“Ministers are personally responsible for deciding how to act and conduct themselves in the light of the Code and for justifying their actions and conduct to Parliament and the public. However, Ministers only remain in office for so long as they retain the confidence of the Prime Minister. He is the ultimate judge of the standards of behaviour expected”.

The passing of this motion would change that. Rather than decisions being made by Ministers and the Prime Minister, an independent adviser would, at his own instigation, pass judgments on Ministers. The Prime Minister is Prime Minister because he commands a majority in the House, and under our constitution it is the Prime Minister who appoints Ministers who are accountable to him and to the House, but passing the motion would change that.

What worries me is that a huge constitutional weight would be placed on the “Ministerial Code” for which it is entirely ill-suited. This document has not been approved by the House; it has not even been approved by the Cabinet. John Major’s Cabinet agreed to publish it, but there was a strong view that it should not be published because it would lead to inappropriate weight being placed on it. At best it is a prime ministerial document, but in reality it was only under Attlee that that was the case.

According to what I believe is the only history of the development of the “Ministerial Code”, by a lady called Amy Baker,

“Attlee had tailored the document very much to his own style and the needs of his own Labour administration—and succeeding Prime Ministers may have followed suit, had the Cabinet Office not intervened.”

However, the original Cabinet Secretary, Hankey,

“had drafted the very first guidelines in order to establish some continuity of procedure which would enable the Cabinet Office to organise business without being disrupted too much on a change of government.”

We know what has happened as the code has developed. Winston Churchill took no interest in it and Eden refused to issue a code, but it was used by Macmillan. Home and then Wilson took over in 1963 and 1964, and the Cabinet Secretary claimed that the document bore the great imprimatur of various Prime Ministers when that was in fact not the case. What had happened in 1963 and 1964 was used to push through paragraph 4.7,

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which puts junior Ministers under the thumb of the permanent secretary and says that they cannot tell the permanent secretary what to do even if the Secretary of State is happy for them to do so. According to Amy Baker’s book, at the time that

“may have seemed quite convenient”

to the drafters of what was then “Questions of Procedure for Ministers” ,

“who knew that their amendments would now be ‘automatically’ approved by the new Prime Minister”.

Similar circumstances arose when Margaret Thatcher became Prime Minister in 1979 and the rules governing the roles of parliamentary private secretaries changed. According to the book,

“amongst those directives which senior officials selected for incorporation into QPM, were instructions prohibiting dissent in the Commons from parliamentary private secretaries.”

Again, we see a system whereby the House is denuded of its rights and civil servants decide what happens to the “Ministerial Code”.

According to a former Cabinet Secretary,

“This process meant that on a change of government, senior officials in the Cabinet Office had a wider discretion to initiate amendments, as the incoming Prime Minister would be unaware of recent issues and would generally approve the draft handed to them on appointment.”

That is how we arrived at the reference to an overarching duty to obey international law. There is no basis for it in this Parliament or in our courts, but if the motion is passed, the position will become even worse. Not only will the code be a constitutional document, but a retired civil servant will decide how it applies to each individual Minister, and I think that that is wrong.

1.45 pm

Paul Flynn (Newport West) (Lab): We have seen the degradation of a very valuable reform that was made when Tony Blair was Prime Minister. I was a member of the Public Administration Committee at the time, and we were not happy with everything that the last Government did. We wanted to go further: we wanted a pre-appointment hearing. However, if we look at the history of the code, we see that it was used once by the last Government on an occasion involving Shahid Malik and has not been used by the present Government in three serious cases, although it was used in a minor case.

We should heed what was said about lobbying by the Prime Minister when he was in opposition, and in last week’s report from the Political and Constitutional Reform Committee. When in opposition, the Prime Minister said, quite rightly, that lobbying was the greatest scandal facing us, and that money was buying power and power was fishing for money. Sadly, that is exactly what has happened under this Government, and to an even greater extent. We must look to our reputation. We must recognise the fact that we are not winning back the trust and the confidence of the people, which is our prime task after the expenses scandal, but are losing that trust and that confidence and providing even greater cause for scandal.

The first of the three cases that should have been investigated by the independent adviser, as he says himself, was the case of the right hon. Member for North Somerset (Dr Fox). We now have a new doctrine of

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absolution by resignation: those who resign will not be subject to a full investigation of their conduct by the only legal enforcer of the “Ministerial Code”. An investigation was carried out virtually over the weekend for party political reasons, in order to get it over with rapidly.

The second case involved a Minister who argued that he did not have to declare a meal with which he had been provided by a lobbyist because on the day in question he was digesting with his private rather than his ministerial stomach. That was accepted, and no investigation was carried out.

Thirdly, there was the case of the Culture Secretary, on which we had a debate the other day. I believe that we must look to the conduct of the adviser on that. In extraordinary circumstances, following receipt of a letter from the Prime Minister dated the day of the debate, an answer came back before 12 pm virtually absolving the Minister involved of the charge that he and his staff had been approached by a lobbyist 500 times, because it had been deemed not to be a legitimate area for investigation. All those cases should have been investigated under the “Ministerial Code”.

I am grateful to the Chairman of the Public Administration Committee, which is behaving as it should. There is unanimity on the Committee about the reform that is necessary. When the new independent adviser appeared before the Committee, I asked him what he would do if we expressed our unhappiness about his appointment. We suggested that he had a reputation for being a poodle—for having followed Ministers around for years, obeying them with “Yes sir” and “No sir”. That had long been his role. He was not the Rottweiler that we needed. He said that if we expressed our unhappiness he would consider relinquishing his post, and we did express our unhappiness. I believe that before appointing such a person we must decide by means of a pre-appointment hearing whether he possesses the necessary robust independence.

Robert Halfon: Does the hon. Gentleman consider that the ratifying of the “Ministerial Code” by Parliament would deal with some of the objections raised earlier by my hon. Friend the Member for Rochester and Strood (Mark Reckless)?

Paul Flynn: No, it would not, because, under this Government, in the three serious cases I have mentioned, the code has not been used, when it should have been. The only time it has been called upon was in a case of some triviality, where the person involved admitted her guilt, and that went through. These other serious potential abuses have not even been investigated, and we must question the impartiality of the adviser because of his conduct on the day of the debate in question. All the misgivings we had were justified.

We, as an institution, are in grave danger of deepening public cynicism against us. We have had new cases of allegations, backed up with films showing a lobbyist trying to get access to the Prime Minister or boasting of access—

Mr Deputy Speaker (Mr Nigel Evans): Order. Time is up. I call Sir Alan Beith.

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1.50 pm

Sir Alan Beith (Berwick-upon-Tweed) (LD): The Public Administration Committee has been consistent on this matter, and it has been right on this matter. It is not about the choosing of Ministers; it is not even about the dismissal of Ministers. It is about ensuring that, if there is the possibility of impropriety in ministerial conduct, that can be investigated. It is too much to expect the Prime Minister not to be influenced by other factors in deciding whether to refer such a matter. To lose one Minister is bad enough; to lose several is careless. The Prime Minister will always have an anxiety that an adverse report by the investigator could lead to his needing to dismiss a Minister. It is simply naive to suppose that no Prime Minister will be affected by such considerations. Therefore, the adviser should be free to initiate investigations. Indeed, they would often do so in circumstances where it is to the advantage of the Minister concerned that there be a straightforward, clear and swift way of vindicating him, if he is innocent.

1.51 pm

Kelvin Hopkins (Luton North) (Lab): I rise to speak briefly in support of the comments of the hon. Member for Harwich and North Essex (Mr Jenkin), the Chair of the Select Committee. He put the case very well. We do not need to use extreme language, as the proposal is common sense, particularly given recent events. We want an investigator who has the capacity to conduct proper investigations and offer advice. The constitutional relationship between the Prime Minister and this House would not be changed by that. He could accept or reject the advice, but at least investigations could be made independently, without having to ask the permission of the Prime Minister first. That would be a significant change.

Mark Reckless: Regardless of the formal situation, does the hon. Gentleman accept that the political reality will be that if this independent investigator decides to conduct an investigation off his own bat and then gives a withering condemnation of the Minister concerned, it would be very difficult for the Prime Minister to keep that Minister in office, and de facto control would pass to the adviser?

Kelvin Hopkins: I trust that the investigator would make a withering condemnation only if that were justified. The recent events surrounding the right hon. Member for North Somerset (Dr Fox) and his amanuensis, Adam Werritty, deserved to be thoroughly investigated, but in my view they were not properly investigated.

Such a situation would not arise in future. I hope the Chairman of the Select Committee will not mind my mentioning that we will undertake a report on special advisers. I hope we will recommend putting their relationship with Ministers on a better footing in future, so that situations such as the Adam Werritty case do not arise again.

This proposal is timely. Recently, Prime Ministers have operated in an extremely powerful, individualistic way, and in a secretive way. They have often not trusted full Cabinets to discuss important matters. We are now moving towards a situation where the Prime Minister

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will be a little more open and accountable, without damaging our constitution in any way—in fact, this proposal will improve it.

Bob Stewart (Beckenham) (Con): It seems to me that the Prime Minister will be assisted by this appointment of an independent investigator, as he will not have to make these tricky decisions.

Kelvin Hopkins: I thank the hon. Gentleman for those comments. A situation might arise in which a Minister who has not behaved very well is a personal friend of the Prime Minister of the day. The Prime Minister could then say to the Minister, “Well, the investigation wasn’t instigated by me. It was instigated independently, and I have to accept the advice of the report. It is not me who is causing you difficulty; it’s the investigation by the independent adviser.”

In every way, therefore, this proposal is a progressive advance that is in keeping with the spirit of the times. I hope that in future more of the Prime Minister’s current powers will be devolved.

Greg Mulholland (Leeds North West) (LD) rose—

Mr Deputy Speaker (Mr Nigel Evans): I will not put the clock on you, Mr Mulholland, but I ask you to resume your seat at 1.58 pm.

1.55 pm

Greg Mulholland (Leeds North West) (LD): I am a member of the Public Administration Committee, and I am very proud that we have come up with this sensible and important proposal. It is hugely important for Parliament, as it addresses the holding of Ministers to account, which is one of our key roles. We must remember that it is important outside this place, too; it is important to ordinary people, who saw the unseemly events of the past few months and have therefore come to regard the current system of accountability as wholly inadequate. Recent episodes have also left a nasty taste in the mouths of Members on both sides of the House, who agree that the current situation is wholly unacceptable.

When Sir Alex Allan appeared before our Committee, we had what can only be described as a wholly unsatisfactory discussion with him in respect of both the realities of the role and, I am afraid, our confidence in his ability to perform it as it should be performed, rather than as it is, sadly, currently performed.

We must remember that this proposal was introduced by the previous Government. In response to the predecessor Committee’s previous report on the issue, they made it clear that the appointment would be a personal one by the Prime Minister and that he would need to have confidence that the person appointed would be able to provide independent and impartial advice.

We want the Minister to say that the Government will accept our sensible proposal, and we also want the Opposition to agree to it; they must accept the original principles of this new office as set out under the last Government. I have asked the same of the Deputy Prime Minister, and I believe that he is happy to do so on behalf of the Liberal Democrats.

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The full title of this post is “the independent adviser on Ministers’ interests” but the simple reality is that it is the Prime Minister’s adviser on Ministers’ interests. The current title is fraudulent and misleading to Parliament and the public. If these reforms are not accepted and implemented, the Government should at least have the decency to change the title to “the Prime Minister’s adviser on Ministers’ interests.”

Sir Alex Allan was appointed to the post with no open competition. We do not believe anyone else was even in the frame for the job, and there was no detail whatever on the process he went through. That is simply unacceptable.

Our proposal is based on an extremely simple idea. If—free from political interference and regardless of any media witch hunt—the independent adviser believes there is sufficient genuine evidence for an investigation, he should intervene. That is all we are asking for.

Mr Deputy Speaker (Mr Nigel Evans): Order. Time is up. I call Gareth Thomas.

1.58 pm

Mr Gareth Thomas (Harrow West) (Lab/Co-op): This has been a brief but interesting debate. I commend the work of the Public Administration Committee, chaired by the hon. Member for Harwich and North Essex (Mr Jenkin). He has rightly received praise for the tenacious way in which he and his Committee have pursued these issues. I hope he will forgive me if I praise my hon. Friend the Member for Newport West (Paul Flynn), too, for he has also pursued these issues with considerable vigour and tenacity.

I studied the contributions of all Select Committee members. I carefully read the questions they put to Sir Philip Mawer and Sir Alex Allan, and noted in particular the contributions of my hon. Friend the Member for Luton North (Kelvin Hopkins), who is also a consistent campaigner on these issues, my hon. Friend the Member for Glenrothes (Lindsay Roy), and the hon. Member for Leeds North West (Greg Mulholland). They all made good contributions to this debate, too.

This debate would not have the resonance it currently has outside the House if it were not for the Prime Minister’s mishandling of key questions about possible violations of the ministerial code—a point that was implicit in the speech of my hon. Friend the Member for Glenrothes.

The Opposition remain determined to take the steps necessary to continue the process of restoring trust in the political process. When we were in government, we took steps to reform Parliament, passing new laws to protect our democracy. We acted to increase transparency and strengthen public accountability for Members of the House of Commons. On ministerial accountability, we also introduced further reforms. The then Prime Minister, my right hon. Friend the Member for Kirkcaldy and Cowdenbeath (Mr Brown), introduced the publication of an annual report and a list of Ministers’ interests, again to increase transparency and Ministers’ accountability to this House. He also appointed Sir Philip Mawer as the independent adviser on Ministers’ interests, calling on him, as a number of Members have mentioned, to investigate the then Member for Dewsbury in May 2009, against whom a particular allegation—it was unfounded,

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as it turned out—had been made. Sir Philip investigated and the Minister was cleared and returned to his ministerial duties.

I have a number of questions for the Minister and, if I may, the Chairman of the Public Administration Committee, but the context of our debate is worth touching on. It is the Prime Minister’s refusal, using the Leveson inquiry as his reason, to ask Sir Philip’s successor, Sir Alex Allan, to investigate the conduct of the Secretary of State for Culture, Media and Sport, and the Prime Minister’s failure to call in the independent adviser in the case of the right hon. Member for North Somerset (Dr Fox), that form the backdrop to our debate. The fact that so many Members wanted this debate is in no small part due to the Prime Minister’s refusal to use consistently a system which the last Prime Minister established and used, but which the current Prime Minister now appears unwilling to use—except when he is sure of the outcome.

In short, the motion before the House today is the direct result of the belief of too many Members, on both sides of the House, that the Prime Minister has mishandled his responsibility for the ministerial code.

Mr Jenkin: I resent the hon. Gentleman making that implication, because I do not think that it does reflect why all the signatures are on the motion. What it does reflect, however, is the fact that the previous Labour Government did not accept this recommendation from the predecessor Committee. It is incumbent on him to explain whether the Labour party has now changed its mind and will support this motion, or whether he is just going to use this opportunity to make political points in this debate.

Mr Thomas: I will come to the position that Opposition Front Benchers are taking, but the Chairman of the Public Administration Committee is wrong not to recognise the considerable concern on the Opposition Benches—and the Government Benches—at the Prime Minister’s decision not to refer the case of the right hon. Member for North Somerset to the independent adviser, which I understand prompted the Committee’s original inquiry into this issue in this Parliament. The Prime Minister’s more recent decision to refer the case of the noble Baroness Warsi and not that of the Culture Secretary has galvanised interest in the Committee’s work in this area.

The shadow Leader of the House, my hon. Friend the Member for Wallasey (Ms Eagle), set out in her speech on 13 June some detailed concerns, which I do not intend to dwell on now, about the Prime Minister’s failure to uphold the code and to ensure that an appropriate investigation took place.

Alun Cairns: The hon. Gentleman talks about the Opposition’s concern about this issue, but does he not accept that their remarks would have far greater traction if they said that they now supported the motion and regretted not having taken action when in government?

Mr Thomas: As I think I set out earlier, we did take action when we were in government, and the House is better for it. However, I want to come to some of the points that the hon. Gentleman made not only in this debate but in the Public Administration Committee’s hearings.

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There is a particular outstanding question that the Prime Minister still needs to answer, and perhaps the Minister can give us some clarity on it. Why is it appropriate for the independent adviser to be used in the case of the noble Baroness Warsi and not that of the Culture Secretary? I also have a series of questions on which I would welcome the views of the Chair of the Public Administration Committee in his concluding remarks. As I hope I made clear, I think some further work by his Committee in this area would be useful for the whole House, not least in questioning the current ministerial adviser on his lack of consultation in the case of the Culture Secretary.

The new independent adviser told the Committee when giving evidence that he had made the point to the new Cabinet Secretary, Sir Jeremy Heywood, that

“there are advantages to him in bringing the Adviser in early and whenever major issues arise.”

That appears at odds with the comment in a letter from Sir Alex that was deposited in the Library, accepting the Prime Minister’s decision not to refer the case and noting the work of the Leveson inquiry, and with the clear view of Sir Brian Leveson that his inquiry was not an appropriate place for the Secretary of State’s conduct to be investigated. I raise this question not in any way to express doubt about Sir Alex’s capacity or commitment, but to inquire whether the Committee will continue to explore the circumstances in which it would be appropriate for the ministerial adviser to be brought in, and to suggest—in a spirit of helpfulness, I hope—that Sir Alex’s evidence may well be helpful in that context.

Will the Chairman of the Public Administration Committee be summoning the Cabinet Secretary to explore the extent to which there was consultation with Sir Alex over the Culture Secretary’s case? In my intervention on the Chairman, I raised the possibility of further work by his Committee in this area, highlighting two issues that Sir Philip Mawer raised, in part in answer to some questions from the hon. Member for Vale of Glamorgan (Alun Cairns): whether suspension of a Minister is really possible during a code investigation in practical political terms; and the possibility of the Committee helping to establish a set of “ground rules”—his words—for a situation where an investigation is under way and the media is in full pursuit of that Minister.

The Opposition will listen carefully to the position and argument that the Minister, and indeed the Public Administration Committee Chairman, develop. We will want to consider the Government’s response to the Committee’s report, which it is a pity was not available for today’s debate. I have genuinely an open mind on this issue. The Opposition’s instinct is that further work is required.

This debate is born out of frustration with the Prime Minister’s handling of his responsibility for the ministerial code.

Greg Mulholland: Will the hon. Gentleman give way?

Mr Thomas: I am winding up.

The failure to use the independent adviser in the case of the right hon. Member for North Somerset, compounded by the failure to contemplate using him in the case of the Culture Secretary, provides the context for this

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debate. Sadly, it is yet another debate called in this great House because of the errors of judgment of the current Prime Minister.

2.8 pm

The Parliamentary Secretary, Cabinet Office (Mr Nick Hurd): I am grateful to the hon. Member for Harrow West (Mr Thomas) for clarifying the Labour party’s position on this issue—or not. I would like to begin by registering my personal respect for my hon. Friend the Member for Harwich and North Essex (Mr Jenkin) and the other members of his Committee for their persistence on this matter. I note carefully his comment that that persistence is not going away. I also note, on the Government’s behalf, that the motion has cross-party support and has been signed by a number of distinguished Chairmen of Select Committees. This short debate is therefore one the Government must listen to, and I believe are listening to, carefully, and we will consider carefully what has come out of it.

I think it would be helpful if I restated an important principle that the Labour party also clung to in its 13 years in power: when it comes to the ministerial code, the Prime Minister is the ultimate judge of the standards of behaviour expected of a Minister and the appropriate consequences of a breach of those standards, as my hon. Friend the Member for Rochester and Strood (Mark Reckless) pointed out. The bottom line is that Ministers remain in office only for as long as they retain the confidence of the Prime Minister. He or she decides, and is accountable to Parliament for those decisions.

The advent of an independent adviser is clearly welcome—although the Labour party seemed to fight it for many years—and he or she clearly has an important role. It is worth clarifying that there are two aspects to the role, both of which are important. One part of the role is, at the request of the Prime Minister, to look into allegations of breaches of the ministerial code, if the Prime Minister thinks that is necessary, and to advise the Prime Minister. But it is for the Prime Minister to take this decision and be accountable for it. In some cases, the Prime Minister will have no need to ask for advice, as the issues will be clear. In other cases, there may be the need for further investigation before the Prime Minister can take a decision. In those instances, he will refer to the independent adviser.

It is to misunderstand the intended role of the independent adviser to suggest that he or she should be able to instigate his or her own investigations. The adviser is there, personally appointed by the Prime Minister, to advise the Prime Minister on allegations of breaches of the code, if the Prime Minister thinks it is necessary. I shall now read out an important quote from the Prime Minister’s evidence to the Liaison Committee on 3 July:

“The ministerial adviser on interests is there to advise the Prime Minister; he gives the advice and the Prime Minister has to make the decision.”

There has been no change in approach; this is the same practice that existed under the previous Government.

Greg Mulholland: I am listening with interest to my hon. Friend, as he is actually dealing with the issue, unlike the hon. Member for Harrow West (Mr Thomas) in his extraordinary and pathetic contribution. Does

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my hon. Friend not accept that if the independent adviser had the powers we are talking about, he himself would say that there is not the evidence to proceed with an inquiry? The proposed approach would do that job and give the public confidence that there was no need for an inquiry in the first place.

Mr Hurd: I thank my hon. Friend for his intervention, and I can see the passion with which he makes his argument, but the important principle is who is ultimately responsible, and that is the Prime Minister.

Paul Flynn: The Chairman of the Committee on Standards in Public Life, Sir Christopher Kelly, said in evidence to the Public Administration Committee that in his view the Prime Minister had broken the ministerial code in one of these instances. As the Prime Minister is unlikely to refer himself to the adviser, is it not crucial that we have someone of independence who can take on the Prime Minister when he is suspected of breaking the ministerial code?

Mr Hurd: I have not seen Sir Christopher Kelly’s evidence on that, but there is no shortage of opportunities to hold the Prime Minister to account on anything.

Providing advice to the Prime Minister on allegations about a breach of the ministerial code is one aspect of the independent adviser’s role. I also wish to explain the other important aspect of the role, as it has been ignored in the debate: the adviser provides an independent check and source of advice to Ministers on the handling of their private interests in order to avoid any conflict between those interests and their ministerial responsibilities, as set out in section 7 of the ministerial code. This is very much behind-the-scenes work; it is about sorting out issues before they arise. However, it does result in the publication by the Cabinet Office of the list of Ministers’ interests, which puts into the public domain a list of all the relevant interests of all Ministers and enables external scrutiny of possible conflicts of interest. Obviously, this is an ongoing process as issues arise, not a one-off. It is important to put on record that second dimension to the independent adviser’s work.

Some questions were raised about particular cases this afternoon, although I think that the hon. Member for Harrow West struck the wrong tone, not for the first time, by seizing the opportunity to try to make a political attack on the Prime Minister. Rather than rehearse some arguments about why one particular case was referred or otherwise, I simply say that in each case—those of the former Secretary of State for Defence, my right hon. Friend the Member for North Somerset (Dr Fox), my right hon. Friend the Culture Secretary and Baroness Warsi—there were no shortages of opportunities for the House or for the media to hold the Prime Minister to account for the decisions he took.

Mark Reckless: Did not the hon. Member for Newport West (Paul Flynn) go beyond that by suggesting that the code, rather than being a prime ministerial document for Ministers, actually applies to the Prime Minister, too, and that the independent investigator should investigate whether the Prime Minister has breached it? If that were the case, should we not all just pack up, go home and let the independent advisers decide everything?

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Mr Hurd: I share my hon. Friend’s reservations about placing too much weight and responsibility on someone who is ultimately an adviser, and this will not be the first time that the hon. Member for Newport West has overstated his case. The point that I was trying to make about the political attacks on the Prime Minister by the hon. Member for Harrow West was that the reasons in each particular case that he cited were made public and the Prime Minister, as we are extremely well aware, was held very accountable for all those decisions.

Mark Durkan (Foyle) (SDLP): Does the Minister not recognise that history shows that the ministerial code has been invoked more as a shield against public and parliamentary accountability than as a tool for enabling those things? For as long as the code remains the personal app of the Prime Minister and the independent adviser does not have independence, surely all we are looking at is a feeble cross between a figment and a fig leaf.

Mr Hurd: The hon. Gentleman gives me an opportunity to discuss the issue of whether Sir Alex is independent enough, which featured in the thrust of the argument from many hon. Members.

Robert Halfon: Following on from the point made by the hon. Member for Foyle (Mark Durkan), does my hon. Friend agree that to solve this problem the ministerial code should be ratified by Parliament?

Mr Hurd: I thank my hon. Friend for his intervention and for his suit, which has enlivened proceedings today.

In the time available to me, I wish to make a comment about the issue of the independence of Sir Alex Allan, because it has been suggested that he is not independent enough or even that he is perhaps not up to the job, having only just retired from a senior role at the heart of government before taking up the role. As I have said, this is a personal appointment by the Prime Minister of the day. A number of qualities are required for the job. In particular, the independent adviser needs to be somebody whose expertise and experience enable them to provide confidential and trusted advice to Ministers and their permanent secretaries. It is our judgment, and the judgment of the Prime Minister, that Sir Alex Allan has that experience, as well as the necessary skills and judgment to make him ideally suited for the role.

In conclusion, today’s debate has shown the range of views on the issue. I hope that we have made it clear that the Government treat issues of ministerial conduct with the utmost seriousness. The Government will reflect carefully on the points made in this debate, and will reflect on them in our response, overdue as it is, to the Public Administration Committee report. That response will be published shortly.

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2.17 pm

Mr Jenkin: I am extremely grateful for the opportunity to reply to this debate, Mr Deputy Speaker. It is custom and practice in this place to say what an interesting debate we have had, but we really have had an interesting exchange on this occasion. I am very grateful for, and indeed touched by, the warm remarks of members of the Public Administration Committee who have made comments about how much they enjoy working on that Committee—that goes for me, too. I very much appreciate their participation and support for our activity.

Many of those hon. Members spoke in this debate, but by far the most interesting contribution was made by my hon. Friend the Member for Rochester and Strood (Mark Reckless), who raised a number of interesting things about the ministerial code. We are not debating its content; we are debating how the code should be enforced. He should somehow take part in our inquiry into the ministerial code, when we get to it, because he has a lot of important and interesting contributions to make, but I submit to him that the code should be owned by Parliament and controlled by Parliament in order that it can become a mechanism that can be used by Parliament to hold Ministers to account.

Let us remember that the code was secret until quite recently. It was published only recently and it was only very recently that it started being referred to in statute. The point has been made that a change has been smuggled in whereby Ministers have to obey international law even if there is no statute that requires them to obey that law. That is an extraordinary constitutional innovation and it is one of the things that we would want to look at.

I want to complete my remarks by referring to the two Front Benchers. They are both erudite and intelligent people who have done their best to avoid addressing the crunch issue. I understand why the Government are reluctant to make the change, but I am prepared to press this to a vote because otherwise we will be back again having exactly the same debate as we always do. I put it to the Opposition spokesman: if we finish up with another debate moved by the Opposition on why somebody has not been referred—

2.20 pm

One hour having elapsed since the commencement of proceedings on the motion, the Deputy Speaker put the Question (Order, 11 July).

Question agreed to.


That this House calls on the Government to implement the recommendation made by the Public Administration Select Committee in paragraph 44 of its Twenty-second Report of Session 2010-12, The Prime Minister’s Adviser on Ministers’ Interests: independent or not?, that the Independent Adviser on Ministers’ Interests ‘should be empowered to instigate his own investigations’; and notes that this motion has been agreed by the Public Administration Select Committee.

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Summer Adjournment

Motion made, and Question proposed,

That this House has considered matters to be raised before the forthcoming adjournment.—(Bob Blackman.)


2.20 pm

Greg Mulholland (Leeds North West) (LD): I rise to take the opportunity to discuss the Safe and Sustainable review into children’s heart surgery in England and Wales and the concerns about the process that led to the closure of the excellent Leeds unit. The decision was taken on 4 July. Families from up and down the country were asked to be present to give their views and the joint committee of primary care trusts—the JCPCT—deliberated in public all day. The decision was due, but it was delayed, delayed and delayed again, until it was finally announced that Leeds would close. What left a particularly nasty taste in the mouth was that it was abundantly clear when documentation was produced that the decision had already been taken and that that day, including asking the families of children who had needed to use the surgery unit, was a charade. I am afraid that that was all too typical of the way in which this process has been handled.

There are serious questions about how the JCPCT reached that decision. It ignored clear evidence and, I am afraid to say, there has been a clear and obvious bias all along towards Newcastle. Leslie Hamilton was on the committee despite being based at Newcastle, but there was no one from Leeds. No one in Leeds or, I am sure, up and down the country was at all surprised at the decision, because we expected it. We could see that the JCPCT was simply not considering the evidence.

In the brief time I have available I shall raise a few points and I know that my hon. Friend the Member for Pudsey (Stuart Andrew) will raise a few more. I am sure that other hon. Members will also seek to do so and I shall look forward to having a full debate in the autumn, when we can place on the record the myriad serious concerns on this point.

First, 600,000 people signed a petition in support of the retention of the unit at Leeds, yet that was counted as only one response by the committee. At the same time, 22,000 text messages from unknown sources supporting Birmingham were counted as 22,000 submissions. So, how can the JCPCT say that it does not “count heads” when it is ignoring 600,000 people, counting them as one submission, yet counting 22,000 text messages as 22,000 separate responses?

Why has the JCPCT watered down expert advice on the gold standard of collocation? It has adopted a watered-down version on the advice of fewer than 10 clinicians in the steering group and on the recommendation of Sir Ian Kennedy, who is not a clinician. How can the panel justify following that advice rather than that of the country’s most respected gatherings of experts in this field? How can it be right, if this closure happens in Leeds, for the Yorkshire and Humber region to go from enjoying the highest standards of collocation in the country to having the lowest?

The Safe and Sustainable model of children’s heart surgery is also dependent on networks of care, but whereas the Leeds network was recognised as “excellent”,

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Newcastle’s was regarded as “poor”. Why is the Yorkshire and Humber moving from a centre that delivers an excellent network to one with a record of delivering a poor one?

The JCPCT accepted the advice that 90% of doctors in the relevant areas of option B would be happy to refer to Newcastle, yet the referring doctors in Yorkshire and Humber have never been asked about that. That is simply outrageous.

I am aware that there has been a referral from the joint overview and scrutiny committee in Yorkshire, which we fully support and insist is properly investigated. We must also consider the very worrying situation in Glasgow. The Yorkhill unit is currently failing and a separate report by Sir Ian Kennedy stated:

“The panel had significant concerns about important aspects of the service in the surgical unit and in the broader congenital heart network. Of most concern was a lack of leadership and coherent team working. Also of concern was a sense that the provision of paediatric intensive care may be unsafe if critical staffing problems are not addressed.”

That has not been part of the review, however, and extraordinarily the Scottish Government have now decided that three surgeons performing 300 operations is safe in Scotland. However, that is not considered to be safe in Yorkshire. That is simply unacceptable. Today we are saying that we have no confidence in the review and that we want the whole process to be reconsidered.

2.25 pm

Siobhain McDonagh (Mitcham and Morden) (Lab): In south-west London, the NHS has just proposed to close the A and E, maternity unit and various other services at my local hospital, St Helier. It will take 200,000 people longer to get to hospital in an emergency. On its website, outlining why it is doing this, NHS South West London states that providers

“will have to deliver £370 million savings each year…a reduction of around 24% in their costs.”

Yet thanks to birth rates, an ageing population and poor health due to poverty, A and E visits will go up 20% in five years and births will increase by 10%. The area’s four hospitals are overcrowded now, so let us try cramming the same number of patients into just three.

What is worse is that there is no extra funding for the hospitals that remain. In no way do I support the hospital closures in north London, but at least that area gets an extra £138 million for “out of hospital” care to cope with the closures. Down in south-west London, we will get nothing. If St Helier loses its A and E, visits to the remaining three hospitals will rise by a third. Many will have to be admitted, but, with no extra funding, where can they go? Will they go on to the corridors, as in the 1990s?

It is claimed that 50% of A and E patients will go to GPs or community services instead, but even the report by the watchdog, the national clinical advisory team, does not believe that they could cope. That is a key paper and no cuts should take place without the public knowing what the watchdog thinks, so it should be published immediately. NCAT is right to be sceptical about whether GPs can halve the numbers going to A and E. Clinical commissioning obviously makes that very attractive for GPs, but for most people in my constituency it is easier to go to a walk-in centre or

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A and E than to a GP, so A and E visits have continued to rise year after year. The fact that GPs, who are making all the financial decisions, will get more funding if there are fewer A and E visits, does not mean that people will stop going. Apparently, some GPs now realise that those plans are looking very dodgy. A poll of Sutton’s GPs has shown a majority against the closure and a similar poll is taking place of Merton’s GPs that will, I am sure, show the same.

It is not just St Helier’s A and E that is under threat—so is its maternity unit. However, of the four hospitals, St Helier has the only maternity unit that meets clinical standards. If we lose St Helier, the other three hospitals will need to deliver a third more babies than they do now. It is widely accepted that maternity units delivering more than 6,000 births a year are a bad thing. It is far better, and far safer, to have slightly smaller units with good midwife cover, but not in south-west London, it seems.

We will lose our children’s unit and other services, such as intensive care. The “Better Services Better Value” review states that, to compensate, GPs will force patients from all around south-west London to go to St Helier for minor, planned treatments, but who would want an operation, even a routine one, in a hospital as depleted as St Helier? What is more, making people in St Helier drive across the suburbs for A and E and maternity and making people drive to St Helier for routine operations will add literally millions of miles of journeys to our already congested roads. No, the impact of that is not considered.

The other obvious questions have not been asked. Why would a patient from Kingston want to drive the best part of an hour to St Helier for a treatment they can currently get in Kingston? The other three hospitals do not like the idea either, as they cannot afford to lose the income from those planned treatments.

These plans are all over the place; they are a total shambles. Next Thursday, NHS South West London was due to rubber-stamp St Helier’s closures. It booked a big theatre in Croydon in readiness, but now it has put the decision off. Good, but this is obviously not the end. St Helier has been under threat before, but now it is under threat again from a combination of cuts and GP commissioning. The demands on our four hospitals are growing, not shrinking. I hope the Minister will reassure me, and my constituents, that that disaster will not happen on his watch.

2.30 pm

Jason McCartney (Colne Valley) (Con): I, too, rise to speak about the Safe and Sustainable review of children’s heart surgery. The joint committee of primary care trusts—the decision-making body comprising local commissioners—was tasked with considering the pattern of children’s heart surgery services. On 4 July, it announced its decisions, which included the news that Leeds general infirmary will not provide children’s heart surgery in future.

The two-hour radius around the Leeds heart surgery unit reaches 14.5 million people. Including check-up appointments, the unit sees 10,000 children annually and performs about 350 operations.

I acknowledge that the decision was independent of the Government. Local council overview and scrutiny committees are free to refer decisions to the Secretary of

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State, via the independent panel. I heard this morning that our OSC has just done so; I welcome that move. Our Yorkshire body was due to meet on 24 July. Now that the committee has referred the decision to the Health Secretary, I hope he will revisit it based on the four tests stipulated for the redesign of services.

The Minister of State, Department of Health (Mr Simon Burns): If my hon. Friend is correct—and I am sure he is—in saying that his local authority OSC has referred the matter to my right hon. Friend the Secretary of State, the process is that the OSC explains why it does not agree with the decision and asks my right hon. Friend to refer it to the independent reconfiguration panel for consideration. The panel will then respond to my right hon. Friend and state whether it thinks the decision is right or wrong.

Jason McCartney: I thank the Minister. I said earlier that the decision would go to the Secretary of State via the independent panel. I look forward to its going through that process.

The first test for redesigning services is that there should be clear clinical benefit. The health impact assessment was that option G—to keep Leeds open—had fewer negative impacts than the chosen option. The second test is clinician support. There is no evidence that the decision has the support of clinicians; in fact, most have given their support to the Leeds unit.

The third test involves the views of the public. Surely nothing can be clearer than the views of the 600,000 people who signed the petition to keep the Leeds unit open, and the admirable cross-party support for the campaign. The fourth and final test is that there should be support for patient choice. A survey in west and south Yorkshire clearly shows that patients would not travel up to Newcastle.

Many constituents with experience of the Leeds unit have been in touch since the announcement on 4 July.

Greg Mulholland: The evidence clearly shows that Newcastle will not hit the magic number of 400, making the point of the process farcical. As we now know that Glasgow will continue, but will perform only 300 operations a year, there will be two underperforming units, and we will have lost Leeds, which could easily reach those numbers. Does that not make the whole thing a farce?

Jason McCartney: My hon. Friend makes a good point. There is an assumption that all the patients who have been going to the Leeds unit will automatically migrate to Newcastle. That is a big flaw in the assessment, and I look forward to further exploration of that matter.

Constituents who have been in touch with me include teenager Seb, who recently did work experience with me. He had three heart operations and a pacemaker fitted at Leeds. He wants the Yorkshire unit to stay open; he stresses the fact that there are good transport links to the Leeds unit.

Paul told me about his 10-year-old stepson who suffered a cardiac arrest last August. His stepson had a defibrillator fitted internally, which he will have for the rest of his life. Paul said the Leeds location was key for their family.

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Ruth told me about her six-month-old daughter Eleanor who was born with a heart defect caused by Down’s syndrome. Ruth fears for the emotional and financial stress families will be put under by the longer travelling distances, as parents try to hold down their jobs, care for other children and fulfil other responsibilities.

I was also contacted by the grandparents and, separately, the parents and siblings of four-year-old Lily Rose, who had surgery in the Yorkshire unit. They asked how a four-year-old was expected to cope at such a traumatic time without being able to see her mummy each day. The emotional impact on the rest of the family would be enormous. They stressed that distance from the centre is extremely important. They reiterated the population figures: 14.5 million people are within two hours of Leeds, whereas only 3 million are within two hours of Newcastle.

Those cases are real; the families were in touch with me over the past two weeks. In the past year, I have spoken in the Chamber about George Sutcliffe, Ben Pogson and Joel Bearder who, with their families, have been campaigning locally for the Leeds unit to stay open. I compliment them and all the families who have worked so hard on the campaign, and will continue to do so.

It is clear that the plans do not meet the four tests, which are factual; they are not about emotion. I look forward to the flawed decision eventually being referred by the independent panel to the Secretary of State so that the tests can be looked at again. I firmly believe the JCPCT decision clearly fails all the four tests for redesigning services, and I look forward to its being reconsidered.

2.36 pm

Mr Andy Slaughter (Hammersmith) (Lab): On 4 July, a committee of primary care trust chief executives made the extraordinary decision to end children’s heart surgery and intensive care at one of the best performing and largest centres in England: Royal Brompton hospital, a specialist heart and lung hospital that treats children and adults from all over the country who have some of the most severe forms of heart and lung disease. It was quite a surprise for the doctors and other staff at Royal Brompton to find out last year that they were earmarked for closure. The national review panel that made the recommendation, in February 2011, had previously specified that for children’s heart surgery centres to be viable they must have four surgeons each doing at least 100 operations every year, and they must offer round-the-clock care.

Royal Brompton has four surgeons, each undertaking more than 100 operations every year and it offers round-the-clock care. It also has a safety and outcome record of which any centre would be proud. Rates of patient satisfaction at the hospital are exceptionally high.

The national review of paediatric heart surgery set out to reduce the number of hospitals offering children’s heart surgery, because it was felt that in some areas surgeons did not have enough cases to maintain their skills in the longer term. London has three centres, although two of them, Royal Brompton and Great Ormond Street, are recognised national specialist centres and treat patients from all over the country. The decision was made to close a London centre, and divert its patients to the

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remaining two, once their facilities are improved and extended, at significant cost to the taxpayer. A proposed solution to develop a network in London that would mean closer collaboration between the three existing centres, but no closures, was ignored.

Time prevents me from going into detail about why Royal Brompton drew the short straw of closure; it came down to a complicated scoring mechanism that eventually ended up in the High Court. I must stress, because it is of utmost importance, that there was never any suggestion that Royal Brompton’s clinical services for children are anything other than first rate. A better insight may be provided by the comments of a civil servant at a meeting of the London specialised commissioning group on 26 April:

“It is likely that the rest of the country will take the view that London should take its share of the pain of closures and will seek to make one closure in the capital in order to make closures elsewhere more palatable.”

Removing children’s surgery and intensive care from Royal Brompton will have devastating consequences, and not just for the young patients who value the hospital’s cardiac care so highly. Losing its children’s intensive care unit will destroy Royal Brompton’s world-class paediatric respiratory service, which specialises in the treatment of children with cystic fibrosis, severe asthma and a number of severe and complex respiratory conditions. Without the back-up of intensive care and on-site anaesthesia, doctors will not be able to undertake the more complex specialist treatments they do now, because they will consider it unsafe to do so.

Royal Brompton’s respiratory teams also undertake groundbreaking research into important areas such as cystic fibrosis, severe asthma, lung disease, inflammation of the airways and neuromuscular conditions. That research can be carried out only at a specialist hospital, where the combination of clinical expertise and the type and number of patients seen provides the necessary conditions. Without an intensive care unit and provision for anaesthesia, research will simply not be possible.

Greg Mulholland: The hon. Gentleman makes a passionate case for the Royal Brompton unit. The chief executive of Little Hearts Matter says that, in the Glasgow case, a unit that does 300 operations can be made perfectly safe by other means, without closing units. Does the hon. Gentleman share my frustration at the fact that in the Royal Brompton, Leeds and other places, those involved are not prepared to do that? It does not make sense.

Mr Slaughter: I am grateful for that intervention, because, in case my comments are seen as special pleading from the hospital, I was just coming on to mention some independent recommendations and sources that support the argument that, if there is no opportunity for research, and if experts—in Leeds, as well as the Royal Brompton—are prevented from working to the level of their abilities, many are likely to seek work elsewhere, possibly outside the UK.

Dr Neil Gibson, a consultant in paediatric respiratory medicine at Glasgow’s royal hospital for sick children, wrote to the chair of the review as follows:

“The unit at the Royal Brompton Hospital from a paediatric respiratory point of view is truly one of the world’s leading centres with an already impressive track record…There is a

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significant potential for irreparable damage to be made to the only world class Paediatric Respiratory Research Unit in the United Kingdom.”

Professor J. Stuart Elborn, president of the European Cystic Fibrosis Society, wrote that

“high quality research is a key determinant of the ability of a centre such as the Royal Brompton to retain and recruit the world leading clinical and academic staff on whom its respiratory services depend. Adverse impact upon the ability of the clinical staff to carry out cutting-edge research will undermine the sustainability of the clinical services, to the detriment of its patients.”

Asthma UK, the Cystic Fibrosis Trust, the Muscular Dystrophy Campaign, and the Primary Ciliary Dyskinesia Family Support Group wrote a joint letter to the chair of the committee, saying:

“We have explicitly mentioned respiratory research because it is an issue of fundamental importance to each of our charities because of the excellence of the Royal Brompton’s paediatric respiratory research and clinical trials programmes and the importance of that work for improving patient outcomes in the future.”

Patients and staff at Royal Brompton are understandably deeply distressed at the prospect of losing their high-performing children’s heart unit, soon to be followed by their specialist respiratory services. They do not understand how such a decision can be made by bureaucrats who have never visited the hospital and have no specialist knowledge of the care provided there. They have written to their MPs and to the Secretary of State. Indeed, one resourceful mother brought the matter to the attention of the Prime Minister in Downing street last Thursday.

The Secretary of State for Health assures the parents of these seriously poorly children, and the dedicated teams that treat them, that this is a matter not for him, but for the NHS. For the sake of the thousands of children whose care will be damaged by the decision of Sir Neil McKay’s committee, the sake of the research programmes that will be destroyed, and the sake of common sense, I hope that the Minister of State will realise that the time has come for him to meet clinicians from the Royal Brompton and at least hear what they have to say. Perhaps he will be able to persuade them that destroying NHS services and research programmes that are viewed by international peers as among the best in the world is a good idea. I wish him luck in doing so.

2.42 pm

Tracey Crouch (Chatham and Aylesford) (Con): I am very fortunate never to have been in a situation where I have continuously required alcohol to blot out misery or pain. I am fortunate enough to have never been so drunk in a public place that my safety or personal dignity was compromised. In fact, I abhor drunkenness, public or otherwise. It upsets and frightens me that some people become so inebriated that they are incapable of standing, speaking or securing their safety.

Although I do go to the pub, like hundreds of thousands of professional women up and down the country, I do most of my drinking at home. I probably do not think I am doing anything wrong because, every day, women go home after work and pour themselves a large glass of wine—and then another. How can it be wrong? I do not get drunk, throw up in the street, or wake up with a hangover. Yet could that be why alcohol consumption among women is becoming a problem, albeit one that may not present itself for decades?

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Alcohol consumption by women has been rising steadily since the 1960s. Since 2002 alone, the number of alcohol-related admissions accounted for by women has more than doubled, from just below 200,000 to more than 400,000 in 2010. Although I accept that there is some debate about those sets of figures, the trend is undeniably upward, not downward. Alcohol consumption by women remains at a historic high, but it is interesting to note that it is falling at a faster rate among 16 to 24-year-olds. However, a significant number of middle-aged and older women, usually on higher incomes, prefer to drink at home to dangerous levels. It is the silent majority of drinkers we should be looking to prevent from becoming risky, harmed or dependent drinkers.

Justin Tomlinson (North Swindon) (Con): This is a very serious issue. Does my hon. Friend agree that the silent majority are very much the problem, because they simply do not seek help?

Tracey Crouch: I agree entirely. We should remember that a significant number of people in this country do not drink at all; it is those who drink to excessive levels whom we need to be concerned about.

Since the 1960s, many more women have entered the work force. Some have put off raising families and the associated responsibilities in favour of pursuing their career. As a result, they have much more money and time to spend drinking. That is statistically demonstrated by the fact that women in managerial or professional roles admit to drinking almost double the amount drunk by women on lower incomes.

Where the drinking takes place, and not just the quantity, is a cause for concern. While men still account for the majority of regular pub goers, women are more likely to drink at home, drinking cheaper supermarket wine that is aggressively marketed and probably bought in bulk.

Mr Angus Brendan MacNeil (Na h-Eileanan an Iar) (SNP): Does the hon. Lady agree that providing calorific information, as opposed to just the unit content of alcohol, on a bottle might have a significant impact on a large number of women who care a lot about the calories that they consume? If that was set out on alcohol packaging, it might help to alleviate the problems that she mentions.

Tracey Crouch: The hon. Gentleman makes a good point. Labelling of alcohol has improved significantly over the past few years, particularly in relation to pregnant women.

In many ways, drinking at home poses a real issue. It is difficult to assess the true extent of the problem of home drinking because the only data we have to go on are results from surveys, and many respondents are likely to under-report their consumption. However, recent studies have shown a clear link between harm and home drinking. An overwhelming 93% of recent interviewees who had all suffered alcohol-related harms bought the majority of their alcohol from off-licences and supermarkets. With alcohol now part of most people’s weekly shop, and women less likely to buy alcohol in pubs, it is no surprise that the impact of home drinking on a person’s health is likely to be more pronounced among women. Little stigma attaches to home drinking, and it is perhaps only later in life that women realise

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that there was any drawback to what they have been doing. Liver damage is an obvious related condition, but breast cancer and dementia are also often cited as conditions with a link to alcohol.

Given that what somebody does in their own home is a matter for them, what role is there for the Government in tackling the issue? The introduction of a minimum unit price for alcohol is a welcome development and will tackle many alcohol-related problems, but I doubt very much that it will tackle the high level of drinking among well-off and professional women. It may dissuade somebody who is doing the weekly shop from taking advantage of deep discounting, and prevent the pre-loading that goes on among some younger drinkers, but more needs to be done on education and awareness.

For professional women drinking at home who do not come into contact with the traditional services that offer alcohol-based education and interventions, the workplace could prove particularly important. Alcohol Concern is championing the need for businesses to take a responsible approach to alcohol, calling for the inclusion of an alcohol policy in the corporate governance code. In principle, workplace interventions should definitely be encouraged, and I hope that the Government will support that campaign.

Undoubtedly, home drinking is extremely difficult to quantify. The only indication we have of the scale of the harm done is the level of alcohol-related admissions. It is therefore a concern that the official measurements used to calculate alcohol-related hospital admissions could be altered in the near future to reflect only those admissions where alcohol is a primary diagnosis. That could potentially exclude the reporting of conditions for which excessive alcohol consumption were partly responsible, such as a broken leg as a result of falling at home, or even domestic violence. I urge the Government to reconsider carefully the changes to the measurements. If they do not, we may never truly understand the scale of the problem, and the idea that we could achieve the targets set out by the Prime Minister for reducing alcohol dependency could be simply farcical.

A vast number of women, especially in professional roles, are steadily drinking at home to the detriment of their health. That is an issue on which it is difficult to provide direct intervention, but not one that we should simply ignore. I hope that this Government, who are responsibly trying to tackle alcohol misuse, will recognise the problem and do whatever they can to ensure that it is not simply left to fester behind the closed doors of homes up and down the country.

2.49 pm

Jonathan Ashworth (Leicester South) (Lab): Like many other Members, I should like to say a few words about the outcome of the Safe and Sustainable review. Children’s heart surgery services in Glenfield, in the constituency of my hon. Friend the Member for Leicester West (Liz Kendall), have been earmarked for closure—a decision that came as shattering news when we heard it the other week to many of the staff who work there and many families of patients who have been treated there.

Many of my constituents have got in touch with me, and I have also been contacted by people across Leicester and the country. I do not have time to go through

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everything that they said, but Stacey Whiteley from Lincoln has contacted me. People have contacted me from Corby, Coalville and Northampton to express deep concern and opposition to the decision. Many of them said that there were a number of questions that they wanted answered and, as I think that they are legitimate concerns, I want to put them on the record.

My constituents have asked me, for example, why the extra options I to L were not presented for public consultation. Other constituents have pointed out that option A was the most popular, but was apparently ignored. Some constituents have questioned the impartiality of some advisers to the panel and others have pointed out that, in the consultation document, option A was described as being consistently the highest scoring option. Why was there a U-turn and option B chosen? It is right that those decisions should be made by clinicians, but these are legitimate questions from people concerned about the decision.

Andrew Percy (Brigg and Goole) (Con): The hon. Gentleman makes an important point, but the decision was made not by clinicians but by commissioners, who have left the eastern side of England between Newcastle and England without a heart unit. Many of my constituents would have gone to Leicester in preference to Newcastle. Now they will probably travel to London or Liverpool.

Jonathan Ashworth: Indeed. Many of the hon. Gentleman’s constituents would have been welcome in Leicester. He is quite right: where do our constituents in the east of the country, between Newcastle and London, go? That is something else that many of my constituents have raised with me.

I wish to concentrate on the biggest deficiency of the decision, which is the impact on our world-class ECMO—extracorporeal membrane oxygenation—service. On Friday, the Secretary of State announced that he would accept the recommendation to shift our ECMO service from Leicester to Birmingham. In Leicester, we have had a brilliant, world-renowned ECMO service for 20 years.

Liz Kendall (Leicester West) (Lab): I am grateful to my hon. Friend for accepting my intervention, as I cannot speak in the debate because I am a Front-Bench spokesperson on health. Is he aware of the international evidence that shows that Glenfield’s ECMO survival rates for children are 50% to 75% higher than other centres? Those very good survival rates, and the benefits that they bring for children, must be taken into consideration as part of the review.

Jonathan Ashworth: My hon. Friend is right, and she makes the point with her usual eloquence and insight. I pay tribute to the work that she has done and, indeed, the work of other Leicestershire Members—I see that the hon. Member for Loughborough (Nicky Morgan) is in the Chamber—on the ECMO service. I thank the Minister for agreeing to meet a delegation of east midlands MPs, as we had a useful discussion.

Giles Peek, a consultant paediatric heart surgeon, said last year of the ECMO service:

“We use it not just after surgery but also to stabilise children and to stop them dying before surgery. We are always full and often take children from other hospitals…Our role at Glenfield as a national reference centre for this treatment is important and underestimated.”

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I fear that Giles Peek’s concerns have come true and that our ECMO service has been underestimated.

I was grateful that the Minister said in the meeting that the Secretary of State’s decision was based on the Agnes review, but there are other ECMO experts who disagree with that review, so I hope that he will consider publishing the Agnes report. In the few minutes I have left, I shall run through the points that various ECMO experts have made. For example, Glenfield has a world-class facility with more than 20 years’ worth of service. There are deep concerns that by uprooting it from Leicester to Birmingham expertise will be lost along the way. Mr Kenneth Palmer, an ECMO expert, gave a stark warning on Radio Leicester today that, as a result of shifting the children’s ECMO service from Leicester to Birmingham, lives would be lost, saying:

“They could never have the same survival rate in another unit if you move it like this. Leicester has one of the highest survival rates in the world, 10%-20% higher than the normal survival rate in the world. To come up to the same skill it will take 5 years at least.”

He has been joined by other experts who have warned about the impact of shifting the unit from Leicester. Jim Fortenberry, the chair of the ECMO leadership council in Atlanta, when asked whether he agreed that lives would be lost, said:

“I do agree with that unfortunately. I think the risk is great that by attempting to move and start over that you’d really start the learning curve all over again and the improved outcomes take time and experience to develop, and so by effect starting over on the learning curve you certainly would potentially put lives at stake and it could be very significant.”

I accept that the Minister takes advice from experts, but given that there is one set of experts making one argument, presumably he receives advice from a different set. If he published his evidence, those of us who are laymen on health policy can try to make our own judgments as those experts scrutinise one another’s work.

Concerns have been raised about the Birmingham facility and whether it can deal with the new ECMO service. Dr Andrew Coe, a paediatrician from Coventry, said on Radio Leicester this morning that he was

“not convinced that Birmingham will cope with increased demand following closure”

of Glenfield. It was suggested to me that if the 80 ECMO nurses at Leicester are not prepared to leave Glenfield, it will take up to eight years for nurses in Birmingham to be trained to the appropriate level of expertise.

I conclude by mentioning the family from South Cambridgeshire, which the Secretary of State represents, who appeared on Radio Leicester this morning. They said clearly and movingly that the service they received for their little girl was the best they could receive and went beyond what staff needed to do. I hope that the Minister will give us guidance on what is next for Leicester’s ECMO service. I hope that he will consider publishing his evidence, and that we can have some sort of review of, or at least look again at, the shift of Leicester’s ECMO service to Birmingham.

2.57 pm

Andrew Selous (South West Bedfordshire) (Con): I wish to raise the issue of neuroblastoma. I do so as someone who is proud of this Government’s record on the health service and who strongly supports their introduction of the cancer drugs fund.

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Neuroblastoma is an aggressive childhood cancer affecting about 100 new children in the UK each year. It is the most common cancer diagnosed in infancy and is responsible for 15% of cancer deaths in children. There are very few treatments available in the United Kingdom for children with high-risk neuroblastoma, particularly those who have relapsed, and they have to travel abroad for treatment, generally to Germany or the USA.

I had never heard of neuroblastoma before my constituent, Mr John Macglashan of Dunstable, came to see me in March this year. His two-year-old daughter Lilly has stage 4 neuroblastoma. The Neuroblastoma Alliance, along with the people of Dunstable and the surrounding area with the help of The Dunstable Gazette, have helped to raise funds to send Lilly for treatment in America. The whole family is going through an enormous ordeal, and I want to relay their experiences to the House, and make four suggestions to the Minister as to how the UK can improve the provision of treatment for children with neuroblastoma.

First, I know that the Government want high-quality treatment for children with neuroblastoma to be available in the United Kingdom, and I strongly support that. To that end, the Government are participating in a European collaborative research network on neuroblastoma through the Société Internationale d’Oncologie Pédiatrique en Europe. That European trial does not appear to adhere to UK ethical standards of offering the best treatment available as a baseline for all children meeting the eligibility criteria. I urge the Minister to make sure that the best treatment available is offered as a baseline for all children in the United Kingdom.

My second concern is that clinical trials in the UK are taking far too long to begin. In March 2010, the Department of Health agreed to commence a new trial to give monoclonal antibody therapy to all children who might benefit from it, but according to the Neuroblastoma Alliance, that has not yet begun. The Government should ensure that this trial commences as quickly as possible.

Thirdly, it is important that the Government ensure that there is a standard procedure for allocating funds for treatment abroad across all primary care trust areas. That is particularly important as there are currently no NICE guidelines on the subject, which remains important while there is no viable treatment available in the UK. My constituent Mr Macglashan has taken his daughter Lilly to the Memorial Sloan-Kettering cancer centre in New York at considerable personal expense and with huge funds raised by the Neuroblastoma Alliance, a charity that campaigns for children with the condition. Mr Macglashan tells me that in the same hospital there are children from Norway, France, Spain, Italy and Greece, all of whom are being funded by their national health services while his family has had to rely on charity.

Fourthly, it is important that the best treatment options from abroad, whether from Germany or the USA, should be examined and, where the clinical evidence supports the case, introduced into the United Kingdom as quickly as possible. At the moment, there are too few options available for high-risk neuroblastoma children who fail to achieve a lasting remission after front-line treatment. In the UK, parents see a system that gives up on their children too soon while there should still be hope. Much higher numbers of children are surviving for much longer with the American treatment, and some

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are achieving permanent remission following treatment at the Memorial Sloan-Kettering cancer centre in New York. We need to make sure that that level of expertise is available here in the United Kingdom.

This is not simply a call for even greater NHS spending than the Government are currently budgeting for, as the costs of prolonged chemotherapy and radiotherapy in the UK are not cheap and have been shown to have less success than the treatments provided in America. It appears that the UK is not spending its health budget as effectively as it could in this regard, and I ask the Government to look again at the issue. The NHS already sends children suffering from cancer for treatment in America—for proton radiation treatment, for example—so no precedent would be set by sending more children for treatment in America and Germany.

Finally, I ask the Government to look at the training of consultants in neuroblastoma, as there are too few who specialise in this area.

3.2 pm

Nicky Morgan (Loughborough) (Con): It is a pleasure to speak in this debate and particularly to follow the remarks of the hon. Member for Leicester South (Jonathan Ashworth) about children’s heart surgery at Glenfield hospital in Leicester. In view of the time limit, I will not repeat the issues to do with the Safe and Sustainable review, because those have been well rehearsed by other Members.

It is no great surprise that all Members, as well as all patients, all staff, all parents and all families, want the best services when dealing with children’s heart surgery. We are talking about very sick young babies and children, and there is no doubt that high-quality services are wanted across the country. At the same time, we have to recognise that in the 21st-century national health service there are bound to be reconfigurations. The reconfiguration that has been worked on by the Safe and Sustainable review arises out of what happened in Bristol, and there is a very good reason for what it proposes. As we have heard, there are some serious questions still to be answered about the process and the way in which decisions have been made.

In the debate in this Chamber in June 2011, I talked about the ECMO—extracorporeal membrane oxygenation —service offered in Leicester, which the hon. Member for Leicester South discussed. It is a world-class, excellent service, and the question is what will happen to it if the children’s heart surgery unit is moved from Leicester to Birmingham. Like the hon. Gentleman, I thank the Minister very much for meeting a delegation of east midlands MPs this afternoon to talk about this. ECMO is a nationally commissioned service and the Secretary of State is therefore required to sign off the move. I understand that he accepted the recommendations of the panel last Friday.

Those of us who are most interested in this and have been listening to constituents and to consultants and staff at the Glenfield unit have a number of questions to raise with the Minister. I would like to be sure of three things before I can be happy with how the decision has been taken. First, before the Secretary of State signed off the move, was he aware of the misgivings of experts that have been described by the hon. Member for Leicester

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South? Letters are still arriving from international experts. Indeed, since I have been sitting in the debate I have seen a letter that has arrived from the medical director of the Children’s Hospital of Philadelphia. I should like to read out a couple of quotes. The first is from Stephen Conrad, who is chairman of the steering committee of the Extracorporeal Life Support Organisation and who says that

“moving an ECMO program is non-trivial and amounts to much more than moving equipment and some key personnel. Excellent outcomes that are now characteristic of the Leicester group, whose work was instrumental in the worldwide adoption of pediatric and adult ECMO, would not be maintained following such a move.”

Liz Kendall: I am grateful to the hon. Lady for her work on, and support for, this important issue. Does she agree that this is not simply a matter of moving the machines but also about the expertise and skills of the staff, which would not be easy to move? Leading international experts on ECMO say that it could take between five and 20 years for the excellent level of service that is available in Glenfield to be made available anywhere else in the country.

Nicky Morgan: I am grateful to the hon. Lady; she is absolutely right. The hon. Member for Leicester South referred to Kenneth Palmer, who was retained to give his expert advice to the Joint Committee of Primary Care Trusts on the move. Since the decision was made on 4 July, he has said:

“You will take over 20 years of experience from one of the world’s absolute best ECMO units and throw it away and then to rebuild it in another place and probably it will take at least 5 years to have some kind of quality and probably 20 years to come back to top quality, if it’s ever possible.”

As the hon. Lady said, it is about the staff. Of course the machinery is important, but what has been built up in Leicester, and what it is most renowned for, is the expertise of its consultants, nursing staff, and all the other staff. That is what people particularly rely on. In addition, Leicester has the only paediatric mobile ECMO unit, which is often called out to fly by helicopter to other parts of the country to retrieve patients and take them back to Leicester. I hope that the Secretary of State and the JCPCT were aware of that when they made their decision.

My constituent, Mrs Edith Felstead, who wrote to me and talked about the risk of moving the service, says that survival rates at Glenfield are 20% better than in the rest of the world. The point that I made last year and still want to make is that we have an excellent, internationally renowned service, and if we move it, we must be sure that we are doing so to obtain better outcomes. Will the Minister tell me what advice was given to the JCPCT about the likely outcomes if the move were made?

The rather hefty tome that was published to help the JCPCT to make its decision on 4 July, refers to the secretariat being able to provide “reasonable assurance” that paediatric respiratory ECMO could be transferred safely to Birmingham. I am concerned about that phrase. What assurances have been given? In particular, if the move goes ahead and has to be implemented, what will happen if it then becomes clear in the course of preparing for the move that the service cannot be safely moved and we need to undo some of what has happened as a result of the review?

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As the hon. Member for Leicester South said, two narrow questions could be independently reviewed in relation to the Leicester move. I very much hope that following the meeting that we have just had and this debate, the Minister will agree to such a review. I would like to know what advice was available to the Secretary of State and to the JCPCT and the Advisory Group for National Specialised Services before they made their decision.

3.8 pm

Stuart Andrew (Pudsey) (Con): I am grateful for the opportunity to speak in this debate, Mr Deputy Speaker. May I offer you my congratulations on the honorary degree that you received yesterday from Swansea university?

I recognise that I may repeat many of the things that have been said, but this is such an important issue for constituents in Yorkshire and Lincolnshire that I make no apology for doing so. I am going to talk about the Safe and Sustainable review as well. We have received a number of e-mails from charities yesterday, one of which said:

“As some MPs look to reignite”

the debate about changes to children’s heart units

“we urge MPs to think about the children.”

Frankly, I found that rather offensive, because throughout the whole campaign I have only ever thought about the children.

When I worked at Martin House children’s hospice, I saw the effect on families when they were driven apart because the poorly child had to be a long distance away. On my visit a week or so ago to the unit in Leeds, I met a family who live in Sheffield. They brought their baby who was a few days old into the unit when the baby suddenly went very blue. Thankfully, because of the excellent work at the unit, that baby’s life was saved. That child was described as “marginal” in the review meeting on 4 July. That is not my description, but that of the decision makers. That is a shocking statement in my opinion. I also met another family who live in Sheffield. The father is making three trips a day between Leeds and Sheffield because there are other siblings at home. How on earth are such people expected to travel three times a day up to Newcastle?

I recognise that the review has been independent of Government, but I have grave concerns over the way in which it has been run. I support a review, because I want the best services for our children. I was grateful for the Minister’s comments earlier, when he said that the call-in process means that the matter will go to an independent panel. I would be grateful for clarification of whether that panel is independent of the JCPCT.

Mr Simon Burns: May I reassure my hon. Friend that the Independent Reconfiguration Panel is nothing to do with the JCPCT, my right hon. Friend the Secretary of State or me? It is an independent organisation that is there to look at reconfigurations across the country that are referred to it by my right hon. Friend following an oversight and scrutiny committee writing to him.

Stuart Andrew: I am extremely grateful to my right hon. Friend for that clarification. I hope that the independent review body will look at the issues that I raise.

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Logical health planning clearly dictates that services should be based on where the population live. Doctors should travel to where the patients are, rather than the other way around. Even the British Congenital Cardiac Association has said that:

“Where possible, the location of units providing paediatric cardiac surgery should reflect the distribution of the population to minimise disruption and strain on families.”

After all, it is not buildings that perform operations, but the doctors and surgeons within them. That definition seemed okay in the case of Birmingham. The review stated:

“The Birmingham centre should remain in all options due to the high level of referrals from the large population in its immediate catchment area.”

Why on earth does the argument about the large immediate population not apply equally to Leeds?

The independent analysis of patient flows states that many of the people in west and south Yorkshire and in Lincolnshire will probably go to Birmingham, Liverpool or even London instead. The JCPCT reaches the figure of 403 surgical procedures for Newcastle on the basis of only 25% of the patients going there. Even that is doubtful. How was the figure of 25% arrived at?

Andrew Percy: It is very convenient that the 25% figure gets Newcastle just over the 400 mark. However, my constituents in east Yorkshire and north Lincolnshire will not travel to Newcastle at a rate of 25%. They will go straight up the M62 to Liverpool or head south to Birmingham or even London, which are much easier to get to.

Stuart Andrew: My hon. Friend is right. I am sure that that is the case for constituents across Yorkshire and the Humber.

Greg Mulholland: I am happy to be working so closely with my hon. Friend on this matter. When all the evidence is considered, is not the reality that Leeds is being sacrificed simply to allow Newcastle to achieve a level of operations that it might not even achieve? That is no reason to close a good unit.

Stuart Andrew: I could not agree with my hon. Friend more.

The decision flies in the face of a fundamental aspect of the NHS constitution: patient choice. The JCPCT asserts that Newcastle could reach the minimum number of procedures if parents are “properly managed” to go to there. That is simply unacceptable. The whole point of patient choice is that people decide where they want to go.

As my hon. Friend the Member for Leeds North West (Greg Mulholland) said, the review ignored a petition of 600,000 people, counting it as only one response, when 22,000 text messages in support of the Birmingham unit were counted as 22,000 separate responses. Why was that?

The scores in the review were allocated to four bands. Each of the points from one to four were multiplied by the weighting. That gave 286 points to Newcastle and 239 points to Leeds. However, there was no clarification of how the figures had been arrived at. Also the figures were not definite, but were rounded up or down, which may have made a huge difference to the outcome.

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As has been mentioned, clinical experts at the BCCA, the Bristol inquiry, the Paediatric Intensive Care Society and the Association of Cardiothoracic Anaesthetists all say that surgical centres should be chosen on the basis of their having paediatric services all on one site. That is something that we enjoy in Leeds, which has a wonderful children’s hospital with all the services that are needed. On meeting such children, it is clear that they need the support not just of heart surgeons, but of other experts. In Newcastle, the extra support will be some 3 miles away. There will therefore be a worse service for people who live in and around Yorkshire, not the world-class service that we all want.

There is much more detail that I would like to go into. I sincerely hope that we will have a Back-Bench debate on this issue when we come back in the autumn, because it is of grave concern to hundreds of thousands of people in the Yorkshire region. We will not give up our fight to save our unit.

3.16 pm

Dr Matthew Offord (Hendon) (Con): I wish to raise the issue of wet age-related macular degeneration and the treatments that are available.

The condition usually affects the sight of people from the age of 60, although it can affect people at an earlier age. AMD is the most common cause of sight loss in the western world. In the UK, more than 500,000 people have the condition and about 250,000 people are registered as visually impaired. Because people are living longer, the number of people who are affected by AMD is increasing.

Although the condition causes central vision loss and can have a devastating impact, it does not lead to complete blindness as sufferers retain their peripheral vision. Unfortunately, there is no known cure, but drugs are available that can slow the growth of blood vessels in the eye. Such anti-vascular endothelial growth factor medicines prevent blood vessels from forming or growing. Three drugs have been used in the treatment of wet AMD: Macugen, Lucentis and Avastin. It is the latter two drugs with which my speech is concerned.

Fundamentally, what is the difference between the two drugs? At first glance, the answer is the cost. Lucentis costs about £700 an injection, while Avastin costs £60. The bigger answer is that Avastin is not officially approved for eye treatments. Lucentis gained its European Medicines Agency approval in 2007. It is officially approved for use in eyes and is the treatment recommended in England and Wales by the National Institute for Health and Clinical Excellence. The certification is based on extensive trials that show that is safe and effective for all lesion types in wet AMD. The trials have shown that it stabilises sight in more than 90% of cases and improves sight in 40% of cases.

The cheaper Avastin has not been approved by the EMA for use in treatments of the eye because it has not gone through the proper clinical trials. It has been approved as a treatment for colorectal cancers, and is therefore readily available. When used for colorectal cancers, the drug is injected into a vein in the arm. When it is used for the treatment of wet AMD, it is given into the eye.

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The findings of two trials comparing Avastin and Lucentis have been published recently. Those are the comparison of age-related macular degeneration treatments trial, known as CATT, which was carried out in the United States, and the inhibit VEGF in age-related choroidal neovascularisation trial, known as IVAN, which was carried out in the UK and was funded by the National Institute for Health Research. The IVAN trial, which was NHS funded, involved 610 patients in 23 hospitals. It was one of the largest research projects studying eye diseases in the UK. The one-year results were presented at an international conference in May this year and have been accepted for publication in the peer-reviewed journal, Ophthalmology.

The greatest debate about the differences between the two drugs is likely to be over their safety when used to treat wet AMD. Academics say that, overall, both drugs are extremely safe. My contention is that it is likely that cost pressures on the NHS will lead to increased use of Avastin. The IVAN researchers estimated that if the NHS were to substitute Lucentis for Avastin across the UK, it would save £84.5 million each year if 17,295 eyes were treated.

However, I am aware of the financial environment in which pharmaceutical companies operate. Like other industries, they manufacture products that must be sold at a profit, but in contrast to manufacturers in other industries their research and development costs are prohibitive. That means that they must make money on their investment. I recognise that they must not only regain their expenditure through profit but achieve profits to cover all the drugs that fail to get on to the market.

There has been criticism of NICE’s failure to recognise and adopt innovative new medicines. The UK is a world leader in medicines research, development and manufacture, but it is one of the slowest countries to enable patients to have access to innovative treatments. Avastin fits into that classification. I do not seek the Department’s licensing it immediately, but I call for the Government to establish an independent appraisal of it for use in ophthalmology. Clinicians are already using it off-label, so that would not be a leap in the dark. The savings that there would be for the NHS if the drug did work have already been quantified. However, if it is not safe, we must act to ensure the public’s health. I therefore ask the Minister to consider my request.

3.20 pm

Priti Patel (Witham) (Con): My comments will focus on the treatment of one GP in my constituency and his patients in Kelvedon, and on the state of health services in Witham town.

With the Government rightly empowering patients and medical practitioners, it is deeply alarming to see how one GP in my constituency is being treated. Dr Conor Macnamara has served the people of Kelvedon for a quarter of a century and is currently a salaried GP at the Brimpton House surgery in Kelvedon. He has been a stalwart of our local community, and whole families throughout the locality respect and trust him. He has upheld the values of the NHS on the front line and enthusiastically supported local residents.

Despite Dr Macnamara’s strong record, the primary care trust, which is now called NHS Mid Essex, and the GP principal at Brimpton House surgery, Dr Alsayed,

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have decided to end his employment and stop him treating local patients. They did so at the end of last year without consulting his patients, and they issued a statement informing his patients of the decision before Dr Macnamara himself was formally notified of it.

The decision to remove Dr Macnamara, and the way in which it was carried out, have caused considerable consternation among local residents. They are up in arms, and they have signed a petition objecting to any attempt to remove this long-standing family doctor from Brimpton House surgery. Yesterday, alongside the patient action group, they handed in a petition and delivered a letter to Dr Alsayed, reiterating their wish to see Dr Macnamara reinstated. I pay tribute to them for their campaign and remain extremely disappointed by the lack of engagement by the PCT and Dr Alsayed in addressing local concerns, and by their failure to address Dr Macnamara’s concerns. In my view, that is a classic example of NHS bureaucracy overriding patient choice. I hope that my right hon. Friend the Minister will look into the matter and help us find a good resolution that will lead to Dr Macnamara’s reinstatement.

As well as ignoring patient choice in Kelvedon, NHS bureaucrats have neglected health provision in Witham town. It is a growing town, and the local community is being overlooked in the provision of health services. We have a growing population, and the demand for new health service provision is reaching breaking point. Our population is increasing and more and more new homes are being built, so the provision of good-quality local health services is vital. Instead of investing in local services, the PCT has shamelessly spent hard-pressed taxpayers’ money on more managers and administrators.

The number of patients registered at the four GP practices covering the town and surrounding villages has reached almost 30,000. Those patients are covered by just 13.5 whole-time equivalent GPs, which makes more than 2,000 patients per GP. That is 40% higher than the 2011 national average of about 1,600. Local people need more GPs instead of managers, and I hope that my right hon. Friend the Minister can offer us some advice as local health campaigners. We want to press the new clinical commissioning groups to increase local GP provision. Progress must be made, and my constituents in Witham would welcome any intervention and encouragement that he can provide to nudge the process along, particularly given the Government’s reforms.

The Government have rightly prioritised the NHS, and their reforms will help save it in a time of financial uncertainty. I hope they will now do everything possible to ensure that their commitment to support patient choice and invest in front-line health services can be delivered in Witham, to avoid a health crisis and bring much-needed and long-overdue benefits to my constituents.

3.24 pm

The Minister of State, Department of Health (Mr Simon Burns): This has been an interesting and diverse debate, giving hon. Members an opportunity to raise a range of different subjects affecting their local communities and the health and well-being of their constituents. If there has been a main theme, it has been the Safe and Sustainable review of paediatric heart surgery. I fully recognise the strength of feeling and emotion on that difficult and sensitive subject, which is why so many Members have

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talked about it. They have included the hon. Member for Leeds North West (Greg Mulholland); the hon. Member for Hammersmith (Mr Slaughter), who mentioned the Brompton hospital in London, which is part and parcel of that review; the hon. Member for Leicester South (Jonathan Ashworth), who took interventions from the hon. Member for Leicester West (Liz Kendall); and my hon. Friends the Members for Pudsey (Stuart Andrew), for Colne Valley (Jason McCartney) and for Loughborough (Nicky Morgan).

I fully accept that the reorganisation of children’s cardiac services is a matter of real concern for the families involved, as indicated by the strength of feeling shown in the contributions of all the Members who have taken part in the debate. I know that some families have been disappointed by the outcome of the JCPCT’s recent decision. As hon. Members will know, children’s heart surgery has been a subject of concern for more than 15 years. Clinical experts and national parents groups have repeatedly called for change, and there is an overwhelming feeling that change is long overdue.

As passionately as people want to defend their local hospitals, it is far more important to ensure safety and quality of care for all children with congenital heart disease. We must ensure that those children continue to receive the very best care that the NHS can deliver, and I know that no Member would disagree with that overarching principle. That was what the NHS Safe and Sustainable review was aimed at, and as I have told many Members over the past 22 months, it was wholly independent of Government.

The review was led by clinicians and had the support of the Royal Colleges and national charities. Its conclusions were clear: for children with congenital heart disease to receive the very best care, specialist surgical expertise needs to be concentrated in a smaller number of centres. That will mean that surgeons have sufficient clinical work to maintain and develop their skills; that they can provide those services around the clock; and that they can train and develop the next generation of surgeons. I must stress that the JCPCT’s decision is not about closing or cutting back on children’s heart services—quite the opposite. It is about ensuring that the whole range of children’s heart services can deliver the very best care now and in future.

I thank in passing my hon. Friend the Member for Loughborough and the hon. Member for Leicester South for meeting me earlier this afternoon to discuss the important issue of ECMO and how it directly affects Glenfield hospital in Leicester.

Keith Vaz (Leicester East) (Lab): I am afraid other duties in the House prevented me from being at the meeting. Had I been there, I would have supported what the hon. Member for Loughborough (Nicky Morgan) and my hon. Friend the Member for Leicester South (Jonathan Ashworth) said.

Mr Burns: I am extremely grateful to the right hon. Gentleman. Not only am I sure he would agree with every word that my hon. Friend the Member for Loughborough and the hon. Member for Leicester South said, but I have considerable sympathy with him, as he was unable to attend the meeting owing to other pressing parliamentary duties in his role as Chair of the Select Committee on Home Affairs. To be even fairer to the right hon.

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Gentleman, the meeting was originally planned for 3 pm or 3.15 pm, but unfortunately, neither my hon. Friend, the hon. Gentleman nor I would have been able to attend because we were at that moment in the Chamber.

I understand from the nature of our discussions, as they will, that this is a difficult issue, because there are a number of complicated parts to the problem. I hear what they and other hon. Members have said about the Safe and Sustainable review, but I stick to my original position. The review is independent and is carried out not by the Government, but by the JCPCT. It would be inappropriate for me to become directly involved, to take sides or to pass comment because it would be felt that I was interfering. If hon. Members’ local authorities disagree with the decisions or recommendations of the JCPCT, their overview and scrutiny committees can write to my right hon. Friend the Secretary of State for Health to express their disagreement with the decision as it affects their local community or local hospital, and to request that the matter be referred to the independent reconfiguration panel, so that it can consider it independently and come up with a decision.

As my hon. Friend the Member for Colne Valley said, his local authority has today done just that. It may be helpful to him if I explain the procedure. My right hon. Friend the Secretary of State receives the representations and communication from the local authority overview and scrutiny committee specifying that it believes that the decision and recommendation as they affect the local hospital—Leeds, in my hon. Friend’s case—are wrong. The overview and scrutiny committee then asks my right hon. Friend whether he will refer the matter to the independent reconfiguration panel. I do not want to prejudge, but it is almost certain that my right hon. Friend will refer the matter. It will be then be up to the IRP, which is independent, to look at the recommendation and the criticisms made by the overview and scrutiny committee, and to reach a conclusion, which will be an independent conclusion, on whether it agrees with the recommendation or the criticisms of it and perhaps of the procedures involved. The IRP will then make my right hon. Friend aware of its independent view of the complaint.

Jason McCartney: Will the Minister clarify the time scale of the procedure he has described and also tell us who has the final say?

Mr Burns: It is difficult to give a time scale for this reason: as soon as my right hon. Friend receives representations from the overview and scrutiny committee, he will consider as quickly as he can whether to make a referral. As I have said, in the life of the IRP, every request for a referral has been granted—that is certainly true of my right hon. Friend’s time in office, but I believe it is also true of previous Secretaries of State under the previous Government. It is up to the IRP. I know of one example of my right hon. Friend requesting that the IRP respond within a certain time frame, but that was on a single issue. It is possible, with regard to the Safe and Sustainable review, that a number of referrals could be made by different OSCs in relation to the recommendations—I do not know but it is a possibility.

Stuart Andrew: Will the Minister give way?

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Mr Burns: I will give way once more, but then I will have to make progress, because I only have 10 minutes to respond to the whole debate.

Stuart Andrew: Will the independent panel have the power to request all the documentation that the Safe and Sustainable review and the JCPCT have been looking at? Will everything be released so that it can look at the evidence in detail?

Mr Burns: The IRP?

Stuart Andrew: Yes.

Mr Burns: I think I can assure my hon. Friend that the IRP will have available to it all the evidence, in all shapes and forms, to help it to form its final opinion of the complaint referred to it. I hope that that reassures him. I say to my hon. Friend the Member for Loughborough and the hon. Member for Leicester South that the same can apply with regard to the decision about ECMO. I have no doubt that Leicester city council will give consideration to that.

I shall briefly respond to the remaining issues. My hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) made several extremely interesting suggestions. Some of them might not be in line with current Government thinking, but I shall certainly refer her ideas and views to the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), who deals with our alcohol strategy. Similarly, my hon. Friend the Member for South West Bedfordshire (Andrew Selous) raised an important issue, and again I will refer it to the Under-Secretary of State.

The hon. Member for Mitcham and Morden (Siobhain McDonagh) mentioned the potential reconfiguration at St Helier hospital. As she will know, the proposals are still being worked on. There has not yet been a consultation process, but the decisions have been taken locally by the local NHS. I trust that, if and when there is a consultation process, she will get involved.

Siobhain McDonagh: Absolutely.

Mr Burns: I thought she would say that. That is very good. After the consultation, the due processes of reconfiguration can move forward.

My hon. Friend the Member for Hendon (Dr Offord) asked about Avastin. A study is being done into its effects. We are following that closely, and when we find out more we will consider the matter and potentially reach a judgment, but I cannot give him any commitments at the moment.

Finally, I turn to my constituency neighbour, my hon. Friend the Member for Witham (Priti Patel). I am sorry to hear about the problems that she highlighted on behalf of her constituents. I do not want to disappoint her, because she is my neighbour and I have to live with her on a weekly basis, but given the background to the case, I think it is a matter for the GP practice as the employer of the GP whom she mentioned. I encourage her to engage with Mid Essex PCT, even though it has no direct powers or role in this matter, and the clinical commissioning group in the mid-Essex area, because they are best placed to address the concerns about the provision of services for her constituents, which I know she is fearless in defending, protecting and promoting.

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Mr Deputy Speaker (Mr Nigel Evans): I thank the Minister. I wish him and those Members not staying for the other debates a happy and productive recess. We now move to a short debate on foreign and commonwealth affairs, after which we will proceed to a debate on the environment, food and rural affairs. Members listed under other topics will then be taken in the general debate. We still have the five-minute limit on speeches.

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Foreign and Commonwealth Office

3.39 pm

John McDonnell (Hayes and Harlington) (Lab): Once again I wish to raise the issue of human rights and the death penalty in India. I pay tribute to four organisations—Kesri Lehar, Liberation, Amnesty International and Human Rights Watch—that have continued to expose the Indian Government’s failure to address human rights abuses effectively. Kesri Lehar launched the “Wave for Justice” campaign, along with a petition, which has now been signed by more than 100,000 people, to seek a full debate in Parliament on the issue, which I hope we can secure later in the year.

I want to raise three issues of concern. The first issue is the historic failure of the Indian Government to bring to justice those who perpetrated the massacre of the Sikhs in Operation Blue Star in 1984, which started with the attack on the Golden Temple in Amritsar and resulted in the murder of hundreds of thousands of Sikhs in the following decade, and was described as Indian’s hidden genocide. Despite various commissions of inquiry into abductions, disappearances, extra-judicial executions and secret cremations, Amnesty’s latest report confirms that the Indian Government have failed to hold the perpetrators to account. In 2004, on the 20th anniversary of the massacre, I launched a report in this House called “1984: Sikhs’ Kristallnacht”. We called for an independent commission of truth and justice, under the auspices of the United Nations, to investigate the slaughter. Since then there has been no progress and the Sikhs still await justice.

What is even more galling, however, is that two individuals—Jagdish Tytler and KPS Gill, who are both accused of playing leading roles in the human rights violations in 1984 to 1995—may well seek to visit Britain for the Olympics in their capacity as Olympic officials for India. It would be a travesty of justice and cause deep offence to the whole of the Sikh community in the United Kingdom if these brutes were allowed to enjoy this country’s hospitality.

The human rights abuses go on. Human rights NGOs have confirmed that human rights violations against minorities continue today, including against the Sikhs. Human Rights Watch’s latest report dealt with custodial killings and police abuses, including torture. On average, 1,500 people a year are dying in custody in Indian prisons and police stations, while rape is used as a form or torture. For 18 years the Indian Government have denied the UN rapporteur on torture access to India. Amnesty now reports that over the past two years 30 human rights defenders have been targeted for abuse by state and non-state organisations, with eight people being killed as a result. Meanwhile, the Indian Government have failed to repeal the laws that afford state impunity to human rights abusers. Indeed, impunity seems to be common for the perpetrators of human rights abuses in India. That is not acceptable by any standards.

The ultimate violation of human rights, however, is to take a person’s life. That is why there was such shock and anger at the Indian Government’s threat—made only months ago, after an eight-year hiatus—to implement the death penalty against people such as Professor Davinder Singh Bhullar and Balwant Singh Rajoana. Professor Bhullar was convicted only on a confession

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that was obtained by torture and later retracted. Balwant Singh Rajoana has already served 17 years on death row and has suffered enough. The threat of capital punishment for those individuals has been lifted for the time being, but now two thirds of the world has renounced the death penalty. I say as a friend of India that it is time India did so too.

I appreciate what both the last Government and this Government have done in making representations to the Indian Government over the years. I also pay tribute to the work that the Minister has done in pressing the Indian Government on these issues. However, I once again urge the Government to use our bilateral talks, and the EU-India human rights dialogue, to call on India to take decisive action to protect human rights and, in particular, to abolish the death penalty. It is time India addressed this issue. India is the largest democracy on the globe, yet it stands alone in the developing world in still supporting the death penalty. India should adhere to human rights and, at the same time, ensure that capital punishment is no longer a stain on the country.

3.44 pm

Paul Flynn (Newport West) (Lab): The professionalism, valour and courage of our soldiers who have served in Afghanistan and those serving there now are as distinguished as any in our long military history. Some of our allies have already decided to withdraw their troops. They are not the nations that were not enthusiastic about the war, but those that have paid huge costs in blood and treasure. Canada withdrew its combat troops after a debate in its Parliament that was supported by every party. The Netherlands has also done so, and we now know that Australia and France intend to bring their troops home early.

The United Kingdom has lost 422 troops, and we have spent £20 billion, but that is only part of the cost. We must also take into account the number of troops who return from Afghanistan broken in body and in mind. Figures from America show that more of its veterans from Afghanistan take their lives after combat than die in combat. The same applied to our figures from the Falklands war. We know that the dying will continue.

A case in Pembrokeshire involved a soldier who had suffered grievously in Afghanistan. His death is not counted among the 422 casualties, however. In Afghanistan, he was shot twice and involved in two separate incidents involving improvised explosive devices, but his loved ones explained that the experience that haunted him was holding his best friend, who had lost a number of limbs in an explosion, and watching as the life retreated from his eyes. It was that experience that drove him to take his own life.

There are powerful reasons for saying that we are continuing to order soldiers to risk their lives for the cause in Afghanistan, but I do not believe that a case can be made for doing so any more. A recent briefing said that we needed to get all our equipment out of Afghanistan at enormous cost, because we did not want to see the Taliban riding round in British tanks in five years’ time. However, having gone into Afghanistan when it was ruled by the Taliban and engaged in a civil

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war, the likelihood is that, by the time we leave, there will be another civil war and that it will be ruled by the Taliban once again.

For 10 years, we have heard optimism being expressed by all Governments, along with exaggerations of success and dismissals of the failures that mounted up, year after year. It was not necessarily a mistake to go there, although no British interests were threatened in 2001. It was, however, a terrible mistake to go into Helmand province. In our first five years in Afghanistan, only two of our soldiers died. Then, we provocatively stirred up the hornets’ nest in Helmand, in the foolish and mistaken belief that not a shot would be fired. Our operations in Helmand were described in the House at the time as being as futile as the charge of the Light Brigade, but we have now lost three times as many troops in Helmand as were lost in that charge.

It is a dereliction of duty for the House not to debate the withdrawal of our troops from Afghanistan. We know that the people of this country are strongly in favour of such a withdrawal. In a recent by-election, a candidate from a minority party with only one policy—withdrawal from Afghanistan—gained 56% of the votes and humiliated all the other parties. We also know that 80% of the public want our troops to withdraw now, yet we are being distracted by the bread and circuses of all the events taking place this year, and we cannot find a moment in our parliamentary diary to discuss whether we should bring our troops home before we reach the point that Senator Kerry described when he was an officer in Vietnam in the final days of that war. He spoke of asking the agonising question: who will be the last soldier that I will order to die for a politician’s mistake?

3.49 pm

Keith Vaz (Leicester East) (Lab): I had hoped that, after the election of President Hadi in Yemen, I would no longer need to raise the situation in that country. Sadly, however, the situation has deteriorated even further since the election. Only last week, 22 people died in a suicide bomb attack in Sana’a. That attack followed a number of others perpetrated by al-Qaeda in the Arabian Peninsula. I remain deeply concerned that, even though the old regime has gone and President Hadi has been elected, there is still a major security problem in this beautiful but troubled country.

As the House knows, I was born in Yemen, and I spent the first nine years of my life there. I have the pleasure and privilege of chairing the all-party parliamentary group on Yemen. I have not been able to visit the country over the past two years because of the security situation; so if it is bad for someone such as me and other Members, it is very bad for people in Yemen.

I am delighted to see at the Dispatch Box the Under-Secretary of State for Foreign and Commonwealth Affairs, the hon. Member for North East Bedfordshire (Alistair Burt), and I want to pay tribute both to the Foreign Secretary and to him for all the good work they have done in ensuring they keep a dialogue going with the Yemeni Government and the Yemeni authorities. The Minister met last Thursday, as did I, Dr Abu Bakr al-Kurbi, the long-standing Foreign Minister of Yemen, and I know that useful discussions were held about the situation.

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I am very pleased that Nicholas Hopton has taken over as our ambassador in Sana’a, although the difficulty of having an embassy there is recognised by the fact that this is truly a hardship post, and it is time limited, which is something we do not do to many of our embassies all over the world. The first issue, then, is security. What does the Minister have to say about the security situation in Yemen? What can we do to help the new Government? What can we do to ensure that they have the equipment and support they need?

A few years ago, I spoke of the need for one scanner at Sana’a airport, and I recently tabled a question asking whether the scanner had arrived, two years later, and was told that the information could not be released because it was not in the public interest to do so. I then put in a freedom of information request. I do not think it is a big deal to tell an MP whether a scanner that was promised two years ago has arrived at Sana’a airport. I hope that the Minister can provide that information in his reply.

The second limb of any discussion about Yemen is the humanitarian situation, and I want to pay tribute to my near constituency neighbour the Minister of State, Department for International Development, the right hon. Member for Rutland and Melton (Mr Duncan) for all the work he has done. He has attended a number of the Friends of Yemen conferences, and £2.5 billion has been pledged over the last few years. I know that our Government have given £31.7 million in humanitarian aid. It remains the case that 500,000 people are displaced as a result of the situation in Yemen, and it remains the case that 50% of the Yemeni population do not have access to clean water and sanitation. It remains the case, too, that the vast majority of Yemenis live on less than £1.29 a day. This situation can only help to feed the ambitions of al-Qaeda in the Arabian peninsula.

All I ask from the Minister—as I said, Ministers have continued the good work of Ministers under the last Government—is that we continue our strategy and our plan to help the Government of Yemen, and that we give them whatever support they need. We must be cautious about one aspect: when we have international conferences, many countries—the Saudis, for example—pledge a lot of money, but I do not know whether it is actually paid. We must ensure that, having made a pledge, the donors ensure that the money reaches the people who matter—the people of Yemen.

3.53 pm

The Parliamentary Under-Secretary of State for Foreign and Commonwealth Affairs (Alistair Burt): I thank the three colleagues who have spoken briefly and succinctly, but equally powerfully, in each set of comments. I am not time limited, but I will do my best to be as brief as possible, fair in responding to what colleagues have said and fair to those who are waiting to speak. I shall deal with colleagues’ contributions in order.

The hon. Member for Hayes and Harlington (John McDonnell) raised the issue of the death penalty in India and some particular cases. One of the advantages of having a deep and wide-ranging bilateral relationship with India is that it allows us to have frank and open conversations about all areas of interest and concern. Where we have concerns about human rights issues, we have made them clear to the Government of India.

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I know that the death penalty is of particular concern to Members and their constituents, as the hon. Gentleman made clear. Both my right hon. Friend the Foreign Secretary and the Minister of State, Foreign and Commonwealth Office, my hon. Friend the Member for Taunton Deane (Mr Browne), who has responsibility for matters relating to India, receive a significant amount of correspondence on the subject.

We have made our opposition to the death penalty in all circumstances clear to the Government of India on many occasions, urging them to formalise the now eight-year de facto moratorium with a view to eventual abolition. The decision earlier this year to proceed with the execution of Balwant Singh Rajoana was therefore deeply concerning. We took every opportunity to express that concern to the Government of India, and I am grateful for what the hon. Gentleman said about our efforts. According to the note I have here, the issue of the death penalty and particular cases have been raised deliberately on 11 occasions in the past 12 months. We are obviously pleased that a stay of execution for Balwant Singh Rajoana was announced on 28 March so that the President could consider an appeal for clemency.

Much of the correspondence received by my ministerial colleagues refers specifically to that and a number of other cases relating to Sikhs, and to events in the state of Punjab in recent decades. Our principled opposition to the death penalty is of course separate from the specifics of cases in which we must be careful to avoid interference in India’s judicial process, just as we would wish other Governments to respect our own. However, the UK is active in encouraging an improvement in the treatment of minority communities in India. The British high commission in New Delhi has discussed minority community issues with the Indian National Commission for Minorities and with various other state-level authorities, and I assure Members that those discussions will continue.

In addition to such bilateral exchanges, the main forum for discussing concerns such as those raised by the hon. Gentleman is the annual EU-India human rights dialogue, the next round of which will take place soon. It allows a frank exchange of views, and, crucially, it is a two-way process. The matters that the hon. Gentleman has raised today will certainly be raised again in the course of that dialogue.

During the United Nations Human Rights Council’s universal periodic review of India in May, we urged it to maintain its de facto moratorium on the death penalty. We asked about the Indian Government’s response to concern about India’s security legislation, and also noted concern about reports of a significant number of cases of torture by police and security authorities. We recommended that India expedite the ratification of the convention against torture and its optional protocol, and adopt robust domestic legislation to that effect.

The hon. Gentleman also raised the issue of the Olympic games, and asked specifically about accreditation. We do not routinely comment on individual cases, but our policy is clear: accreditation will be refused to any individual who may present a safety or security risk or whose presence at the games or in the UK would not be conducive to the public good, and it will be refused if there is independent, reliable and credible evidence that an individual has committed human rights abuses.

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The hon. Member for Newport West (Paul Flynn) made a familiar but none the less passionate and heartfelt plea in relation to those who are serving in Afghanistan, repeating concerns that he has raised regularly about what he believes to be their overlong presence there. There is no doubt that when he speaks about the circumstances affecting individual soldiers and what they have experienced, either personally or through what they have observed with others, he speaks movingly and with heartfelt compassion, and no one could deny the force of what he says. He constantly raises the questions “What has it been worth?” and “Is it ever worth it?” It would be wrong for me to stand at the Dispatch Box and not give a positive answer to those questions, or rebut, as gently as I can, some of the hon. Gentleman’s worst fears.

As I have said to the hon. Gentleman before, I believe that there are genuine signs of progress. We know that there are still difficult days to come, but let me offer an answer to those who feel that absolutely nothing has been achieved. The number of district governors has risen from five in 2008 to 12. Eight of Helmand’s 13 districts, and the municipality of Lashkar Gah, are now either in transition or about to embark on it. That means that their security will be no longer the responsibility of UK or international forces but that of Afghan forces, which are gradually taking more and more responsibility for their own areas. Tranche 3 of the transition will see some 75% of the population of Afghanistan covered by their own forces, which have been trained by the international forces in order to meet the security needs of the people in the future. That will allow the UK and international forces to retreat from their international obligations in 2014, as has long been planned. I also say to the hon. Gentleman that we have no sense that we are not going to stick to that timetable, which truly matters for the future security of those in Afghanistan.

Some 145 schools are open, an increase of 79% since 2008. There are 89,000 male students in Helmand province and 29,000 female students. There are women teachers, too. All these things did not happen before, which is why the people of Afghanistan are so concerned that the progress must be maintained. We can ensure that only by sticking to the timetable.

The series of international conferences in the past year or so—Bonn, Chicago, Tokyo, Istanbul—have all been designed to demonstrate that, although combat troops will be leaving in 2014, the international community’s commitment to Afghanistan will continue. Chicago was about how the future security will be guaranteed. Tokyo was about international development support; we are committing to give the same level of support as now until 2017, after which time the situation will be reviewed. All these assurances are absolutely essential for Afghanistan’s people as they take more responsibility for their own future.