The difficulty in obtaining transcripts of judgments is an important problem that is causing difficulties in ensuring that the appellate system operates properly. There were two cases in Birmingham recently where there was no transcript on the file. It took almost three

14 Jan 2013 : Column 700

months to obtain the transcript in one of these cases. The Bill does nothing about this. Furthermore, an appeal from the family proceedings court to the county court can exhaust domestic proceedings. That might be good for anyone wishing to take a case to Europe, but it raises a further question about the integrity of the legal system if the Court of Appeal cannot look at something before it leaves the domestic jurisdiction. The Bill, in creating a single family court, might deal with this, but it is a matter of detail that needs to be sorted out.

I have helped litigants in person with three cases that involved appeals in the Court of Appeal where the appeal was allowed. I will not go into the details, because I do not have time, but all the appeals were allowed. One can have no certainty that any of these appeals would have gone before the Court without my involvement, and I am not a lawyer. I see many cases that I think would win appeals, but it is simply the procedural complications of getting the paperwork together, including access to the original case files and judgments, that prevents this.

I am also aware of a number of cases where a party is frightened to appeal because they are likely to face the judge in the Court of First Instance again and fear the use of judicial discretion to punish them for appealing. To me, appeals that have the potential to be allowed but which are not heard are miscarriages of justice just as much as the case referred to in early-day motion 835—a case where the parents were banned from talking to the media in any way. The Bill does nothing to deal with any of those situations.

The Bill does deal with conflicts of interest relating to judges—in paragraph 8 of schedule 9—but it remains the case that a firm of solicitors can act for parents in one case against a local authority and act for the same local authority in a second case, even with the same individual solicitor doing the work. That is a clear conflict of interest and gives rise to what is known as repeat player prejudice. I have seen a number of cases where this conflict of interest appears to have had an effect on the advice given and the consequent outcome for parents. A social worker previously told me how he had colluded with parents’ solicitors to ensure that the parents lost. However, this conflict of interest appears to be tolerated by the system, and the Bill proposes no modification.

The House of Commons often does not manage to scrutinise proposals effectively where there is not a proper party or adversarial division. This, even if I rushed my speech, is one of those areas.

9.39 pm

Jenny Chapman (Darlington) (Lab): I am afraid I will sound rather slow after the previous speaker. The hon. Member for Birmingham, Yardley (John Hemming) made a speech at great speed; he managed to read it quickly into the record—well done.

My right hon. Friend the Member for Wythenshawe and Sale East (Paul Goggins) added his support for GPS tagging, which we will explore further in Committee. He made some sensible comments on restorative justice, emphasising the need for consent and full involvement of the victim at all times—something we will also explore deeply in Committee. We are very keen to ensure that the quality of restorative justice is maintained.

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My right hon. Friend the Member for Blackburn (Mr Straw) spoke of the tensions between national and local policing, and gave his support, following Norgrove, for the single family court, as did the hon. Member for Enfield, Southgate (Mr Burrowes). My right hon. Friend the Member for Blackburn gave a succinct analysis of what is becoming known as the “bash a burglar” clause, and promoted his memoirs. We all look forward to the film of those memoirs. The right hon. Member for Berwick-upon-Tweed (Sir Alan Beith) suggested that the clause was not actually that great a change; in fact, he said it was not a change at all. The hon. Member for Dewsbury (Simon Reevell) discussed at some length the complexities and contradictions in the Bill. He highlighted some issues that I think will get a thorough airing in Committee.

The right hon. Member for Dwyfor Meirionnydd (Mr Llwyd) raised concerns about the anxiety of witnesses arising from the televising of court proceedings. We look forward to exploring those concerns fully in Committee. We are keen to ensure the protection of witnesses, victims, jurors and also defendants through the court process.

My right hon. Friend the Member for Leicester East (Keith Vaz) and my hon. Friend the Member for Leeds East (Mr Mudie) mentioned something that I think will be of grave concern to many Members: the right of appeal on family visit visas. There are fears about the serious impact on families. Bearing in mind the high level of errors in decision making, we are keen to discuss that further. My right hon. Friend the Member for Leicester East went on to discuss the welcome changes to drug-driving. We can all commend the hon. Member for Croydon Central (Gavin Barwell) for the work he has done in that area.

My hon. Friend the Member for Stretford and Urmston (Kate Green) spoke with great insight on diversity in the judiciary. We strongly welcome those changes. We are also keen to explore the issues raised by Alan Milburn in his social mobility report on the under-representation of state-educated people in the judiciary.

The hon. Members for Gainsborough (Mr Leigh), for Congleton (Fiona Bruce) and for Cambridge (Dr Huppert) spoke of the importance of amending the Public Order Act 1986. The hon. Member for Gainsborough asked that the Labour party keep an open mind, and I assure him that we will do just that.

My hon. Friend the Member for Middlesbrough (Andy McDonald) is concerned about whether there will be sufficient resources to fight organised crime, and we share those concerns. My hon. Friend the Member for Hayes and Harlington (John McDonnell) discussed the scandalising of the judiciary, suggesting that it should not just be a right, but perhaps become a duty. He discussed clause 23 and expressed concerns about the practices of bailiffs, and I assure him that we will be exploring those concerns in Committee.

The hon. Member for Foyle (Mark Durkan) talked about how the National Crime Agency will operate in Northern Ireland, and the Government will need to respond to his concerns. The hon. Member for Mole Valley (Sir Paul Beresford) talked about the hotbed of crime that is his constituency, and about the Child Exploitation and Online Protection Centre. We have concerns about child protection and the NCA, which

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we will explore further. We are happy to give support to much of the Bill and we will not vote against it on Second Reading.

On self-defence, there is agreement across the House that a victim of burglary, who is compelled in traumatic circumstances to use force for their own protection, should be protected in law. Burglary is a terrible and invasive crime. Victims must have the right to defend themselves and their loved ones, and know that the law is on their side. The Labour Government changed the law to give that support to victims of burglary. In 2008, Labour gave victims the right to use “reasonable force” to defend their homes. That is not “reasonable force” as decided by a risk assessment; it is force that, as the Crown Prosecution Service and the Association of Chief Police Officers put it, is

“what you honestly and instinctively believe is necessary in the heat of the moment”.

The current law provides a complete defence for those using reasonable force in self-defence or the defence of their loved ones or property, and according to the Director of Public Prosecutions it works very well.

Mr Vara: The hon. Lady cites the CPS, but what does she have to say about the fact that at least four Metropolitan Police Commissioners, including the present one, believe that the law should be strengthened and enhanced?

Jenny Chapman: As I was about to say, we are ready and willing to engage with the Government on any proposals they have that might further improve the law. We want to see the system work as best it can for victims of crime and, of course, to see justice done in every case. However, concerns have been expressed by many outside this place, and these need answering. The Government need to assure the public that the change does not add confusion and explain exactly how it adds protection. The line between “disproportionate” and “grossly disproportionate” is still unclear.

While we are talking about how people protect themselves during a burglary, we should be just as keen to discuss how we punish a burglary or prevent it in the first place. My right hon. Friend the Member for Tooting (Sadiq Khan) has uncovered disturbing statistics about some of the sentences being handed to burglars with strings of previous convictions. The Government are introducing a number of measures in the Bill on community sentencing and the use of measures such as tagging. We need to ensure that they are used appropriately. When the Bill was introduced in the other place, it included, at the end of part 2, a rather vague clause that promised the Secretary of State for Justice scope to do what he pleased in the area of community sentencing. It is therefore welcome that, after a wait, we find that what pleases the Secretary of State has been laid out in schedule 15 for debate in this House. We welcome the inclusion of proposals permitting the extended and earlier use of restorative justice. Restorative justice is an effective tool that can do a lot to improve the experience of our justice system and what it offers victims of crime. There are questions that need to be answered on the details, however. How, where, by whom and how uniformly will restorative justice be provided?

There is much that we agree on. In his foreword to the long anticipated response to the Government’s consultation on community sentences, the Secretary of State states

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that, in order to be both “credible and effective”, community sentences need to strike a balance between punishing an offender for their wrongdoing and rehabilitating them to prevent a repeat offence. He also rightly notes that the public reserve some concerns about community sentences. The ambition of improving public safety and public confidence is strongly welcomed and shared across this House. In order to be “credible and effective”, however, the Secretary of State needs to get this right. The Government say they want all community sentences to include a punitive element, unless there are exceptional circumstances. We support the premise, but two questions arise: what counts as a “punitive element”, and what counts as “exceptional circumstances”? Until we hear the answers to those questions, we will not know whether there is anything new in the Government’s plan or whether the change is nothing more than window dressing.

On the extended use of tagging, we do not want this used inappropriately as a cheap alternative to prison for those who should be behind bars. If the public are to find such sentences credible, they need to be certain that they will be used with great discretion and only when wholly appropriate. I note that in 2011, eight adults convicted of rape and hundreds convicted of serious violent offences were given community sentences. It is also timely to mention the point that the public need to have faith that those supervised in the community rather than in prison are being expertly and safely supervised. This is an area where—amidst cancelled pilots and detail-light plans for managing offenders’ risk—we find some cause for concern. We look forward to exploring that further in Committee. In particular, I look forward to examining in more depth the Government’s intentions on provision in the community for female offenders. The Opposition also strongly support the provisions in schedule 13 that seek to facilitate greater diversity in judicial appointments.

There is much that we agree with in the Bill and we will not vote against it on Second Reading.

9.49 pm

The Minister for Policing and Criminal Justice (Damian Green): I am grateful to everyone who has contributed to what has been a wide-ranging debate—irrespective of whether they did so at normal speed or, as in the case of the hon. Member for Birmingham, Yardley (John Hemming), at turbo-charge speed.

As my right hon. Friend the Home Secretary noted when she opened the debate, we need to do more to protect the public against serious and organised crime, and to improve further the efficiency responsiveness and transparency of the justice system. I welcome the broad support of a number of provisions from all sides, including from the hon. Member for Darlington (Jenny Chapman) who wound up the debate for the Opposition.

In establishing the National Crime Agency as a key objective of the Bill, it also brings forward, as we have heard today, many other noteworthy reforms. The package of court and justice reforms introduced in part 2 will deliver a swifter, more open and effective courts and tribunal system while improving judicial diversity and establishing a new tool to tackle economic crime—namely, deferred prosecution agreements. For that work, the House should pay tribute to my hon. and learned Friend the Member for Harborough (Sir Edward Garnier).

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In many instances, these reforms will have a real and meaningful impact on those who use the court and justice system. For example, the establishment of a single family court will make the court system more accessible and less confusing for families who come into contact with it.

We are also determined to improve the public’s confidence and understanding of the criminal justice system. That is why this Bill introduces measures that require courts to include a punitive element in every community order for the first time. This will help bring community orders into line with other sentences such as fines and custody where it is clear that punishment is a key purpose of the sentence.

Furthermore, the introduction of court broadcasting, initially in the Court of Appeal, will help to demystify the justice system. Justice must be done and seen to be done if it is to command full public confidence.

Sir Alan Beith: Can the Minister give us any clue as to how we know what constitutes a punitive element in a community sentence?

Damian Green: I think those receiving the sentence will know. I cannot set out the details, because that is for the courts. Anything that requires the deprivation of liberty at a particular time or the performance of a task at a certain time can contribute to the punitive element of a sentence.

Let me move on to deal with some of the detailed points raised during the course of the debate.

Mr Straw rose

Damian Green: I suspect I will not be able to deal with them all—in fact, I certainly will not be able to do so, but I give way to the right hon. Gentleman.

Mr Straw: Will the right hon. Gentleman explain his train of thought when he says that demystifying what happens in the courts will automatically lead to a rise of public confidence in them?

Damian Green: As a former Lord Chancellor, as well as a former Home Secretary, the right hon. Gentleman will surely wish to join me in paying tribute to the judiciary, who will be the first people to be televised giving verdicts in the high courts. I am sure he will agree that that will help to explain the decisions they come to.

Returning to detailed points in the debate, I am delighted that my hon. Friend the Member for Gainsborough (Mr Leigh) congratulated the Government on clause 38. Having been a Member of the House for 15 years, I have to say that this is the first time I have ever heard him do so for any Government, and I look forward to many more such occasions in the coming months and years.

Mr Leigh: Don’t get too excited.

Damian Green: As my hon. Friend says, I should not get too excited.

The shadow Home Secretary asked how the NCA would work with police and crime commissioners. The PCCs have a national role in tackling the sort of serious and organised crime whose pernicious effects are felt in

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every community in every street in the UK. They will be key strategic partners for the NCA. Keith Bristow has already spoken with the newly elected commissioners as part of the central PCC briefing that the Home Secretary hosted in November. He and the wider NCA will obviously continue to engage with them, including through the Association of Police and Crime Commissioners.

The right hon. Lady raised the issue of the tasking element, as did many other Members. She asked whether direct tasking by the NCA director general would cut across the authority of police and crime commissioners. I do not believe that there will be any conflict. Fighting serious and organised crime is a shared concern of the NCA and the PCCs. Tasking by the NCA will be used to fight the kind of cross-boundary serious and organised crime that is more difficult for individual forces to tackle, and to which PCCs must already have regard under the strategy policing requirement to which they, as well as just chief constables, must sign up.

The right hon. Lady also asked about the framework document. It will be a joint statement of intent by the Home Secretary and the director general of the NCA, setting out how they will work together. The final NCA framework document cannot be produced until after Royal Assent; it will be published and laid before Parliament in due course.

There was much discussion of the self-defence clause. The right hon. Member for Wythenshawe and Sale East (Paul Goggins) referred to it, as did my hon. Friend the Member for North West Cambridgeshire (Mr Vara) and the right hon. Member for Dwyfor Meirionnydd (Mr Llwyd). We are not changing the fundamental premise that people can use only force that is reasonable in the circumstances as they believe them to be. What we are saying is that when a person is attacked by an intruder in his or her home, in the light of all the terror that that brings—greater, probably, than the emotions that would be aroused in someone defending commercial premises—it may be reasonable for that person to use a greater degree of force than is permitted by the current law. Householders should not be treated as criminals if they have used force that was reasonable in the circumstances as they believed them to be, even if that force turns out to be disproportionate when viewed in the cold light of day.

My hon. Friend the Member for Dewsbury (Simon Reevell) asked why the provision was limited to householders. It is attacks by intruders in the home that cause the greatest public concern. A home is supposed to be a haven, a refuge, a place where people have every right to feel safe, and that is why we believe that householders deserve special protection.

I am grateful to many Members, including the right hon. Member for Wythenshawe and Sale East and the hon. Member for Stretford and Urmston (Kate Green), for their support for the restorative justice proposals. A number of interesting details emerged, which I shall certainly consider. I share the desire of the right hon. Gentleman and the hon. Lady—and, I think, of the wider House—to develop the idea of restorative justice so that it becomes much more important to the way in which we continue to cut crime and prevent reoffending. I know that it is one of the key elements that my right hon. Friend the Justice Secretary wants to introduce in order to continue our success in that regard.

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The right hon. Members for Leicester East (Keith Vaz) and for Blackburn (Mr Straw), among others, mentioned family visit visas. The current family visit visa appeal right no longer serves its intended purpose. The appeal right for visitors is an anomaly: no other types of visit visa, such as business and tourist visas, attract the full right of appeal. People who are refused visit visas may reapply as many times as they like, and may provide further information in support of their applications. The expenditure on family visit visa appeals constitutes a disproportionate use of taxpayer funding for the benefit being sought. Removing the full right of appeal from family visitors will save £107 million over the 10 years following enactment.

Inevitably, questions were asked about the efficiency of the system. Of course the system can always be improved. In 2011, however, 79% of family visit visa applications were granted at the initial decision-making stage, 2% were granted as a result of an allowed appeal, and a further 2% were granted after entry clearance manager reviews following the receipt of appeals. That demonstrates that the majority of people are able to follow the application process, and are successful.

I join others in congratulating my hon. Friend the Member for Croydon Central (Gavin Barwell) on his successful campaign following the tragic incident of drug-driving and its effects in his constituency. He asked various questions. We aim to improve any devices that meet the requirements for testing at a time as near as possible to the commencement of the new offence, which is planned for 2014. I hope that that gives my hon. Friend some reassurance. My hon. Friend the Member for Castle Point (Rebecca Harris) asked about medically unfit drivers; I am happy to tell her that that specific issue will be the focus of a meeting tomorrow.

I look forward to exploring those and other issues in Committee, along with the Minister of State, Home Department, my hon. Friend the Member for Taunton Deane (Mr Browne), who is the Minister responsible for crime prevention. I believe that the Bill will greatly enhance the national response to serious and organised crime, while delivering a swifter, more transparent and more effective courts and tribunals system, and I commend it to the House.

Question put and agreed to.

Bill accordingly read a Second time.

Crime and Courts Bill [Lords] (Programme)

Motion made, and Question put forthwith (Standing Order No. 83A(7)),

That the following provisions shall apply to the Crime and Courts Bill [Lords]:


1. The Bill shall be committed to a Public Bill Committee.

Proceedings in Public Bill Committee

2. Proceedings in the Public Bill Committee shall (so far as not previously concluded) be brought to a conclusion on Thursday 14 February.

3. The Public Bill Committee shall have leave to sit twice on the first day on which it meets.

Consideration and Third Reading

4. Proceedings on consideration shall (so far as not previously concluded) be brought to a conclusion one hour before the moment of interruption on the day on which those proceedings are commenced.

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5. Proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion at the moment of interruption on that day.

6. Standing Order No. 83B (Programming committees) shall not apply to proceedings on consideration and Third Reading.

Other proceedings

7. Any other proceedings on the Bill (including any proceedings on consideration of any message from the Lords) may be programmed.—(Damian Green.)

Question agreed to.

Crime and Courts Bill [Lords] (Money)

Queen’s recommendation signified.

Motion made, and Question put forthwith (Standing Order No. 52(1)(a)),

That, for the purposes of any Act resulting from the Crime and Courts Bill [Lords], it is expedient to authorise the payment out of money provided by Parliament of—

(1) expenditure incurred by a Minister of the Crown or a government department by virtue of the Act,

(2) expenditure incurred in making payments to persons who select judges or who select selectors of judges, and

(3) any increase attributable to the Act in the sums payable under any other Act out of money so provided.—(Damian Green.)

Question agreed to.

Crime and Courts Bill [Lords] (Ways and Means)

Motion made, and Question put forthwith (Standing Order No. 52(1)(a)),

That, for the purposes of any Act resulting from the Crime and Courts Bill [Lords], it is expedient to authorise—

(1) the imposition, on persons liable to pay sums adjudged to be paid by a conviction or treated as sums adjudged to be paid by a conviction, of liability to pay amounts in respect of costs of collecting sums of that kind,

(2) the charging of court fees by virtue of the Act,

(3) charging by the National Crime Agency for the provision of services or facilities,

(4) provision about functions in relation to regulation of bailiffs and enforcement agents, and

(5) the payment of sums into the Consolidated Fund.—(Damian Green.)

Question agreed to.

Business without Debate

Delegated Legislation

Motion made, and Question put forthwith (Standing Order No. 118(6)),

Charging Orders

That the draft Charging Orders (Orders for Sale: Financial Thresholds) Regulations 2012, which were laid before this House on 26 November 2012, be approved.—(Nicky Morgan.)

Question put.

The Speaker’s opinion as to the decision of the Question being challenged, the Division was deferred until Wednesday.

Finance and Services


That Mr Shailesh Vara be discharged from the Finance and Services Committee and Mr Greg Knight be added.—(Alan Campbell, on behalf of the Committee of Selection.)

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Vascular Services (Wycombe Hospital)

Motion made, and Question proposed, That this House do now adjourn.—(Nicky Morgan.)

Mr Speaker: Before I call the hon. Member for Wycombe (Steve Baker) to present his case on behalf of his constituents, may I appeal to Members leaving the Chamber to do so quickly and quietly, affording the same courtesy to the hon. Member that they would wish to be extended to them in comparable circumstances?

10.1 pm

Steve Baker (Wycombe) (Con): I am most grateful to you for that, Mr Speaker. I am also grateful to my hon. Friend the Minister for being here at this hour to discuss vascular services in Wycombe hospital, as I know he has thought carefully about the subject. It is a subject that will be of interest to your constituents, Mr Speaker, so I am glad to see you in the Chair, and to my right hon. and learned Friend the Member for Beaconsfield (Mr Grieve), a number of whose constituents campaign vigorously on the issue, so I am glad to see him here supporting this case. The nub of the issue is that we in Wycombe have been told repeatedly that it is in our interests for hospital services to be centralised away. There is today a clear momentum to centralise vascular services for the Thames Valley in Oxford, yet Wycombe enjoys better results and Oxford has been subject to a range of criticisms, as I shall set out.

We need to look at the historical context to understand why the opposition to what is happening is so vociferous. Wycombe hospital is in a position perhaps typical of a generation of district general hospitals: we lost our accident and emergency unit; we lost consultant-led maternity, retaining a midwife-led unit as a concession; we lost paediatrics; and in 2012 the emergency medical centre—the EMC—was downgraded to a minor injuries unit, repeating much of the local outcry about the loss of the accident and emergency unit. At each stage, campaigners expressed fears that the withdrawal of services would lead eventually to the closure of the hospital. At each stage, those fears were vigorously stoked by dissenting voices among the affected medical staff. At each stage, the NHS management no less vigorously denied that such an outcome could ever occur, and after each stage the NHS management went on to propose further service withdrawals. It is no wonder so many local people fear closure.

In Wycombe, we do have the Buckinghamshire units for cardiology and stroke, which treat two of the biggest killers, but, scandalously, the minor injuries unit recently failed to admit a lady who arrived with suspected heart trouble—the Minister will recall taking my question in the House on that occasion. It is now being suggested by some clinicians, specifically those within the vascular unit at Wycombe, that losing vascular services at the hospital could threaten those excellent services we have left.

I feel sure that the Minister will appreciate the excruciating sensitivity of this issue. The long, grinding decline of our hospital has sown anger, despair and cynicism, not least because the public have come to appreciate that NHS consultations seem to be exercises in manufacturing consent—or perhaps the appearance of consent—rather than providing democratic accountability and control.

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The recent “Better Healthcare in Bucks” consultation on the downgrade of the EMC mentioned vascular services, supporting the view that vascular should remain in Wycombe until a review in 2014. We are now approaching that review and a series of leaked documents has shown two important points: first, vascular care in Wycombe is superior to that in Oxford; and, secondly, the transfer of vascular services to Oxford is essentially a done deal.

Let us consider how vascular services have changed, because I know that it has affected many of my hon. Friends and Opposition Members. Diseases of the arteries and veins used to be treated by surgery only, but problems are now reached via other blood vessels using techniques known as interventional radiology. Vascular surgeons and interventional radiologists support cardiology, cardiac surgery, stroke and other disciplines. The new vascular specialty was approved by Parliament in March 2012. Vascular is now listed as a specialty on the General Medical Council website, although the approved curriculum and assessment system was not available today. There is also a Vascular Society.

According to the authors of a report on the centralisation of vascular services in Oxford,

“the advent of separate specialty status for vascular surgery together with speciality commissioning plans for 2013 onwards…will reduce the number of hospitals providing vascular surgery to about 50 in England and Wales”

from 150, and

“commissioners will not purchase arterial interventions except from arterial centres.”

I think that is why the issue has affected so many of my colleagues.

Eric Ollerenshaw (Lancaster and Fleetwood) (Con): I congratulate my hon. Friend on securing this important debate. In north Lancashire, the situation is similar. It is perhaps not the policy that is the problem but the implementation of it, because if it is implemented some of my constituents, particularly in rural areas, will face transport times of more than one and a half hours. The national target for improvement is just one hour, which is why, unfortunately, I have to support my local hospital, the Royal Lancaster infirmary, which has reached the point of considering taking the implementation of the policy to judicial review.

Steve Baker: My hon. Friend raises an important point about transport, which will be an issue for many of our constituents, not least because they will not have cars.

People in need of vascular care will include those with abdominal aortic aneurysms, a life-threatening weakness of the main artery that must be repaired, and those who have had strokes or mini-strokes—transient ischaemic attacks. After a stroke, drugs are administered immediately, but they need to be followed up with a procedure to clear the carotid artery, called a carotid endarterectomy or, mercifully, a CEA. Other people requiring care will include those with poor blood supply, including smokers and diabetics, who might endure serious complications that might even lead to amputation.

Wycombe hospital provides the full range of services. It is proposed to move them all to Oxford university hospitals on the basis that the present arrangements are

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“not sustainable”, but I have yet to see evidence that supports that assertion. Leaked documents suggest that Oxford provides worse outcomes and is struggling to be ready.

Tim Farron (Westmorland and Lonsdale) (LD): I am extremely grateful to my hon. Friend for giving way and congratulate him on securing the debate. Further to the point raised by my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw), in the north-west the number of units will go down from four to three. Folks in Morecambe bay will no longer be able to go to Lancaster but will have to go to Carlisle, Blackburn or Preston. Does my hon. Friend the Member for Wycombe (Steve Baker) agree that the majority of vascular surgery these days is not elective but acute, following road traffic trauma and incidents such as coronary emergencies? We are talking not about elective surgery but about acute emergency provision, so it is vital that the services are close at hand.

Steve Baker: My hon. Friend is possibly inviting me to stray beyond my expertise, but perhaps the Minister can deal with that point. The concern in Wycombe is about elective treatment of aneurysms, and particularly the treatment that goes with stroke services. The key concern is that it is an excellent service that will be degraded if it is moved to Oxford, according to the clinical evidence.

I am grateful to Dr Annet Gamell, chief clinical officer of the Chiltern clinical commissioning group. She has given me a clear explanation of the position in Buckinghamshire, which is that things are waiting on the outcome of the review in 2014. Once a new theatre is open at Oxford, it is proposed that all complex elective vascular surgery will go there. It is planned that outpatient and diagnostic services will remain at Wycombe. CEA services would be subject to review in 2014, and I understand from Dr Gammell that the group would support moving CEAs to Oxford only if results indicated that patients would benefit from it. The Chiltern clinical commissioning group would take into account the impact of such moves on other services. Dr Gammell points out that if it is agreed to transfer CEAs to Oxford, there would be another local consultation, but on the basis of recent experience it is not clear to me what end that consultation would serve. The decision would have been made and it is clear that there is vast momentum to take services in that direction, despite the clinical evidence.

The key performance indicators for the south central cardio-vascular network show that in the first two quarters of the 2012-13 reporting year, Wycombe performed 17 aneurysm repairs and Oxford 16. Wycombe carried out 31 carotid endarterectomies to Oxford’s 47. Almost half of patient records at Oxford did not provide the dates of patients’ symptoms. Eighty per cent. of CEA patients at Wycombe received the procedure within two weeks of referral. At Oxford, the figure was just 23%, although patients seem to have received their treatment within 48 hours of symptoms. At Wycombe, 58% of patients were treated within 48 hours. Oxford achieved a ratio of total vascular interventions to amputations of 4.55:1, whereas at Wycombe the ratio in the period was 8:1, which shows a considerably greater degree of success in maintaining people’s limbs in very difficult circumstances.

The clear clinical evidence in that period is that Wycombe outperforms Oxford, and it does so with fewer clinical staff. All this is not mentioned in the

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“Oxford University Hospitals Review of Phase 1 of the Centralisation of Vascular services”, which has been sent to me under cover of a letter dated 12 August from the chief executive of NHS Berkshire. It was among a number of documents leaked to me. The report describes the resignation of a vascular consultant, Mr Peter Rutter, following significant difficulties associated with the move from Wexham Park to Oxford. Those difficulties including antiquated theatre instruments, poor quality theatre lighting and patient safety issues.

Mr Rutter observed:

“Vascular surgery is not very important in Oxford and would take 5 years to bring up to standard.”

He also said that vascular had no champion at Oxford, which is confirmed in other documents. Other remarks in the review include, for example,

“Many outlying district general hospitals have better endovascular facilities”,

“Oxford is not a modern endovascular hospital”


“Oxford has no culture of multidisciplinary working”,

which is essential when vascular supports those other specialties. Furthermore,

“Little thought had been given to the effect on Interventional Radiology in DGHs”

and very worryingly, an

“Oxford senior surgeon threatened to make Bucks vascular surgeons redundant unless they toed the line.”

A comment in the review implies that Wycombe’s excellent interventional radiologists would join Oxford University Hospitals only if CEA and bypass surgery stayed at Wycombe, which has been rejected. Presumably, these valuable experts who make the excellent service possible will resign and go elsewhere.

In summarising, the review explains that the impression had been given that OUH had not properly thought through the implications of centralisation. In discussing theatre upgrades, it concludes that

“there remain concerns about the quality of lighting, ventilation, anaesthetic facilities and sterility.”

I am only a humble aerospace and software engineer, but it seems to me that these are fairly basic concerns. Despite all this, the review clearly states:

“It will not be possible for carotid surgery to remain in Wycombe as CE and CAS will not be commissioned from Wycombe beyond 2013.”

Surely this is a matter for the commissioners.

The reviewers are clear that it is not viable for Wycombe to keep carotid surgery and bypass, but they do not state the evidence for their assertion beyond the new status of vascular as its own specialty. Before making recommendations, the review says:

“OUH practices Vascular Surgery more like a DGH than an important Teaching Hospital. Several of the surrounding DGHs, currently being centralised into Oxford, probably provide a better endovascular service.

Vascular surgery at OUH seems to be safe but has not developed in the way that it has in other hospitals in the United Kingdom. It seems to be positioned about ten to fifteen years behind the best.”

Notwithstanding the evidence of superior performance at Wycombe and shortcomings at Oxford, the review insists that vascular services must transfer, ultimately on the basis that it is inevitable that vascular services will be co-located alongside Oxford’s major trauma unit. That is a blatant rejection of the principle that is constantly used to justify centralising services away:

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clear clinical evidence. All the time that Wycombe provides better care and the team can provide it sustainably, in its opinion, and while local commissioners are prepared to buy it, why surrender to Oxford’s desire to be the Thames valley super-hospital, whatever the cost to patients?

Any responsible Member would admit that the trend in health care is towards specialisation. When my hon. Friend the Member for Bracknell (Dr Lee) was describing his Thames valley super-hospital proposal in Marlow, he said that any politician who claimed that they could restore A and E to a district general hospital would be a liar. I am grateful that I have not fallen into that trap, but it illustrates a point. Politicians are accountable to their electorates and businesmen are accountable to their customers, but managers and clinicians in the NHS who follow rules and guidelines seem to account seriously only to one another and, significantly, to do so on the basis of who carries the greatest authority through prestige.

In the midst of all that, senior NHS executives keep circulating. Stewart George and Fred Hucker—irrespective of their individual merits—who chaired the Bucks and Oxfordshire PCTs, became joint chairmen of the cluster. Mr George is now moving to the CCG, and Mr Hucker to Buckinghamshire hospitals trust. A new era of openness, accountability and genuine public involvement seems unlikely, and continuity seems a dreary inevitability, but all that ought not to be.

Vascular services in the Thames valley appear to be not so much sleepwalking into disaster as positively driving towards it. Vascular services in Wycombe are not some ditch and gatepost operation to be salvaged by the great Oxford University hospitals, as Wycombe outperforms them with a smaller team. In this regard, it is the John Radcliffe that needs saving.

Let me ask the Minister some specific questions. Is the Chiltern CCG able to insist that it will purchase vascular surgery from the Bucks health care trust at Wycombe despite national guidelines? What are the roles and authority of the NHS Commissioning Board, the local health and wellbeing board and the south central vascular network? Crucially, has the elevation of vascular surgery out of general surgery and into a specialisation of its own led to such things as turf wars, demarcation disputes and office politics? What formal influence are locally elected representatives—councillors and MPs—supposed to have?

Wycombe has had its own hospital since 1875. The current hospital was not founded by the NHS; it was built in 1923 with donations from local people, which were mostly given in pennies, as a memorial to the men we lost in the great war. The public are therefore right to be incandescent with rage at changes that appear to be driven by remote sectional interests, not local patient care.

Recently, my right hon. Friend the Secretary of State said:

“I need to say this to all managers: you will be held responsible for the care in your establishments. You wouldn’t expect to keep your job if you lost control of your finances. Well don’t expect to keep it if you lose control of your care.”

What is needed is real accountability. Let us get health under the control of the people who pay for it and start by keeping vascular at Wycombe for all the time that that remains in patients’ best interests.

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10.17 pm

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): I congratulate my hon. Friend the Member for Wycombe (Steve Baker) on securing the debate and raising issues that are pertinent not only to his constituents but to those of my right hon. and learned Friend the Attorney-General, who has been sitting next to me on the Front Bench listening to the debate and who shares a number of my hon. Friend’s concerns.

Before I discuss the substantive points about Wycombe, I should address my hon. Friend’s point about failing management in the NHS. He is right that there is a tendency to recycle failing managers in the NHS, and I am sure that the House will return to that point when my right hon. Friend the Secretary of State responds to the concerns raised in the Mid Staffordshire inquiry, following the Department’s receipt of the report.

It is worth paying tribute to the dedicated health care workers in Wycombe and the surrounding areas of Buckinghamshire, because my hon. Friend has a number of excellent clinicians. He highlighted several local successes in delivering high-quality care through vascular surgery, and I know that there are good outcomes locally in specialties such as carotid endarterectomy. He has many excellent doctors and nurses and other front-line health care professionals, and also some very good managers, who have the best interests of their patients at heart and deliver high-quality health care outcomes for local patients on a daily basis, 365 days a year.

My hon. Friend rightly highlighted some local concerns about the ongoing loss of services at Wycombe hospital, and it is worth reiterating some of his words. He said that the hospital had lost A and E, consultant-led maternity—retaining a midwifery-led unit as a concession —and paediatrics, and this year the emergency medical centre was downgraded to a minor injuries unit, resulting in a repeat of much of the local outcry at the loss of A and E, and now he has highlighted eloquently the concerns over the potential loss of some of the vascular services at the hospital.

It is worth pointing out that I was reassured today before coming to the debate by local health care commissioners in the Wycombe area that there is a strong future for Wycombe hospital. There is no threat of the hospital being downgraded to the point of closure. Commissioners today reassured me—and I hope that this reassures my hon. Friend—that in many areas Wycombe provides a very good site further to develop health care services the better to meet the needs of the local population. It is an excellent satellite site, combined with Stoke Mandeville, for providing high-quality, close-to-home health care. From discussions that I have had, I believe that there may be the possibility of improving further some of the cardiac care that is offered.

I come specifically to the issues that my hon. Friend raised about vascular services, which are particularly important in Wycombe, which has a large Asian population, among whom, as we all know, there is a higher rate of cardiovascular disease. It has a higher rate of diabetes and many cardiovascular illnesses. My hon. Friend highlighted eloquently the number of local vascular services provided, and particularly referred to amputation services. We know that one of the complications of vascular disease and diabetes is the higher rates of

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amputation among some patients. It is quite right that he wants to make sure that high-quality services are provided locally to meet the established need for patients who require vascular services, and that those patients have a holistic service that looks not just at their immediate medical needs but provides high-quality surgical care.

We know that as lifestyles, society and medicine change, the NHS must continually adapt. The NHS has always had to respond to patients’ changing expectations and to advances in technology. When we do change and reconfigure services, it must be about modernising facilities and improving the delivery of high-quality patient care. In that context, it is also important that while we have to recognise that some services are better provided in larger centres of care— for example, the John Radcliffe centre, which can offer super-specialist services—where the clinical outcomes for patients are better, we must also provide high-quality local services, particularly for older people. We know that the majority of vascular patients often fall into an older age demographic, and it is important that when there is any service reconfiguration, those day-to-day outpatient clinics for vascular patients are maintained locally. I am reassured that in the potential reconfiguration, bread-and-butter outpatient clinics and continuity of care for vascular patients will be maintained.

The Government are also clear that the reconfiguration of front-line health services is a matter for the local NHS. Services should be tailored to meet the needs of local people, and the four tests laid down in 2010 by the previous Secretary of State for Health, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), require that local reconfiguration plans demonstrate support from GP commissioners, strengthened public and patient engagement, clarity on the clinical evidence base and support for patient choice. If my hon. Friend is worried that these tests have not been met in the local reconfiguration, he has the opportunity directly to challenge them or to ask the local health scrutiny committee to refer them to the Secretary of State for review.

Tim Farron: The Minister rightly says that the NHS reforms allow local councillors to vote to refer such matters to Ministers. In my area of Morecambe bay, that opportunity comes on 22 January. Will he assure councillors that Ministers will take such referrals very seriously and look into them with great rigour?

Dr Poulter: Yes. I assure my hon. Friend that when a referral is made by a local overview and scrutiny panel the Secretary of State will look at it and decide whether to refer it to the independent reconfiguration panel. That is often the decision that is made in these cases, but it lies initially with the Secretary of State, who will then have to consider whether to refer it. I am happy to write to my hon. Friend further to outline these steps if that would be helpful.

It is worth highlighting the national parameters that are being set for the delivery of good vascular surgery by the NHS Commissioning Board, which takes over full responsibility for commissioning from April this year. The board published a draft national service specification for vascular surgery for consultation. The consultation commenced in December 2012 and will conclude on 25 January 2013. It identifies the service model, work force and infrastructure required of a vascular centre. It says:

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“There are two service models emerging which enable sustainable delivery of the required infrastructure, patient volumes, and improved clinical outcomes. Both models are based on the concept of a network of providers working together to deliver comprehensive patient care pathways centralising where necessary and continuing to provide some services in local settings…One provider network model has only two levels of care: all elective and emergency arterial vascular care centralised in a single centre with outpatient assessment, diagnostics and vascular consultations undertaken in the centre and local hospitals.

The alternative network model has three levels of care: all elective and emergency arterial care provided in a single centre linked to some neighbouring hospitals which would provide non arterial vascular care and with outpatient assessment, diagnostics and vascular consultations undertaken in these and other local hospitals. All Trusts that provide a vascular service must belong to a vascular provider network.”

In essence, this is about making sure that we deliver high-quality vascular care. There are two or three circumstances in which someone would require vascular care. First, there is emergency care—for example, when there is a road traffic accident, or when someone has a leaking aortic aneurysm, which is a very severe and potentially life-threatening emergency. We know from medical data that such service provided in an emergency is much better provided in a specialist centre—an acute setting such as the John Radcliffe, which would be the hub and the central focus. There is also good evidence that trauma care in any setting, including the requirement for neurological specialists potentially to be involved, is better served in a specialist trauma centre. A specialist centre provides better care in emergencies.

At the same time, it is clear from those models that there can also be a strong role for other hospitals as satellites of the central hub at the John Radcliffe. My hon. Friend clearly made the case for the high-quality outcomes at Wycombe hospital for carotid endarterectomies

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and other vascular services. I would suggest that there is a role for challenging local commissioners if they wished to remove some elective procedures from Wycombe when there is a case that they can still be delivered in a high-quality manner and to a good standard for patients.

Steve Baker: I apologise for intervening on the Minister when there is so little time left, but I can see the campaigners leaping up and down and saying that the clinical evidence in this case is that Wycombe is doing better than Oxford on aneuryism repair.

Dr Poulter: The evidence on the outcomes of patients from many trials does stack up over a period of time. Generally speaking, all surgeons need to do a minimum number of procedures in order to maintain regular competency, and to maintain continually high and good outcomes for patients when carrying out aneuryism repair. That is the reason for the service reconfiguration. The argument can be made, as my hon. Friend has done, that Wycombe should continue to provide those services, but we know that the national data and best evidence point to the fact that the services are best provided at specialist centres.

However, there is a good case for my hon. Friend to take forward to the local commissioners about ensuring that more of those elective procedures and elective amputations remain local, and I am sure that he will do that. I am sure that he will also want to talk to his local health scrutiny committee to ensure that it refers cases to the Secretary of State for review, if required. I thank him once again for raising the matter in the debate.

Question put and agreed to.

10.30 pm

House adjourned.