—

Mr Speaker: Order. I apologise for having to interrupt the hon. Gentleman, but topical questions must not be statements or essays; they must be very brief questions. I think we have got the thrust of his question, and we are grateful to him.

Mr Lansley: Through the listening exercise and in response to the report of the NHS Future Forum, which we hope to see shortly, we hope to be able further to strengthen the principles of the Bill and its implementation of the White Paper, so that patients can share in decisions about their care and access the services that give them the best quality. That includes, in many instances, patients having access to a choice of providers as well.

T5. [57840] Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op): Doctors, nurses and PCT staff in my area tell me that the Government’s pausing of the health reforms has had no impact whatever on the ground, and that implementation of the Health and Social Care Bill is proceeding just as it was before. Does the Secretary of State believe that that is wrong—and if not, does it not mean that this whole consultation period is an absolute farce?

Mr Lansley: No, not at all. We were very clear—indeed, I was clear to the House on 4 April when I announced the pause to listen, to reflect on and improve the Bill—that it was specifically related to achieving in the legislation the necessary support for the many changes happening across the NHS. It cannot be right, however, that people across the NHS who are engaging in delivering improved care, redesigning clinical pathways—or designing clinical services to deliver the best outcomes for patients—should be told to stop making those positive changes. They are engaging with those positive changes and we are not preventing them from doing so.

T2. [57837] Duncan Hames (Chippenham) (LD): I am wearing neither sandals nor flip-flops, Mr Speaker. Given that local GPs typically charge £500 a day, what action is the Minister taking to ensure that GP consortium board members do not cost the NHS as much as £25,000 each a year for just one day’s work a week?

Mr Lansley: Among the intentions that we have made clear from the outset is our intention to reduce the running costs of management in the NHS. We propose to cut administration costs by a third in real terms, including the running costs of the commissioning consortia when they are established. There will be a constantly tight envelope for running costs, which means that whoever is working for a commissioning consortium, it must deliver value for money.

T7. [57842] Hazel Blears (Salford and Eccles) (Lab): For the 200,000 people in the country with dementia who are currently in residential care, the recent horrific

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events at Winterbourne View and the financial problems at Southern Cross have caused huge anxiety. The Minister is now proposing to make local authority safeguarding boards mandatory, at a time of huge cuts in social care budgets. What extra resources will he make available to ensure that the system works and protects the most vulnerable people in our country?

The Minister of State, Department of Health (Paul Burstow): I think that Members throughout the House share the right hon. Lady’s concern about the events that were revealed in more detail last week. We will deal with an urgent question on one of the other matters later this afternoon. She also asked about funding for social care. In last year’s spending review we not only secured additional resources enabling us to put safeguarding boards on a statutory basis, but ensured that by 2014 an additional £2 billion would go into social services. Much of that will come via the NHS to ensure much closer working between health and social care services, which is an essential prerequisite for the delivery of better outcomes for people with dementia.

T4. [57839] Harriett Baldwin (West Worcestershire) (Con): One of my constituents, a vulnerable young adult with complex needs, was recently sectioned under the Mental Health Act 1983, taken from the family home, and placed in Winterbourne View. The mother was very concerned about her child’s care there, and contacted me. However, I was told by adult social services that I could not know the details of the case because of data protection. When reviewing the regulations involving vulnerable adults, will the Minister ensure that questions from Members of Parliament about such cases can be answered, so that they can stand up for even their most vulnerable constituents without their express written permission?

Paul Burstow: I am grateful to the hon. Lady for highlighting that issue. I think that Members in all parts of the House experience the same frustration from time to time when they feel that they are unable to discharge their responsibilities on behalf of constituents and obtain the information that they think they need in order to do that job. I will certainly undertake to examine the issue again. Patient confidentiality is complex and we must respect the confidentiality of individual patients, but we should not let that get in the way of ensuring that good-quality care is delivered.

T8. [57843] Mr John Spellar (Warley) (Lab): When I asked the Minister about Southern Cross on 2 December, he replied:

“The responsibility for providing or arranging publicly supported residential accommodation under section 21 of the National Assistance Act 1948 rests with councils with adult social services (CASSRs), not the Department.

Any discussions regarding continuing provision for residents of care homes should take place between care providers and CASSRs.” —[Official Report, 2 December 2010; Vol. 519, c. 1014W.]

Does the Minister now regret that complacent and wholly inadequate reply, which lost vital months in which the crisis could have been dealt with?

Paul Burstow: No, because it was an accurate statement of the legal position, which is what the question required.

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Since these issues became a cause for concern many months ago, the Department of Health has been very much engaged with them at both official and ministerial level. We have also ensured that all parties—the local authorities, the Care Quality Commission and others—are clear about their responsibilities. I should have thought that that was what the hon. Gentleman would expect us to do, and it is what we have done. We are ready for any eventuality.

T6. [57841] Gavin Barwell (Croydon Central) (Con): Croydon University hospital recently took on responsibility for community care, which will allow much better integration of acute and community services. What scope does my right hon. Friend think exists for wider application of that model in our NHS?

Mr Lansley: As my right hon. Friend the Prime Minister made clear today, we continue to believe that we can achieve more integrated services for patients, and we are determined to do so. That must be at the heart of the way in which reform and modernisation of the NHS deliver improving outcomes for patients. For patients, the results of care, and indeed their experience of it, will be greatly enhanced if it is designed and integrated to meet their needs. We know that that is effective, we know that it works for patients, and we are determined to make it happen. My hon. Friend has given just one example, and an important one, of the way in which hospital and community services can be integrated.

Mrs Mary Glindon (North Tyneside) (Lab): The Prime Minister has stated this afternoon that competition will be an integral part of patient choice. How will the Secretary of State ensure that all patients are able to make a fully informed choice of treatment when market forces fully exist?

Mr Lansley: I do not accept the hon. Lady’s premise. We do not intend that there should be an unrestricted market—or a free market, as she described it—in the NHS. It is a regulated, social market with powerful regulations governing how the participants in the provision of care meet their responsibilities. We are very clear that competition is a means to an end. It is not an end in itself; it is there to support the integration and delivery of services in the best interests of patients, but it does include giving patients choice. The hon. Lady highlights an important point. In our consultation earlier this year on the information revolution in the NHS, we set out how we felt we could empower patients, including those for whom in the past the NHS has provided a rather impenetrable route to getting the best treatment. I hope that when we respond to that consultation, we will demonstrate how we will make that better for all patients.

T10. [57845] Nigel Mills (Amber Valley) (Con): Does the Minister agree with my constituent Susan Garrity that licensed treatments for multiple sclerosis such as Sativex should be accessible to all people, wherever they live?

Paul Burstow: Certainly I agree that MS patients should have access to clinically effective and cost-effective treatments. The National Institute for Health and Clinical Excellence has not issued any guidance on the use of Sativex, and it is for primary care trusts to make funding

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decisions based on the available evidence and the individual patients’ circumstances. Following consultation, NICE expects to make a decision later in the year on whether to update its clinical guidance on MS, and whether to re-evaluate Sativex as part of that.

Dame Anne Begg (Aberdeen South) (Lab): There are 12 Southern Cross homes in Aberdeen, nine of which are in my constituency. Just in the past month, one of them, Eastleigh in Peterculter, received a damning report from the Scottish care commission. Is it any wonder that relatives of the people in those homes are concerned that the company that runs them is in financial difficulty, and that the quality of the care provided may suffer as a result? Over the past few years I have also been approached by constituents about self-funders facing unfair cost increases in order that their home might be able to overcome its financial difficulties.

Paul Burstow: As I said earlier, the key concern of this Government—and, I think, of all Members—is to ensure the continuity and quality of the care of residents in Southern Cross homes. That has been the purpose of the Government, and of all the other agencies involved, throughout our engagement with Southern Cross. It is also important that the quality inspectorates in both Scotland and England continue to discharge their role of making sure that the essential standards of safety and quality are being maintained.

Jo Swinson (East Dunbartonshire) (LD): As the public health White Paper recognises, building positive self-esteem is important for children’s health and well-being. Yesterday, the Bailey review highlighted many parents’ concerns that exposure to very sexualised imagery in our visual culture fuels children’s anxieties about their bodies and reduces self-esteem. How do the Government plan to tackle that as a growing public health issue?

The Parliamentary Under-Secretary of State for Health (Anne Milton): I thank the hon. Lady for her question. She raises an important point about children’s exposure to such imagery from a variety of media sources. It is crucial for the future public health of our country that children get help and support over this and are able to learn the skills they need, and we are determined to get that right. Many of our plans are laid out in the White Paper, and we look forward to seeing them become a reality.

Debbie Abrahams (Oldham East and Saddleworth) (Lab): Can the Secretary of State or the Minister confirm whether they will take up the offer from my Front Bench for bipartisan discussions about the future of adult social care—or will he put political interests before the public interest?

Mr Lansley: We were very clear that the commission that we established, led by Andrew Dilnot, should look at the reform of long-term social care funding in such a way as to secure maximum understanding, consensus and agreement. Andrew Dilnot has gone about that process in an exemplary manner, and the right thing for us to do now is await his report, which should then form a basis for taking things forward.

Mr Peter Bone (Wellingborough) (Con): Does the Secretary of State agree that the competition measures in the Health and Social Care Bill will drive up standards and quality outcomes for the NHS?

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Mr Lansley: I am sure that my hon. Friend is aware of the evidence—for example, in reports published by the London School of Economics and by Imperial college, London—on this country’s experience of the Labour party’s implementation of choice in elective care and the impact that had on the quality of services. What is clear from that evidence is that where there was an NHS price—a tariff structure—the more competitive areas of the country secured greater improvements in quality.

Valerie Vaz (Walsall South) (Lab): I thank the Secretary of State for writing to me on 12 May about the listening exercise and its cost, although he could not quantify that. Now that the listening exercise is over, can he say how much the cost to the public purse has been?

Mr Lansley: I will, by all means, write again to the hon. Lady. The cost is not dramatic. Many organisations and people across the NHS have participated, giving freely of their time. Some 8,000 people have participated in the listening exercise events, of which there were more than 250. This has been immensely valuable; its value far exceeds any costs involved.

Pauline Latham (Mid Derbyshire) (Con): A constituent of mine who suffers from bowel cancer has so far failed to be funded for Avastin on the NHS via the east midlands cancer drugs fund. She has already spent more than £40,000 of her own money. Her oncologist has written before on her behalf to appeal, but as not one of his appeals has been successful, for her or for any of his other patients, he is reluctant to write again to

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appeal for her, although she desperately needs this. What assurance can the Secretary of State give my constituent and her consultant?

Mr Lansley: My hon. Friend is assiduous in representing her constituent, and I will gladly discuss this matter further with her to see what the situation is. I should, however, emphasise that these are decisions being made in the use of the resources to deliver access to new cancer medicines for patients by clinical panels in each region—in each strategic health authority. To that extent, I am not seeking to substitute my judgment for that of the senior clinicians involved. None the less, if it would help my hon. Friend I will also arrange for the national clinical director for cancer services to have a discussion with her constituent’s consultant to examine this case.

Mr David Ruffley (Bury St Edmunds) (Con): The Labour Government paid independent sector treatment centres 11% more, on average, than they were prepared to pay NHS hospitals. Will the Secretary of State confirm that such a practice forms no part of his health reforms?

The Minister of State, Department of Health (Mr Simon Burns): I share my hon. Friend’s concerns, and those of his constituents, about the appalling situation whereby not only were ISTCs paid more than the NHS, but they were paid considerable sums for doing no work at all. It was a sham and a waste of money that could have been spent on front-line services, and I can give him the categorical assurance that it will not happen under this Government, or under my right hon. Friend the Secretary of State.

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Winterbourne View Care Home

3.33 pm

Emily Thornberry (Islington South and Finsbury) (Lab) (Urgent Question): To ask the Secretary of State for Health to make a statement on the Government’s decision not to hold an external independent inquiry into the abuse of vulnerable adults at Winterbourne View.

The Minister of State, Department of Health (Paul Burstow): Nobody watching the BBC’s “Panorama” programme last week could have been anything but shocked and appalled by the systematic abuse of residents at Winterbourne View. May I, first, extend my deepest sympathies, and those of all of my colleagues in the Government, to those so horribly mistreated and abused, and to their families and loved ones? For the avoidance of doubt, I should say that we have not ruled out an independent inquiry. A criminal investigation is under way and it is important that we do nothing that could prejudice it.

In the coming weeks, the Care Quality Commission will inspect the other 22 hospitals run by Castlebeck and the reports will then be publicly available on CQC’s website. The CQC is also starting a three-month inspection of the 150 hospitals that care for people with learning disabilities, and this will include unannounced inspections. Where it identifies inadequate care, the CQC will require the necessary improvements to be made immediately. South Gloucestershire council will also lead an independently chaired serious case review. I have asked the Department of Health to draw together the findings of these various investigations and ensure that they are completed in a thorough and timely manner. I can also report that Mark Goldring, the chief executive of Mencap, will bring an independent voice and a depth and breadth of knowledge of the needs of people with learning disabilities to the task of drawing conclusions and learning lessons. Once in possession of the full facts, and once the police investigation has concluded, we will be in a position to decide what further action is required.

Since being made aware of the abuse, our priority has been ensuring the safety of patients at Winterbourne View. Fifteen staff have been suspended by Castlebeck and no further patients will be accepted at Winterbourne View. All residents now have a personal advocate and the CQC is working with all the agencies involved to find suitable alternative placements for them, taking into account their specialist needs and the wishes of their families. I issued a full written ministerial statement on these matters at 9.30 this morning.

It is the right of every individual being cared for by others to be treated with dignity and respect and it is the responsibility of those trusted with their care to provide it: a responsibility that weighs most heavily on those who care for the most vulnerable, including those with learning disabilities. This responsibility rests in four places: with the providers themselves, in this case Castlebeck; with commissioners, both primary care trusts and local authorities; with the regulators, including both the Care Quality Commission and the professional regulators, and the CQC has acknowledged it should have acted sooner and issued an unreserved apology; and, of course, with individuals. No training, guidance or management

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should be needed to tell people that the behaviour experienced by the residents of Winterbourne View was nothing other than obscene and unacceptable.

In future, our proposed HealthWatch organisations will provide a valuable early warning and will be able to ask the CQC to investigate where concerns exist. We intend to put safeguarding adults boards on a statutory footing, helping local authorities, the NHS and the police to work together to safeguard vulnerable adults. We will do everything in our power to prevent incidents such as those at Winterbourne View from happening again and to ensure that, if they do, the system responds quickly and decisively to protect those at risk.

Emily Thornberry: The Opposition agree entirely with the sentiments expressed by the hon. Gentleman. It was with great shock and sadness that we saw the terrible events happening, before our eyes, on the television screens. To see the abuse of the most vulnerable by those entrusted with their care was truly shocking and sickening. In the wake of this tragedy, however, vital questions must, in our view, be answered fully and impartially.

Although internal investigations conducted by the CQC and South Gloucestershire council, both of which are directly connected with this failure, will be of some value, they are nevertheless insufficient. We are asking for an independent inquiry similar in nature to the well-respected “Healthcare for all” inquiry, which Sir Jonathan Michael carried out in May 2007. The Government could include in that inquiry experts to work alongside Mark Goldring, such as Professor Jim Mansell, who has already conducted two reviews for the Department of Health into the structure of homes for those with learning disabilities, because the issues raised in his reports are still to be resolved, as this tragic case suggests.

We need full and frank answers. Was the CQC’s failure to monitor the treatment of residents due to the lack of resources? Was it due to the shortage of 300 staff, as reported in the Financial Times last week? Does the CQC have adequate powers to act in cases such as that of Winterbourne View and, if so, is it using its powers appropriately? If not, how must the CQC be strengthened to prevent a repeat of this failure and what actions will the Government take to ensure that staff working in social care are better trained and regulated so that events such as those at Winterbourne View can never be repeated?

Last week, the Minister created confusion with his response. On Tuesday, he seemed to imply that there would be an independent review of the case but by Wednesday he seemed to have changed his mind. Does he now think that internal reviews will be sufficient to answer the questions? I hear what he says about sub judice and the police inquiry, but we are not asking for an inquiry into individual culpability. We are asking for an independent inquiry into the failure of the system, for that inquiry to begin immediately and for there to be no delays. We need assurances that there will be a wide-ranging review, held in public, that will shine a light on the terrible events at Winterbourne View. Only an independent inquiry will do.

Paul Burstow: Of course, we need to ensure a full and thorough inquiry into all these matters, which is being undertaken in the serious case review, which will be

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chaired independently, and in the work of the CQC. That will go on as the Department brings together all the different reviews and that is why we are very pleased that Mark Goldring will take part in the process.

The hon. Lady suggests that there was confusion last week, but the confusion was only that which she sought to spread. We were very clear from the outset that we wanted to examine all the results from all the different inquiries, and that is what we are doing. We are not ruling out any further inquiries, but we want to ensure that the processes that are in hand are concluded and that we make judgments with the full facts available.

Mr Stephen Dorrell (Charnwood) (Con): May I welcome my hon. Friend’s announcements to the House this afternoon? Does he agree that although there has quite properly been a lot of focus on the CQC—Dame Jo Williams accepts that there have been quite clear failures in its supervision of the home—there are also some difficult questions to be answered, particularly by the commissioners of the care? What were they doing paying for care that clearly was not to the required standard? Equally importantly, there are some important questions for the professional regulatory bodies to answer. Did no doctor ever go into the home? If they did, what conclusions did they draw? Where were the nursing regulators in this case?

Paul Burstow: My right hon. Friend poses a number of questions that are at the heart of the various current inquiries. He is right to say that to focus solely on the CQC is to miss the point, as the primary responsibility rests with the provider organisation to recruit, train and supervise the right staff in the first place. He is also absolutely right to ask about the role of the commissioners and the professional regulators. Those are the issues that we are looking at and will examine, and I will come back to the House with answers in due course.

Mr Michael Meacher (Oldham West and Royton) (Lab): As the CQC has been forced, by Government cuts, to reduce its inspections by no less than 70%, how are the Government going to prevent similar abuses from occurring elsewhere and going uninspected and undiscovered unless someone happens to blow the whistle or offer undercover photographic evidence?

Paul Burstow: Let me start by addressing the whistleblowing issue. Terry Bryan, the whistleblower in this case, is to be applauded for his tenacity in pursuing it. The Government have been clear about the need to strengthen the arrangements and safeguards for whistleblowers, because that is an essential first way in which we can make sure that the system protects those who are vulnerable. The right hon. Gentleman suggests that the Government have in some way cut the number of inspections, but he should reflect back to 2008 when his Government introduced the current mandate for the CQC and changed the basis on which it would inspect. That is what led to the changed inspection system. Perhaps he should ask some questions about that as well.

Mr Robert Buckland (South Swindon) (Con): Does my hon. Friend agree that the model of large-scale institutionalised provision for people with learning difficulties is now broken and that we should support

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even more moves towards personalised and supported care close to the families and loved ones of people with learning difficulties?

Paul Burstow: My hon. Friend makes a very good point. The move towards personalisation and greater supported living is undoubtedly the direction that we wish to move in. That was started by the previous Government and we have been continuing it. We have made a massive transfer of resources from the NHS to local authorities to support that very transfer of responsibility, which is undoubtedly the way to deliver better results for individuals.

Mr Dennis Skinner (Bolsover) (Lab): Is it not self-evident that if there were a full inquiry we would be able to hear about the owners and the people who make money out of these business ventures—businesses such as Lydian Capital Partners, which owns Winterbourne View, and people such as J. P. McManus and John Magnier, who have rubbed shoulders in royal circles? Is it not ironic that those two billionaire Irishmen, at the same time as the British people are bailing out the Irish economy, are making misery for disabled people by inflicting the damage they have caused and are making money in the process?

Paul Burstow: In my public statements and in my statement today, I have made it clear that the spotlight needs to be shone just as clearly on the provider organisation in this case, and not just on the CQC. That will be my continued intention as we pursue this matter to its conclusion.

Dr Sarah Wollaston (Totnes) (Con): Will the Minister address the question of how long these vulnerable people were filmed being abused, because that simply would not have been tolerated if they were children?

Paul Burstow: My hon. Friend makes an important point. I do not know the answer to the question of how long the people were filmed before the whistle was blown again by “Panorama”. However, it is an important point that will undoubtedly become clearer as we come on to the details of the inquiry.

Glenda Jackson (Hampstead and Kilburn) (Lab): I endorse the Minister’s praise for the whistleblower in this horrific case, but may I remind him that he blew the whistle three times to the Care Quality Commission, which did precisely nothing? What are the Government doing to ensure that such a situation can never arise again?

Paul Burstow: The local authority was notified in the same way, so there are a number of agencies at which we need to look carefully and critically, and that is what the independently chaired serious case review will do. That is what the review by the CQC is about, and we will pull all those reviews together. If there are any gaps in the information that comes from that process, we will make sure that they are filled. However, the key thing is that lessons are learned along the way and changes are made straight away.

Robert Halfon (Harlow) (Con): Further to what the hon. Member for Hampstead and Kilburn (Glenda

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Jackson) said, given that the CQC clearly ignored the advice it was given, there should be resignations at the highest level—the buck has to stop somewhere.

Paul Burstow: I am afraid that I am not going to agree with the hon. Gentleman today that we should call for anyone’s head. I want the heads of that organisation to be relentless in pursuing the questions that hon. Members have asked today and which I have asked since this came to light about why failures occurred—not just the CQC’s acknowledged failure but failures by others in allowing this to go on for the time it did. I am not calling for resignations, but I am calling for action and resolution. Learning should take place, and there should be change as a result of that learning.

Mark Durkan (Foyle) (SDLP): The Minister has rightly addressed the issue of whistleblowers. Will he assure us that there will be protection for whistleblowers in future, whether they are relatives or staff, so that they have the confidence to act? In relation to staffing issues, are any of the inquiries making any assessment of whether there is a correlation between shift lengths and pay rates and the poor care in some of those institutions?

Paul Burstow: Again, those are all matters that need to be properly considered and weighed up in the reviews and that the Department will want to make sure is part of the overall report. When that work concludes, we will report to the House and make sure that the information is available to all hon. Members so that they can assess it and make their own judgments. It is certainly the Government’s intention to strengthen the protections on whistleblowing. We are consulting on how that might be given effect, and I urge the hon. Gentleman to contribute to the consultation.

Duncan Hames (Chippenham) (LD): Does the Minister envisage that putting safeguarding adults boards on a statutory footing would help care home residents, their families and all those concerned; and would bring these incidents to light and, indeed, to a halt sooner in future?

Paul Burstow: It is essential to establish a statutory basis for safeguarding adults boards, but it is not sufficient, as other issues must be addressed in the review, which is why various aspects of the work are progressing. However, it is right that we should respond quickly to the Law Commission, which recommends that we should put the boards on a statutory basis, and that is what we will do when legislation is introduced.

Malcolm Wicks (Croydon North) (Lab): If, as is often said almost as a cliché, a test of a civilised society is how we care for the most vulnerable—sadly, it is likely that Winterbourne is not an isolated example, and that even today many frail elderly people, often with dementia, and people with mental illnesses or learning difficulties are being abused and neglected—we must all think hard about how to move forward. Strong and unannounced inspections are clearly a significant part of the answer, but are there ways in which we can involve local communities and concerned citizens in safeguarding the well-being of people in homes—often private homes? If around every home there were two or three citizens who had rights to enter and could befriend some of the people there, that might be another way in which the

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community could add to the statutory services to try to prevent occurrences in future.

Paul Burstow: I am grateful to the right hon. Gentleman for his question. We must acknowledge that there will never be a time when there is an inspector in every room of every care home for every minute of every day. We must therefore make sure that the systems in place are robust, and that organisations are recruiting the right people and delivering the right training and supervision. However, the right hon. Gentleman’s point about the involvement of the community is spot-on. That is why we are proposing the establishment of HealthWatch and why we see that as an opportunity for citizens to become involved in the provision and scrutiny of health and social care in their communities.

Margot James (Stourbridge) (Con): Very often a whistleblower is the vital link that people in such vulnerable circumstances have with the outside world, so I am pleased to hear that that will be a big part of the review. I have written to the chairman of the CQC to ask how many such whistleblower complaints were made in the past 12 months but not been followed up. The data are essential. May I have the Minister’s assurance that the review will find out that information?

Paul Burstow: My hon. Friend draws attention to an area that we need to look at as part of the various aspects of the work that I described to the House today. Although I do not know the basis on which such data are collected by the CQC, I undertake to look at what data are available.

Ms Gisela Stuart (Birmingham, Edgbaston) (Lab): I accept the Minister’s logic in not asking for heads to roll ahead of the report of the independent inquiry, but will he give the House an undertaking that once he has asked the questions and received the answers, he will not shy away from allocating responsibility and will do what the NHS is usually very bad at—allocating responsibility at some stage and asking people to resign?

Paul Burstow: I think I will say yes to that, but I want to make it clear that I am not answering in the context of hypotheticals. I do not know the conclusions of the exercise, and Ministers who come to the Dispatch Box and promise that things will never happen again are all too often and too soon proven wrong. We must make sure that we do everything we can to learn lessons from this to minimise the risks in the future, and we need to make sure that responsibility and accountability are at the heart of the reforms that the Government are making to health and social care.

Fiona Mactaggart (Slough) (Lab): The Minister is right to say that we need to learn lessons from this, but how long will it take us? The CQC has admitted inspecting Winterbourne View three times in the past two years. The South Gloucestershire safeguarding board was informed in October, but apparently took no action before the programme was aired on television. This is not the first such scandal. When I was first elected, one of the first things I did was to persuade the Department of Health to commission the Bergner report into the Longcare home scandal on the borders of my constituency —a similar huge institution in which residents were raped, abused and tortured by the people who were given care of them. It seems to me that it is not just the

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individual institutions but Government who need to learn the lesson. How much money is the Minister putting into advocates and listeners of the volunteer kind mentioned by my right hon. Friend the Member for Croydon North (Malcolm Wicks), or of the professional kind, so that the voices of those who cannot always speak for themselves are heard in the inspection process?

Paul Burstow: I mentioned in my statement that each of the individuals who have been affected in this terrible way have advocates. The hon. Lady makes an important point about the role that advocacy plays for those who lack capacity or the ability in certain circumstances to advocate on their own behalf. We are looking at that as part of the overall reforms of health and social care, but as for a precise sum of money, I do not have a figure in my head that I can give her now. I will write to her on that point.

Kerry McCarthy (Bristol East) (Lab): My elderly constituent, Mr Ivor Needs, has been looking after his vaccine-damaged son, Matthew, for many, many years. Ever since I became an MP, he has been expressing concern to me about what will eventually happen to Matthew when he is no longer able to look after him. How can we reassure people such as Mr Needs that the Government are pulling out all the stops and doing all they can to ensure that care homes in the Bristol and south Gloucestershire area will be fit for purpose and a fit place for him to entrust the care of his son?

Paul Burstow: I entirely understand that question. I suspect the hon. Lady speaks for many who saw the programme and therefore fear for their loved ones who may be in other institutions. That is why we have to act in a thorough and thoughtful way, why we have to act quickly, and why the various processes that I described today are the best way to reach conclusions quickly. Because of the separate criminal inquiry, a separate independent inquiry would not be able to start until those judicial processes had been completed. That is why we want the internal processes to go forward. We have provided external scrutiny to make sure that they deliver what we all want—greater assurance that the system will deliver the best quality care for our loved ones.

Fiona O'Donnell (East Lothian) (Lab): The Minister has stated that there cannot be an inspector in every bedroom, and that is why he and hon. Members across the House this afternoon have acknowledged the vital role of whistleblowers in protecting vulnerable adults. Will he speak to colleagues in the Department for Business, Innovation and Skills to ensure that any changes to employment law do not make it more difficult for people to blow the whistle, especially new employees who often see a service through fresh eyes and therefore see faults that others have grown used to?

Paul Burstow: I will certainly have those discussions, and I would add that there is another area that we need to focus on, and that is the training and development of

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the work force. That is why just two weeks ago I announced not just a work force development strategy, but additional new resources to underpin that strategy for all providers to enable them to ask Skills for Care for the resources to develop their work force.

Diana Johnson (Kingston upon Hull North) (Lab): Will the Minister also look at the vetting and barring scheme in this country, and in particular have regard to the provisions in the Protection of Freedoms Bill, which is going through the House at the moment, that will remove millions of people who work with vulnerable adults from the thorough background checks that the Independent Safeguarding Authority carries out at the moment?

Paul Burstow: I will take away that point, reflect upon it and write to the hon. Lady rather than give her an off-the-cuff answer of any sort.

Dame Anne Begg (Aberdeen South) (Lab): Like my right hon. Friend the Member for Croydon North (Malcolm Wicks), I too believe that we are kidding ourselves if we think that this is a one-off and it is not happening day in, day out. There will be vulnerable adults living in their own homes today, behind locked doors, who are in fear of the carers who are paid to look after them. Might not another way of getting an eye into the locked environment be the use of telecare to make sure that someone outside is aware of what is happening in these locked institutions?

Paul Burstow: I would not want to give the impression that we would see that as a substitute for any of the other points that have been made on this urgent question today, but undoubtedly telecare, telemedicine and assisted technologies have their part to play, both in improving the quality of care and increasing independence for individuals. That is why the Government support that as part of the way in which we see the future for social care unfolding.

Catherine McKinnell (Newcastle upon Tyne North) (Lab): A recent Tyne Tees television report uncovered cases of appalling abuse and neglect in the north-east that are now being investigated, and the staff in those cases reported dreadful treatment from their employers, not just losing their jobs but having their professional reputation smeared. Will the Minister please elaborate today as there will be workers who are aware of abuse but are in fear of their jobs, who could report abuse if they had some reassurance today of the changes that the Government are looking to make to protect vulnerable workers?

Paul Burstow: The first thing I would say is that if anyone sees criminal activity of the sort that took place at Winterbourne View, they should blow the whistle on it. There is no if or but about that. The Government have consulted and we are looking at the responses to the consultation on whistleblowing. I am not in a position to elaborate further, but it is absolutely vital that people feel able and safe enough to come forward if they have concerns about neglect, abuse or poor-quality care.

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Middle East and North Africa

3.59 pm

The Secretary of State for Foreign and Commonwealth Affairs (Mr William Hague): With permission, Mr Speaker, I would like to make a statement on north Africa and the middle east. On Saturday I visited Benghazi with my right hon. Friend the Secretary of State for International Development. We went to show our support for the people of Libya and their legitimate representatives, the national transitional council. Our overriding impression was of a great sense of optimism among ordinary Libyans, who are hopeful that Gaddafi will leave and deeply grateful for what the United Kingdom has done. I pay tribute to the brave men and women of our armed forces and to our diplomats and aid workers in Benghazi for their courageous work.

Benghazi is functioning well under the circumstances, with police visible on the streets, many shops and restaurants open and food staples in good supply. We also noted a dramatic expansion of civil society groups, which rightly see themselves as one of the key building blocks of a free Libya.

The UK’s approach is as I have set out many times before. We continue to take robust action to implement UN Security Council resolution 1973, which authorises military action to put in place a no-fly zone to prevent air attacks on the Libyan people and all necessary measures to stop attacks on civilians while ruling out an occupation force. The case for this action remains utterly compelling.

Operating strictly within the limits of the UN resolution, we are steadily intensifying the military, economic and diplomatic pressure on the Gaddafi regime. We have increased the tempo of air strikes against regime forces, which are currently taking place at a rate of approximately 50 strike missions per day and include the targeting of military command and control sites in Tripoli, regime tanks, artillery, rocket launchers and armoured fighting vehicles. Nearly 10,000 sorties have been carried out since 31 March, including more than 3,700 strike sorties, on top of operations to disrupt regime military activity and arms shipments at sea. On 1 June the North Atlantic Council agreed unanimously to extend NATO’s operations for a further 90 days from 27 June.

It is right that we ensure that our military operations are as effective as possible and that we adapt our tactics as the regime forces change theirs. Last week Britain deployed Apache helicopters to operations in Libya, alongside French helicopters, which is enabling the precise and potent targeting of regime forces.

The Gaddafi regime is isolated and on the defensive. Last week a number of senior military officers abandoned it, including five generals. The head of the National Oil Corporation also recently fled Libya. On 17 May, Arabsat joined European satellite companies in suspending Libyan state television broadcasts, a significant blow to Gaddafi’s ability to carry out psychological warfare, and we press all satellite companies to take similar action.

British humanitarian support has already played a vital role in Libya. My right hon. Friend the Secretary of State for International Development has announced further assistance to protect 200,000 people in Misrata and elsewhere from land mines. We have deployed an international stabilisation response team to Benghazi,

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which is leading the international effort to plan detailed assistance for Libya when the conflict comes to an end, ensuring that clear plans are in place for the international community to support. Separately, we are providing additional communications equipment, uniforms and bullet-proof vests to help the national transitional council develop responsible security forces and to protect civilians.

In our meetings, we found the NTC focused on Libya’s future. It has published a road map for the transition to democracy, with an interim Government including some technocratic members of the regime and elections. We have advised the NTC to develop its proposed transition in more detail to ensure that comprehensive plans are in place.

Any political settlement in Libya requires an end to violence and Gaddafi’s departure. At the G8 summit in Deauville on 26 May, participants, including Russia, agreed that Gaddafi has lost all legitimacy and must go. On 11 May, at the Foreign Affairs Council, the EU agreed to intensify efforts to block the regime’s access to resources, funding, military hardware and mercenaries. Today the EU has added six regime-controlled port authorities in western Libya to the EU sanctions lists. This will help prevent the regime acquiring military resources and will support the protection of Libyan civilians.

The next meeting of the Libya contact group will take place on Thursday in the United Arab Emirates, where Britain will call for all this international pressure to be intensified and maintained. The House should be in no doubt that the efforts of Britain and our partners are saving lives and enforcing UN resolutions. Had we not acted, the bloodshed would have been far greater and the consequences for Libya’s neighbours and the entire region would have been extremely serious.

The Gaddafi regime is not the only Government seeking to suppress peaceful protest. Scores of people were killed in Syria over the weekend after demonstrations involving tens of thousands of people. Members on both sides of the House will have been horrified by the killing of many children and the death of 13-year-old Hamza al-Khateeb, who was allegedly tortured. The regime is using live fire against protestors and blocking UN efforts to get help to those in need. There have been reports overnight that a number of security force personnel have been killed in the town of Jisr al-Shughour, close to the Turkish border, and we call for restraint in response to this incident.

Since my previous statement, our efforts to agree EU sanctions against President Assad and other individuals responsible for the violence and repression in Syria have been successful. We are exploring with our European partners the potential for further sanctions if the violence continues.

Britain has circulated a draft UN Security Council resolution condemning the repression in Syria and calling for the Syrian Government to meet their people’s legitimate demands, to release all prisoners of conscience, to lift restrictions on the media and internet and to co-operate with the UN High Commissioner for Human Rights. The House will appreciate that a resolution is not in our gift and needs the support of nine UN Security Council members and no vetoes. We are working to persuade other countries that the Security Council has a responsibility to speak out. President Assad is losing legitimacy and should reform or step aside.

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We must show the same resolve and purpose in supporting change and democratic development elsewhere in the region, using, for example, the economic appeal of the EU to act as a magnet for positive change in the region. We welcome the review of the European neighbourhood policy, issued on 25 May. It includes many British proposals and follows weeks of intensive engagement by Ministers, including the Prime Minister and Deputy Prime Minister. It offers a new partnership based on progressively greater economic integration, including trade, and increased funding for the southern neighbourhood of €750 million. It links EU support with progress on political and economic reform, and it includes a civil society facility and a European endowment for democracy to help fund new political parties and small non-governmental organisations.

The G8 summit agreed the Deauville partnership, which will provide more than $20 billion in vital assistance to Tunisia and Egypt and to countries that commit to more open and democratic government, and in February I announced Britain’s new Arab partnership initiative to support civil society and democratic development in the region, with initial funding of £5 million. The Prime Minister announced at the G8 summit that we will increase that funding more than twentyfold, expanding it to £110 million over four years.

The fund will provide support for lasting political and economic reform through the building blocks of democracy: independent institutions, political pluralism, free media and economic opportunity. It includes up to £40 million to work with Parliaments, civil society, human rights groups and reforming Governments, and up to £70 million to support growth and tackle the fundamental problems that leave so many millions of young people throughout the region without a job. This is in our vital national interest as well as true to our values.

Tunisia has made significant progress towards a more democratic society, but there is a risk of political reform being destabilised by economic challenges. In Egypt there have been further demonstrations calling for faster political and economic reforms and a revised electoral timetable. We are concerned that planned parliamentary elections in September will be too early to allow political parties to organise their activity and to contest the elections. The Prime Minister and I have pressed the Egyptian authorities to ensure an open and plural election process.

The situation in Yemen is extremely uncertain following President Saleh’s departure to Saudi Arabia to receive medical treatment and his transfer of authority to the Vice-President. We urge the Vice-President to work closely with all sides to implement the Gulf Co-operation Council agreement and to begin political transition now. Yemen faces huge humanitarian and economic challenges, and the Yemeni Government need to dedicate all their efforts to confront the impending crisis, with international support.

Recent events have shown just how quickly the security situation in Yemen can deteriorate into ferocious and unpredictable fighting. It is of the utmost importance that all British nationals leave the country immediately by commercial means while it is still possible to do so, as we have advised them to do since 12 March. I warn again that it will be extremely unlikely that the British Government will be able to evacuate British nationals from Yemen.

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We are also concerned about developments in Bahrain, particularly the arrest and trial of a large number of politicians, doctors and nurses and the allegations of torture. I raised our concern and the need for the Bahraini Government to meet all their human rights obligations when I saw the Crown Prince of Bahrain last month. I also emphasised the need for a long-term political solution that builds bridges between the different religious communities.

I welcome the lifting of the state of national safety on 1 June and the announcement by the King of Bahrain that a comprehensive and inclusive national dialogue will start on 1 July. Urgent dialogue on genuine political reform is the only way to address the legitimate concerns of the Bahraini people and to ensure long-term stability.

With a month to go before South Sudanese independence on 9 July, we have made strong representations about the violence in Abyei and southern Kordofan. I met the Sudanese Foreign Minister yesterday and urged a peaceful and durable solution for Abyei and agreement on outstanding areas of the comprehensive peace agreement. This is only more urgent following the very worrying reports received just this morning of renewed fighting in southern Kordofan. We are in touch with the UN mission in Sudan and monitoring these developments closely. I urge both sides to cease all hostilities immediately and to return to negotiations under the auspices of the African Union.

The Arab spring underlines the importance of a breakthrough on the middle east peace process. This long-standing conflict needs to be resolved, through negotiations, to give the Palestinian people the state that they need and deserve and the Israeli people long-term security and peace. The status quo is not sustainable, nor will these populations be immune from the effects of change and instability elsewhere. We strongly support President Obama’s recent statement that negotiations should be on the basis of 1967 lines with mutually agreed land swaps and proper security arrangements, and along with France and Germany we are pressing the parties to return to the table.

The new Palestinian Authority should be composed of independent figures on the basis that President Abbas set out on 4 May. As was the case with the outgoing authority, it should uphold the principle of non-violence, be committed to a negotiated two-state solution, and accept previous agreements of the Palestine Liberation Organisation. Hamas will remain a proscribed terrorist organisation unless and until it abandons violence and commits to a two-state solution, and we call again for the immediate release of Gilad Shalit. The UK will judge a future Palestinian Government by their actions and their readiness to work for peace. We are also concerned by this weekend’s violence in the Golan heights, resulting in many deaths, and we continue to urge restraint and call for the avoidance of the lethal use of force.

There must also be no let-up in our efforts to prevent nuclear proliferation in the middle east. Iran is combining brutal suppression of Opposition leaders at home with the provision of equipment and technical advice to help the Syrian regime to crush protests in Syria. This is unacceptable, and compounds our concern about Iran’s behaviour and its intentions over its nuclear programme. We support peaceful pressure on Iran to persuade it to negotiate, backed by the offer by the UK, the US,

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Russia, China, France and Germany to reach an agreement through talks. That is why the UK has recently helped to extend Iran sanctions in the EU, with over 100 new designations, while keeping the door open to further negotiations. Until Iran negotiates seriously, international pressure against it will only increase.

In all these countries, Britain’s approach in the coming months will be consistent and determined. We will support greater economic and political freedom while anticipating and addressing threats to our own security, and we will work with our allies to protect our nation’s interests while standing up for the highest values of our society.

Mr Douglas Alexander (Paisley and Renfrewshire South) (Lab): I thank the Foreign Secretary for his statement and for advance sight of it.

Let me begin my remarks with Libya. The mission to enforce Security Council resolution 1973 continues to have the support of the Opposition, but, as has been the case from the start, we will continue carefully to scrutinise the Government’s policy towards Libya. The brave and professional work of our armed forces in Libya has already helped to avert a slaughter in Benghazi and continues to provide vital support to the Libyan people, and I am sure that I speak for the whole House in saying that they continue to have the support of every Member of this House.

It has been clear from the outset that this conflict was always going to be easier to start than to finish. I therefore note all that the Foreign Secretary has said about post-conflict planning and, in particular, the work of the transitional national council, which is now producing a road map towards a more democratic future post-Gaddafi. Could he give the House a sense of the time scale by which further documentation might be available and what assessment he has made of the TNC’s capability to meet the challenges set out in this plan? Can I take it from his words this afternoon that in addition to our significant military commitments, the United Kingdom, in the form of the international stabilisation response team, is now also in the lead in developing the international community’s post-conflict planning?

On the Apaches, I think it is a matter of record that the French Defence Minister, Gérard Longuet, announced the British deployment before it was confirmed to this House. Does the Foreign Secretary agree that it is a matter of regret when French Ministers seem better informed about the deployment of British military personnel than the British Parliament?

I welcome what the Foreign Secretary has said about the increased pressure on the regime, but given the continuing limited capacity of the opposition forces to make broader strategic gains within Libya, by what means does he think the pressure can and will be increased in the weeks ahead?

Let me turn to events in Syria. I associate myself with the Foreign Secretary’s condemnation of the actions of the Assad regime thus far, and with what President Obama said recently:

“The Syrian government must stop shooting demonstrators and allow peaceful protests; release political prisoners and stop unjust arrests; allow human rights monitors to have access to cities like Dara’a; and start a serious dialogue to advance a democratic transition.”

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Will the Foreign Secretary update the House on the regime’s efforts to shut down internet and mobile networks in parts of Syria? What work, if any, is under way in the United Kingdom to support people in countries such as Syria, whose freedom of expression is being restricted in that way?

Given the welcome work that is under way at the United Nations, will the Foreign Secretary provide the House with an assessment of the prospects for securing support among the P5 members for a resolution on Syria? What impact does he judge the action in Libya has had on those prospects? Will he tell the House whether consideration is being given to referring Syria’s leaders to the International Criminal Court? Does he agree that the European Union can further strengthen such pressure? The EU can and should be looking at further sanctions on the regime, irrespective of what is or is not agreed at the Security Council. What discussions have the Government held with the Arab League on Syria, given its regrettable silence to date on that issue?

The situation in Bahrain continues to be deeply concerning. I reiterate our belief that the legitimate demands of protesters should be met with reform and not repression. Will the Foreign Secretary therefore give the House more details on the points that he and the Prime Minister made to the Crown Prince of Bahrain at the end of his recent visit to London? Did they raise the issue of military courts continuing to dispense summary justice? Did they raise the cases of the hundreds of protesters who have been jailed and the 90 or so who have been killed or simply disappeared? If they did raise those questions, what answers did they receive? What answers did they receive on the sharpening polarisation between communities within Bahrain?

In that context, what discussions have taken place between the Government and the governing body of Formula 1, the FIA, about its recent decision to reinstate the Bahrain grand prix in October? Will the Foreign Secretary confirm that now is not the time to decide on that event, especially given the need for restraint, reform and reconciliation to be the focus in Bahrain in the months ahead?

When I visited Tunisia recently, a number of senior figures in the transitional Government and the fledgling political parties felt that the European Union had not come up with an assistance package to match the scale of the task on which they have embarked. Will the Foreign Secretary therefore update the House on what steps Britain is taking to ensure that more comprehensive offers than those that have been outlined are made to Tunisia and Egypt to help them on the path to democracy and to assist in their economic development?

I concur with the Foreign Secretary’s concern that September is too early to ensure that all political parties in Egypt have sufficient time to organise their activities and contest the elections. Following the work of my right hon. Friend the shadow Secretary of State for International Development to highlight this issue, how confident is the Foreign Secretary that the place of women in Egyptian society will be advanced and not set back by the constitutional settlement that is under construction?

Given our vital interest in the emergence of broader based democratic, prosperous countries across the middle east, how does the Foreign Secretary respond to the report by the Institute of International Finance, which

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predicts that Egypt’s economy will contract by 2.5%? Inflation is now above 12% and unemployment is up this year. According to Reuters, the country’s foreign exchange reserves fell by as much as a third in the first three months of the year. Newspaper estimates suggest that $30 billion have left Egypt since the start of the revolution. Given that the Deauville partnership of which he spoke applies not to one country but to the whole region, and given the scale of the capital flight, does he really feel that the World Bank’s package of $1 billion in each of the next two years and the International Monetary Fund’s loan of $3 billion are adequate? Can he really assure the House that he is confident that the international community’s response is appropriate to the opportunity and the risk of the present moment in the middle east?

There have been significant developments in relation to Israel and Palestine over the last few weeks, to which the Foreign Secretary alluded. I welcome the US President’s decision to reaffirm his country’s long-standing support for a two-state solution based on 1967 borders and mutually agreed land swaps. Last week’s clashes on the Israel border and the Golan heights, in which a number of protestors were killed or injured, were deeply concerning. Israel of course has a right to protect its borders, but can the Foreign Secretary tell the House what the Foreign Office is doing to ensure that Governments on both sides of those borders do everything they can to avoid provocations and escalations that make it harder to find peace? After the President’s speech in the United States and his speech to parliamentarians here in Westminster Hall, can the Foreign Secretary update us on any further discussions that he has had with Secretary of State Clinton on how, in practical terms, the United States and the UK will push for progress on the issue in the coming months? In addition—

Mr Speaker: Order. I think the shadow Secretary of State is approaching his last sentence.

Mr Alexander: I am indeed.

In addition, given the widespread discussion that the Palestinians plan to argue for statehood at the United Nations later this year, can the Foreign Secretary give his assessment of, first, where European Union allies are on that issue and, secondly, when the UK Government intend to come to a final view on the matter?

Mr Hague: I am grateful to the right hon. Gentleman for that wide range of questions. There are many subjects within the topic of the middle east and north Africa. I am grateful to him, of course, for joining me in paying tribute to the work of our armed forces, diplomats and aid workers, and for reaffirming what we said together in the House on 21 March—that we needed to avert slaughter in Benghazi. The action that we took did so, and that has been the foundation of the unity of this House on the conflict in Libya. We continue to be grateful for that.

The right hon. Gentleman asked about the time scale for the national transitional council producing more detail. I hope that it will do so at the contact group meeting in Abu Dhabi this week, and that it will take every further opportunity to publicise a more detailed programme for the process of transition in Libya. What it has already produced is absolutely sound, and we can support it, but it needs the added credibility of detail to be ready for Gaddafi’s departure.

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The right hon. Gentleman is right in assuming that the work done by the stabilisation response team, which my right hon. Friend the Secretary of State for International Development and I visited in Benghazi on Saturday, means that Britain is in the lead in post-conflict planning. We met Italian and Turkish experts who are also working with the team there, but we are certainly playing a leading role.

The right hon. Gentleman asked about the reference by a French Minister to the deployment of our helicopters. As my right hon. Friend the Defence Secretary would tell him, the decision had not been taken in the United Kingdom at that time, although it was clearly assumed in other capitals. That has been known to happen before on other subjects, and I have no doubt it will happen again.

The increasing pressure on the regime comes in all the ways that I set out in my statement. It is military, economic and diplomatic, and it is having its effect. There is no doubt that the regime has lost the initiative both in the military campaign and on the political scene in Libya in recent weeks, as a result of what we have been doing.

As for the right hon. Gentleman’s questions about Syria and internet use, this has been another unacceptable aspect of the Syrian Government’s behaviour in closing down freedom of expression however they can. We will always do what we can to protect people’s freedom of expression, but of course we are not universally able to do so in every county of the world. In the P5 on the Security Council, Russia and China have strong reservations about a UN Security Council resolution on Syria. Russia in particular has expressed those reservations and some hostility to a resolution. We continue to work on the matter at the Security Council.

The right hon. Gentleman asked about a possible reference to the International Criminal Court, but he will be aware that in the case of a country that is not a party to the ICC, as with Syria, such a reference would require a UN Security Council resolution. As we are not able at the moment to pass a resolution on the terms that I described, we are clearly also unable to pass a resolution on a reference to the ICC. The European Union is considering additional sanctions, as he called for, and I discussed the position with the Arab League when I was in Cairo a few weeks ago. However, Arab nations have more divided loyalties than they had in the case of Libya, so there is not the same degree of Arab League unity. We have to face up to that fact.

The Prime Minister and I raised with the Crown Prince of Bahrain all the subjects that the shadow Foreign Secretary asked about. For his part, the Crown Prince is very keen for a national dialogue to be resumed and to mobilise moderate voices in Bahrain on both sides of what is, unfortunately, a very sharp sectarian divide. Formula 1 must take responsibility for its decisions, but if such an event is to take place, it should be a focus for improvements in Bahrain, and provide an incentive for all in that country to work together on a national dialogue. However, Formula 1 must make its own decisions.

The shadow Foreign Secretary asked about several vital matters on Egypt and was quite right to draw attention to the very serious economic situation. In fact, the main conclusion that I drew from visiting Egypt a few weeks ago is that the economic challenge is, if anything, even bigger than the political challenge. Although

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the measures announced at the G8 and by the EU might have to be revised and expanded over time, they are an ambitious start. It is important that EU nation states follow up with real determination what the Commission has said. The risk of the policy that the EU has announced not being followed through is that nation states will say, “Well, market access for products from north Africa is not so easy,” and will not follow through on the commitments. We must be a strong voice for following that up, for implementing the support for civil society, human rights and the diversity of politics in those countries, and for helping the creation of liberal and secular parties. Part and parcel of that is the great importance of the strong participation of women in society and politics in Egypt and other north African countries, to which the shadow Foreign Secretary drew attention.

On the middle east peace process, of course we are active in urging all sides to avoid provocations. We are in constant touch with France, Germany and the US in encouraging both sides back into negotiations on the back of President Obama’s speech. In my view, the strength of our case would be added to by a statement by the Quartet to follow the US statement. We have asked the US in addition to support that.

Several hon. Members rose

Mr Speaker: Order. A great many hon. and right hon. Members are seeking catch my eye, but I just remind the House that Members who entered the Chamber after the Foreign Secretary began his statement should not expect to be called.

Richard Ottaway (Croydon South) (Con): I welcome the Foreign Secretary’s statement and congratulate him on his visit to Benghazi with the International Development Secretary, which was right and timely.

There is a gap between the humanitarian nature of resolution 1973 and the stated aim of removing Gaddafi. Russia’s shift of position means that a further UN resolution on Libya is conceivable. Does the Foreign Secretary believe that such a further resolution is necessary?

Mr Hague: The resolution on Libya is now nearly three months old, and circumstances have developed since then. My hon. Friend is right to point to the fact that it has been hard to adapt the resolution because of a lack of agreement on the Security Council to do so. We will continue to search for agreement on, for instance, adapting the sanctions regime, which of course requires unanimity in the sanctions committee, which is a bigger hurdle than a resolution in the Security Council itself. Russia’s position at the G8 holds out some hope that such agreements may be forthcoming, but I cannot yet say to my hon. Friend that the Russian Federation’s change of position at the G8 has been followed by a wider change of position at the Security Council and elsewhere.

Mr Jack Straw (Blackburn) (Lab): May I first express my appreciation to the Foreign Secretary and his right hon. Friend the Defence Secretary, and to their officials and our armed forces, for the work that is being carried out, above all in Libya but across the middle east? May I ask the Foreign Secretary specifically about Israel? He

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said in his statement that the “status quo is not sustainable”—I think the whole House will agree with that—but does he not acknowledge that the one person who believes that the status quo is indeed sustainable is Prime Minister Netanyahu? It is perfectly obvious from the rebarbative, obdurate speech that he made in Washington straight after President Obama’s statement that he has no intention whatever of making any constructive moves towards a settlement. That is clearly accepted in the States, as I recognised when I was there over the past two weeks.

In that context, is it not time for the British Government to abandon the approach of successive Governments, which is to deal with Israel with kid gloves? Should we not make it clear to Israel that we will make decisions in the interests of the Israeli people, of which the Israeli Government now seem incapable, as well as the wider Arab world?

Mr Hague: Prime Minister Netanyahu is the elected Prime Minister of Israel, and we must always bear that in mind, but the right hon. Gentleman is right to say that we should make a strong case, as we do, for an agreement based on the 1967 borders. Our Prime Minister met Mr Netanyahu a few weeks ago and made that case very strongly, as I have done to him and to the Foreign Minister, Mr Lieberman. We will continue to make that case based on diplomatic persuasion, but we will also vote in accordance with our convictions. In February, we voted in the Security Council for the Palestinian resolution on settlements. That was a clear indication of the view in this country and in this House on those matters and on the importance of taking forward the peace process. I would express this a bit more diplomatically than the right hon. Gentleman did, but it is incumbent on me to do so, as it is no longer incumbent on him.

Sir Menzies Campbell (North East Fife) (LD): In spite of my right hon. Friend’s understandably restrained language in relation to Bahrain, does he understand that many of us in the House and outside it think that the decision to reinstate the grand prix is simply shameful, and that it does the sport of motor racing no favours whatever? If the dialogue that is to begin in July is to be given a good start, could that not involve the cancellation of the race and, equally importantly, the release of those doctors and nurses who have apparently been arrested for having the temerity to tend the wounded?

Mr Hague: It is very important that due process should be followed. One of the most alarming things is the use of military courts in such cases. That was one of the issues that we took up with the Crown Prince, and on which we are looking for further assurances from the Bahraini Government. I am sure that my right hon. and learned Friend is right to say that the sport of Formula 1 has not done itself any good by that announcement. The important thing is to encourage all sides to get back into a real dialogue. There is no way for Bahrain to proceed into the future without a successful dialogue between the two communities; there is no other way of resolving the situation in Bahrain. We must continue to be on the side of that dialogue while always taking up our very strong human rights concerns, as we have done with the Crown Prince and as I have done in my telephone calls with the Foreign Minister. We will continue to do that.

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Mr Bob Ainsworth (Coventry North East) (Lab): On post-conflict planning for Libya, the Foreign Secretary is reported to have said at the weekend that although such planning is vital, it is as yet in an “embryonic” state. I do not know whether that is true, but it is what I read in the press. Surely there is now an urgency to post-conflict planning. The Gaddafi regime could go on for some time yet but, equally, it could be on the point of collapse. What is the hold-up? What urgency can the Foreign Secretary bring to post-conflict planning for Libya, and what can he tell the House about the problems and plans involved?

Mr Hague: The right hon. Gentleman is right to point out the urgency of this situation. This is why we are taking the actions that we are. The main case that I made to the national transitional council in Benghazi was that it must step up its own planning for the day that Gaddafi departs. In Libya, it will have prime responsibility for proceeding into the future in a stable, democratic way. We are, however, at the forefront of the work being done. There is real urgency involved, which is why my right hon. Friend the Secretary of State for International Development has sent the stabilisation response team to Benghazi. It is undertaking its assessment there now and will return within the next week or so to write its report. All its work has been accelerated—[ Interruption. ] Well, it has to be a good report, as well as being done quickly. There is a balance to be struck between those two things. The United Kingdom has taken a strong lead in this, and we have shown the greatest sense of urgency of all the Governments that are engaged in the issue.

Nicholas Soames (Mid Sussex) (Con): The Foreign Secretary is clearly right to give priority to the need to get rid of Gaddafi in short order, and then to bring what help we can to the transitional government, but does he agree that the linchpin of the whole of the middle east is Egypt, and the encouragement of the values of human dignity, freedom and opportunity there? Will he quantify what further assistance the British Government are giving to the Egyptian people to help them in their democratic process?

Mr Hague: Clearly, Egypt, with its geographic position, its vast population and its history, is at the centre of so much; my hon. Friend is quite right about its central importance. As I said earlier, the economic side of our work with Egypt is of prime importance. To quantify it further, Egypt will or can benefit from the £110 million Arab partnership fund, to which I referred earlier; from the entire EU southern neighbourhood policy, with €750 million of additional funding; and, indeed, from the $20 billion of various forms of financing set out at the G8 summit in Deauville. That is the quantification of the available assistance, most of which, given the distribution of the economies in north Africa, is available to Egypt. It is also necessary for Egypt to undertake its own economic reforms to give confidence to investors and the private sector so that the country can succeed; it cannot all be done by the international community. The Egyptians must have the right environment for economic success set out by their own Government as well.

Mr Denis MacShane (Rotherham) (Lab): Why did the Foreign Secretary use the term “allegations” of torture about what The Timesreported as

“47 health professionals… on trial, accused of seeking to overthrow the Gulf state’s monarchy”

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in a closed court. It continued:

“The doctors and nurses did this, in reality, only by treating the sick. Only the most paranoid of regimes could see treason in the Hippocratic oath.”

Instead of rolling out the red carpet at Downing street, is it not time that the Foreign Secretary got a little bit more robust with this torturing regime?

Mr Hague: It is often necessary to use the word “allegation” and I have used it in respect of certain cases in Syria, which are as disturbing as some of the cases the right hon. Gentleman mentions in Bahrain. He has been a journalist in his time, so he will know that, based on what we read in newspapers, we sometimes have to refer to “allegations” rather than “established facts”. Of course, these things are a huge cause for concern. It is important, however, to maintain our own contact with, and pressure on, those in Bahrain who are looking for a successful dialogue. One of those is the Crown Prince of Bahrain. It is important to maintain contact both with him and with those on the Shia side in Bahrain. Simply not to talk to anybody in Bahrain because terrible things have happened would not be the correctly constructive position of this country.

Mr Edward Leigh (Gainsborough) (Con): Will the Foreign Secretary say a bit more about post-war planning? As we saw in Iraq, getting rid of a bloody tyrant in the middle east is a lot easier than ensuring stability afterwards. Let me press him more particularly on these talks with Italian experts. What exactly does that mean? Benghazi and Tripoli were divided for centuries before the Italians imposed unity. What evidence is there that Tripoli will co-operate with the national transitional council after the fall of Gaddafi, if he does fall?

Mr Hague: Of course these are valid questions from my hon. Friend. We do not know what the exact circumstances will be whenever it is that Colonel Gaddafi departs the scene. We do know that the national transitional council is preparing for that and we have advised it to prepare more intensively. Already included in the national transitional council are members representing the Tripoli area—in fact, I met those members on Saturday—so it already has representation from all parts of Libya. Its stated goal is to include current members of the current regime—what one might call the more technocratic members of it—in an interim Government. The plans are there; they need fleshing out in more detail, but they are more grounded in sensible reality than was the case immediately after the fall of Saddam Hussein in Iraq.

Angus Robertson (Moray) (SNP): The Secretary of State has highlighted the pending independence of South Sudan on 9 July, which no doubt we all welcome. Will he confirm that this was accepted by the United Kingdom Government after the international norm of a single independence referendum?

Mr Hague: There was a single referendum, but there was also a 99% vote in favour.

Mr Tobias Ellwood (Bournemouth East) (Con): I welcome the statement. I have just returned from a visit to Cairo. Whoever one speaks to there—the Muslim Brotherhood, the military or, indeed, the youths in Tahrir square—no one can predict where Egypt will be

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in 12 months’ time, but what is certain is the wish for a delay in the elections, which my right hon. Friend mentioned. What encouragement is Egypt being given to allow the newly formed parties time to establish their democratic base, rather than allowing the old institutions to keep their momentum going?

Mr Hague: The case advanced by my hon. Friend is mounting all the time, as is apparent to many in Egypt and outside. We must respect the sovereignty of the Egyptians—it is their decision—but we will certainly be making the case, as the United Kingdom, that they would be wise to delay the parliamentary elections. In fact, there would be merit in their holding a presidential election before the parliamentary elections, which I believe would allow the most orderly transition to a democratic system. We will make that case, while respecting the fact that the Egyptians must make their own decisions in Cairo.

Mr David Winnick (Walsall North) (Lab): Does the Foreign Secretary really believe that his remarks about the killing of Palestinian demonstrators by Israel—it was Israel, by the way, which was not mentioned by him—were sufficient, and that remarks that he made urging restraint were enough? Would it not be far better to condemn absolutely what happened over the weekend? I thoroughly agree with my right hon. Friend the Member for Blackburn (Mr Straw) that it is time that the British Government made it clear to Israel that certain actions, such as what happened over the weekend, are totally unacceptable.

Mr Hague: Obviously we condemn anything that leads to unnecessary deaths, and I have made a strong appeal for avoidance of the use of lethal force. Israel’s response is certainly one that should be criticised, but Israel is not the only country that may be criticised in this regard. The area on the other side of the Golan heights boundary is under the direct control of the Syrian Government, and the access that people have gained there leads one to speculate about the motives of the Syrian Government in this matter. So the responsibility may not be all on one side, and trying to cross the borders is not the way to resolve the problems of the middle east.

I think we are all absolutely clear about the fact that the use of lethal force should be avoided whenever possible.

Several hon. Members rose

Mr Speaker: Order. There is intense interest, which is reflected in the number of Members who are seeking to catch my eye. I want to accommodate colleagues because these are very important matters, but there is now a premium on economy, a legendary example of which I know will now be provided by Mr Mark Pritchard.

Mark Pritchard (The Wrekin) (Con): Thank you for your generosity, Mr Speaker. No pressure!