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House of Commons

Tuesday 21 February 2012

The House met at half-past Two o’clock


[Mr Speaker in the Chair]

Business Before questions

London Local Authorities and Transport for London (No. 2) Bill [Lords] (By Order)

Transport for London (Supplemental Toll Provisions) Bill [Lords] (By Order)

Second Readings opposed and deferred until Tuesday 28 February (Standing Order No. 20).

Oral Answers to Questions


The Secretary of State was asked—

PFI Debt (NHS Hospitals)

1. Chris Kelly (Dudley South) (Con): What steps he is taking to address levels of PFI debt in NHS hospitals; and if he will make a statement. [95312]

9. Oliver Colvile (Plymouth, Sutton and Devonport) (Con): What steps he is taking to address levels of PFI debt in NHS hospitals; and if he will make a statement. [95320]

The Secretary of State for Health (Mr Andrew Lansley): The previous Government left 102 hospital projects with £67 billion of PFI debts. We have worked closely with NHS organisations for which PFI affordability is an issue to identify solutions for them, which have included joint working with the Treasury to reduce the costs of PFI contracts. Despite that, some trusts have unaffordable PFI obligations. On 3 February I announced how each of them could access ongoing Government support to help meet those costs.

Chris Kelly: I thank my right hon. Friend for that answer. Russells Hall hospital was expanded in 2003, but still has £1.8 billion of PFI debt attached to it—debt which will not be paid off until 2042. What steps is he taking to help reduce the PFI costs for hospitals such as mine that have not been completely crippled by Labour’s PFI and therefore do not qualify for central support, but none the less have high levels of debt?

Mr Lansley: I am grateful to my hon. Friend, who illustrates the precise issue with what Labour left. Labour talked of building new hospitals but left this enormous mortgage, in effect, of £67 billion. He refers to Russells Hall hospital, which, like others, is having its contracts

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reviewed for potential savings following the Treasury-led pilot exercise that I described, which was undertaken at Queen’s hospital, Romford.

Oliver Colvile: Given that the PFI process has been proven to have flaws in delivering value for money for taxpayers, what effect does my right hon. Friend feel that that will have on new commissioning boards?

Mr Lansley: My hon. Friend will know from the very good work being done by the developing clinical commissioning groups in Plymouth that they have a responsibility to use their budgets to deliver the best care for the population they serve. It is not their responsibility to manage the finances of their hospitals or other providers; that is the responsibility of the strategic health authorities for NHS trusts and of Monitor for foundation trusts. In the future, it will be made very clear that the providers of health care services will be regulated for their sustainability, viability and continuity of services but will not pass those costs on to the clinical commissioning groups. The clinical commissioning groups should understand that it is their responsibility to ensure that patients get access to good care.

Grahame M. Morris (Easington) (Lab): The Secretary of State will recall that he cancelled the new hospital planned for my area shortly after the general election. Will he advise the House how many hospitals the Government are building that use models other than PFI?

Mr Lansley: The hon. Gentleman will recall that his foundation trust was looking to receive more than £400 million in capital grant from the Department, which went completely contrary to the foundation trust model introduced under the previous Government. I pay credit to North Tees and Hartlepool NHS Foundation Trust, which is developing a better and more practical solution than that which it pursued before the election—many of the projects planned before the election were unviable. The hon. Gentleman will know that projects are going ahead, and last November, together with the Treasury, we published a comprehensive call for reform of PFI. We achieve public-private partnerships and use private sector expertise and innovation, but on a value-for-money basis.

Valerie Vaz (Walsall South) (Lab): John Appleby of the King’s Fund says that PFI represents less than 1% of the total annual turnover of £115 billion. Does the Secretary of State agree?

Mr Lansley: I gave the hon. Lady the figure: £67 billion of debt. Seven NHS trusts and foundation trusts are clearly unviable because of the debt that was left them by the Labour Government.

John Pugh (Southport) (LD): Is the Secretary of State confident that subsidising hospitals burdened with PFI will not be deemed anti-competitive under forthcoming legislation, or state aid under EU legislation? Has he taken appropriate legal advice?

Mr Lansley: I always act on advice, and I am absolutely clear that the support we have set out for NHS trusts and foundation trusts will not fall foul of anti-competitive procedures.

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NHS Reorganisation

2. David Wright (Telford) (Lab): What recent assessment he has made of the potential risks of NHS reorganisation. [95313]

The Minister of State, Department of Health (Mr Simon Burns): The Department monitors risks associated with the implementation of the health and social care reform programme on an ongoing basis.

David Wright: “An open, transparent NHS is a safer NHS”: not my words, but those of the Secretary of State for Health. Is it not amazing that Ministers do not want to release documentation relating to the reorganisation of the NHS? Is it not an absolute scandal that they will not publish the documentation? Is it not the fact that the reorganisation of the NHS is looking a bit like the Norwegian blue? Should it not shuffle off the perch?

Mr Burns: No, the hon. Gentleman is wrong. As he, or certainly the right hon. Member for Leigh (Andy Burnham), will know, the risk register is an ongoing document—discussions between Ministers and civil servants on the formulation, implementation and transition of policies—and it would be wrong, in my opinion, for it to be published. That is why my right hon. Friend the Secretary of State appealed to the tribunal following the decision of the Information Commissioner, in line with the precedent adopted by Secretaries of State in the Labour Government in both the Department of Health and the Treasury.

David T. C. Davies (Monmouth) (Con): Does the Minister agree that the risk of not reorganising would be the longer waiting lists, longer waits for ambulances and lower access to life-prolonging drugs that we currently see in socialist-dominated Wales under the Assembly?

Mr Burns: My hon. Friend is absolutely right, and of course he speaks from the authority of living in a country that has a Labour Administration, where we see spending cut, waiting times and lists rising, and utter chaos in the quality of care for patients.

Hywel Williams (Arfon) (PC): The Minister will know that large numbers of people from Wales, particularly north Wales, access treatment in England. What assessment has he made of the risks to such treatment if the legislation goes through?

Mr Burns: If the hon. Gentleman is trying to tease out of me what is in the risk register, I am afraid he will be unsuccessful, but if it is of any reassurance I can tell him that for people living close to the border there have been arrangements between Wales and the English NHS and they will continue. Those people will benefit if treated in England, because waiting times are falling in this country, unlike Wales where they are increasing.

Mr Jamie Reed (Copeland) (Lab): What a pleasure it is to see the Secretary of State here today; he managed to make his way in.

I am afraid I have to describe the Minister of State’s answer as codswallop. Let me give him an example of one risk to the NHS that we already know about. The number of NHS nurses has fallen by 3,500 since the general election, and that figure could be at least 6,000 by the end of this Parliament. The Bill is damaging front-line

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services in the NHS right now. Why does the Minister not put patients before his, the Secretary of State’s and the Prime Minister’s pride, drop this unwanted Bill, and use some of the money it would save to protect those 6,000 nursing posts?

Mr Burns: I have to say that, unfortunately, notwithstanding what the hon. Gentleman thought was a rather clever way of describing my answers, his figures are factually incorrect. As Jim Callaghan once said, an inaccuracy can be halfway round the world before truth gets its boots on. The facts are these: there are 896—[ Interruption. ] If the hon. Gentleman would listen to the answer he asked for, he might learn something and stop making misrepresentations. There are 86 more midwives working in the NHS—[Hon. Members: “86?”]—896, which is an increase of 4%. There are 4,175 more doctors working in the NHS: an increase of 4%. There are 15,104 fewer administrators working in the NHS—a decrease of 7.4%—and 5,833 fewer managers. There are more doctors. There are more midwives. There are fewer administrators.

Private Health Care

3. Jessica Morden (Newport East) (Lab): What recent assessment he has made of the future of private health care. [95314]

6. Teresa Pearce (Erith and Thamesmead) (Lab): What assessment he has made of the future of private health care. [95317]

13. Mr Russell Brown (Dumfries and Galloway) (Lab): What assessment he has made of the involvement of the private health care sector in the NHS. [95324]

The Minister of State, Department of Health (Mr Simon Burns): The Department has made no assessment of the future of private health care. This is not the role of the Department of Health. The private sector has always provided services to the NHS and the Department monitors trends where it does so—for example, the number of NHS patients choosing a private provider under patient choice.

Jessica Morden: Given that the Prime Minister said there would be no top-down reorganisation of the NHS, the coalition agreement ruled it out and nobody voted for it, what exactly is the Secretary of State’s mandate for turning the NHS into a “fantastic business”, as the Prime Minister has said?

Mr Burns: I am extremely sorry if the hon. Lady really believes the mantra that she has just spewed out. If she had read pages 45 and 46 of our manifesto, she would have seen that it says that we would introduce clinical commissioning groups, take away political micro-management from Whitehall, free up the NHS and cut bureaucracy, as we are doing, which will save £4.5 billion to reinvest in the health service. Our coalition colleagues, the Liberal Democrats, had in their manifesto the abolition of SHAs. So I have to tell the hon. Lady that she is wrong. The test of what is going on and what is a success is the fact that if one meets GPs around the country, they support commissioning for their patients.

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Teresa Pearce: On the BBC’s “Newsnight”, the Minister of State stated that the Health and Social Care Bill would turn the NHS into a “genuine market”. How does this belief fit in with the NHS founding principle that access should be based on need, not market forces?

Mr Burns: I am sorry—the hon. Lady has obviously not listened properly to me. It has been my guiding principle and my core belief from the day I entered politics that we should have a national health service free at the point of use for all those eligible to use it. In no shape or form does the Bill, or any actions by this Government, compromise that core belief of mine.

Mr Brown: The Minister is aware that funding for the health service in Wales and Scotland is through the Barnett formula. For every pound saved by the Government—in other words, for every pound less spent per person in England—there is a knock-on consequence for the budgets in Wales and Scotland. What assessment has he made of the fact that he will be funding NHS provision from private patient fees, rather than the public purse?

Mr Burns: As the hon. Gentleman knows better than I do, the running of the NHS in Scotland and Wales is a matter for the devolved authorities. I speak for the English NHS, and I can tell him that that we have guaranteed that the budget of the NHS in England will be a protected one for this Parliament in which there will be real-terms increases, albeit more modest than in the past. But we have seen in Wales in particular a fall of just over 8% in funding. That is the decision of a Labour Welsh Government. The moneys that are saved in the health service in England through cutting out bureaucracy and through greater effectiveness in delivering care will be totally reinvested—100%—in the NHS in England.

Sir Paul Beresford (Mole Valley) (Con): I may have an interest—a remote one—in this question. I expect my right hon. Friend would agree that every patient who chooses to have private health care rather than national health service care, for whatever reason, is one less case on the national health cost and care bases. Does my right hon. Friend agree that it may be appropriate for the Treasury to do a cost-benefit analysis so as to consider a tax encouragement for individuals, especially those over 65, to take out private health insurance?

Mr Burns: I do not want to disappoint my hon. Friend, but I am afraid I do not agree with that. What the Government have to concentrate on is giving the maximum amount of resources within the protected budget to the provision of health care in this country, to ensure, enhance and improve the quality of care for patients in England. That is the priority, not providing tax relief in any shape or form for people who use their choice for private health care.

Margot James (Stourbridge) (Con): Professionals working in the NHS told the Health and Social Care Bill Committee that income from private patients was important to the development and improvement of NHS services. What steps will my right hon. Friend take to ensure that that income benefits NHS patients?

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Mr Burns: I am grateful to my hon. Friend for her question, because it might clarify some of the misinformation being bandied around on the Opposition Benches. Any money generated by private patients or by the private sector within the NHS must be spent on NHS patients, so it will benefit NHS patients and the NHS, and that is to be welcomed.

Andrew Bridgen (North West Leicestershire) (Con): Does my right hon. Friend agree that collaboration between the NHS and the independent sector can deliver real benefits for both patients and the taxpayer?

Mr Burns: My hon. Friend is absolutely right, because we need to drive up the quality of care. What we are doing with the Health and Social Care Bill is closing a loophole so that there can be no favouritism towards the private sector, so the travesty introduced under the previous Government, including the right hon. Member for Leigh (Andy Burnham), whereby independent treatment centres had an advantage that put the NHS at a disadvantage in providing care, and were paid more than the NHS, will stop, because it is unacceptable.

Mr Kevin Barron (Rother Valley) (Lab): Part 3 of the Health and Social Care Bill will introduce competition policy to the NHS by law for the first time in its history. Does the Minister think that that is likely to lead to more private care in this country or less?

Mr Burns: I am sorry, but the right hon. Gentleman, who always asks this question, is wrong. We have not introduced competition into the NHS; it was there under the previous Administration.

Andy Burnham (Leigh) (Lab) indicated dissent.

Mr Burns: It is a bit rich for the former Secretary of State to bleat about that. What I want is the finest health care for patients so that they are treated more effectively and quickly and their long-term conditions are managed in a way that enhances the patient experience.

Hospital Management

4. Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con): What steps he is taking to address underperforming hospital management teams. [95315]

The Secretary of State for Health (Mr Andrew Lansley): The performance of hospital management teams is the responsibility of their boards. Those are accountable to strategic health authorities for NHS trusts, and foundation trusts are accountable to their governors to ensure that they comply with Monitor’s framework. As part of our work to strengthen NHS trusts so that they can reach foundation trust status, we have published guidance on strengthening trust boards, their clinical leadership and management. We are further strengthening accountability through quality accounts and open reporting so that the public can see the absolute and relative performance of all NHS service providers.

Dr Poulter: I thank my right hon. Friend for that answer. It is absolutely right that managers take responsibility for the decisions that they take at a local level on behalf of patients and are held accountable for

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them. A doctor or nurse who fails in their duty can be struck off, so there is clear accountability, but there appears to be no clear accountability or traceability for the decisions of hospital managers. Who will hold those people properly to account when they have failed?

Mr Lansley: My hon. Friend knows that the management of trusts should be accountable directly to their boards. As I said, the management of foundation trusts are accountable, through their boards, to their governors. An important point that arose in relation to Mid Staffordshire NHS Foundation Trust is that we should ensure—we are looking at how to fulfil this—that there is also a code of practice to which managers are held accountable. He knows, as I do, that management must be accountable through their boards.

Rosie Cooper (West Lancashire) (Lab): The Secretary of State has part-begun to answer this question, as he recently threatened to sack NHS boards that do not meet their financial and waiting time targets. The question is this: why is he abolishing those powers in the Health and Social Care Bill? Is he really saying that governors of foundation trust hospitals have the power and wherewithal to sack a board?

Mr Lansley: The hon. Lady should know that we intend to enhance the powers of foundation trust governors, but I am simply taking what was her Government’s policy before the election—that all NHS trusts should become foundation trusts, with the freedoms that go with that, and the responsibilities and accountability. We are putting that into place where her Government failed.

NHS Constitution

5. Penny Mordaunt (Portsmouth North) (Con): What recourse patients have when denied facilities to which they are entitled under the NHS constitution. [95316]

The Parliamentary Under-Secretary of State for Health (Anne Milton): The patient may complain either to the local organisation that provides the service or to the primary care trust. If it proves impossible to resolve the complaint locally, the complainant has the right to ask the health service ombudsman to look into their case. They have the right also to make a claim for judicial review if they think that they have been directly affected by an unlawful act or decision of an NHS body.

Penny Mordaunt: In the short time that I have been a Member, I have had to challenge my local trust over its policies on cancer drugs, metabolic surgery, IVF and a raft of other issues in order to get my constituents the treatment that their doctors say they need. When will all NHS patients in Portsmouth and elsewhere be able to have treatment based on clinical need?

Anne Milton: My hon. Friend’s constituents are fortunate to have such a vigilant MP who has taken up their individual cases. Patients have the right to expect local decisions on the funding of drugs and treatments to be made rationally, following proper consideration of the evidence. I suggest that she, like many other Government Members, will not be going out to march to preserve the PCTs, which often make flawed decisions.

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Dame Joan Ruddock (Lewisham, Deptford) (Lab): Has the Minister seen an article today by the respected journalist Polly Toynbee—[ Laughter. ] Respected by the Prime Minister—[Hon. Members: “Stop laughing.”] I am not laughing at all—

Mr Speaker: Order. I want to hear the views of Polly Toynbee, as enunciated by Dame Joan.

Dame Joan Ruddock: On a very serious issue, a waiting list clerk of 17 years has just resigned because she was asked to adopt a range of devious methods to make sure that people coming up to the 18-week target for treatment were taken off lists. Does the Minister understand that patients will not always know whether they have had proper treatment, and that it will be far too late to refer them to an ombudsman at some later date?

Anne Milton: I thank the right hon. Lady for her question. I am devastated to say that I have not seen the article to which she refers, but I am sure that I will. The Department has made it very clear to the NHS that clinical priority is and remains the main determinant of when patients should be treated. When I was in opposition I made various visits to various hospitals and saw them fiddling around at the edges, with admin staff forced to do things that they did not want to do, in order to tick boxes for the previous Government.

Mr Speaker: Right. Can we now speed up a bit? We have a lot to get through, and I should like to accommodate the interests of colleagues, so everybody needs to tighten up.

NHS Allergy Services

7. Jo Swinson (East Dunbartonshire) (LD): What assessment he has made of the effectiveness of NHS allergy services. [95318]

The Minister of State, Department of Health (Paul Burstow): A number of reports have highlighted variations in NHS allergy services and a lack of integration throughout primary, secondary and tertiary care. The Department has funded the NHS in north-west England to pilot an integrated model of care, and the results of that work have been widely disseminated. The Government expect NHS commissioners to commission services to meet the health needs of their local population and to deliver improving outcomes for patients.

Jo Swinson: I thank the Minister for that reply. He mentions the recent north-west allergy pilot, and its report contains a number of recommendations, including improved education for commissioners about the impact of allergy on primary care, and the allocation of additional specialist allergy training posts. How does he intend to act on those recommendations in order to improve services for millions of allergy sufferers?

Paul Burstow: I am grateful to my hon. Friend, who I know campaigns on these issues and has a parliamentary reception on them later this week. She is absolutely right that we need to ensure that there are improvements in the area, and that is why I can confirm today that discussions are under way with clinical leaders on the

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potential development of a tariff to cover allergy services and the steps necessary to make that possible. On training places, I can confirm also that the joint working group, on which the Department, strategic health authorities, NHS Employers, postgraduate medical deans and professional organisations sit, does look at those issues and make recommendations about additional places.

Derek Twigg (Halton) (Lab): What services is the Secretary of State setting up for professionals who have become allergic to his Health and Social Care Bill and to him?

Paul Burstow: That was a pretty limp attempt. One of the most striking things about this Question Time is how many Opposition Members are yet again suffering from another health problem—memory lapses. When it comes to the Labour party’s record in government, £12 billion was wasted on a computer system that did not work, with which 60,000 nurses could have been recruited and employed for a decade.

Patient Outcomes

8. Iain Stewart (Milton Keynes South) (Con): What progress he has made in improving outcomes for NHS patients. [95319]

The Secretary of State for Health (Mr Andrew Lansley): Last December, we published data against 30 indicators in the new NHS outcomes framework, which has been supported enthusiastically by patients, by professionals and internationally. The data show that for 25 of the new measures, the NHS improved or maintained performance, including MRSA infections being down by half and C. difficile infections being down by 40% since 2008-09. I expect continuing improvement over the coming years, as the focus on outcomes drives change and improvement.

Iain Stewart: Campaigns such as “Be Clear on Cancer” are invaluable in ensuring the early detection and treatment of serious conditions. Will the Secretary of State do what he can to ensure that there is proper co-operation between charities and local hospitals about the timing of such campaigns, to ensure that the spike in referrals that follows is dealt with as efficiently as possible?

Mr Lansley: I will indeed ensure that that happens. We work closely with the cancer charities. We are working with them as we roll out the campaign that was piloted in the east of England to encourage the awareness of symptoms and the earlier diagnosis of bowel cancer. I hope that we will ensure that the services, such as endoscopy services, are available to support that.

Mr Ben Bradshaw (Exeter) (Lab): Is the Secretary of State aware of this week’s report from the distinguished health academic at Exeter university, Dr Mike Williams, which states that his NHS upheaval is putting patient safety at risk and making a Mid Staffordshire-style hospital scandal more likely? Given that, will he assure the House that he will publish the findings of the Mid Staffordshire public inquiry in time to inform the final outcome of the Health and Social Care Bill, if it ever gets through this place?

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Mr Lansley: The right hon. Gentleman should know that the timing of the publication of Robert Francis’s public inquiry is a matter for the inquiry, not for me. It is pretty rich for him, who came to this Dispatch Box to disclaim all responsibility for what happened at Stafford hospital, to accuse us of being responsible for something like that. Something like that will not happen because our plans focus on quality for patients, which he failed to do.

Mr Adrian Sanders (Torbay) (LD): The Secretary of State will be aware of the report today that more than 1.3 million diabetes patients have not been offered vital tests. Does that not re-emphasise the need for a plan post-2013, when the national service framework for diabetes comes to an end?

Mr Lansley: Yes, indeed. I share my hon. Friend’s view about the importance of this publication. For the first time, we are publishing the data so that we are absolutely transparent about performance in this and other areas. It is wrong that there are primary care trusts that are failing to meet the nine standards of care that are set out. That is why we published the atlas of variation. By focusing on that variation and through the commissioners’ responsibility to meet the standards, not least in the publication of the quality standards, we will deliver improving standards across the country.

Andrew Gwynne (Denton and Reddish) (Lab): But the Secretary of State must surely be aware that, for seven weeks running since the new year, the NHS has missed its target for 95% of patients to be seen within four hours at A and E. That is precisely what Labour warned would happen when this Government downgraded the waiting times standard. Is it not clear that he has lost control over waiting times while he focuses on the largest top-down reorganisation in the NHS’s history? That is why he is losing public trust on the NHS. He should focus on what matters to people and drop the Health and Social Care Bill.

Mr Lansley: Let me tell the hon. Gentleman that the average time that in-patients waited for treatment at the time of the last election was 8.4—[ Interruption. ] The hon. Gentleman asked a question and I am telling him the answer. The average time was 8.4 weeks. That has gone down to 7.7 weeks. For out-patients, the average waiting time was 4.3 weeks at the time of the election. That has gone down to 3.8 weeks. The number of patients waiting for more than 18 weeks at the time of the election was—

Andy Burnham (Leigh) (Lab): A and E.

Mr Lansley: I made it very clear after the election that, on clinical advice, we would relax the 98% target to 95%. Patients are being seen within four hours in A and E far more consistently in England than in Wales, where there is a Labour Government. Let me remind the hon. Member for Denton and Reddish (Andrew Gwynne) that we have more than halved the number of patients who wait more than a year for treatment since the election.

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Cancer Care

10. Dan Jarvis (Barnsley Central) (Lab): What progress he has made on tackling inequalities in cancer care. [95321]

The Minister of State, Department of Health (Paul Burstow): Through the national cancer equality initiative, we are working in partnership with patients, professionals, academics and the voluntary sector to take forward a range of projects, such as working with Macmillan Cancer Support and Age UK to tackle the under-treatment of older people, our launching of the “Cancer does not discriminate” campaign with black and minority ethnic groups and our funding of work to target lesbian and bisexual women with cervical screening.

Dan Jarvis: I am sure the Secretary of State and the Minister will acknowledge that cancer mortality rates are higher in my constituency than in his. Can he therefore justify to my constituents why Barnsley primary care trust is being forced to spend £17 million not on addressing issues surrounding the inequality of cancer care but on delivering an undemocratic, unwanted and unnecessary top-down reorganisation of our NHS?

Paul Burstow: I say two things to the hon. Gentleman: first, that the reforms will actually release resources from back-office costs and put them back into the front line, which I hope all hon. Members want to happen; and, secondly, that when it comes to our cancer strategy, we committed additional resources in the spending review to invest in cancer services. If he wants to raise specific issues with me, I will be only too happy to address them.

Mr John Baron (Basildon and Billericay) (Con): The Minister will fully understand the importance of early diagnosis in cancer outcomes and tackling cancer inequalities. May I therefore urge the Government to include the one-year outcome measure in the commissioning outcome framework, so that we can measure the performance of clinical commissioning groups?

Paul Burstow: My hon. Friend, who chairs the all-party group on cancer, has been pursuing that issue vigorously. We certainly need to ensure that we use both proxy and other performance indicators on cancer outcomes, and I will want to continue examining whether that indicator is the most appropriate one to tell us what we need to know about improvements in cancer outcomes performance.

Liz Kendall (Leicester West) (Lab): The hon. Member for Basildon and Billericay (Mr Baron) is right that early diagnosis is crucial for treating cancer, and it is often very worrying for people to wait for their test results. Under the current Government, waiting times for diagnostic tests have soared. Will the Minister confirm that the number of patients waiting more than six weeks for their test has more than doubled since May 2010, the number waiting more than 13 weeks has more than trebled and the average wait is up, too, by 28%? It is a simple question, so will he give us a simple answer—yes or no?

Paul Burstow: It was a somewhat longer question than that, so I hope the hon. Lady will let me go a little further than a yes or no. I tell her that at the end of December 2011 only 1.4% of patients were waiting six

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weeks or longer for one of the 15 key diagnostic tests, and that just five NHS trusts are responsible for about 30% of all waits of six weeks or longer. We are working specifically with those five trusts to bear down on those waits and ensure that people do not have to wait so long. Of course she is right to make her point about waits, which is why the Government are focused on the issue and have sent in the additional support needed to ensure that trusts deal with it.

Health and Social Care Bill

11. Andrew George (St Ives) (LD): If he will withdraw the Health and Social Care Bill. [95322]

The Minister of State, Department of Health (Mr Simon Burns): No, Sir.

Andrew George: I respect the Minister, but massive opposition to the Bill is mounting at the same time as its meagre support is ebbing away. Any more rational process would have resulted in the dignified withdrawal of the Bill long ago. Is there anything that would persuade the Secretary of State—frankly, he should be answering this question—to change his mind?

Mr Burns: The straightforward answer is no, because everyone, including the right hon. Member for Leigh (Andy Burnham), accepts that the NHS has to evolve to keep up and meet its challenges. What matters to patients is not who delivers their care but the quality of the care that they receive, their experience of that care and the dignity and respect with which they are treated at all times. Cutting bureaucracy by a third to reinvest £4.5 billion in front-line services between now and 2015 is the way forward. Frankly, if one goes and talks to doctors around the country, one finds that they wish that Labour’s party political squabbling would stop so that they can get on with implementing the modernisation programme.

Ms Diane Abbott (Hackney North and Stoke Newington) (Lab): The Minister talks about party politics. Is he not aware that not a day goes past without an organisation representing doctors and nurses coming out against his Bill? Most recently, the Royal College of Physicians is having to hold an extraordinary general meeting because of pressure from its members. The Royal College of Paediatrics and Child Health is consulting its members. Why should anyone in this House support a Bill to which the men and women who work in the health service are so opposed and which even Tory Cabinet Ministers are briefing against?

Mr Burns: I suspect that the hon. Lady does not get out and about much to meet doctors who are beginning to commission care for their patients. If she did, she would know that the mantra she is repeating from organisations that are not representative of doctors in this country—[ Interruption. ]

Mr Speaker: Order. The Minister of State is such an emollient fellow that I cannot imagine why people are getting so worked up, but they are getting very worked up, and they must calm themselves. We are only on Tuesday; we have got some time to go. Let us hear the Minister.

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Mr Burns: Very briefly, Mr Speaker, I can say to the hon. Lady that a number of the organisations that she mentions are trade unions that do not represent the views of GPs up and down the country who are actually engaged in implementing the modernisation by commissioning care for their patients.

Dementia Care

12. Lorely Burt (Solihull) (LD): What steps he is taking to improve the standard of dementia care in hospitals. [95323]

The Minister of State, Department of Health (Paul Burstow): As many as four out of 10 people in hospital have dementia, and people with dementia stay longer in hospital. We know that there is much room for improvement. That is why we have set a new national goal for hospitals actively to identify people with dementia.

Lorely Burt: According to the Royal College of Psychiatrists’ report on dementia care in hospitals, only one in three staff said that they felt that their training and development in dementia was sufficient. What action is the Minister taking better to equip staff to be able to take care of dementia patients in future?

Paul Burstow: I am grateful to my hon. Friend. Training is certainly one of the issues highlighted by the audit. We are taking a number of steps. We are working with the Royal College of Nursing, which has developed an online dementia information resource; we have been working with Skills for Care and Skills for Health to provide a series of training workshops for staff; we have been working with Oxford Deanery to trial a new approach to dementia education and training for GPs; and we are funding another audit to make sure that we keep track of the improvements that we expect to see across the NHS.

Jim Shannon (Strangford) (DUP): What discussions has the Minister had with universities such as Queen’s university in Belfast with regard to new treatments and medication for those suffering from dementia, and when will those advances filter through to patients?

Paul Burstow: I have not had such conversations with the university to which the hon. Gentleman refers. However, this Government, right from their first Budget, have indicated their commitment to prioritising research into dementia—both the basic research that gives us the targets for detailed research and the translational research. We have put in place all the building blocks that will allow this country not only to maintain its pre-eminence but to accelerate the pace of research.

PFI Schemes

14. Chris Skidmore (Kingswood) (Con): What progress he has made on reducing the costs of PFI schemes in the NHS. [95325]

The Secretary of State for Health (Mr Andrew Lansley): We have made a lot of progress. All PFI schemes are having their contracts reviewed for potential savings following a Treasury-led pilot exercise. We are providing seven of the worst affected PFI schemes with access to a

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£1.5 billion support fund, and we are working with 16 other trusts to address long-term sustainability. As I said, in November last year the Treasury announced plans for a complete reform of the current PFI model, using public-private partnerships, private sector expertise and innovation, but at a value-for-money price for the taxpayer.

Chris Skidmore: I thank the Secretary of State for that answer. The new Southmead hospital in Bristol will cost over £400 million, to be funded by PFI, yet it will take over 30 years, at £37 million per year, to pay that off. That cannot be good value for money for the taxpayer or for the NHS. What more can the Government do to ensure that these contracts can be renegotiated in future?

Mr Lansley: My hon. Friend will be aware of the difficulties involved in the contracts that we inherited; that is true for PFI, as well as for the NHS IT contracts and many others. We have to try to use PFI contracts more cost-effectively; on average, the Treasury exercise demonstrated a 5% saving on their costs. Beyond that, we have to ensure that from now on the NHS delivers a much more value-for-money approach to using private sector expertise, including proper transfer of risk.

Nick Smith (Blaenau Gwent) (Lab): PFI enabled the building of many new hospitals and brought benefits to millions of patients. However, the Public Accounts Committee has found that lengthy procurement timetables led to increased costs. What will the Department do to sharpen its capital funding procurement model to get a good deal for the taxpayer?

Mr Lansley: That is a sensible question, and precisely why we are pursuing, as we said in November last year, a new approach to public-private partnership that does not entail the extreme costs, delays and burdens that past PFI projects have left. We are working with projects—for example, one at Alder Hey in Liverpool—to ensure that they demonstrate enhanced value for money compared with past PFI projects.

Health and Social Care Bill

15. Mr Stephen Hepburn (Jarrow) (Lab): What recent representations he has received from health care professionals on the Health and Social Care Bill. [95326]

The Parliamentary Under-Secretary of State for Health (Anne Milton): The Government have received a wide range of representations throughout the passage of the Health and Social Care Bill, including from health care professionals, the public and voluntary bodies, and the trade unions.

Mr Hepburn: The vast majority of people, whether they work for or use the health service, see the Bill for exactly what it is: a Tory plan to privatise the national health service. When will the Minister listen to people, stop trying to pull the wool over their eyes—it is not working—and scrap this tawdry Bill?

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Anne Milton: The only bit of the hon. Gentleman’s supplementary question that I recognise is a diatribe from the Labour party that perpetuates a myth about the Bill and fails to understand that the Bill is about the public of this country. This is about the people—patients—getting the health care that they need and deserve.

Dr Thérèse Coffey (Suffolk Coastal) (Con): May I pass on the representation of a health care professional in my constituency—one of the general practitioners involved in the commissioning group—who said that he felt the Health and Social Care Bill had been written for GPs, and that it was perfect for improving care in our community?

Anne Milton: My hon. Friend echoes many of the comments that I have heard as I have gone around the country. Without the Bill, we cannot strip out primary care trusts and strategic health authorities, which will save £4.5 billion over this Parliament. I cannot see anybody going out on a march to save PCTs and SHAs. The public want the outcomes and the quality of care that they deserve, which they were denied under the previous Government.

Topical Questions

Mr Speaker: I remind Members on both sides of the House—Back and Front Benchers alike—that topical questions and answers must be brief.

T1. [95337] Nic Dakin (Scunthorpe) (Lab): 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 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 to support and protect vulnerable people.

Nic Dakin: If the argument is that doctors are the best people to commission health and manage finances, why not listen to doctors themselves, who universally reject the Government’s plans? Why not listen to the royal colleges and patients groups and drop the Bill?

Mr Lansley: The hon. Gentleman just does not know what is happening around the country. All over the country doctors taking clinical leadership in foundation trusts and NHS trusts, and GPs and their nursing and medical colleagues taking responsibility in the new clinical commissioning groups, are demonstrating that they can improve the quality of care for the patients they serve. They hear what is said by the hon. Gentleman and some of his colleagues and think they are completely out of touch with the world in which they live.

T5. [95342] Annette Brooke (Mid Dorset and North Poole) (LD): I appreciate that the Government have allocated additional funding for social care, but what more will and can they do in the short term not only to address the current crisis in funding and ensure that funding is used creatively and efficiently locally, but to cater for those with lower-level needs through preventive measures and early intervention?

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The Minister of State, Department of Health (Paul Burstow): My hon. Friend is right about the need to invest in early intervention and prevention. In addition to the £7.2 billion that we will invest this Parliament, this January we announced an extra £120 million for the remainder of the year to support care services. Furthermore, we are funding, jointly with the Local Government Association, work to support councils in delivering improved productivity and sharing best practice to ensure that they deliver improvements to services, and not just cuts.

Andy Burnham (Leigh) (Lab): The Secretary of State said that he would listen to doctors and nurses but yesterday shut the door of No. 10 Downing street in their faces. But now things take a sinister turn. Let me quote from a letter from an NHS director received last week by a respected clinician of many years’ standing:

“I understand that you are a signatory to a letter which highlights your personal concerns about the Health Bill. It is inappropriate for individuals to raise their personal concerns about the proposed Government reforms. You are therefore required to attend a meeting with the Chief Executive to explain and account for the actions you have recently taken.”

Will he confirm that it is now his policy to threaten NHS staff with disciplinary action if they speak out against his reorganisation?

Mr Lansley: No, it is not my policy. I do not know the letter to which the right hon. Gentleman refers, and if he had shown it to me beforehand I could have investigated it. Yesterday, I and the Prime Minister met doctors and medical professionals and they discussed precisely how to improve services for patients. I went to Queen’s hospital in Romford and met nurses, midwives and doctors working to make the trust one in which their public can have confidence and, in due course, a foundation trust. All these things—foundation trusts, clinical commissioning, patient choice—used to be things that he believed in. They are now things that we are achieving but which he has rejected.

Andy Burnham: It is, it would seem, the Secretary of State’s new top-down bullying policy, and it is happening right across the NHS. How does he reconcile that with what he used to say about whistleblowing? I remind him of what he once said:

“The first lines of defence against bad practice are the doctors and nurses”,


“have a responsibility to their patients to raise concerns if they see risks to patient safety. And when they do, they should be reassured that the Government stands full square behind them.”

Full square behind them so that he can plunge the knife straight into their backs! The truth about his mismanagement of the NHS is coming out: staff bullied into silence, professionals frozen out, crucial information in the risk register—

Mr Speaker: Order. We get the gist.

Mr Lansley: When the right hon. Gentleman has no argument, he resorts to abuse.

T6. [95343] Ben Gummer (Ipswich) (Con): Dentists in Ipswich are increasingly concerned about having to put right work done by dentists from outside the UK who have received temporary registration from the General Dental Council, causing yet more cost to the NHS and

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trouble for those receiving care. How will Ministers measure the quality of those receiving temporary registration?

Paul Burstow: The hon. Gentleman raises an important issue that we are discussing with the GDC. The council’s work on revalidation will ensure that the work of those supervising foreign dentists and, where appropriate, foreign dentists themselves is properly covered.

T2. [95338] Mrs Mary Glindon (North Tyneside) (Lab): Given that managed clinical networks for neuromuscular conditions can help to reduce the number of unplanned hospital admissions for patients with life-shortening illnesses and save the NHS money, will the Secretary of State commit to establishing such networks with funding from the NHS Commissioning Board?

Mr Lansley: As we have set out clearly, we want to promote clinical networks more widely, not just in relation to cancer and stroke, as has been the case in the past. I shall write to the hon. Lady about whether it would be appropriate for neuromuscular conditions and whether it is embraced in any plans that the NHS Commissioning Board and commissioning groups have in place already.

T7. [95344] Mr Philip Hollobone (Kettering) (Con): Northamptonshire residents are rightly concerned that in the county in the last four months of 2011 the East Midlands ambulance service reached fewer than 69% of category A calls within eight minutes. The target is 75%. What hope can my right hon. Friend offer to local residents that this poor performance will rapidly improve?

The Minister of State, Department of Health (Mr Simon Burns): I hope that I can give some reassurance to my hon. Friend by telling him that East Midlands ambulance service is working with commissioners, hospital trusts, community health services and social care services in taking measures to address its response time performance. NHS Milton Keynes and NHS Northamptonshire have received £1.7 million in additional funding, and NHS Midlands and East advices me that some of that has been used to fund further measures to help improve EMAS response times, including through the provision of additional ambulance crews and the deployment of hospital-ambulance liaison officers in each accident and emergency department to improve handover and turnaround times.

T3. [95340] Mrs Madeleine Moon (Bridgend) (Lab): The Secretary of State says he acts on advice. May I advise him to read the horrendous report from Mencap that details the death of 74 people with learning disabilities due to a lack of basic care and a lack of understanding of the health care needs of people with learning disabilities? Will he follow the advice of Mencap and ensure that the undergraduate and postgraduate training of doctors and nurses includes intensive training in the needs of people with learning disabilities, so that there will be no further unnecessary deaths of people with learning disabilities due to neglect in NHS hospitals?

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Mr Lansley: I am grateful for the hon. Lady’s question, and I am glad to say that I had a useful meeting with Mark Goldring of Mencap. I have read his report and, in response to what the hon. Lady has said, I would be glad to write to her and put a copy in the Library.

T8. [95345] Karl McCartney (Lincoln) (Con): Is my right hon. Friend as concerned as I am that the employment tribunal of the former United Lincolnshire Hospitals Trust chief executive Gary Walker ended in secrecy? Does he agree that the NHS should stop using public money to impose gagging orders to suppress information that is not only in the public interest, but that impacts on patient safety?

Mr Lansley: My hon. Friend will know that it is the policy of the NHS not to use compensation agreements in order to suppress information that is in the public interest, and I will certainly write to him about the case that he raises.

T4. [95341] Kerry McCarthy (Bristol East) (Lab): Before the election, the Conservative party and the then shadow Health Secretary received substantial donations from the chairman of the private health company Care UK and his wife. Does he agree with the then Liberal Democrat health spokesman, the hon. Member for North Norfolk (Norman Lamb)—who has now been promoted to Minister—when he said:

“This is a staggering conflict of interest which completely undermines the Tories’ claim that the NHS would be safe in their hands”?

Mr Lansley: If not abuse, then smear. I never received any money personally from the chief executive of Care UK. The Conservative party solicited and received donations that were declared in the normal way. They had no influence, and we would never permit any such influence over our party’s policies.

T9. [95346] Simon Wright (Norwich South) (LD): I recently met Norwich and District Carers Forum to hear about the work that it is undertaking, together with GP surgeries in Norfolk, to help identify carers in the county. What recent steps have Ministers taken to help identify and support carers in Norwich and elsewhere?

Paul Burstow: I am grateful for my hon. Friend’s question, and I know that a lot of work is being done across the county of Norfolk between the NHS and social care. Nationally, the Government are working with the Royal College of General Practitioners, Carers UK, the Princess Royal Trust for Carers and Crossroads Care to recruit GP carers champions and volunteer carers ambassadors, and make them aware of the need not just to identify carers, but to ensure that they take the necessary action to assess and provide appropriate support, so that carers get a break from their caring responsibilities and have the opportunity both to stay in work, if that is what they want to do, and to have a life, not just a caring responsibility.

Mr David Winnick (Walsall North) (Lab): If I was concerned only with the politics of the situation, I would be urging the Secretary of State to carry on with the Health and Social Care Bill, in view of the political

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fallout. However, does he realise that the strength of opposition throughout country—certainly among the medical profession, as well as the public—is based on the fact that they believe that the national health service will be seriously undermined if the measure goes through? Why is he not willing to listen to the voices of people who are so concerned that the institution—which we all believe is so necessary—will be threatened and damaged as a result of his measure?

Mr Lansley: The hon. Gentleman should go back to last year and recall that not only did we consult on the White Paper, but—following the listening exercise last year with dozens of independent health professionals, who conducted hundreds of meetings with thousands of professionals across the service, who made a substantial series of recommendations, and with the Future Forum clear that the principles of the Bill were supported, just as many organisations continue to say that they support them—we took on board and accepted those recommendations. That is why the Bill, which is in another place, was supported by a majority in this House and was supported by a majority there.

Steve Brine (Winchester) (Con): There has been much talk today about improving outcomes of patient care—when we move beyond the politics—so will the Secretary of State commend the excellent hyper-acute stroke service that he saw with me in Winchester just a few weeks ago? As he knows, the service rightly enjoys the support of the emerging care commissioning group. Indeed, he also met those in the group and saw how positive they are about the changes.

Mr Lansley: Yes, and I am grateful to my hon. Friend for the invitation that he extended to me to visit Winchester, which is now forming part of the Hampshire Hospitals NHS Foundation Trust and looking to do so very successfully. I share with him the optimism derived from a meeting with the members of the West Hampshire clinical commissioning group. They, like others across the country, are demonstrating how they will use the responsibilities that they will be given to improve care for patients.

Mr Dennis Skinner (Bolsover) (Lab): As the House will know, I have been a regular customer of the NHS over the last 12 years, and it hurts me to think of what is happening, after all the wonderful treatment that I had for cancer, as well as a bypass and a hip replacement. I am still here to tell the story because of the treatment by those nurses and doctors. Please stop this savage attack on the NHS, and drop this dreadful Bill.

Mr Lansley: The hon. Gentleman clearly has no idea of what is actually in the Bill or the modernisation process. It is only about simple things. It is about giving patients information and choice. It is about empowering doctors and nurses and health professionals, and it is about strengthening the ability of the NHS to improve care in the future. That is all that it is about, and it cuts the cost of bureaucracy in so doing. It will enable us and the NHS to do the things that his Government supported in the past—he might not have supported them, but his friends did—including commissioning by clinicians, patient choice and using the best qualified

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provider. Those are the things that his Government used to believe in, and they are the things that we are doing. There is no privatisation, no charging and no break-up of the NHS. There is only supporting the NHS.

Nicky Morgan (Loughborough) (Con): Ministers will be aware of the Centre for Mental Health’s report last week, which showed that physical health outcomes are linked to mental health outcomes, and that both need to be treated at the same time. Can the Minister update the House on the Department’s progress on implementing its mental health strategy?

Paul Burstow: I can indeed. We will shortly be publishing a more detailed implementation plan showing the role that the NHS Commissioning Board, the clinical commissioning groups and others will play, alongside the voluntary sector, in delivering the strategy. More importantly, we are also doing work on long-term conditions that will begin, for the first time, to join up the way in which we commission physical and mental health services. We have to do that in order to deliver better outcomes for people.

Simon Danczuk (Rochdale) (Lab): Every week in my surgery, I hear more and more residents complaining about having to wait too long for an operation, if they can get on to the waiting list at all. This top-down reorganisation is clearly exacerbating the problem. Why do not the Government just drop the Bill?

Mr Lansley: The hon. Gentleman is going to have to explain why the NHS’s performance is improving, and why it is better than it was at the election. We have cut mixed-sex accommodation, more people have access to NHS dentistry and hospital infections are at a record low. He talks about waiting times. The number of people waiting over a year for treatment has halved since the last election. The total number of people waiting beyond 18 weeks is lower than it was at the election, and the average wait for patients is lower than it was at the election. I am afraid that the premise of his question is completely wrong.

Ian Swales (Redcar) (LD): Following the closure of a specialist ME clinic in Bolton, will the Minister review the narrow NICE guidelines on the treatment of ME, so that patients can get the outcomes that work for them, and so that the doctors providing such treatment are not placed at risk of losing their licence?

Mr Lansley: My recollection is that NICE itself is undertaking a review of the guidelines relating to the commissioning and provision of services for ME. I will check to ensure that that is the case, and if I am wrong I will of course correct the record. I will write to the hon. Gentleman in any case. It is not for Ministers to write NICE guidelines; that is a matter for NICE to deal with independently.

Several hon. Members rose

Mr Speaker: Order. I am sorry to disappoint colleagues but, as usual, Health questions have been heavily oversubscribed. The House is in high spirits, and it is only Tuesday afternoon.

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Points of Order

3.34 pm

Sir Gerald Kaufman (Manchester, Gorton) (Lab): On a point of order, Mr Speaker. I wish to raise with you an issue that goes to heart of the rights of hon. Members—whether they have been elected here 11 times and are in their 42nd year as an MP or whether they came to this House for the first time at the last election. The greatest right of hon. Members is freedom of speech within the rules of order. On that basis, I went to the Table Office before questions yesterday to table an early-day motion relating to the maltreatment and mistreatment of one of my constituents. I discussed it with the Clerk to whom I handed the motion, and he told me that it would be printed today unless I heard from him meanwhile.

Not having heard from that Clerk meanwhile, I assumed that the early-day motion would be printed, but when I looked at the list, I found it was not there. With some difficulty, I then made further contact with the Table Office, a representative of which told me that the early-day motion was still being examined to see whether it was in order. The Table Office had seven and a half hours yesterday and six hours today to look into it. It discussed with me the basic question that it said needed answering—whether the early-day motion contained any sub judice elements. It did not. I have found it impossible to get an answer, 25 hours after I tabled the motion, as to whether it will be printed so that I can air my constituent’s grievance and raise it again.

I have to say that I regard it as discourteous and incompetent of the Table Office to have left the situation in this way on a matter that is crucial for any Members of Parliament, whose servants the Table Office staff are—they are not in charge of us; they serve us. That being the case, Mr Speaker, I ask you first to instruct the Table Office to print my motion and, secondly, to investigate why some people working in that Table Office believe that they have the right to dictate to Members of Parliament in carrying out their duties.

Mr Speaker: I am sorry to learn of the right hon. Gentleman’s disappointment and of the sequence of events that he has relayed to the House. I hope it will be helpful to him if, on the basis of what I have been advised thus far, I respond.

I say to the right hon. Gentleman and the House that I have a duty to uphold the sub judice rule. I note what he said about that, but I have something to say. That rule applies equally to written as it does to oral proceedings, and I expect the Table Office to support me in upholding the rule by taking precautions to ensure that there is no inadvertent breach of the rule. It can sometimes take a little time to check whether there are active proceedings in a particular case. I will take steps to assure myself that the right hon. Gentleman’s motion has been treated no differently from how one presented by any other Member would be treated in similar circumstances. However, I stress the importance I attach to taking all reasonable steps to ensure that the sub judice resolution of the House is abided by at all times.

I have been informed by the Table Office that the Ministry of Justice has confirmed that there are no active proceedings and that the right hon. Gentleman’s early-day motion has been tabled. I hope he will understand

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that I am responding on the basis of what I have been advised. I just want to say one other thing to the right hon. Gentleman, which is that I hope that nobody who works in this House and serves its Members would ever suppose it is his or her role to dictate, to rule or in any sense to trump Members. Everybody is here to serve Members, which should be a matter of pride. I am genuinely saddened if the right hon. Gentleman feels let down. I am happy to look into the matter further. I do not want him to be unhappy, and I hope he will take it in the right spirit if I gently add for his benefit and that of the House that I am relieved at least that at the point at which he discovered against his expectations that his motion had not been tabled, I was not myself anywhere near him.

Sir Gerald Kaufman: Further to my point of order, Mr Speaker. I should point out that my courtesy towards you is maximal in comparison with any that I show to anyone else in the country apart from Her Majesty the Queen.

That having been said, anyone reading the 120 words of my motion would have had to be hyper-critical to imagine that it related in any way whatsoever to court proceedings or to the sub judice rule, and that being so, I hope that in future the Table Office will not take to itself rights over what Members of Parliament themselves have the right to say beyond what you yourself, Mr Speaker, would accept.

Mr Speaker: The role of the Table Office is to assist the Speaker in upholding the rules of the House. I hope that that is widely understood.

The right hon. Gentleman will understand that I cannot debate this matter further now, and that it would not be right to do so, but he has made his point very clear. I have heard it, representatives of the office in question have heard it, and I hope that that will suffice for now. I will keep the matter under close review, and I am sure that the spirit of what the right hon. Gentleman has said will be respected.

Mr David Winnick (Walsall North) (Lab): On a related point of order, Mr Speaker.

Mr Speaker: I will take a point of order from a Member who first arrived in the House four years before the right hon. Member for Manchester, Gorton (Sir Gerald Kaufman).

Mr Winnick: You have made a point that I was not going to make, Mr Speaker, except perhaps in passing.

I have the highest respect for my right hon. Friend the Member for Manchester, Gorton (Sir Gerald Kaufman). His point of order illustrated that, having been in the House for nearly 42 years, he is still always willing to act on behalf of his constituents, which is highly commendable. I do not think that a single Member in the House would disagree with that.

However, given that my right hon. Friend was highly critical of the Table Office, I wish to put on record that during my years in this place, I have always found those at the Table Office co-operative and courteous. I have never found them rude at any stage. Had I done so, I should have reported the matter to the Clerk of the House or to the Speaker, as the case might be. I look on

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the Clerks of the House, as on the other Officers, as dedicated servants of the House of Commons who serve the House of Commons, and I think that that should be put on record.

Mr Speaker: I appreciate what the hon. Gentleman has said, and I think that the Clerks who serve the House will appreciate it too. Perhaps we can leave it there for today.

Dr Julian Lewis (New Forest East) (Con) rose—

Mr Speaker: I am sure that the hon. Gentleman wishes to raise an entirely separate and unrelated point of order.

Dr Lewis: On an entirely separate and unrelated point of order, Mr Speaker. No doubt you will recall the excellent work done by the Leader of the House—whom I am pleased to see sitting on the Front Bench at this moment—in relation to the question of the demonstrations in Parliament square. I believe that we have freedom of speech in the House, but that does not mean that we have the freedom to shout and bawl our opinions incessantly whether people wish to hear them or not. I understand, however, that an application has been made to Westminster city council to reinstate permission for amplified noise to be used to broadcast, for hours on end, abusive and hostile political messages at this House, in the way that was done—causing maximum disturbance—by the late Brian Haw, notwithstanding his lawyers’ assurances to Westminster city council when they applied for a licence that he would not use it to harass people going about their normal work in the Chamber.

May I ask, Mr Speaker, whether you have had any indication of a statement from the Leader of the House on whether he is willing to make representations to the city council that no requirement of freedom of speech enables people to have the right to broadcast at top volume, when no demonstration is taking place, political

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messages which are intended to disturb people going about their lawful occasions, not least the armed security guards who have to be on constant readiness in front of the Houses of Parliament?

Mr Speaker: I am grateful to the hon. Gentleman for his point of order. Certainly no concept of free speech should mean that some people have a right to shout at the tops of their voices through an amplifier at other people irrespective of those other people’s wishes. The point that the hon. Gentleman has made seems to me to be entirely reasonable; but the Leader of the House is stirring in his seat, and I feel certain that the House will want to hear what he has to say.

The Leader of the House of Commons (Sir George Young): Further to that point of order, Mr Speaker. I share my hon. Friend’s concern, and I am planning to respond to the application to Westminster city council in terms of which I think he would approve.

Hon. Members: Hear, hear.

Mr Speaker: It sounds as if the Leader of the House may not be the only one, but we are grateful to him for what he has said.

Bill presented

European Convention on Human Rights (Temporary Withdrawal) Bill

Presentation and First Reading (Standing Order No. 57)

Mr Peter Bone, supported by Mr Andrew Turner, Mr Nigel Dodds, Mr William Cash, Mr Philip Hollobone, Mr David Nuttall, Philip Davies and Mr Douglas Carswell, presented a Bill to make provision for the temporary withdrawal of the United Kingdom from the European Convention on Human Rights.

Bill read for the First time; to be read a Second time on Friday 27 April, and to be printed (Bill 308).

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Road Safety (No. 3)

Motion for leave to bring in a Bill (Standing Order No. 23)

3.45 pm

Mr John Leech (Manchester, Withington) (LD): I beg to move,

That leave be given to bring in a Bill to require drivers to undertake an eye test when renewing a driving licence; to make provision to reduce the permitted blood alcohol level for drivers from 80 mg per 100 ml of blood to 50 mg; to make the turning back of a vehicle milometer, except in specified circumstances, a criminal offence; to promote safe walking, cycling and use of public transport by children to and from school; and for connected purposes.

My Bill, which is appropriately but rather unimaginatively named the Road Safety (No. 3) Bill, has an overarching aim of improving safety on our roads for the benefit of all, through a reduction in the number of people drink-driving; through a reduction in the number of people driving with poor eyesight; by improving the roadworthiness of vehicles; and through the promotion of measures to encourage and prioritise walking, cycling and the use of public transport. In the short time that I have, I will briefly outline the plans for the Bill, and why it would be important in helping to improve road safety.

The North review of the drink-drive limit recommended a reduction in the limit from 80 mg to 50 mg, which would bring us into line with most of Europe. This was rejected by the Government, with the argument that we needed to concentrate our resources on tackling those drink-drivers over the 80 mg limit before focusing our attention on those who drink more than 50 mg but below the 80 mg level. The argument was that the Government were winning the battle, but there was still work to be done.

Unfortunately we are not winning the battle, which is why the Government need to look again at this issue. Recently published figures from the Christmas period show that despite the number of people being tested going down, the number of people over the drink-drive limit went up. In 2010, according to Department for Transport figures, 250 people were killed and 1,230 seriously injured by drink-drivers. Statistically, drivers with a blood alcohol level between 20 mg and 50 mg have a three times greater risk of dying in a vehicle crash, and are at least six times as likely to do so when their blood alcohol level is between 50 mg and 80 mg. When the drink-drive limit was reduced in Australia, there was a significant decrease in fatal accidents, including a massive 18% drop in Queensland. Assuming that a change in the UK would have similar results, we would see a reduction of 144 road deaths and 2,929 serious injuries. If we use the data from Europe, the evidence suggests that deaths could be reduced by a minimum of 77 a year to a maximum of 168, and injuries could be reduced by between 3,611 and 15,832 in England and Wales.

One of the major problems with the current alcohol limit is that people do not really know what the current limit is. According to confused.com in 2011, 51% of people admitted that they did not know what the legal alcohol limit was for driving. Even more worrying is that of the people who think they do know the limit, most do not actually know what amount of a particular drink will bring them to that limit. People are regularly found to be over the limit who genuinely believed that

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they were below it. By reducing the limit we would send a strong message to those people that they cannot even risk one drink without potentially breaking the law and losing their licence for a minimum of 12 months. Of course this is not going stop the serial offenders who will exceed the limit regardless—only enforcement will deal with those people who show no regard for their own or anyone else’s safety on the roads—but it would send the message that even a small amount of alcohol is simply not acceptable, and it would encourage far more drivers not to drink at all when they are driving.

It is frightening to hear that 10% of all drivers would fail their driving test if they retook, it simply because of poor eyesight. More than 50% of the population wear glasses, and the figure rises dramatically to more than 80% among the over-45s. According to the International Glaucoma Association in 2009, a person can lose 40% of their vision before they realise that they have a problem. According to the RAC, one in three Britons has such poor eyesight that they are unable to see properly when driving, and 20% have had an accident as a result of poor vision.

Evidence from the road safety charity Brake showed that 75% of drivers support compulsory eye tests for drivers every five years. My Bill would introduce a compulsory eye test on renewal of the 10-year photo licence, with a commitment to review its effectiveness. Evidence from medical checks in Spain and Holland shows that one driver in 10 aged 50, and one in six aged 70, drives with their eyesight not properly corrected.

We have all heard tragic individual stories. In 2010, two stories were prominent in the media. In one, an almost blind 78-year-old driver killed a pedestrian and in the other a driver of a heavy goods vehicle was charged with driving with poor eyesight after he killed a cyclist in London. A change in the law would help to reduce the instances of driving with poor eyesight and make drivers more sensitive to how serious a problem poor eyesight can be. Compulsory eye-testing has the support of a number of road safety organisations, and I am pleased to say that the cycling charity CTC strongly the supports this measure. It has said:

“the current legal framework around eye sight testing for drivers is utterly inadequate; ensuring a proper eyesight test at each licence renewal would certainly improve matters.”

Some people might argue that the third element of the Bill is less about road safety and more about tackling fraud, but I would argue that it is about both. It is estimated that car clocking costs British consumers a whopping £580 million each year. The actual scale of the problem is difficult to judge because many cars have their mileage reduced shortly before the first MOT at three years and therefore do not show up in Government figures, thus masking the true cost. According to the BBC, more than 681,000 cars recorded a lower mileage last year than they did in the previous year’s MOT, in 2010, and HPI estimates that one in eight vehicles that it checks has a mileage discrepancy. My Bill will make it a criminal offence to reduce the mileage on the clock and help to bring to an end the deliberate practice of making a car appear to be worth more than it actually is.

According to the insurance company General Accident, only 9% of people are confident that car clocking is not a problem and 92% of people thought it should be treated more seriously by the law. Not only would my Bill do that, but it would have a positive impact on road

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safety, because owners of vehicles would have confidence that the mileage on their vehicle was correct and that routine maintenance had been carried out at the appropriate mileage for the type of vehicle.

Lastly, but by no means least, my Bill seeks to make roads safer for pedestrians and cyclists, putting a particular emphasis on children travelling to school. I have unashamedly incorporated elements of the Sustrans “Free Range Kids” campaign and The Times “Cities fit for cycling” campaign. My Bill seeks to give extra priority to measures that promote walking and cycling, particularly encouraging children to get on their bikes. Nearly half of all kids want to cycle to school, but only 2% do so. The Bill would set a target of 2% of the Highways Agency budget being set aside for cycle infrastructure, putting cycle safety at the heart of the driving test and introducing additional safety measures to trucks and lorries.

In the previous Parliament, I introduced a ten-minute rule Bill to reduce the default speed limit on local roads to 20 mph, but unfortunately it did not become law. Although this Bill does not go that far, it would introduce a 20 mph limit on residential streets with no cycle lanes and around all schools. It would also introduce a duty in respect of all new residential streets to incorporate cycle lanes and 20 mph limits in the design of the new road.

Road accidents are the single biggest cause of accidental death among five to 14-year-olds, and traffic causes 50% of all accidental deaths of young people. About 5,000 children under the age of 16 are killed or injured on our streets every year, with about 20% of those accidents occurring on the way to and from school. People have only a 50% chance of surviving being hit at 35 mph, but that increases to 97% when speed is reduced to 20 mph. Despite claims to the contrary by the self-proclaimed road safety organisation the Association of British Drivers which, in my opinion, does not appear to have any interest in road safety, 71% of adults support 20 mph speed limits in residential areas and only 15% of people are against them.

It is time to put walking and cycling at the heart of our policy making. By putting walking and cycling first, by making our cars safer and by ensuring that all drivers are fit to drive, we can make our streets safer and a more welcoming environment to encourage people back on their feet and back on their bikes.

Question put and agreed to.


That Mr John Leech, Dr Julian Huppert, Caroline Lucas, Sir Bob Russell, Tessa Munt, Andrew George and Julie Hilling present the Bill.

Mr John Leech accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 27 April, and to be printed (Bill 307).

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Welfare Reform Bill

Consideration of Lords message

Mr Speaker: I must draw the attention of the House to the fact that financial privilege is involved in all the Lords amendments. If the House agrees to the amendments, I shall ensure that the appropriate entry is made in the Journal.

Clause 11

Housing costs

3.57 pm

The Minister of State, Department for Work and Pensions (Chris Grayling): I beg to move, That this House disagrees with Lords amendment 3B, and Lords amendment 26B.

Mr Speaker: With this it will be convenient to discuss the following:

That this House does not insist on its amendment 19A, and agrees with Lords amendments 17B to 17D and 19B.

That this House agrees with Lords amendment 73BA.

Chris Grayling: If I may, I shall deal first with amendments 17B to 17D and 19B, on employment and support allowance time-limiting, and amendment 73BA, on child maintenance. The Government wish to accept these amendments.

Amendments 17B to 17D and 19B do not change the Government’s existing policy on the time-limiting of contributory ESA. The limit will remain at 365 days for those in the work-related activity group and will take effect from April 2012. I believe that the limit strikes an appropriate balance between the needs of sick and disabled people and the interests of taxpayers who contribute towards the cost. It will make a significant contribution to reducing the fiscal deficit, which I remind hon. Members once again is the most pressing priority facing the coalition Government. We estimate that the one-year time limit will reduce expenditure by £1 billion a year by 2014-15.

We have listened carefully over the course of the debate, however. The amendments would allow a future Government, if they could identify an appropriate funding source, to increase the length of the time limit by order rather than further primary legislation. We have considered that and decided that it is a sensible and appropriate use of an order-making power and we are happy to accept the amendments.

Amendment 73BA clarifies some of the powers introduced by the previous Government under the Child Maintenance and Other Payments Act 2008 and gives examples of the provisions that may be made under regulations. I should stress again that it does not imply any change to our proposed policies on charging. Specifically, I highlight the fact that we maintain our commitment to a maximum application charge of £20 and to collection charges within the ranges set out in the January 2011 Green Paper.

On Report in the Lords, we committed to undertake a review of the charging policy 30 months after the implementation of the powers, to understand their effect and impact. The amendment clarifies that if changes to

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our approach are required following that review, we will have the ability to make them. Although our core proposals on charging remain the same, the amendment ensures that in future—particularly following our review—we will be able to change the charging regime, with specific reference to apportionment and waivers, if we deem such changes to be necessary.

I shall deal now with housing, where I am afraid we do not agree with Lords amendments 3B and 26B. As you indicated, Mr Speaker, the amendments infringe the financial privileges of this House, and if they are rejected that will be the reason given to the House of Lords.

Let me first ensure that the House is clear about the financial implications of the amendments. We know about the big financial challenges we face. Since we last debated the Bill, Moody’s has placed the UK’s triple A credit rating on negative outlook and made it clear that the Government’s strategy is necessary to retain the credibility of our nation in the international financial arena. That is not a context in which we can relax public spending. We made it perfectly clear on 1 February, when we last considered Lords amendments, that the earlier amendments, which could cost around £300 million a year, were unaffordable. The Government’s response to amendments costing £100 million, as these new amendments would, is no different.

4 pm

Mr Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab): When the Minister considers financial implications, does he bear in mind the fact that the Government’s own calculations indicate that 66% of disabled people will bear the burden of an average loss of £13 a week? Is it any wonder that organisations such as Mencap are appalled that it takes the House of Lords to point out to us the unfairness of such proposed legislation?

Chris Grayling: The right hon. Gentleman needs to remember what the amendments are about. Large numbers of people in our community are under-housed and others are in temporary accommodation. We have formed the view that it is neither good value for the taxpayer nor right for those people that we pay for those in social housing to have spare rooms. That is the purpose of our amendments.

Sheila Gilmore (Edinburgh East) (Lab): If the Minister is successful and people move from homes that they under-occupy and other people move in, and assuming that the same proportion of people are on housing benefit, there will be no financial saving. Which is his real argument?

Chris Grayling: The hon. Lady simply has not thought things through properly. At the moment, we are paying expensive temporary accommodation costs, partly because the previous Government—her own party—had such a lamentable record in office in building social housing. When Opposition Members make those claims, they should remember how poorly they performed in that regard.

Ann Coffey (Stockport) (Lab): I seek clarification from the Minister. The new under-occupancy rule will only apply to working-age housing benefit claimants.

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To be of working age, claimants have to be under the qualifying age for pension credit, which will be 61 and a half in April 2013. Will the Minister clarify whether, on the introduction of the change to occupancy in 2013, a couple claiming housing benefit are protected from the change if one of them has reached pension credit qualifying age, or will both need to do so?

Chris Grayling: The approach we are taking across all our reforms is that if somebody in a household is of working age, we expect them to work. All our efforts and the support we are putting in place are designed to ensure that people work and that households benefit from an income from employment rather than otherwise.

As I said, the amendments would cost £100 million. They are not modest amendments, as suggested in the other place. In fact, Lord Best, who proposed them, believed that they might cost even more—£150 million a year. Either way, it would significantly reduce the estimated annual savings of £500 million. We simply do not have a blank cheque that will cover the costs of the amendments.

To give their lordships credit, there was at least some acknowledgement in the other place that £100 million is “serious money.” I am glad we can agree on that point; the amendments are certainly not modest. It is incumbent on us to do what we can to drive down the spiralling cost of housing benefit. Left unchecked, expenditure on housing benefit would reach £26 billion by 2014-15. The shadow Secretary of State is always complaining about the cost of housing benefit, yet he and his party have been consistently hostile to measures that bring the cost under control.

Mr Edward Timpson (Crewe and Nantwich) (Con): Will my right hon. Friend confirm that foster carers will not be included in the new under-occupation rules because of the specific discretionary housing payment that will be made available to local authorities to compensate foster carers to ensure that they do not end up unable to continue their great work in our community?

Chris Grayling: I give my hon. Friend that assurance and pay tribute to him. I know that he has a deep knowledge of the sector. It is very important, but the approach that we have sought to take is that there should not be a one-size-fits-all solution. Where we can, we should localise and give discretion. There may be circumstances in which somebody is still a foster carer and has a property that is much too large even for those needs, but we want to make sure that we provide proper protection for those who carry out such a vital role in our society. We are making substantial amounts of money available to local authorities so that they have the discretion to protect the people who are performing that important role.

Charlie Elphicke (Dover) (Con): One concern that I have in my constituency is that many people live in overcrowded accommodation and have been waiting to get accommodation with the space that they need. Across the country there are 250,000 people in that position. Meanwhile there are empty-nesters rattling round in houses with spare rooms. Surely we should have an incentive for people with excess housing space to move out and enable overcrowded families to have the space that they need.

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Mr Speaker: Order. Before the Minister of State responds, may I remind the House that we have only an hour for Lords amendments? After the Minister, there is another Front-Bench speech. There are Back Benchers who wish to speak, so I exhort colleagues who are intervening to remember that they should do so briefly.

Chris Grayling: Indeed, Mr Speaker, and I shall try to be as rapid as I can for that reason.

It would be all too easy to bow to pressure to backtrack on these reforms, but we will not do that for precisely the reasons set out by my hon. Friend the Member for Dover (Charlie Elphicke). There is a real problem of people in temporary accommodation, and we also have about a million spare rooms being funded by housing benefit. We must sort out the situation and solve the problem to which he rightly refers. These reforms are designed to do that.

Simon Hughes (Bermondsey and Old Southwark) (LD): I am grateful to Ministers for their engagement on this difficult but important issue. With reference to families who cannot find suitable alternative smaller accommodation but are in the categories that the Government have wisely exempted from the benefit cap, will the Minister explain to me why they should be penalised and where they will find the money to meet the extra bill—potentially £750 a year?

Chris Grayling: I know my right hon. Friend has expressed concerns about the policy. Let me say to him that we will carry out detailed reviews of it, as I know he wishes us to do. We will look at the impact of the policy. We have a year to work with the families involved, and we are providing substantial sums. An additional £30 million was announced as part of the debate on these measures, as well as the substantial amounts available for discretionary housing payments. It is our expectation that in most cases what we will see over the next 12 months is a change of circumstances that addresses many of his concerns, but there will be discretionary funds available to local authorities so that in his constituency and others they can deal with the kind of situation that he has described.

Simon Hughes: If the Bill goes through, but before regulations are laid, will the Minister work with colleagues and local government to make sure that the people affected have certainty? The problem with discretionary payments is the uncertainty, and people who cannot work have enough uncertainty already.

Chris Grayling: Let me give my right hon. Friend an assurance that we will work closely with him on the process of reviewing the impacts and over the coming months we will continue our dialogue with him, which has been very helpful and constructive, to make sure that we make him aware of the approach that we are taking and that we seek his input in that approach. I give him that assurance.

Mr Alan Reid (Argyll and Bute) (LD): I am pleased to hear my right hon. Friend say that there will be discretionary housing payments to take into account particular circumstances. I draw his attention to the particular circumstances of islands and very remote communities where, because of the nature of the housing

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stock, there may be no alternative for people to move to. When funds are allocated to local authorities, will the position of islands and remote communities be taken into account?

Chris Grayling: We will certainly look very carefully at that. I give the hon. Gentleman that assurance, and again we will talk to him in detail about those issues.

This latest amendment looks to protect certain groups from the size criteria measure where they have one spare bedroom and no suitable offer of alternative accommodation has been made. However, I remind hon. Members that we have already committed to providing extra help—£30 million—to some of those groups, particularly foster carers and disabled people living in adapted accommodation. That money can help around 40,000 claimants. We are not ignoring the fact that some people will find it hard and have sought to put safeguards in place. Our aspiration is to protect the most vulnerable in society while also dealing with the broader challenge of under-occupation. There are a number of responses that individual households can choose to make to this measure.

Mr Liam Byrne (Birmingham, Hodge Hill) (Lab): The Minister has sketched out for the House a number of important concessions for groups that will be adversely affected by this policy. When does he expect guidance on how discretionary housing payments will actually work to be available for review by Members of this House?

Chris Grayling: Of course, many of the local decisions will be taken by local authorities, but we will provide information to the House as quickly as we can. We are aware that we have 12 months before the measure is in place and so will work quickly. Indeed, we are already working with local authorities to plan ahead and will be happy to make information available to the House in a timely way as it becomes available.

It is all too easy to criticise this measure and propose costly amendments, but I think that that serves to highlight the real challenges we face. What we propose is fair for the taxpayer and for tenants in the private sector who receive housing benefit based on the same size criteria. There is no plausible fairer or affordable alternative.

Nick de Bois (Enfield North) (Con): Will the Minister help me to put this in context? Is he aware that there are high earners living in social housing with excess bedrooms who really should make way for other people who need the space?

Chris Grayling: As we know, there are even people close to this place who still occupy social housing. It is our view that, where possible, social housing should be targeted at those on the lowest incomes, those who face the greatest challenges and those who are perhaps struggling in temporary accommodation. I think that those who are living in accommodation that is out of kilter with their financial circumstances might think about their personal circumstances, as was discussed when this matter was before the House previously.

The average weekly reduction will be £14. Nearly 80% of those affected are under-occupying their accommodation by just one bedroom and so are likely

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to see an average weekly reduction of £12. By comparison, for private sector tenants the average cost of an extra room is about £20 a week, based on local housing allowance rates. What we are doing is introducing fairness and consistency of treatment for social sector and private sector tenants alike.

Dr William McCrea (South Antrim) (DUP): Can the Minister assure me that he and his Department are working closely with the devolved Administrations, especially the Minister for Social Development in Northern Ireland, on his proposed reforms?

Chris Grayling: I am happy to give the hon. Gentleman that assurance. My noble Friend Lord Freud, who has direct responsibility for housing benefit matters in the Department, is also responsible for liaising with the devolved Assemblies and so is having those kinds of discussions all the time.

Stewart Hosie (Dundee East) (SNP): In his discussions, will the Minister make it clear that the Scottish Government have pointed out that some 70,000 families will be affected by this proposal? There was a huge imbalance between the 95,000 properties that are under-occupied and the 26,000 that are over-occupied, and the cost to people in Scotland and the Scottish economy will be around £54 billion a year. That does not seem to make sense, particularly when he could not answer the point made by the hon. Member for Edinburgh East (Sheila Gilmore), which is that if his policy works there will be no under-occupancy to penalise.

Chris Grayling: I suggest that the hon. Gentleman check his facts. The total cost of housing benefit is £26 billion a year, so this cannot cost the Scottish economy £54 billion a year.

Our Department and local authorities have a good track record of delivering housing benefit reform. I am confident that these changes will be communicated and delivered successfully in the same way the local housing allowance reforms were delivered last year. We will work hard to ensure that there is a smooth transition in order to address the challenges and protect the most vulnerable through discretionary payments.

Several hon. Members rose

Mr Speaker: We are extremely grateful to the Minister of State for concluding so pithily, and I am deeply obliged to him for doing so entirely when I expected him to.

4.15 pm

Stephen Timms (East Ham) (Lab): I hope that Government Members think long and hard before simply voting down Lords amendments 3B and 26B, but at the outset let me comment on the other amendments, as the Minister did.

I want in particular to welcome the Government’s concession on time-limiting contributory employment and support allowance for people in the work-related activity group. Amendments 17B to 17D and 19B provide in circumstances prescribed in regulations for a longer

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time limit than one year. That is a very welcome change, and I am grateful to Ministers for permitting it. The Government have made it clear that they have no intention of bringing forward such regulations, but the Bill will now at least allow a future, more fair-minded Government to do so, and I welcome that change very much.

The Minister in the other place also gave some assurances about people being treated for cancer, which has been an important issue in this debate. His assurances were, however, rather vague. They do not help people recovering from strokes or from severe mental health problems, or others who have no chance at all of getting back into work within a year, but the assurances in respect of cancer patients, in so far as they went, were helpful.

Amendment 73BA, which the Government tabled, would allow them to waive charges for the parent with care when accessing the child support system in specified circumstances. Again, we have no idea what those circumstances will be, but the amendment is nevertheless helpful rather than unhelpful.

There also needs to be movement on the policy addressed by amendments 3B and 26B, which the Minister before us still opposes. They have some perfectly reasonable aims, to which attention has been drawn in this debate. Under-occupancy of social housing is a problem; many people are stuck—overcrowded—on housing waiting lists; fewer people under-occupying would help; and a workable penalty for people who refuse an offer of smaller, more suitable accommodation could achieve that aim.

Mr Tom Clarke: I follow absolutely my right hon. Friend’s logic, but in the field of disability does he not recognise that in many cases the so-called extra room is there for a carer or for other physical reasons to help the disabled person? It is therefore pretty unacceptable to change that arrangement.

Stephen Timms: My right hon. Friend is absolutely right, and that is why the Lords propose in their amendment an exemption for people in receipt of disability living allowance, thereby addressing exactly that point.

Our original amendment would have penalised under-occupation in a workable way. If a tenant refused a suitable offer of a smaller home, they would suffer the penalty. If, however, no smaller home were available, they would not suffer that penalty. Unfortunately, that amendment was defeated in our previous debate, but I pay tribute to the 12 Liberal Democrat Members and two Conservative Members who supported it. I am glad to see some of them in their places this afternoon.

Legal challenge to the Government’s policy seems inevitable, because it penalises people for a situation that it is impossible for them to change. The amendment could not be reintroduced in the other place because the Government claimed financial privilege, so this afternoon we have in amendments 3B and 26B a much weaker proposal. It does, however, at least protect those, like the people to whom my right hon. Friend has just drawn attention, who will be hardest hit if the Government’s policy goes through.

The proposal would safeguard four tightly defined groups: first, people in the employment and support allowance support group—those who are too ill to be expected to return to work in the near future; secondly,

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adults and children who receive disability living allowance or its successor, the personal independence payment; thirdly, war widows; and fourthly, foster carers, because for the purposes of housing benefit calculations foster children do not count towards a bedroom need.

Let me underline how modest the proposal now is. Many Members will take the view, for example, that war widows should not be penalised for having a spare bedroom. The proposal, however, would not protect war widows in that way. It simply says that no war widow should be fined for under-occupying her home unless she has been offered appropriate smaller accommodation. If such an offer has been made to her and she has refused it, under the Lords amendments she would be penalised. The amendments would protect her position until such an offer was made. Only tenants in one of the four specific groups would have even that safeguard. Everybody else who was under-occupying their social tenancy would, under the amendments, be penalised even if it was impossible for them to move to somewhere smaller.

The Child Poverty Action Group has highlighted an example of how similar rules currently apply in the private rented sector, which highlights the point made by my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr Clarke). Let us consider a claimant who has two daughters, one of whom has severe and uncontrollable epilepsy with frequent fits during the night. Her social worker and occupational therapist agree that the two girls need separate bedrooms. The claimant currently rents a three-bedroom house, but housing benefit covers the cost of only a two-bedroom house. The Lords amendments would fix that situation for social housing because the daughter is in receipt of disability living allowance.

I will now consider the hypothetical example of a couple in which one person has terminal cancer, which puts them in the employment and support allowance support group for people who are not expected to work again. That is one of the four specific groups that the Lords amendments would protect. The couple have a spare bedroom in their two-bedroom council house because their child moved out recently. They would be happy to move to a one-bedroom council or housing association flat but none is available. Under the Minister’s policy, that couple will be penalised, on average by £12 a week. Under the amendments, because of the exceptional circumstances, they would not be penalised. That would be the modest and reasonable effect of the amendments that the Lords agreed.

The National Housing Federation tells us that 180,000 social tenants in England are under-occupying two-bedroom homes, but that only 68,000 one-bedroom social homes became available to let in the year 2009-10. The impact assessment from the Department for Work and Pensions, which is well worth reading, states:

“According to estimates from DCLG there is a surplus of 3 bedroom properties, based on the profile of existing working-age tenants in receipt of Housing Benefit, and a lack of 1 bedroom accommodation in the social sector. In many areas this mismatch”—

I am quoting the Department here—

“could mean that there are insufficient properties to enable tenants to move to accommodation of an appropriate size even if tenants wished to move and landlords were able to facilitate this movement.”

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That is the reality in many places. There simply will not be a one-bedroom home to move to. That will be the case in the constituency of the right hon. Member for Bermondsey and Old Southwark (Simon Hughes), who intervened earlier, and in my constituency. Of course, the policy will not release a single one-bedroom home, because one cannot under-occupy a home with one bedroom.

The couple in the example, in which one person has terminal cancer, would see a cut of £12 a week or nearly £60 a month in their income. That is the average across the country. They would somehow have to make that up to their landlord from other income. The Department, no doubt trying to be helpful, gives some suggestions in the impact assessment of how they might do that:

“In these circumstances individuals may have to look further afield for appropriately sized accommodation or move to the private sector, otherwise they shall need to meet the shortfall through other means such as employment, using savings or by taking in a lodger or sub-tenant.”

I ask the House to reflect on each of those three suggestions in the case of somebody with terminal cancer. People in the ESA support group are, by definition, not in a position to work. That is why the Government have placed them in the support group. That suggestion therefore does not help. The DWP suggests instead that our terminally ill tenant in a two-bedroom flat should take in a lodger to help pay the rent. One has to ask whether the people promoting these policies have ever met anyone who will be affected by them. Of course, in many cases, the social landlord would not permit somebody to take in a lodger under the terms of their tenancy. The Department’s other suggestion is that they can use their savings. People in receipt of income-related ESA do not have very much saved—if they did, they would not receive income-related ESA.

Another alternative, as the impact assessment suggests, is that the tenant will have to move out of their council home into the private sector. In that case, their housing benefit will rise sharply. Where is the gain in forcing that to happen? The National Housing Federation, whose members are very worried about the change that the Government insist on making, makes the point that

“a couple with one child moving into the private sector from a three bed social flat in Crawley would be entitled to around £66 per week more in benefit to cover their additional housing costs.”

The key point is that it will be impossible for many of those affected to avoid the penalty. If suitable alternative accommodation can be offered to them, then fine, they can move and will no longer be under-occupying, and their benefit will continue to cover their full rent. The Lords amendments specifically allow for that. However, if there is no smaller flat available, our cancer patient will just have to take the £60 a month hit. How can that be justified?

The Minister will tell us, as he has before, that £30 million has been made available to councils in discretionary housing payments to avoid penalising a limited number of households. However, the Minister in the other place made it clear that, as the Minister of State hinted today, that money is to help foster carers and disabled people with adapted homes—so no help there for our terminally ill tenant.

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Even for foster carers and disabled people in adapted homes, contrary to the impression that the Minister of State gave to the hon. Member for Crewe and Nantwich (Mr Timpson) and the right hon. Member for Bermondsey and Old Southwark, there will be no certainty. People wanting help will have to go to their local council and ask for it, because it will be discretionary—that is what the word means. It will up to each local council to decide what it does with the money. It could use it for that purpose, or it could use it for a different one. If other people have already taken all the discretionary funding that has been provided, that will be it. No further help will be available.

Charlie Elphicke: I understand that the policy in the Lords amendments would cost the Exchequer £150 million. How would it be funded?

Stephen Timms: The hon. Gentleman should reflect on the fact that, as I have described, the costs will be greater in a number of ways with the Government’s provisions in place than they would be if the Lords amendments were retained.

Before I leave the topic of discretionary housing payments, it is worth my noting how the extra £30 million has been found. Initially, the average penalty for under-occupying by one bedroom was going to be £11 a week, and now the Government have increased it to £12 a week. They have increased the penalty for everybody affected in order to scrape together the extra cash to increase discretionary payments.

The last time this policy was debated, we offered an effective alternative whereby a tenant would have their benefit cut as a penalty if they refused a suitable move. Unfortunately, Government Members threw it out. The Lords amendments would limit that safeguard to the four groups that I have mentioned—the sick, the disabled, war widows and foster carers.

Ministers have said that their policy will be a work incentive, but the support group comprises people who are not in a position to work. A work incentive will do them no good at all. Let us call a spade a spade: this is a spiteful cut in people’s income. Foster carers provide a service that saves the Exchequer billions. The Fostering Network has warned that people will be forced by the penalty to give up fostering, which will increase costs to the Exchequer. War widows and widowers have seen their loved ones die for their country. Their grieving barely over, they will be fined under the Government’s policy because they have one bedroom too many. I ask whether that is really what Government Members came into the House to do to their constituents. The Government’s policy, without the Lords amendments, will penalise everybody regardless of whether they could move.

Fourteen Government Members joined us in voting for the relevant Lords amendment last time. I thank them for that, and their constituents will do so as well, even if their Whips will not. As we were not successful, social landlords will have to take on extra staff to chase the resulting arrears that will start to accrue in every social landlord’s stock across the country. The current Lords amendments are much more modest than the previous ones, but they would at least protect those who

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stand to lose the most from what the Government want to do. I hope that hon. Members will support the Lords amendments and oppose the Minister’s motion.

Andrew Percy (Brigg and Goole) (Con): When I spoke during our last consideration of the Lords amendments to the Bill, I expressed concerns about this policy, particularly about the changes to child maintenance payments. I am pleased that there has been some movement on that front, but I find myself once again in support of their lordships. I am sorry about that, because the ministerial team is one of my favourites. I will not tell you which is my least favourite, Mr Speaker, but people can guess.

4.30 pm

The amendments are less perfect than the original set, but the reasons for that have already been explained. As I said last time, when we talk about people’s homes, we need to remember that they are exactly that—people’s homes, not just a public asset that we need to release for others. We all have constituents who have problems with being in houses that are not suitable for them and want bigger homes, but I am not sure that this measure is necessarily the right way to deal with that. In my constituency, one of the biggest problems of under-occupation relates to older people. That age group is completely exempted from the measure. Staff time will be focused on dealing with the problem before us, and that could detract from the work that can be done in helping and encouraging older people into more suitable housing, to free up bigger houses. The amendment is imperfect because it is restricted to people in receipt of certain benefits, and I would have preferred it to be more widely constructed.

When I spoke to a constituent about this a week or so ago, her explanation of why she needed another bedroom brought it home to me that, as I said, these are people’s homes and not just public assets. She said, “My kids have moved away, but they come and go. They sometimes come back home because relationships break down, and so on, and having the space there for them is very necessary.” She added that her husband snores a lot and she likes to kick him out into the spare room, but I suspect that that is not necessarily a reason to allow people to have extra housing. It is important to remember that nowadays people come and go and relationships are flexible. Like the shadow Minister, I was concerned to hear the ideas about how people can find extra funding. It is not practical to expect people to take in an additional lodger, and in the case of many social housing landlords that would not be allowed anyway.

I will again support the Lords on this matter, with apologies to my colleagues on the Front Bench. They have entirely the right reasons for taking the policy forward, but in policy making we always have to consider the law of unintended consequences. When I served for 10 years as a councillor in the city of Hull, we had a large council estate where there was a huge problem with people under-occupying homes, and it was incredibly complicated and difficult to deal with. It is a fallacy to think that we will suddenly be able to move all these people out into more suitable accommodation.

Mr Tom Clarke: I find myself agreeing with almost everything that the hon. Gentleman has said, apart from his view of those on the Treasury Bench. In addition

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to his experience in his own constituency, is he influenced by the fact that disability organisations have told us about the example of a man with a learning disability who had to wait for 25 years for appropriate accommodation? It turned out to be a two-bedroom house, which has now become his home.

Andrew Percy: I do not know the circumstances of that case, but in my time as a councillor we had a number of properties that were very difficult to let because people did not want to live in them. That was particularly true of the maisonettes. In Old Goole in my constituency, a two-bedroom maisonette has recently been let to an individual after about 20 years. He will be under-occupying because of the spare bedroom, but we are grateful that he has taken the property off our hands.

Mr Kevan Jones (North Durham) (Lab): Given my time in local government in my constituency, I totally agree with the hon. Gentleman on that. Does he recognise that for many years, the Housing Corporation, which funds a lot of social housing, has not given grant to the building of one-bedroom properties?

Andrew Percy: Indeed. The standard for many housing associations is to provide two bedrooms—there is a programme in my constituency to renew such properties at the moment. In a few years’ time, we could end up with a lot of people who, through no fault of their own, are under-occupying homes because the standard has changed.

Julian Sturdy (York Outer) (Con): Is that not the argument? There is a lack of family accommodation and we need to house families who are in temporary accommodation, especially for the children.

Andrew Percy: We need to address the failure to provide adequate housing stock in this country. However, I say to my hon. Friend and near neighbour that the Government’s proposal is not a way to do so. It is not a simple problem to solve.

The crux of the amendment is that if there is suitable accommodation to go into, people should go into it, but just as there is an insufficient number of bigger homes for families, there is an insufficient number of smaller, one-bedroom properties for those groups of people to go into. If we apply the argument that there is no suitable housing for one group of people and we must therefore do something about them, we should also argue that we should not penalise people who are under-occupying if there is no suitable accommodation for them.

The sensible element of the Lords amendment is that the penalty kicks in only if people refuse a suitable property. That is eminently fair. Hon. Members must come to their own conclusions, but I will vote accordingly. I look forward to hearing other contributions to the debate.

Mr Frank Field (Birkenhead) (Lab): As the House may know, I agree with the Government on many aspects of the Bill and I have not always shared the sentiments of Opposition Front Benchers. I regret that,

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but I have made my position clear. However, I today wish to speak against the Government on their stance and to support my right hon. Friend the Member for East Ham (Stephen Timms).

I do so because the change that the Government are making is shameful. Anyone who has sat through debates on the Bill will know that the Government’s body language is totally different to that in respect of other measures. They have been forced to take this measure by the Treasury. It goes against all that the Bill tries to achieve, which is to work with the grain of human nature. This proposal, which has been forced on the Department for Work and Pensions, works against that grain.

There are four reasons why Government Members should today save their favourite Front Benchers from the course that the Treasury is making them go down. First, let us imagine that places are available—that we could wave them into existence with a magic wand—and that all the people whom the Government condemn as under-occupying could move. That is the last thing the Government want, because to satisfy the Treasury requirements, the Department has had to enter into the accounts that it will make a substantial saving. If it were possible for people to move—all hon. Members know that it is not—the measure would fail, because it is being introduced not to even out housing, but to deliver a major saving in public expenditure to the Treasury by singling out the group who under-occupy. Therefore, the first reason why I hope Government supporters reject the measure is that it makes no sense.

Secondly, as we have heard, even if people move into the private sector, the total bill to taxpayers will be greater than if they stayed in social housing and were not penalised. The Government risk making the achieving of cuts in public expenditure that much more difficult than it is.

Thirdly, the Government’s proposal strikes against other major Government objectives with which I agree. The Government say that the reform is aimed at strengthening families and building stronger communities, but this move sticks a dagger into both those objectives. It will affect parents in families that have broken up and wish children to come and stay, and people who have carers rather than entering permanent care. Furthermore, as the hon. Member for Brigg and Goole (Andrew Percy) said in his fine speech, people might snore. How many marriages have been saved because one partner who snored could move into another bedroom? These details do not appear in public accounts details but they appear in real life. If this measure passes, far from strengthening families and enabling them to relate to and visit one another more easily, it will make it more difficult, and it might well drive out of the community upstanding citizens who play a much wider role, in the most difficult circumstances, in trying to beat the yob culture that engulfs them.

There is a fourth reason I speak and wish Members, particularly on the Government Benches, to vote against the Government and save their own Front Benchers. The Government know that I do not accept all their poverty data, but they do not have the courage to come out, as I want them to do, and declare on that—perhaps one day they will find that courage. I do not think that the poverty data properly measure whether people are benefiting from the general rise in living standards that

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has occurred for generation upon generation in this country. Harold Macmillan said that the poor should benefit from rising living standards. One way of ensuring that they do so is to give them the freedoms that I and other hon. Members have—those small differences in life that so improve its quality. Having a spare bedroom with which to offer hospitality to family and friends can make such a difference to the quality of one’s life.

The Government know that they are going against a valuable tradition dating back to the Macmillan era. This is not a welfare reform measure. It will be a recruiting sergeant for the money lenders and will be looked on as an eviction measure. Given that the DWP cannot save itself from this terrible measure, forced on it by the Treasury, I hope that Government Members will save the Department from pushing through this nasty, mean little measure. I hope that the House will send a clear message to the House of Lords that, even if we do not win tonight, they should keep up the fight and send it back until there are enough Government Back Benchers to save the Department from this shabby little folly.

Stephen Lloyd (Eastbourne) (LD): It is a privilege to follow the right hon. Member for Birkenhead (Mr Field) on this issue and the issue of welfare reform generally. I have read what he has written for many years. I have some sympathy with what he and other colleagues have said, and with the amendment, and I have some specific concerns that I would like to put to the Government and on which I look forward to receiving clarification from the Minister.

First, however, I want to welcome the fact that the coalition Government have already put aside funds in the comprehensive spending review for severely disabled people who need carers either for 24 hours or overnight. I am glad of that. It was in the Lib Dem manifesto, and I am glad that it is being delivered by the coalition Government.

I have four concerns about the amendment, however, on which I seek reassurance from the Minister. The first is straightforward and concerns foster carers and social housing, about which one of my colleagues talked earlier. I would like the Minister to clarify exactly how the Government will manage the periods during which foster carers have one spare bedroom. Clearly the children of foster carers sometimes move on and there will be a gap before the next child arrives. I would therefore welcome some clarification from the Government of how that will be managed.

Secondly, a number of my disabled constituents, such as wheelchair users, have had extensive adaptations in their homes—I am thinking of one particular individual, in Langney—which have made a considerable difference to their lives. It took probably two or three years to get the work done in that case, and it would frankly be daft to move that individual out of her home because of the one-bedroom rule; the local authority has already spent £10,000 on those adaptations.