Stephen Mosley (City of Chester) (Con): Apprenticeships have been one of the Government’s big success stories so far. In Chester, the number of apprenticeships has

14 Mar 2013 : Column 492

more than doubled, with 900 people starting one last year. When I talk to companies and businesses, however, I find that micro-businesses find it difficult to take on apprentices. Does the Minister have a view on how we can encourage companies with only one or two employees to take on an apprentice?

Matthew Hancock: We are making it as simple as possible. I studied at West Cheshire college in my hon. Friend’s constituency. Colleges and other providers can help small businesses to bust some of the bureaucracy, but I want to bust some of the bureaucracy myself to make it easier.

Mr William Bain (Glasgow North East) (Lab): Increasing skill levels will be among the critical long-term policies for turning around the slump in living standards, which is worsening under this Government. Will the Minister learn more from the German approach, in which larger companies receive stronger encouragement and have greater obligations to take on apprentices than is the case in the UK?

Matthew Hancock: I certainly agree that ensuring that everyone reaches their potential through apprenticeships and increased skills is vital. An apprenticeship involves learning and doing a job, and encouraging companies to come to the table is vital if we are to make this happen. Through the reforms and the principles set out in the Richard report, to which we have responded today, that is exactly the direction we want to take.

David Rutley (Macclesfield) (Con): On Tuesday, I was fortunate enough to go to the annual Macclesfield apprenticeship fair, where I saw a wide range of organisations offering apprenticeships. They included McCann Manchester, Siemens and Cheshire East council, as well as the local hospital. What steps is my hon. Friend taking to increase the number of quality apprenticeships in the widest possible range of industry sectors?

Matthew Hancock: The whole report is about doing just that.

Diana Johnson (Kingston upon Hull North) (Lab): Small businesses in Hull tell me that the flat rate that they are paid to take on an apprentice does not take into account the particular needs of small businesses, and that it is the same rate as that paid to larger businesses. Will the Minister support the introduction of a differential rate for small businesses taking on apprentices?

Matthew Hancock: We have introduced a grant of £1,500 for small businesses taking on their first apprentices, precisely to help them with the bureaucracy that the hon. Lady mentioned, and I would encourage her to tell the small businesses that she talks to that it is available. The take-up has been good, but we need to ensure that everyone who could benefit from it knows about it.

Andrew Jones (Harrogate and Knaresborough) (Con): Does my hon. Friend agree that employers will welcome the greater control of funding so that they can direct resources to where they need them most?

14 Mar 2013 : Column 493

Matthew Hancock: I hope that they will. I welcome my hon. Friend as the apprenticeship ambassador in Parliament, as was announced today. His role is to ensure that we expand apprenticeships, listening to both parliamentarians and businesses as we take these reforms forward.

Ann McKechin (Glasgow North) (Lab): The Minister will be aware of the stark gender segregation in STEM apprenticeships. Will he tell us what steps he is going to take to achieve an increase?

Matthew Hancock: Yes, we have specific pilots to deal with this issue. The employer ownership pilot involves a consortium led by Rolls-Royce, BAE and others and it is aimed at increasing the number of women engaged in engineering. The best argument in favour comes from apprentices themselves. The apprentice of the year is a female engineer who works on the Typhoon Eurofighter. She is an inspiration, and it is the arguments that she puts—better than me—that will help to encourage girls and young women to look to engineering as an exciting career prospect.

Barry Gardiner (Brent North) (Lab): Can the Minister find it within himself to praise the General, Municipal and Boilermakers Union for its initiative with British Gas? Will he acknowledge that it is precisely the green skills apprenticeships that they are piloting together that will be the engine of growth?

Matthew Hancock: The engine of growth can come from all sectors in our economy. Apprenticeships have support across the piece. For instance, I find myself agreeing with Dave Prentis of Unison on the importance of employer ownership, so this is an area in respect of which many different parts of society and economy—including, no doubt, parts of the GMB—can work together to ensure that skill provision is made available.

Pamela Nash (Airdrie and Shotts) (Lab): Following the question put by my hon. Friend the Member for Kingston upon Hull North (Diana Johnson), when I speak to small businesses, they tell me not just that they do not have enough money to take on apprentices—[Interruption.] I will continue when the Minister is listening. The small businesses that I speak to tell me that not only do they not have enough financial support to take on apprentices but that the money they receive covers only a small percentage of the actual costs. Will the Government’s proposals tackle this?

Matthew Hancock: Of course, the extra support we have given to small businesses is important, but the crucial point is this: apprenticeships are good for the whole economy; they are good for tackling skills shortages; they are good for apprentices, but they are good for employers, too. So it is right for all three—the Government, apprentices and employers—to pay their part towards the costs of apprenticeships because all three benefit from them. That is one reason why this is such a successful scheme.

14 Mar 2013 : Column 494

Business of the House

11.42 am

The Leader of the House of Commons (Mr Andrew Lansley): With permission, I should like to make a statement about the business for next week.

Monday 18 March—I expect my right hon. Friend the Prime Minister to make a statement following the European Council. This will be followed by the conclusion of remaining stages of the Crime and Courts Bill [Lords]. Colleagues will wish to be aware that the business is expected to go beyond the moment of interruption.

Tuesday 19 March—Proceedings on the Jobseekers (Back to Work Schemes) Bill, followed by motion relating to section 4A(2) of the Parliamentary Standards Act 2009.

Wednesday 20 March—My right hon. Friend the Chancellor of the Exchequer will open his Budget statement.

Thursday 21 March—Continuation of the Budget debate.

Friday 22 March—Continuation of the Budget debate.

The provisional business for the following week will include:

Monday 25 March—Conclusion of the Budget debate.

Tuesday 26 March—Debate on a motion relating to flood insurance, followed by pre-recess Adjournment debate, the format of which has been specified by the Backbench Business Committee.

I should also like to inform the House that the business in Westminster Hall for 21 and 25 March will be:

Thursday 21 March—Debate relating to the post-2015 development agenda.

Monday 25 March—Debate relating to the e-petition on preventable cardiac deaths arising from sudden adult death syndrome.

Ms Angela Eagle (Wallasey) (Lab): I thank the Leader of the House for finally announcing the business for next week. I have been following this morning’s chaotic events largely on Twitter, and it is a deplorable state of affairs. It would be helpful to everyone in the House if the Government could get their act together and learn how to organise their business in a more timely fashion.

Ninety-nine days have passed since the publication of the Leveson report, and a decision must be made. Now is the time to act for the many victims of press intrusion whom the report identified. We wanted a cross-party agreement, and we are disappointed that this morning the Prime Minister pulled the plug on the all-party talks. Even at this late stage, we urge him to think again. When he launched the inquiry, he looked victims in the eye and told them that he would fight for them. It is a sad indictment that he now fights for the people who hurt them.

Will the Leader of the House guarantee that the Government will allow time for a debate and vote on any Leveson proposals in the Crime and Courts Bill on Monday? When can we expect to see the supplementary timetabling motion which was promised by Ministers yesterday, to facilitate the debate and the votes that must accompany it?

14 Mar 2013 : Column 495

I am beginning to think that my prediction that the Government will perform a U-turn every 29 days is going off the rails. The last one arrived three days early, and this week we have seen two more—and that is before next week’s Budget. Despite the urgent question, we still have no idea what the Government’s policy on a minimum alcohol price of 45p actually is. Will the Leader of the House tell us? Perhaps he will also let us know his personal view.

The Government have amended the Enterprise and Regulatory Reform Bill in the other place to abolish the Agricultural Wages Board, which provides vital protection for rural communities. According to the Government’s own impact assessment, the abolition will take £260 million out of rural workers’ pockets and transfer it directly to their employers. The Bill is due to complete its Lords stages on 20 March. Will the Leader of the House tell me when it will return to the House of Commons?

We were all startled by the vivid imagery from the Liberal Democrat conference last week. The party’s president said that his own members were

“like cockroaches after a nuclear war”.

The Deputy Prime Minister described his coalition partners as

“like a kind of broken shopping trolley.”

Mr. Speaker, I present you with our Government: a broken shopping trolley full of cockroaches, veering wildly to the right.

Over the last week, the bookies have been raking it in because an important leadership election has been taking place. The front-runners have been jockeying for position, factions have been forming, there has been whispering in the corridors, people have been excited to see who will emerge as their next leader—and that was just in the Vatican. Meanwhile, here at Westminster, the Prime Minister is searching for divine inspiration. The Home Secretary has openly staked her claim, only to be silenced by the Education Secretary, who harbours his own ambitions. Perhaps the Prime Minister’s Aussie spin doctor should turn his attention to the Cabinet, and stop harassing Tory Back Benchers about their tweeting habits.

The Budget is just under a week away. Everyone is wondering what the part-time Chancellor’s encore will be after last year’s omnishambles, and I have to say that the omens are not good. The Prime Minister has suffered an unprecedented ticking off from the Office for Budget Responsibility for obscuring the facts on cuts, the Business Secretary is openly campaigning for Labour’s plan B, and the Chancellor lost £1 billion in the 4G auction and has failed his own triple A test.

The Chancellor’s plan is not working. People are suffering while our economy flatlines, and he is busy handing out tax cuts to millionaires. Perhaps he should listen to the 81% of his own constituents who think that he should spend less time in the Tory bunker and more time in his day job. The Guardian quotes a senior Tory as saying:

“The Conservative party has two moods. Panic and complacency.”

Will the Leader of the House tell us which mood he thinks his party is in?

Mr Lansley: I am grateful to the shadow Leader of the House for her response.

14 Mar 2013 : Column 496

On press conduct and the implementation of the Leveson report, the hon. Lady will recall that yesterday the Minister of State, Home Department, my hon. Friend the Member for Taunton Deane (Mr Browne), made it clear in response to the debate on the programme motion that if the talks conclude, either with or without agreement, we will bring forward a supplementary programme motion to ensure that issues relating to press conduct are debated on the second day of consideration of the Crime and Courts Bill. That is what we are doing.

The Prime Minister announced this morning that further all-party discussions have this morning concluded without agreement. For the benefit of the House I will read out what he has said:

“I believe that what we have on the table is a system that will deliver public confidence and justice for the victims. It’s a system that would introduce the toughest press regulation this country has seen and a system that will defend press freedom in our country.”

The Government will now publish the royal charter again so people can see how it would deliver the principles that Lord Justice Leveson set out. Through the consideration of the Crime and Courts Bill on Monday, the minimal legislative changes required to put in place a system of exemplary damages will be tabled. As the Prime Minister made clear this morning, other parties can also table amendments, although we hope, of course, that they will see that the minimal legislative changes supporting a royal charter will deliver what is required to balance a tough system of press regulation and the need for freedom of the press. The shadow Leader of the House asked me about the tabling of amendments and motions. As the House is not sitting tomorrow, they will have to be tabled today.

I hope my comments have given Members an indication of the shape of the debate. My purpose is to facilitate the debate of the House. As the Prime Minister made clear this morning, the debate on Monday should resolve this issue and I hope the way the debate is structured—we can discuss that through the usual channels—will facilitate the House reaching a conclusion. The hon. Lady asked about other Bills, including the Enterprise and Regulatory Reform Bill. I hope these steps will enable us not only to achieve the implementation of the Leveson report recommendations, but to enable other important legislation to be concluded in a timely fashion.

Now—[Interruption.] I think we can be quick on other things. On minimum alcohol pricing, the Minister of State at the Home Office, my hon. Friend the Member for Taunton Deane, has just responded to an urgent question, and my personal view is the same as his. [Interruption.] I agree with the Government, no problem.

The Government’s decision to abolish the Agricultural Wages Board is an important deregulatory measure. The minimum wage will remain in place.

The hon. Lady mentioned my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron) referring to Liberal Democrats as cockroaches. We can squash that right now. We all know that Liberal Democrats have a capacity to fly away, as their symbols demonstrate, but we will leave it at that.

The hon. Lady talked about next Wednesday’s Budget statement. I cannot pre-empt what the Chancellor will say, but there are a number of things the House recognises and the hon. Lady and her party ought to recognise: that we were left a dreadful financial mess; that we have

14 Mar 2013 : Column 497

cut the deficit by a quarter; that we have seen private sector employment rise by over 1 million; and, as was discussed when my hon. Friend the Under-Secretary of State for Skills delivered his statement to the House, 1 million people are going into apprenticeships as part of our creating sustainable growth for the future. We are making benefits fairer and we are making work pay. We have taken 2.2 million people out of income tax all together as a consequence of the increase in personal allowances. All this, and so much more, means the Chancellor will be delivering the Budget statement against a background of a record of achievement thus far and can set out proposals that will enable us to secure deficit reduction and our growth prospects for the future.

Harriett Baldwin (West Worcestershire) (Con): May we have a debate in Government time on the important steps this Government are taking to improve life for older people: not only reforms to the state pension but auto-enrolment and the pensions triple lock? All are such good news that we never get time to debate them on the Floor of the House.

Mr Lansley: My hon. Friend makes a good point well. I confess that I cannot immediately identify when such a debate might be possible, but much can be discussed during the Budget debate. I noted, as many other Members will have done, remarks this morning from the House of Lords Committee underestimating what this Government have done to anticipate and create a more sustainable structure to support people in old age. We have made public sector pensions more affordable and sustainable, and auto-enrolment could give an additional 11 million people access to their own pensions in retirement. The draft Pensions Bill will make the state pension system simpler and more affordable, and I would never neglect to mention the many measures in the draft Care and Support Bill that will provide support for vulnerable and frail people in old age.

Mr Ben Bradshaw (Exeter) (Lab): The Prime Minister has pulled the plug on the all-party Leveson talks today. He now expects this House to implement his version of press regulation, which would have no teeth and would not be independent. That would be a gross betrayal of the victims and a craven surrender to the perpetrators. Should we not have a full statement from the Prime Minister or the Culture Secretary, so that Members know exactly what they are voting for on Monday?

Mr Lansley: Members will know the structure of the debate on Monday, and what is important is that, as was made clear yesterday and has been confirmed today, they will have the opportunity to have that debate. I took the trouble to repeat what the Prime Minister said at the Dispatch Box, so that Members are aware of what is now planned.

Simon Hughes (Bermondsey and Old Southwark) (LD): I thank the Leader of the House for his statement. It is extremely regrettable that the all-party talks on Leveson have broken down, and extremely regrettable that the Prime Minister is no longer willing to take part in them. I am clear on behalf of my colleagues here—and, I think, the official Opposition and other parties—that

14 Mar 2013 : Column 498

we do not think a simple charter, without seeking to implement Leveson as recommended, will be at all sufficient. Will the Leader of the House elaborate on Monday’s business? Given that it is likely that other amendments will be tabled—they are actively being constructed at this moment—can he make sure there is sufficient time to debate not just a Conservative amendment but other amendments? That means we will not have a short day at all, because some of us are determined to get it right and not dishonour our pledge made after the Leveson report.

Mr Lansley: My right hon. Friend will have been listening carefully to what I said in my statement. I freely acknowledge that we do not always satisfy everybody in terms of the time made available, but I did say in my statement that colleagues must expect business on Monday to go beyond the moment of interruption, and I fear that will have to be the case. That will allow a debate, and without dwelling on precisely how we achieve that, my and my colleagues’ purpose, through the usual channels, will be to ensure that this House can have the debate—including the votes—that will enable it to resolve the issue, I hope very positively, so that all of us who are concerned to ensure that the Leveson report is implemented in principle see that happen. The Prime Minister set out some very clear proposals that will enable that to happen. I do not suggest for one moment that we will vote on those and not on other amendments, if others are presented. But the House should be given that opportunity.

David Wright (Telford) (Lab): May we have a full ministerial statement on the bedroom tax, which affects thousands of people in Telford? A number of them will be single people looking for one-bedroom accommodation. When I checked, two such properties were available on the social housing register, and only 175 have been available all year. How are those thousands of people supposed to downsize? This is about them paying more money.

Mr Lansley: The House and the hon. Gentleman will have heard my right hon. Friends the Prime Minister and the Secretary of State explain repeatedly that the spare room subsidy is about bringing fairness into the system. It comes in the context of a £23 billion housing benefit bill and circumstances where a large number of people in this country are living in overcrowded accommodation while many are receiving a subsidy in under-occupied property. Although the Labour party, over many years, was perfectly happy to see exactly the same principles applied to those in receipt of housing benefit in privately rented properties, Labour Members do not see that it is perfectly fair to carry that analogy forward into social housing.

Mr Peter Bone (Wellingborough) (Con): Leveson is a hugely important issue. Will the Leader of the House clarify whether the supplementary programme motion has yet been laid, so that we can table amendments? Will he allow Monday’s debate to go until any hour—I urge him to do so—as that would solve the problem of people worrying about having time to scrutinise it?

Mr Lansley: I make just two points to my hon. Friend. As I hope I made clear, motions and amendments relating to proceedings on the Crime and Courts Bill on

14 Mar 2013 : Column 499

Monday need to be tabled today, and they will be laid in due course today. In effect, he is seeking to have no programme motion, with the time to be “on debate”, but I am afraid that I cannot offer that. It is important that the Bill is protected, although we will ensure that time is provided for the debate on press conduct matters.

Mr Nigel Dodds (Belfast North) (DUP): On 1 November 2012, the House debated air passenger duty, unanimously agreeing a motion calling for a “comprehensive” review of that punitive tax: the UK’s is the highest of any country in Europe and for many it is having devastating consequences for tourism, families going on holiday and so on. What progress has been made in response to the motion passed unanimously in this House?

Mr Lansley: I can just tell the right hon. Gentleman that these matters are under active consideration by my right hon. Friend the Chancellor and others in relation to the Budget statement.

Mr Philip Hollobone (Kettering) (Con): In February 2011, the Department of Health announced that it would introduce a statutory register of herbalists by the end of 2012. It is now 2013 and the Department has not even published any draft legislation. May we have a statement from the appropriate Health Minister about the interference from the European Commission in preventing Her Majesty’s Government from introducing a new law of this land?

Mr Lansley: I am grateful to my hon. Friend. As he will know, I am aware of this issue, having been the responsible Secretary of State when that written ministerial statement was made. I do know—this was true before I moved from the Department of Health last September—that we were encountering complex issues relating to the preparation of this legislation. The interface with EU legislation is one such issue, but it is not the only one. We need to get the legislation right, and I know that my colleagues in the Department are working on it and will, of course, make an announcement as soon as they can.

Mr Dave Watts (St Helens North) (Lab): Now that we can all see that the Prime Minister is in the pocket of Murdoch, may we have the Prime Minister making a statement explaining to the families, including the Dowlers, why he has gone back on the pledges he made?

Mr Lansley: I do not accept for a minute what the hon. Gentleman says. I think that what the Prime Minister has described this morning as the proposals that will be brought forward for discussion in our proceedings on the Crime and Courts Bill next Monday is the toughest structure of press regulation this country has seen. I think it is entirely consistent with the Leveson principles, not least in the link with the Crime and Courts Bill and the introduction of a system of exemplary damages.

David Tredinnick (Bosworth) (Con): My right hon. Friend might recall my raising at Prime Minister’s questions in November 2010 the situation in Parliament square, which I described as

“a no-go area surrounded by a campsite”.—[Official Report, 24 November 2010; Vol. 519, c. 257.]

14 Mar 2013 : Column 500

Our right hon. Friend the Prime Minister’s response was that he wanted it “sorted out” as quickly as possible. Will the Leader of the House update the House on the situation and give us some indication of the costs of policing the demonstration?

Mr Lansley: I think that the House will, like me, be grateful to my hon. Friend for his assiduous work in raising this issue. Many Members of this House will take pleasure in celebrating the fact that Parliament square has now been returned to a state in which its splendour and the architectural setting surrounding it can be enjoyed by residents, workers and our many visitors to Westminster. He asked me about the cost to the taxpayer, but I regret to say that I do not know. However, I will draw his question, which he rightly raises, to the attention of the Mayor’s Office for Policing and Crime to see whether it might be able to respond to him about that cost, a matter for which it has been responsible.

Diana Johnson (Kingston upon Hull North) (Lab): May I reiterate the point raised by my hon. Friend the Member for Telford (David Wright) about the need for a clear statement on the bedroom tax policy? After all the U-turns, there still seems to be confusion about exactly how it is going to work. With 4,700 households affected in Hull and only 73 one and two-bedroom properties available, the Government need to be clear about how this policy is going to be implemented in practice.

Mr Lansley: Of course the hon. Lady can reiterate the point, but I will not detain the House by repeating the answer. I will simply say that the clarification that she and other hon. Members actively sought was provided in the written ministerial statement made by colleagues earlier this week.

Andrew Jones (Harrogate and Knaresborough) (Con): More than 20,000 people in my constituency—nearly a quarter of the population—are pensioners. Please may we have a debate about how our country will fund the pensions of the future, both state and private, looking particularly at what help can be provided to help people make provision for their own futures so that they have a secure and dignified retirement?

Mr Lansley: That is an important point. The Budget may well afford an opportunity for some wide-ranging debates, of which pensions could be one part. The measures on auto-enrolment will support people in retirement. The draft Pensions Bill will give people a much simpler and more predictable basis on which to judge the state’s provision for retirement and what they may need to maintain the standard of living they are looking for. Overall, after years of failed experiments with stakeholder and other pensions, we are finally getting something that people can understand so that they can identify how they can meet their needs in old age.

Mr Barry Sheerman (Huddersfield) (Lab/Co-op): May we have an urgent debate on the one thing that blighted the Olympic effort of which we are all very proud? That one thing was the behaviour of G4S. We now understand that it has done a deal with the London Organising

14 Mar 2013 : Column 501

Committee of the Olympic Games and Paralympic Games that is very generous, given its failure to deliver on its contract. At the same time, G4S is refusing to pay what is owed to the hard-working, smaller sub-contractors who worked on the Olympic site. This is a scandal; it will not go away, and G4S must know that Members of this House will not let the public forget it.

Mr Lansley: The hon. Gentleman has put that point on the record. He will know that the Home Affairs Select Committee have been pursuing this issue. I cannot promise him an urgent debate on this matter, but if he were in the House and caught the Speaker’s eye, Home Office questions on Monday 25 March might present a suitable opportunity for him to reiterate his point.

Bob Blackman (Harrow East) (Con): Welfare benefits exist to provide a safety net for people who are not able to work, or the weak and vulnerable, and also a hand-up for people seeking return to work. May we have a statement or a debate in Government time on ensuring that welfare benefits are contribution-based so that those people who paid in through national insurance and taxation receive those benefits, and those who have not paid in are assessed on their personal need?

Mr Lansley: Only a few weeks ago we were celebrating the anniversary of the Beveridge report, and it is important to recognise that the contributory principle was at the heart of that report. I cannot immediately offer my hon. Friend a debate. I am resting at the moment on the wide-ranging character of the Budget debates to allow many such issues to be raised. The House will recognise the importance of the benefit system being fair. It is important to distinguish between the contributory principle for many and the circumstances of those who are so vulnerable and dependent that we are talking about something that does not rely on contributions but is based on need.

In the reforms that we are putting through now, we are focusing on making work pay and ensuring that those who can work do work, but also on making sure that resources are focused, and on increasing resources for those who are most in need through disability.

Kevin Brennan (Cardiff West) (Lab): So that we can understand the context of the debate on Leveson on Monday, can the Leader of the House tell us when the Prime Minister informed the Deputy Prime Minister that he was unilaterally collapsing the talks?

Mr Lansley: I was not present at the discussions this morning between the leaders of the three parties, but I imagine that as the Prime Minister made a statement at the conclusion of those talks, it that must have been communicated in those talks.

Rehman Chishti (Gillingham and Rainham) (Con): Medway council in my constituency proposes to invest half of its unallocated reserve in a new development fund to support future regeneration and development. Will the Leader of the House consider granting a debate on how local authorities can use their reserves to support local communities?

14 Mar 2013 : Column 502

Mr Lansley: I welcome what Medway council is proposing. I know that my hon. Friend will share my support for what my hon. Friends at the Department for Communities and Local Government are doing through their “50 ways to save” publication, which shows how councils can make significant savings. Many councils have reserves, quite prudently, and how they use those reserves, including for investment purposes or, in the case of my council, to work together with others to create an investment bank to support business projects in the county, can show initiative and enterprise.

Steve Rotheram (Liverpool, Walton) (Lab): Following my point of order yesterday on the online petition for the Shrewsbury 24, will the Leader of the House make a statement on the Government’s online petition system? Specifically, will he ensure that the many thousands of people who have allegedly failed to fill out the online form properly are contacted electronically and notified that their signatures have not been registered?

Mr Lansley: I am grateful to the hon. Gentleman for that question. I wrote to him yesterday following his point of order, although I entirely understand that he might not have received the letter yet. I will not detain the House with all that is in that letter, but I hope that it answers the questions he quite properly raised yesterday and today. If it does not, I would be glad to try to clarify further. This has demonstrated to me that there is no problem as such with the online petition system; there are just difficulties in some cases with duplications, addresses and things of that kind.

John Glen (Salisbury) (Con): My constituent Harald Hamley has recently contacted me to express his support for the Defamation Bill. I am sure that many across the country are anxious to see it become law to reduce the possibility of vexatious libel claims and to uphold freedom of expression. When does the Leader of the House expect the Defamation Bill to return to this House for further consideration?

Mr Lansley: The answer to my hon. Friend is that I will make a statement on the further proceedings on the Defamation Bill in due course. It might help him and Mr Hamley if I say that as the Prime Minister has made perfectly clear this morning, we will resolve issues relating to the implementation of Leveson principles in our debate on Monday. As a consequence, I hope it will be possible for us to proceed with other legislation, including the Defamation Bill, in a timely way.

Mr William Bain (Glasgow North East) (Lab): Will the Leader of the House schedule a debate on the full scale of the collapse in living standards affecting our constituents which has been presided over by this Government? Has he seen the new research by Landman Economics for the TUC, published yesterday, which finds that the cumulative impact of Government policy on wages, tax and benefits is a drop in Scottish household income of £28.63 a week, or £1,488 a year? Is that not a truly dreadful record for this Government?

Mr Lansley: Mr Speaker, you would imagine when listening to the hon. Gentleman that May 2010 was year zero and that nothing happened beforehand. At the heart of all this is the 6.2% reduction in the gross

14 Mar 2013 : Column 503

domestic product of this country as a consequence of the bust under a Government who said that there would be no boom and bust. It was the biggest bust we have ever seen and we were left with the biggest deficit we had ever seen. It is not possible to pay down debt, to cut the deficit and to cut consumer debt without having a negative impact on people’s living standards.

Henry Smith (Crawley) (Con): Late on Monday night and in the early hours of Tuesday morning, hundreds of motorists were stranded by the freezing weather conditions on the A23 and M23 in west Sussex. I pay tribute to Sussex police and many of my constituents, who came to the assistance of those who were stranded. May we have a statement from the Transport Secretary about Highways Agency winter preparedness?

Mr Lansley: I echo my hon. Friend’s praise for the emergency services and for his constituents—I was taken with the reports that the Red Cross, for example, was reaching out to people and giving them support. I know that they worked together around the clock in partnership with the Highways Agency and I, too, pay tribute to them. The extreme weather, which was probably experienced to a greater extent in much of northern Europe, had a heavy impact on the south of this country—

Pete Wishart (Perth and North Perthshire) (SNP): And Scotland.

Mr Lansley: And, indeed, on other parts of the country. I note the request for a statement from my hon. Friend the Member for Crawley (Henry Smith). I do not anticipate a statement from my right hon. Friend the Secretary of State at the moment, but I can assure my hon. Friend that we constantly learn from what happens and apply those lessons in ensuring that we minimise disruption to the public and business during severe weather.

Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab): David Green, director of Civitas, said today:

“Labour is showing the way to the present Government, which has shown no imagination in tackling the problems facing SMEs and has ignored too many good ideas.”

Given the failure of the Government’s Project Merlin and other such programmes, may we have a debate on the only growth plan—that is, Labour’s growth plan—including a British investment bank, regionalised banking and business lending?

Mr Lansley: I know David Green, of course, and I suspect that he would not subscribe to the Labour party’s view of how these things should be tackled. None the less, we are determined to support small and medium-sized enterprises. We will push to ensure that small businesses can get access to the finance they need, as we did through Project Merlin, and we are supporting that through the funding for lending scheme and the finance guarantees. The tax measures that my right hon. Friend the Chancellor has put in place, including an exceptional tenfold increase in investment allowances, will support that. If the hon. Gentleman were at the conference being held by my old friends at the British Chambers of Commerce over the road today—I know that my right hon. Friend the Secretary of State for

14 Mar 2013 : Column 504

Business, Innovation and Skills will be there—he would hear their ideas. I know that many of them support what the Government are doing, including not only the deficit reduction but our infrastructure support and the business bank being set up by my right hon. Friend the Business Secretary.

Stephen Mosley (City of Chester) (Con): I know that my right hon. Friend has enjoyed many visits to the welcoming, historic and vibrant city of Chester. May we have a debate that will allow us to champion Chester as a stand-out candidate for city of culture in 2017?

Mr Lansley: I am delighted to hear my hon. Friend be the first in this House to make a bid in business questions for city of culture status on behalf of his constituents. He is right to say that I have enjoyed visits to Chester many times and I look forward to more. Chester has a fantastic history and a vibrant artistic and cultural life, both now and in the future. I look forward to those visits, and perhaps we will share some of that entertainment when we are there.

Tom Greatrex (Rutherglen and Hamilton West) (Lab/Co-op): The Leader of the House might not be aware that next Tuesday marks the bicentenary of the birth of Dr David Livingstone, who was born in Blantyre in my constituency. Members will be aware of his work in Africa and he is, of course, buried in Westminster Abbey. There will be a series of events, including in Blantyre, culminating in a service in Westminster Abbey next week that we hope the President of Malawi, Joyce Banda, will attend. May we have a statement from the Secretary of State for International Development to update the House on the progress towards reintroducing foreign direct aid to Malawi to help in the progress that President Banda hopes to achieve in that country?

Mr Lansley: I am glad the hon. Gentleman has had an opportunity to draw attention to that important anniversary and to the remarkable contribution of Dr David Livingstone as an explorer and someone who, as a consequence of that, was an inspiration to many in this country and beyond. I will talk to my right hon. Friend the Secretary of State for International Development. I am pretty sure she will be meeting the President of Malawi in the course of her visit, and I will draw my right hon. Friend’s attention to the points that the hon. Gentleman raised in the House so that she can incorporate them in that discussion.

Mr Deputy Speaker (Mr Lindsay Hoyle): For the penultimate question, I call Mr Docherty.

Thomas Docherty (Dunfermline and West Fife) (Lab): Thank you, Mr Deputy Speaker. Further to the points raised by the shadow Leader of the House, my hon. Friend the Member for Wallasey (Ms Eagle), and the right hon. Member for Bermondsey and Old Southwark (Simon Hughes), will the Leader of the House now confirm for the record that adequate time will be provided on Monday to debate not only the Prime Minister’s proposals but those of the Opposition?

Mr Lansley: I hope that what I said was clear and helpful to the House. It is our intention to secure adequate time and to do so without prejudice to the

14 Mar 2013 : Column 505

discussion of other very important matters on the second day of the Crime and Courts Bill. That will necessitate the House sitting beyond the moment of interruption on Monday. I do not know precisely what other amendments there may be in relation to press conduct or the Crime and Courts Bill, but I know that we will work with the Chair and through the usual channels to ensure that the House is able to have a full and decisive debate.

Mr Deputy Speaker: Last but certainly not least, I call Pete Wishart.

Pete Wishart (Perth and North Perthshire) (SNP): Thank you, Mr Deputy Speaker. Surely we will have a debate to mark the 10th anniversary of the invasion and the war in Iraq. Iraq remains our most damaging and appalling foreign policy adventure ever, with more than 100,000 dead and the region destabilised. I was in the House with the right hon. Gentleman when we listened to the nonsense and the lies from the Labour Government on the case for war. Surely we should revisit that next week.

Mr Lansley: I was in the House, as the hon. Gentleman recalls, at the time of the debate leading up to the invasion of Iraq—[Interruption.]—and did not vote for it. The shadow Leader of the House is wrong in her intervention from a sedentary position. The hon. Member for Perth and North Perthshire (Pete Wishart) will be aware that a number of hon. Members have sought such a debate from the Backbench Business Committee. From the Government’s point of view, that is a matter for the Committee, but we are only too aware of the prospect of the Chilcot review coming forward at some point, and the importance of being able to debate and understand all the circumstances leading up to that decision in the light of the Chilcot review when it is published.

14 Mar 2013 : Column 506

Points of Order

12.22 pm

Mr Peter Bone (Wellingborough) (Con): On a point of order, Mr Deputy Speaker. The Leader of the House referred to the supplementary programme motion. I have checked with the Table Office and the Public Bill Office, and no such supplementary programme motion has yet been tabled. If Members seek to amend that supplementary programme motion, they have to do so before close of business today. Could you advise, sir, how we can amend a motion that has not been laid?

Mr Deputy Speaker (Mr Lindsay Hoyle): It may be helpful for the Leader of the House to give us an answer to that question.

The Leader of the House of Commons (Mr Andrew Lansley): It is just over four and a half hours until the close of business. We will strive to ensure that the supplementary programme motion is laid, with time thereafter for Members to seek to amend it, should they choose to do so.

Mr Deputy Speaker: It may be helpful to the House to know that manuscript amendments are acceptable in an emergency, if need be.

Mary Creagh (Wakefield) (Lab): At Department for Environment, Food and Rural Affairs questions last Thursday, I asked the Secretary of State why he, the Food Standards Agency and Sodexo had refused to name the company which supplied mince and burgers adulterated with horsemeat. The Secretary of State refused once again to name Sodexo’s meat supplier, thereby preventing other catering organisations from knowing whether their meat supplies were at risk, despite the fact that in every other horse adulteration case, the supplier has been immediately named. Yesterday evening Sodexo finally revealed its two suppliers as Brakes, which supplied the burgers, and Vestey Foods, which supplied frozen halal mince and frozen mince that were adulterated with horse. The chairman of Vestey Foods is hereditary peer Baron Sam Vestey, who is also Master of the Queen’s Horse. Have you had any indication, Mr Deputy Speaker, whether DEFRA Ministers intend to come to this place to explain to Members why they refused to name that meat supplier? Are they not putting their friends in high places above the interests of the consumer?

Mr Deputy Speaker: I can certainly help and normally would take shorter notice that the hon. Lady was asking a question of the Chair. It is not a point for the Chair. As we both know, an urgent question was tabled. Normally I would not refer to that when a decision has already been taken. If nothing else, the hon. Lady’s question is on the record and I am sure that Ministers will have taken it on board, in the same way as we had a point of order yesterday which came up with the right answer in the end. If nothing else, the question will have been noted.

Bill Presented

Jobseekers (Back to Work Schemes) Bill

Presentation and First Reading (Standing Order No. 57)

Secretary Iain Duncan Smith, supported by the Prime Minister, the Deputy Prime Minister, Mr Chancellor of the Exchequer, Danny Alexander, Secretary Chris Grayling,

14 Mar 2013 : Column 507

Oliver Letwin and Mr Mark Hoban, presented a Bill to make provision about the effect of certain provisions relating to participation in a scheme designed to assist persons to obtain employment and about notices relating to participation in such a scheme.

Bill read the First time; to be read a Second time tomorrow, and to be printed (Bill 149) with explanatory notes (Bill 149-EN).

14 Mar 2013 : Column 508

Backbench Business

Justice Committee Report: Youth Justice

12.25 pm

Sir Alan Beith (Berwick-upon-Tweed) (LD): I beg to move,

That this House has considered the matter of the publication of the Seventh Report of the Justice Committee, on Youth Justice, HC 339.

The Committee is having a busy week. We are publishing another report this week about the Government’s plan to abolish the Administrative Justice and Tribunals Council, but it is on the youth justice report that I shall concentrate today. As hon. Members know, I try to make a few points, then I take interventions. That is the only way in which hon. Members can take part in an exchange about the report, and we have 20 minutes in which to do it.

We conducted a wide-ranging inquiry to explore the targeting of resources, the use and effectiveness of available disposals, and the role of the youth justice system in diverting at-risk young people from offending. We took evidence from many witnesses. We made visits to Belfast and to young offenders institutions in Feltham and Wigan and in Denmark and Norway. I am very grateful to Committee colleagues and to the Committee staff for all their work on the report.

We found quite a lot to commend. The Youth Justice Board, youth offending teams and their partners have made great strides towards a more proportionate and effective response to youth offending that prioritises prevention. We welcome the fact that fewer young people are entering the criminal justice system. The numbers have been halved. We welcome the fact that, similarly, the numbers going into custody have been halved, although we are still high among the countries of Europe in the number of young people we have in custody.

That is not to say that we believe that minor offending is being or should be ignored; rather, we believe it should be dealt with differently. When diversion is done well, young people are less likely to go on to more serious and prolonged offending. We are particularly encouraged that agencies in many areas are using a restorative justice approach to resolve very minor offending. Bradford youth offending team, for example, established restorative justice clinics as an arrest diversion, and only 10% of young people attending the clinics were re-arrested.

Nick de Bois (Enfield North) (Con): I am grateful to my right hon. Friend for his work in leading our Select Committee on this subject. Is he concerned, as I am, that we found the practice of restorative justice to be a postcode lottery around the country? Although we recommended that Ofsted may have a role to play when looking at care homes, we need a sense of urgency from the Government to advise on strategy in areas that are not delivering restorative justice. Does my right hon. Friend think we will have the impetus to achieve that?

Sir Alan Beith: I agree with that comment. The phrase “postcode lottery” is one I do not like in areas where there is innovation because what happens is that

14 Mar 2013 : Column 509

some places show what good work can be done, and we want to spread best practice as quickly as possible, but I agree with my hon. Friend’s conclusion that the Government and we as a Committee should put as much weight as we can behind spreading the knowledge, experience and skills involved in restorative justice.

On our visit to Denmark and Norway we saw the benefit of intensive multi-systemic therapy, with a concentrated range of skills dealing with young people who are on the fringes of the criminal justice system and likely to become involved in it.

Rehman Chishti (Gillingham and Rainham) (Con): I congratulate my right hon. Friend on his leadership of the Committee. He talks about different strategies for dealing with youth. Does he agree that we should welcome the strategy proposed by the Government to deal with troubled families? There are about 200 such families in the country and, by giving them access to education, skills and accommodation, we will get them out of the criminal justice system and give them a long-term future away from that as good citizens.

Sir Alan Beith: That is an extremely valuable initiative, and it relates to the point I will make later about early intervention, but as a Committee we think a lot more will need to be done in this area.

Steve Brine (Winchester) (Con): I thank the Chairman, the Committee and the staff for the work they have done in producing what is a weighty tome. Further to that point, we say in the report, based on the evidence that the Royal College of Speech and Language Therapists gave us, that 10% of children in the general population have speech, communication and language difficulties, but the proportion of young offenders with such difficulties is 65% or just over. I am sure he remembers that we heard in evidence how this over-representation is part of a compounding risk model that begins at an early age. Does he therefore agree that, as well as ensuring that our youth justice system has access to speech and language therapists to help young people when they get into trouble and are in the system, we would be smart as a country to widen access—

Mr Deputy Speaker (Mr Lindsay Hoyle): Order. Sir Alan was very generous and I allowed you to intervene, Mr Brine, but you cannot make a speech. You are meant to be making an intervention on Sir Alan, because he wants to reply and we need to get on to other business.

Sir Alan Beith: I think I get my hon. Friend’s point. He is absolutely right, and he and the Committee have regularly reminded us of that problem. There are so many young people in the criminal justice system who might not be there if they had not been so lacking in communication and language skills. We have to put significant effort into dealing with that part of the problem.

There will always be a need to detain a small number of young people who pose a risk of serious harm to the public, but youth custody is expensive. The Youth Justice Board spends £246 million on the secure estate, which is 65% of its total spending. Three quarters of those who leave youth custody reoffend, as opposed to a

14 Mar 2013 : Column 510

much smaller, but still too large, proportion of young offenders generally. That indicates that a lot of resource is going into a problem that we could better have prevented at an earlier stage.

Simon Hughes (Bermondsey and Old Southwark) (LD): I am grateful to my right hon. Friend for a very good report. Does he agree that two strong messages arising from his Committee’s conclusions are, first, that we still send too many young people into custody as opposed to dealing with them outside and, secondly, that we are still hopeless at providing for those who come out, particularly in accommodation, which would give them the security to prevent reoffending?

Sir Alan Beith: Indeed, that is a point we make quite firmly: that the accommodation needs of people leaving custody are often not met adequately. If they are dumped in bed and breakfast without adequate support, that is no help to them.

That applies particularly to looked-after children—that is, children who have been in care. Frankly, we were shocked by the evidence we received showing that vulnerable children are effectively being abandoned by children’s and social services. Public authorities have a duty to ensure that looked-after children are not at greater risk of being drawn into the criminal justice system than other children simply because they lack normal family homes. Poor behaviour that would be dealt with in the family should not be an express route into the criminal justice system. We heard one example of police being called to a children’s home to investigate broken crockery. The relevant authorities must also continue to provide support to looked-after children when they get into the criminal justice system and, even more, when they leave it. We were concerned that the relevant authorities often seem to end their relationship of providing support once looked-after children enter the criminal justice system, particularly if they go into custody, and we are talking about a group of very vulnerable children.

Andy McDonald (Middlesbrough) (Lab): I thank the right hon. Gentleman for his excellent chairmanship of the Committee. Does he agree that one of the key messages to come out of our work is about encouraging local authorities and prosecutors to deal with trivial offences involving looked-after children not in a way that causes them to enter the criminal justice system, but in the same way as ordinary families would? While I have his attention, may I also commend the report for its identification of the issue of brain injury among those in custody? The report sets out that although 10% of the population may sustain a brain injury, the incidence among those in custody is much higher, at 50% to 60%. Neuropsychological assessments of those in custody would be an excellent measure, and I congratulate him on flagging it up.

Sir Alan Beith: What a telling statistic the hon. Gentleman has brought out—indeed, he brought it to the attention of the Committee, too. Although we are glad that a new system of assessment, ASSET-plus—assessing semantic skills through everyday themes—has been approved for use by the Government, we think it will take more than that to identify children who are vulnerable to that and a number of other health-related reasons. As for his point about treating looked-after children more as they

14 Mar 2013 : Column 511

would be treated in a family, if restorative justice skills are available and can be deployed and if training is provided, that can help to deal with difficult situations without putting looked-after children into the criminal justice system.

Mr Elfyn Llwyd (Dwyfor Meirionnydd) (PC): I, too, commend the right hon. Gentleman for his chairmanship of the Committee. I am pleased with our recommendation that we should have legislation to ensure that the judiciary in criminal courts can refer under-18s to a single family court. That is important, bearing in mind his point about people entering the criminal justice system. Does he agree that we can learn a great deal in this context from the Scottish experience?

Sir Alan Beith: The right hon. Gentleman makes an important point. The Scottish system of children’s reporters and children’s panels has been proven over many years. We still have some lessons to learn from it in England and Wales.

Looking more widely at sentencing, we recommend a threshold to enshrine in legislation the principle that only the most serious and prolific young offenders should be placed in custody. We recommend that the custody budget should be devolved to a more local level, so that a local decision can be made about investing in effective alternatives to custody. We want to build confidence in community sentences by giving magistrates and judges more feedback on the outcomes of their sentencing decisions. We also want to take more action to reduce the number of people who breach the terms of their community sentences and address the problem that there is a large number of young black men in custody, far beyond their proportion in the population.

Mr Peter Bone (Wellingborough) (Con): What was the Committee’s view on the fact that if we send only prolific offenders to prison, they will clearly have done a lot of crime before they get there? What consideration was given to the short, sharp shock treatment as a way of dealing with people right at the beginning?

Sir Alan Beith: The idea that we can sort out the problems of a young person who is committing serial, prolific crimes through a process that does not take much time is just a mistake. It takes time to address these problems. We have looked, for example, at the Willow unit at Hindley and a whole series of ways of trying to turn round the lives of young people. I am afraid that the short, sharp shock is an illusion. There is no proven way to deal with prolific young offenders other than by giving them a lot of attention over a significant period.

Jeremy Corbyn (Islington North) (Lab): I thank the right hon. Gentleman for chairing the Committee through the fascinating experience of undertaking this youth justice inquiry. Will he comment on the Rehabilitation of Offenders Act 1974 and say at what point a young person who has committed a fairly minor offence or a more major one would have it written off? We do not want a society in which misdemeanours undertaken by young people, for all kinds of reasons of poverty, naivety or whatever else, follow them for the rest of their lives, damaging their career prospects and us as a society.

14 Mar 2013 : Column 512

Sir Alan Beith: The hon. Gentleman makes an important point, which he has made in the Committee. The Committee recommended that, for example, minor offences that were the subject of cautions should disappear from the register at the age of 18, to give youngsters a chance to get a job and get started in life. I also commend employers who, in the knowledge that people have past criminal convictions, take them on and give them a fresh start, often with success.

Robert Flello (Stoke-on-Trent South) (Lab): The Opposition very much welcome the right hon. Gentleman’s report. I hope we can have an early debate on it, because, certainly judging from the interventions we have heard, there is a need for one. How does he square his Committee’s view that we need to move away from young offender institutions to smaller, more specialised units with what seems to be the Secretary of State’s view—that we should go the other way and roll the smaller units into bigger YOIs?

Sir Alan Beith: In fact, we have been closing young offender institutions over the years because the number in custody is now much smaller. The Committee will continue to press its view that most of the work that can be done successfully with young offenders has to be done in small environments, where it is possible to devote sufficient attention to their problems.

There are a number of key things that I do not want to miss out. One is that the Government produced their own, “Transforming Youth Custody” document just as we were concluding our inquiry, so we did not have the chance to work on it in detail, although I have to say that there is not a lot of detail in it. One thing that puzzles us is the Secretary of State’s idea of creating youth colleges to deal with young offenders, because they are actually there, on average, for only 79 days. We fully support and applaud his interest in, and commitment to, sorting out the education of young offenders in custody, but the concept of the colleges does not fit well with the rapid churn of young offenders. In many cases it is important that we get them back into the education system. We have therefore recommended that schools and colleges could be incentivised to take young people back into education after they have completed their sentence, whether it is a custodial or community one.

The Committee had something to say about deaths in custody. It is unacceptable that so many vulnerable young people continue to die in the custody of the state. We await the Minister’s view on whether to set up an independent inquiry and will return to the issue when we have heard what conclusion the Government have reached.

We have many other detailed recommendations that I do not have time to cover today, but the message I want to leave with the House is that we must be prepared to make radical changes in the way we deal with young offenders if we are to stop them becoming the prolific criminal offenders of the future, which is often what they have the potential to become.

Mr Philip Hollobone (Kettering) (Con): I congratulate the Chair of the Committee on the report. Does he agree that one of the most powerful pieces of evidence in support of his emphasis on getting the transition

14 Mar 2013 : Column 513

from custody to the community right is that which was given by the chief inspector of prisons, who said that

“the thing that unlocks everything else is accommodation. It does not mean that if you have settled accommodation everything else will turn out fine. It means that if you do not have that, nothing else will work”?

Sir Alan Beith: Absolutely. Accommodation in that context often requires support as well; it is not merely bed and breakfast and goodbye. There has to be some way of ensuring that an offender reintegrates into society, or indeed integrates into society for the first time, because they might have had an institutionalised existence prior to that, which is true of many looked-after children.

The second part of the message I want to leave with the House is that we need to ensure that new generations of children do not embark on crime. In order to achieve that, as was mentioned earlier, we must develop early intervention. As with adult prisoners, so much of the Ministry of Justice budget is necessarily committed to custody and to prison by policies that have been pursued over many years, yet the most important work of preventing people from getting into crime in the first place is deprived of money.

The Committee’s broad longer-term view is that we want to see resources not being needed to put people into custody or expensive sentencing processes because money has been spent dealing with troubled families and very young children beginning to show signs of later criminal behaviour—addressing that could prevent them from getting involved in crime in future. I am grateful to my Committee colleagues for the work they have done. We will continue to keep a close eye on Government policy in this area. We are glad to have had a good response to a number of our proposals, but a lot more needs to be done.

Question put and agreed to.

14 Mar 2013 : Column 514

Accountability and Transparency in the NHS

[Relevant documents: The oral evidence taken before the Health Committee on 12 February and 5 March 2013, on Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, HC 982-i and -ii.]

12.43 pm

Charlotte Leslie (Bristol North West) (Con): I beg to move,

That this House believes that in the wake of the Francis Report it is clear that accountability and transparency are of paramount importance to patient safety and trust in the NHS; and further believes that across the NHS individuals found to have breached those principles should face the appropriate consequences.

I would first like to thank the Backbench Business Committee for granting the debate; I realise that it did not have much time left to allocate in the Session and so am particularly grateful to its members for giving the House the opportunity to debate this timely and important issue. I would also like to thank all the Members who supported the motion, particularly my hon. Friends the Members for North East Cambridgeshire (Stephen Barclay), for Bracknell (Dr Lee), for Totnes (Dr Wollaston) and for Southport (John Pugh) and the hon. Member for Vauxhall (Kate Hoey). I must also thank all those who have contacted me, including the Patients First group. I am sorry if we are unable in the time available to do justice to all the information we have been given, but rest assured that this is the beginning of the scrutiny, not the end.

This debate is neither about playing party politics, nor about only the future of one man, David Nicholson; it is about transparency, and about a deadly cover-up in our NHS and how we can ensure that never happens again. As one concerned former nurse wrote to me:

“Please don’t let me read those meaningless words, Lessons Have Been Learned”.

It sometimes seems that politicians can dodge taking responsibility so long as they say quickly enough that “lessons have been learned”, but learning lessons is not the same as simply uttering a phrase. The truth must be revealed, and consequences faced, if accountability and transparency are to be anything more than just words.

Let me make it clear that refusing to play party politics is not the same as letting people evade responsibility and that statesmanship is not the same as letting people off the hook. We owe it to those outside this Chamber. We owe it first and foremost to those patients who were, in some instances, killed in our hospitals, and we owe it to their grieving families, for whom no amount of politicians saying that “lessons have been learned” can bring back their mum, dad, sister, brother, child or friend.

After patients and their families, we also owe it to those dedicated doctors and nurses who were struggling to raise the alarm against a system that systematically suppressed their concerns. Many of them retired early in protest at what they were being asked to do, and some of them tried whistleblowing and were met not with thanks from the authorities, but intimidation and gagging. We will hear about some of that later.

I must congratulate the Prime Minister and the Secretary of State for Health on their appointment of Don Berwick to ensure that the basic requirement of “Do no harm” is

14 Mar 2013 : Column 515

embedded in health care. Don Berwick, an adviser to President Obama, is an internationally renowned authority on health care. The Institute for Healthcare Improvement, which he co-founded and chaired for 21 years, is a world-leading centre of medical improvements based on proven success. I am delighted that the Prime Minister has put him right at the heart of improving our health care system.

The tragedy, however, is that Don Berwick’s wisdom and recommendations are not new; they have been delivered before. They were delivered to the previous Government in no uncertain terms back in 2008, when David Nicholson was chief executive of the NHS. Instead of implementing them urgently, the previous Government were uncomfortable with what they revealed about their NHS, so they decided to suppress those truths. They suppressed a report by Don Berwick and his institute along with two other damning reports by international experts—RAND and Joint Commission International—that contained burning recommendations to be implemented with all urgency.

Alan Johnson (Kingston upon Hull West and Hessle) (Lab): If the hon. Lady turns to page 1,281 of volume 2 of the Francis report, she will see that, far from the reports being suppressed, every one of them was seen by Robert Francis. He states:

“As part of his work leading the working group, Sir Liam”—

Sir Liam Donaldson, the former chief medical officer—

“commissioned reports from three highly respected US-based organisations”.

Francis concludes that section by stating:

“Indeed it is clear that the NSR”—

the next stage review, the Darzi review—

“sought to address many of the concerns raised in these reports.”

Charlotte Leslie rose—

Mr Deputy Speaker (Mr Lindsay Hoyle): Order. Before the hon. Lady responds—[Interruption.] I am sorry, but does the Opposition Whip have something to say?

Lyn Brown (West Ham) (Lab): No.

Mr Deputy Speaker: Thank goodness for that.

We need short and concise interventions, because many Members wish to speak and I do not want to have to reduce the time limit further, but that is what will happen if we are not careful.

Charlotte Leslie: I congratulate the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) on seeking to defend his Government’s record. I will address his point fully later in my speech.

Don Berwick’s report was commissioned by Ministers, led by Lord Darzi and with the support of David Nicholson, to celebrate the 60th anniversary of the NHS. It states:

“The NHS has developed a widespread culture more of fear and compliance… It’s not uncommon for managers and clinicians to hit the target and miss the point”.

It highlighted the inadequacy of quality-control mechanisms in the NHS, stating that the priorities that are emphasised by these assessments are

“seen as being motivated by political rather than health concerns”.

14 Mar 2013 : Column 516

It also highlighted the anger felt by many conscientious medics at Government changes to their employment and at being pressurised to put targets ahead of patients:

“The GP and consultant contracts are de-professionalising... Far too many managers and policy leaders in the NHS are incompetent, unethical, or worse.”

The report warns that

“this… must be alleviated if improvement is to move forward more rapidly over the next five to ten years.”

But those warnings were ignored, and we know that the improvements never happened. The report’s conclusion on a decade of health care reform is that

“the sort of aim implied by Lord Darzi’s vision…is not likely to be realised by the 1998-2008 methods.”

Don Berwick’s report was not alone; let me reveal what the other two reports said. They referred to

“the pervasive culture of fear in the NHS and certain elements of the Department for Health”

and stated:

“The Department of Health’s current quality oversight mechanisms have certain significant flaws”.

Perhaps the most damning indictment of all is that the politicians are responsible:

“This culture appears to be embedded in and expanded upon by the new regulatory legislation now in the House of Commons.”

Instead of being acted on with urgency, this was all buried. We know of the existence of Don Berwick’s report and the other reports only because a medic was so concerned that Berwick’s warnings and solutions had been buried that he tipped off a think-tank, Policy Exchange, which had to use a freedom of information request to bring them to public light in 2010, two years later. They were not even available to the Health Committee.

Let us get one thing clear. The NHS is a huge, monolithic organisation with an exceptionally difficult and, some might say, almost impossible task. In reality, things will go wrong, sometimes very wrong. The crime is not so much that things were going wrong, bad as that is, but that instead of immediately focusing on tackling it, the priority was to cover up an awful truth that was uncomfortable for Ministers and chief executives. All too often, Dispatch Box appearance mattered more than the reality of patients’ lives, leaving whistleblowers and patient groups such as Julie Bailey’s, which was disgracefully dismissed by David Nicholson as a “lobby group”, screaming into a vacuum, often at great personal cost. The crime is the smothering of the truth which costs lives—the deadly silence.

What was the cost of suppressing Don Berwick’s urgent prescription for the NHS? The clinical director of NHS Scotland recently suggested that in following Don Berwick’s recommendations it has experienced an estimated 8,500 fewer deaths since January 2008. We may well ask what was the cost in lives for our NHS of the previous Government’s decision to bury the truth. Across the 14 trusts now being investigated as well as Mid Staffs, there were 2,800 excess deaths between the time that the reports by Don Berwick and others were presented to Ministers and their final revelation in 2010. If the previous Government had been urgently implementing Don Berwick’s recommendations for those five years, who knows how many of those lives might have been saved?

How was this allowed to happen? I have put in freedom of information requests asking what meetings took place to discuss the reports and who was present.

14 Mar 2013 : Column 517

Although David Nicholson was working closely with Lord Darzi on the next stage review, he said in front of the Health Committee that, incredibly, he

“knew nothing about the reports”.

That is the Select Committee, so we must take him at his word. The question that then remains is who did read and suppress these vital reports. Was it Ministers? Was it officials? If officials, how was this allowed to happen? If the Department of Health is to move away from a culture of cover-up, I expect a full and accurate response to my request to know who was responsible, and I ask the Secretary of State to assist me in that.

Former Labour Ministers will complacently say, as they already have, that these reports fed into Lord Darzi’s next stage review and informed the report, “High Quality Care For All”. I ask the House whether a document that starts with the then Secretary of State, the right hon. Member for Kingston upon Hull West and Hessle, beamingly saying

“On its 60th anniversary the NHS is in good health”

reflects the content of the reports that we have just heard about. It certainly does not. Indeed, while the Department of Health claims that it “drew heavily” on the three reports in putting together “High Quality Care For All”, a source close to the authorship of those reports said that they found that claim to be “disingenuous at best”. David Flory, the deputy chief executive of the NHS, later told the Francis inquiry that he at least had some responsibility for what happened to the reports, as he had read them, but insisted that they were “caricatures”. That would help to explain why they were not acted on, but it makes the Department of Health’s insistence that it “drew heavily on them” rather odd.

Further indication that the documents were not acted on is the fact that they raise issues almost identical to those highlighted five years later in the Francis report. If Don Berwick’s warnings had been acted on five years ago, there would be no need to ask him to come back now to step in to sort things out and implement his recommendations.

Alan Johnson: I wonder if the hon. Lady is coming to the point that Francis, a QC, in the course of a two-year public inquiry that produced two volumes, looked at all these documents and said that many of the issues within them had obviously been acted on. During a two-year review, Francis drew completely the opposite conclusions to those that the hon. Lady is drawing.

Charlotte Leslie: I find various elements of the Francis report rather strange, not least that the current chief executive, David Nicholson, is minuted as dismissing the activities of Julie Bailey as merely “lobbying” as opposed to expressing widespread concern about patients, and that this minute was dismissed in evidence, with David Nicholson saying that he could not recall ever having said something like that and thought that he could not possibly have done so. The fact that we are asking Don Berwick back five years after he initially gave his recommendations to Labour Members speaks far louder than a few sentences in the Francis inquiry with which people may beg to differ. However, I will not be distracted by the right hon. Gentleman but go back to my speech.

14 Mar 2013 : Column 518

I will now reveal how crucial mortality data, which Harvard university says should have triggered an “aggressive investigation”, was ignored, and, when it became too prevalent to ignore, was, like so many whistleblowers, discredited. David Nicholson said in response to the Health Committee that he did not know that the Dr Foster mortality data existed until he became chief executive of the NHS in 2006. He also said he did not know there was a problem with the mortality rate at Mid Staffs until 2009. Again, that is the Select Committee, so we must take him at his word. It is odd, however, as we know that David Nicholson attended a presentation in Birmingham in 2004 at which the Dr Foster ethics team gave a presentation on the real-time monitoring tools that it was using to show mortality alerts and the hospital standardised mortality rates.

There are also records of Dr Foster telephoning chief executives of health authorities in 2005 to tell them about the mortality alerts. David Nicholson is named on that list of those getting calls, as chief executive of Birmingham and The Black Country strategic health authority. Between 2005 and 2009, there were 8,000 log- ons to the Dr Foster site from members of staff at West Midlands SHA. We even have a press release from Dr Foster from as early as 2005 congratulating Walsall hospital in, yes, West Midlands SHA, for its improvement in relation to this very same mortality data. The Dr Foster data were published in the “Good Hospital Guide” from 2000 onwards and in national newspapers from 2001 onwards. It is therefore incredible that that was not known about by someone such as David Nicholson, or indeed Ministers and others.

By May 2007, however, people were aware of the data. The then chief executive of West Midlands SHA, Cynthia Bower—Birmingham and West Midlands SHAs play a strangely prominent role in this story—received alerts that there were issues with high mortality rates in the health authority. But instead of taking urgent action to find out what was going wrong, she commissioned the university of, yes, Birmingham to write a report to discredit the data, at a cost of £120,000 to the taxpayer. Stunningly, the British Medical Journal—the journal of the union, the British Medical Association—is on record as allowing the author of the Birmingham report to publish his findings in the BMJ four months before official publication to coincide with the publication of the Healthcare Commission report, in order to discredit the data. A fact little publicised by Ministers and chief executives is that the Birmingham report was severely flawed. Harvard later did a study and found that the data were so watertight that on receiving the alerts,

“it would have been completely irresponsible not to aggressively investigate further.”

Yet again, the reaction to bad news was to bury it, or expensively discredit it, rather than act.

This went all the way to Government. I have seen an internal briefing for the right hon. Member for Exeter (Mr Bradshaw), then a Health Minister, in which officials brief him to stress that the mortality data were not known about until 2007. However, in that very same briefing it is revealed that they know this to be untrue, because they make specific reference to the data being published as far back as 2001 in the “Good Hospital Guide”.

This is only a drop in the ocean of a catalogue of attempts to cover up the awful truth. It is utterly wrong that no one should be held to account for such negligence

14 Mar 2013 : Column 519

in their duty to protect patients. The “Code of Conduct for NHS Managers” says that managers must

“make the care and safety of patients my first concern and act to protect them from risk”


“accept responsibility for my own work and the proper performance of the people I manage”.

If talk of accountability in this Chamber is to have any credibility at all, especially for those individuals who buried loved ones while Government, departmental and NHS individuals buried the truth, actions must have consequences. To scapegoat is not the same as ensuring that those responsible are held to fair account. Those who do not have a voice—the patients and their families—deserve accountability and more than just words.

Don Berwick is right. We must convert our anger over what has happened into action. That is what Julie Bailey did, without whom this debate and a push for a culture change in the NHS would probably not be happening. It is what my right hon. Friend the Secretary of State did this morning in banning gagging orders. Will he confirm whether that measure will be retrospective? I believe that this Government have secured a good base from which to put clinicians—not managers and politicians —at the heart of setting the priorities of our NHS.

Rosie Cooper (West Lancashire) (Lab): Although I appreciate and endorse everything the hon. Lady has said about accountability and the managerial code of conduct, who does she think should enforce the code and ensure that it is being followed? Beyond the board and the chief executive, how will organisations be policed?

Charlotte Leslie: I believe that Francis is right: a regulatory organisation for managers is needed.

We must be brave. There must be a cultural clean-out and a new start, including a new head of the NHS Commissioning Board, who does not appoint a deputy who faces possible investigation for gagging whistleblowers —unless, of course, Dame Barbara Hakin deregisters from the General Medical Council beforehand—and who does not seem systematically to appoint those who had contact with West Midlands health authority or Birmingham, but has the trust and faith of doctors, nurses and patients, and epitomises this new era of transparency and accountability.

I believe that with Don Berwick’s help—albeit about five years later than it could have happened—we are now beginning to step in the right direction to ensure that never again can the NHS be too loved to be scrutinised or too holy to be questioned, and that this debate will go some way to breaking what has been, for more than a decade, a literally deadly silence.

1.2 pm

Andy Burnham (Leigh) (Lab): What happened at Stafford hospital was a betrayal of everything the NHS should stand for. We will face up to what went wrong and I will say more about that today. I repeat the apology to the families of people who suffered appalling abuse and neglect.

We must do more. People affected will be watching this debate and rightly wondering what it will achieve. They want to know what is going to change and when.

14 Mar 2013 : Column 520

The time has come for cross-party agreement on a way forward, and that is my hope for this debate. There must be more accountability and transparency, and that is why we support the motion.

We also support the Secretary of State’s ban on gagging clauses. It builds on statements made by the previous Government, which in turn were a response to previous scandals. That provides a crucial context for today’s debate.

In 1997 Labour inherited the job of responding to the Bristol heart scandal and the Harold Shipman murders. A series of major policy developments followed on patient safety, inspection and regulation. We passed the Public Interest Disclosure Act 1998, protecting whistleblowers. We published data that had never before seen the light of day on survival rates from heart and stroke care, and 1999 saw the first ever independent regulation of hospitals and care standards.

In 2001 we established the National Patient Safety Agency, which has sadly since been abolished and, in 2006, on the back of the public inquiry by Dame Janet Smith, the General Medical Council and the Nursing and Midwifery Council were reformed to end the professional closed shop. The truth is, however, that well-meaning as those steps were, there were places where the underlying culture of the NHS did not change and that is an important lesson for us all. When we make statements in this place and pass policies, we assume that everything changes on the ground, but it does not.

The previous Government made similar statements to that made by the Secretary of State today, yet the use of agreements persisted. Why was that? The answer is that there is a culture in the NHS—a tendency to pull down the shutters and push people and complaints away when things go wrong—that is more ingrained than we might think.

Stephen Barclay (North East Cambridgeshire) (Con): On the subject of pulling down the shutters, will the right hon. Gentleman confirm that the world-leading expert, Professor Sir Brian Jarman, wrote to him in March 2010 listing concerns about 25 hospitals with high mortality rates, and that both the right hon. Gentleman and the Care Quality Commission took no action?

Andy Burnham: No, I will not. I was copied into an e-mail by Professor Brian Jarman in mid-March 2010 and, having asked the CQC to investigate what he had said, I wrote back to him on 31 March 2010. That was literally my last duty as Secretary of State for Health after the general election was called. I was not able to respond further to inquiries. It is important to provide some balance to the hon. Gentleman’s comments.

Changing the culture in the NHS requires vigilance and persistence. As Robert Francis says, we have all been too remote from the front line.

The foundation trust reform was a serious attempt to end the top-down culture in the NHS, bringing more accountability and transparency. If we look back, however, we will see that, when the centre stood back, there were places where an unhealthy local culture became even more firmly established. In some trusts a national top-down style was replaced with a local top-down, bullying style, which can be even worse. I can remember the shock I felt on reading the first Francis report’s finding that,

14 Mar 2013 : Column 521

on receiving FT status, one of the first things that the Mid Staffs board did was to resolve to hold more meetings in private. That was an audacious breach of the spirit of the legislation passed by this House.

Mr William Cash (Stone) (Con): The shadow Secretary of State and I have been engaged on this issue for a very long time. Will he admit that it was totally unacceptable for him and his predecessor to refuse to have a public inquiry, which I demanded relentlessly, under the Inquiries Act 2005? Does he agree that it was wrong to give foundation trust status when it clearly should not have been given, and does he accept that I raised the issue of gagging orders and confidentiality in a health debate in 2009, not 2010?

Andy Burnham: Foundation trust status was not a matter for Ministers. It was a job for Monitor, so it has to answer that concern. The hon. Gentleman is right that we had many discussions about a public inquiry. He will remember that in July 2009, two months after I was appointed Secretary of State, I brought in Robert Francis QC to conduct an independent inquiry into what happened. I did not order a full public inquiry and I will explain the reason why later.

The difficult thing about the fact that the Mid Staffs board was holding more meetings in private was that we in this House had passed up our powers to intervene to stop it. That is another lesson we must learn: that the FT reform was naive in thinking that local autonomy would lead to improvement in all cases. In a national health service, there are areas where national direction is needed, and when things go wrong, there must be immediate powers of intervention, which, on my arrival in the Department in June 2009, I found I did not have. Foundation trust policy needs to be reviewed and adjusted to mitigate those dangers, including through a reconsideration of the power to de-authorise a failing foundation trust, which was recommended by the first Francis report, but repealed by the Health and Social Care Act 2012.

We also need to consider targets and how they are used. Targets helped to deliver the lowest waiting times in history and that must not be forgotten. However, in places, they reinforced negative management practices. In focusing on only part of the patient experience, there was not sufficient focus on the overall patient experience and the whole person—a particular problem when it comes to caring for very elderly people whose needs are a blur of the physical, mental and social.

Robert Francis is right to call for a fundamental rethink of the way in which we care for older people, and I have put his recommendations at the heart of Labour’s policy review. However, there are more immediate things that we can do and I will spend the rest of my time on five substantive points.

Mr Bernard Jenkin (Harwich and North Essex) (Con): Will the right hon. Gentleman give way?

Andy Burnham: I will make some progress.

The first point is about implementation. I would like to take this opportunity to thank Robert Francis for his work on this inquiry and the previous inquiry, which

14 Mar 2013 : Column 522

I commissioned. Robert Francis has taken the best part of three years to consider these matters in detail and has made 290 measured and proportionate recommendations. The people affected by these events should reasonably be able to expect that they will be implemented without delay.

I make a genuine offer today to the Secretary of State. If he brings forward proposals, he will have our support in speeding up implementation. I say that because I am becoming concerned about the timetable for the Government’s response. On 6 February, the Prime Minister told this House:

“We will study every one of the 290 recommendations in today’s report and we will respond in detail next month”.—[Official Report, 6 February 2013; Vol. 558, c. 281.]

Since then, the Government have commissioned a review of the recommendations, which is due to report in July. Although, like the hon. Member for Bristol North West (Charlotte Leslie), I have great respect for Don Berwick, I am surprised that the response to a long public inquiry is to set up another review. Is it still the Government’s intention to respond in detail this month? Although I welcome this debate, it is narrow in focus, so will the Secretary of State consider having a full day’s debate in Government time? Instead of more delays and reviews, we need action and a timetable for implementation. I would be grateful if the Secretary of State would respond to my offer today.

Nicholas Soames (Mid Sussex) (Con): Will the right hon. Gentleman give way?

Andy Burnham: No, I am making some progress.

The second area where more transparency and accountability is urgently needed is on staffing levels. If the Government are not yet able to commit to all the recommendations, I ask them to expedite their response to Robert Francis’s important recommendation on patient-staff ratios. The board of Mid Staffs embarked on a dangerous programme of staff cuts, and yet public and staff representatives had no outside guidance to challenge it. The chief nursing officer said yesterday that staffing should be a local decision. Surely the lesson of Mid Staffs is that there is a need for much clearer national standards and guidelines, as suggested by the Francis report?

This week, the Care Quality Commission reported that one in 10 hospitals in England and, worse, one in five learning disability and mental health services do not have adequate staffing levels. Surely that should ring alarm bells in the Department as it suggests that parts of the NHS are already forgetting the lessons of the recent past.

The third area on which we need a clear statement from the Government today is the accountability and transparency of all organisations providing NHS services. Under “any qualified provider”, the Government are persisting with their assumption that all NHS contracts should be open to full competitive tender. Despite a promise to rewrite the section 75 regulations that are being made under the 2012 Act, my reading of the rewritten regulations is that regulation 5 will not let doctors decide, but will in effect force clinical commissioning groups to open tender for contracts. That raises the prospect that there will be a significant increase in the coming years in the number of private and voluntary sector organisations providing NHS services.

14 Mar 2013 : Column 523

If we believe in transparency and accountability, surely they have to apply across the board and on a level playing field. The problem is that private and voluntary sector organisations are not subject to the same strictures on freedom of information and whistleblowing. If action is not taken, we face the prospect of a serious reduction in transparency and accountability. Our attempts to find out new information under FOI requests on providers selected under AQP have hit the brick wall of “commercial confidentiality”. I say to the Secretary of State that that is not good enough. Accountability and transparency must always be paramount, as the motion says.

Will the Secretary of State require all providers of NHS services to adhere to FOI principles, and will he ensure that whistleblowers working in organisations that provide NHS services have the legal protections that he has announced today? I draw the attention of the Secretary of State to an early-day motion tabled by my hon. Friend the Member for Easington (Grahame M. Morris) on this subject, which has attracted the support of 109 Members.

The fourth area on which the people of Stafford need openness and transparency is the future of their hospital. They will understandably be worried about the recent recommendation from Monitor that the trust should be placed into administration. People will recall, as I said to the hon. Member for Stone (Mr Cash) a moment ago, that I commissioned Robert Francis in July 2009 to conduct an independent inquiry. I know that many people, including the hon. Gentleman, wanted me to go further and order a full public inquiry, but I stopped short because I was concerned about the effect that that would have on the hospital and its viability.

All of us in this House now have a responsibility to help this hospital heal. After all that they have been through, it would be highly unfair to the people of Stafford if, at the end of all this, they were to lose their hospital or their A and E. They deserve a safe and sustainable hospital and I hope that the Secretary of State’s response to Monitor’s recommendation will map out a way to achieve that.

Mr Aidan Burley (Cannock Chase) (Con) rose—

Nick de Bois (Enfield North) (Con) rose—

Andy Burnham: I will give way one final time—to the hon. Member for Cannock Chase (Mr Burley).

Mr Burley: I represent the other constituency that is served by Mid Staffordshire NHS Foundation Trust. Is the right hon. Gentleman implying that it is the holding of a public inquiry that has led to the threat to Stafford and Cannock Chase hospitals?

Andy Burnham: No, that is not what I am saying. I commissioned a second-stage—[Interruption.] The hon. Member for Cannock Chase should listen to the answer. I commissioned a second-stage review before the general election after Robert Francis delivered his first-stage review to me. I simply said that I took that judgment because I was worried that if there was ongoing uncertainty about the hospital for a long period, it may affect its viability. I have seen the statements from Monitor that there is a concern about the future viability of the hospital. I am making an appeal, on a cross-party basis,

14 Mar 2013 : Column 524

to say that all of us owe the people of Stafford a safe and sustainable hospital. I hope that the hon. Gentleman would agree with that sentiment.

My fifth and final point concerns staff morale.

Mr Jenkin: Will the right hon. Gentleman give way?

Andy Burnham: No, I will not.

This is a difficult time in the NHS. The chief executive of the NHS has described it as a period of “maximum risk” as it struggles with the simultaneous challenges of efficiency and reorganisation. Morale in the NHS is low and one thing is clear: patient care will not improve if it stays like that.

The Secretary of State is right to speak out for patients when the NHS falls short, and he should always do that. However, statements should be fair and should recognise the good that the vast majority of staff do, day in, day out, and the pressure that they are under, which is not of their own making. That balance has been missing from recent Government statements. I say to the Secretary of State that hospitals and NHS staff are not coasting—far from it. They are working flat out, with some coping better than others with the pressure that they are under.

Politicians need to do more than just point out the failings of hospitals and NHS staff. We all need to support them with proper staffing levels on the wards. We all need to support them to speak out, wherever they work. We all need to stop the reorganisations that distract them from patient care. Those are the lessons of Stafford. Today, let us all resolve to face up to them.

1.18 pm

The Secretary of State for Health (Mr Jeremy Hunt): I congratulate my hon. Friend the Member for Bristol North West (Charlotte Leslie) on securing this important and timely debate.

We should start by remembering why we are having this debate. Truly shameful things happened at Stafford hospital. Patients were left unwashed for days, sometimes in sheets soiled with urine and excrement. Relatives had to take bed sheets home to wash them because the hospital would not. Patients with dementia went hungry with their meals sitting right in front of them, because no one realised or cared that they were unable to feed themselves. If we are to prevent that from happening again, accountability for what happened is vital. I will talk plainly about that, including about the role of Sir David Nicholson.

At the outset, let me reiterate that the NHS is one of our most cherished institutions. We can be proud that for 65 years it has ensured that everyone is entitled to treatment, regardless of their background or income. We can be proud of the excellent treatment and care that is the hallmark of most parts of the NHS. Most of all, we can be proud of the front-line doctors, nurses and health care assistants who look after 3 million people every week, with dedication, commitment and compassion.

If we love the NHS, we must be prepared to be honest about its failures, and to criticise me for doing so suggests, I am afraid, dangerous complacency from the right hon. Member for Leigh (Andy Burnham). The tragedy of Mid Staffs shows how the desire to celebrate success got in the way of speaking out when things went

14 Mar 2013 : Column 525

wrong, and if we are to prevent such things from recurring, we must never allow our love of the NHS to stifle our determination to hold systems and individuals to account.

Where does that accountability lie? Sir David Nicholson has been the focus of much attention, and as a manager in the system that failed to spot and rectify the appalling cases at Mid Staffs, he bears some responsibility. As he said, the focus was lost, and he has apologised and been held to account by this House and many others. However, I do not believe that he bears total, or indeed personal, responsibility for what happened. He was at the strategic health authority for 10 months during the period in question, overseeing 50 hospitals at a time when his main responsibility was the merger of three SHAs into one. He consistently warned both Ministers and managers of the dangers of hitting the target and missing the point.

It is just not true that if there had been no David Nicholson at the SHA, there would have been no Mid Staffs; others bear far more direct responsibility and the Francis report tells us who. It makes it clear that the primary responsibility for what went wrong lies with the board of the trust. Astonishingly, members of that board seem to have melted into thin air, some moving to other jobs in the system, and others receiving generous payoffs.

Mr Cash: As my right hon. Friend knows, I do not agree with his assessment of Sir David Nicholson in this context. There was a systems failure that affected not only Staffordshire but the entire health service, and that lies very much at the heart of the problem. In my speech I will quote some statements made by Sir David at a conference a few months ago.

Mr Hunt: I obviously take on board what my hon. Friend says, but I want to move on to other aspects of the report.

Nicholas Soames rose

Mr Hunt: I shall give way on that point, and then I will make some progress.

Nicholas Soames: I am grateful to the Secretary of State. May I follow up on one point that he raised? He said that a number of those managers have disappeared or melted away to other jobs in the service. Does he agree that whatever else happened, there was a monumental failure of leadership at many levels, and that it is a failing of public services in this country—and the national health service in particular—that failing managers are too often recycled through the service to the great and constant cost of patient care?

Mr Hunt: I absolutely agree with my right hon. Friend. We will respond to the Francis report this month, as the Prime Minister has committed to do, and make plain measures to ensure that the situation cannot continue. My right hon. Friend is right to raise that point.

Mr Jenkin rose

Mr Hunt: I will make some progress and then I will take more interventions.

14 Mar 2013 : Column 526

My response will detail how we intend to restore accountability to the boards of hospitals, and today I have removed the ability of any hospital to insert gagging clauses on patient safety in compromise agreements made with senior staff. My hon. Friend the Member for Bristol North West asked whether that will be retrospective, and I have written to all trusts to remind them of their responsibilities towards whistleblowers in respect of contracts and compromise agreements already signed. If we are to protect patients, we need an atmosphere of openness and transparency in the NHS—something to which the motion rightly refers.

Several hon. Members rose

Mr Hunt: I will make some progress and then I will take interventions from both sides of the House.

Sir David Nicholson told the Health Committee last week that in the NHS as a whole, patients were not the centre of the way the system operated. Which party was in power when that culture was allowed to operate? If Sir David has been held to account, so too must the Labour party be held to account. The Francis report rightly states that Ministers were not personally responsible for what happened at Mid Staffs, and I have no doubt that no Labour Minister would have condoned, knowingly allowed or wanted the events at Mid Staffs to happen. We also know from the report that the pursuit of targets at any cost was a central driver of what went wrong. As the report set out, above all Mid Staffordshire NHS Foundation Trust failed to tackle an “insidious negative culture” involving a tolerance of poor standards and a disengagement from managerial and leadership responsibilities. It went on:

“This failure was in part the consequence of allowing a focus on reaching national access targets,”.

Ministers, not civil servants, are ultimately responsible for the culture of the NHS, and it is clear that during that period a culture of neglect was allowed to take root in which the pursuit of targets at any cost compromised the quality of care that patients received, and made it harder for front-line staff to treat people with dignity and compassion.

Andy Burnham: I am listening carefully to the Secretary of State but it is not fair to people in the NHS for him to say that Stafford equals everywhere in the NHS, and that we can take one failing—a terrible failing, as I said in my speech—in a locality and apply it to the whole NHS. He must acknowledge that NHS staff did an incredible job to end the situation when people were spending months and years on waiting lists, and even dying on them.

Mr Hunt: I acknowledge the brilliant work done by NHS staff and, contrary to what the right hon. Gentleman says, I do that in every speech that I make on these matters. I will not, however, accept the complacency that says that problems at Stafford hospital were localised and happened only in one place. If we are to sort out those problems, we have a duty to root them out anywhere in the NHS that they occur.

The right hon. Gentleman talked about waiting times targets. Let us be clear: there is an important role for targets in a large organisation such as the NHS. Without the four-hour A and E target, or the 18-week elective

14 Mar 2013 : Column 527

waiting time target, access to NHS services would not have been transferred and I accept that the previous Government deserve credit for that. It was right to increase spending on the NHS, although it is curious that Labour now wants to cut the NHS budget. Labour did however—this is where Labour Members should listen rather than barrack—make three huge policy mistakes, and the right hon. Gentleman must accept that it is not simply a question of Government policy not being implemented in every corner of the NHS. Those three mistakes contributed to the culture of neglect that we are now dealing with.

The first mistake—a huge mistake—was that Labour failed to put in place safeguards to stop weak, inexperienced or bad managers pursuing not only bureaucratic targets but targets at any cost. That is exactly what happened at Mid Staffs, where patient safety and care were compromised in a blind rush to achieve foundation trust status. Secondly, Labour failed to set up proper, independent, peer-led inspections of hospital quality and safety that told the public how good and safe their local hospital was. Instead of a zero-harm attitude to patient safety, we have a culture of compliance and the bureaucratic morass that is the current Care Quality Commission. Thirdly, Labour failed to spot clear warnings when things went wrong. The Francis report lays out a timeline of 50 key warning signs between 2001 and 2009. Why did Ministers not act sooner? If those warnings were not being brought to the attention of Ministers, why did they not build a system in which they were? Instead, there was a climate in which NHS employees who spoke out about poor care were ignored, intimidated or bullied.

Alan Johnson: The Secretary of State is making an interesting speech and there is no way that the Labour party can escape criticism for what happened at Stafford. Does he accept, however, that before 2000 there was no independent regulation of the NHS and no standardised mortality ratios, complaints in hospitals stayed in the hospital and there was no recourse to any independent observance of those complaints, and A and E—a particular problem at Stafford—was a data-free zone?

Mr Hunt: I accept that progress was made in the collection of data and that the previous Government set up a star rating system. The problem, however, was what it measured. It did not measure the quality of patient care but basically focused on access targets. It was possible for a hospital to get a three-star rating by transforming its 18-week access targets, even at the expense of patient care.

Stephen Barclay: It is correct that improvements were made in the collation of data. In fact, the Dr Foster data were published in national newspapers from 2001, but what is remarkable is that they were not acted on. That is the central charge for Ministers. We were the world leader in the collation of mortality data. We had the data, but Ministers did nothing with them.

Mr Hunt: My hon. Friend speaks wisely. Hospitals display 1,400 different pieces of data, but the question is why nothing is done when the data give dangerous messages.

Several hon. Members rose

14 Mar 2013 : Column 528

Mr Hunt: I will make some progress.

The question the right hon. Member for Leigh needs to answer is why he refused 81 separate requests to set up that public inquiry. He says that he did not want to distract the hospital from the essential task of making immediate improvements, but does he now accept that if he wants people to take his party seriously on NHS accountability he needs to apologise? That was a mistake. Until we have a proper apology—not just for what happened, but for the catastrophic policy mistakes made by his party—no one will believe that Labour would not make the same errors of judgment again. On the Government Benches, we are clear that accountability, dignity and respect for patients, particularly vulnerable, older people who are unable to speak out for themselves, must be embedded in every corner of the NHS.

We will announce measures to set up a proper, independent peer review inspection regime led by a new chief inspector of hospitals that will not simply look at targets, but make judgments on whether hospitals are putting patients first. We will set up a single failure regime, where the suspension of the board can be triggered by failures in care as well as failures in finance; a patient-centred culture, by making the friends and family test a key part of the hospital inspection regime; clinically led commissioning, so that key decisions are made by people who see patients in their own surgeries; and an overhaul of the hospital complaints procedures led by the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart. We will do that with the minimum of upheaval. It is worth emphasising that Robert Francis himself says that the changes he calls for can largely be implemented within the system that has now been created by the new reforms.

Several hon. Members rose—

Mr Hunt: I am going to make some progress.

This debate is about accountability. I have been doing this job for six months, and in nearly every exchange on the Floor of the House, the Opposition have avoided engaging in substance, preferring instead to make baseless allegations about the Government’s motives in respect of the NHS. I put it to the House that we have shown our commitment to the NHS time and again through a protection of the budget; a willingness to face up to big challenges, whether in clinical commissioning, the funding of social care or the need to ensure that care is prioritised throughout the system—

Andy Burnham: Will the right hon. Gentleman give way?

Mr Hunt: No, the right hon. Gentleman needs to listen to my point. If Labour is truly committed to the NHS, it, too, has to show that it has learned. I did not hear that in his speech. Labour Members need to accept that they made some terrible policy mistakes that led to a culture of neglect. They must recognise that the party that claims to speak for the most vulnerable in society betrayed many vulnerable people, with tragic consequences. Only then will the public know that the lessons of Mid Staffs have been learnt—not just by the NHS, not just by civil servants, not just by Government, but by all sides of this House.

Several hon. Members rose—

Mr Deputy Speaker (Mr Lindsay Hoyle): Order. I remind Members that there is a seven-minute limit.

14 Mar 2013 : Column 529

1.32 pm

Rosie Cooper (West Lancashire) (Lab): I welcome the opportunity to speak in this debate on our national health service. I resolutely believe that we should have an open and honest debate on how we can each contribute to restoring faith in the national health service, and that we should not play politics with the findings of the Francis report.

Increasingly, there is a deeply concerning creeping veil of secrecy across the public sector—local government, education or health. The application of greater accountability and transparency is the solution, ensuring that the interests of the public remain the singular and overriding No. 1 priority in public service delivery. As a society, we display a huge and deep faith that the NHS is intrinsically good, and we want unquestioningly to believe that at all times it is acting in our best interests. The findings of the Francis report, as they should, shake that faith and belief in the NHS to its very core. Francis should be commended for his report—an extensive and comprehensive forensic examination of Mid Staffs and the structure of the NHS.

I will be as brief as I can and focus on one tiny element: listening to patients, the people who pay for the NHS, and hearing what they are saying and acting on it. We do not need to keep on looking for a black cat in a dark room. Switch the light on! It is no good the Secretary of State simply repeating that we must listen to patients and their families. What assurance does he have that, until the next crisis, they are listening? In hearing after hearing of the Health Committee, senior people associated with the NHS trot out that the regulator is responsible and that the Care Quality Commission needs to deal with it. I never, ever thought I would feel sorry for the CQC, but, when everyone else ducks, it is supposed to catch the ball. We do not need to create another bureaucracy; we simply have to make work—really work—something we already have by giving it real teeth and enough resources to make it effective.

I agree with the comments of Dame Julie Mellor, the parliamentary and health service ombudsman, when she said that she hoped that the Francis report

“will trigger a debate that will support our view that good complaint handling should be at the heart of the NHS.”

From front-line experience, I believe that to be both true and essential. During my time as chair of Liverpool Women’s hospital, a standing agenda item at the public monthly board meetings was a summary of all complaints received that provided an overview—not in minute detail, but an overview—of each complaint and the outcome: upheld or not upheld. Most importantly, there was a column that stated what action was taken. Employing this system of regular review ensured that the board had oversight, asked questions, could spot trends, be assured that action was taken and demonstrate to patients and their families that they were being listened to.

Nick de Bois: Does the hon. Lady accept, notwithstanding the efforts made in the hospital she mentions, that when MPs take up complaints on behalf of constituents and try to get to the truth behind them, we are faced with tremendous bureaucracy and resistance?

Rosie Cooper: Yes, and if MPs have problems, God help members of the public and patients.

14 Mar 2013 : Column 530

We had to demonstrate that we were really listening to patients. The medical and managerial staff had to take ownership and responsibility for complaints. They knew that at each board meeting they could be questioned and challenged. If we accept that there are large parts of the system that work well and focus our time and resources on areas that do not, we can raise standards and tackle deep-seated problems. As chair, I sought to build in assurance and be transparent about complaints; to solve them, not hide from them, and ensure that everyone was accountable right up through the management structure. I never believed in no blame; I believed in fair blame. Each time a problem was resolved properly, we became a better hospital. We were rightly proud that on the front page of the Liverpool Echo Liverpool Women’s hospital was called an NHS gem. Sadly, the main board’s complaints report stopped after I stepped down as chair.

We do not need to reinvent the wheel or have more reorganisation in the NHS, but we must make the complaints system work. From that important but simple action, culture changes happen and become embedded in the organisation. We then have real change, real transparency, real openness and real accountability—something we can all be proud of.

Barbara Keeley (Worsley and Eccles South) (Lab): A complaints system sounds very useful. When staff knew that complaints were being assessed and reported on every month, what impact did it have on them?

Rosie Cooper: In essence, it encouraged a change of culture. They were not operating in a vacuum, where patients did not matter and where the complaint might not ever get resolved—where, if a manager said it was okay, it disappeared. The fact that the light was switched on and that people could ask questions was valued.

There is a huge disconnect between the rules and the enforcement of rules. When local resolution fails there must be another, proper avenue for patients to appeal that decision: just having the NHS investigate the NHS is not the way to improve the health service, or patients’ confidence in it. Currently, the message we send out is that unless people have the financial resources to fight the system in the courts it is easy for families and patients to be ignored.

Chief executives and boards know that the ombudsman investigates only a tiny proportion of the cases referred to it, and it is not as feared as it should be. I say to the Secretary of State that we need an ombudsman service that is properly resourced, has the necessary investigative powers and sanctions, and makes public in its reports its findings to everybody who pays for the NHS, not just to Ministers. Being able to name and shame in the spirit of openness and transparency will be a powerful tool, especially when, in these times of foundation trust hospitals competing to attract business, reputation is the key.

Given that all hospitals will eventually become foundation hospitals, is the Secretary of State willing to say that foundation hospitals will have to report all their statistics openly and that every board meeting should be a public meeting? There should be no hiding; there should be openness and transparency right across the NHS. The light needs to be switched on not just in individual rooms but in the NHS, full stop.

14 Mar 2013 : Column 531

I have on the wall of my constituency office this quote from an editorial in the Liverpool Echo:

“Doing the right things does not automatically follow saying the right things”.

At present, everyone in the national health service is saying the right things. What assurance can the Secretary of State give us that the NHS will do the right things? Frankly, the public do not want any more politics from anybody. They do not want warm words or excuses; they want actions that will lead to real change. No more big reorganisations; we just need to make a difference. He must listen to the people’s complaints. Actually, in Mid Staffs the complaints could not have been any louder.

I said to the hon. Member for Bristol North West (Charlotte Leslie) earlier that we cannot keep on saying that it is somebody else’s fault, that somebody else should be held accountable and that somebody else is going to supervise. This goes to the core of the Department of Health. If we listen to the people and give the ombudsman—the right person for the job—the powers to deliver, we will see a culture change.

1.41 pm

Mr Stephen Dorrell (Charnwood) (Con): I want to follow the hon. Member for West Lancashire (Rosie Cooper) on to very similar territory. She and I both sit on the Health Select Committee, which I chair. I want to start where my right hon. Friend the Secretary of State and the right hon. Member for Leigh (Andy Burnham) started, with what happened in Mid Staffordshire. It was shameful, and we will be judged today by whether we show a serious willingness to learn and apply the lessons of the Francis inquiry.

Francis made 290 recommendations, but they amount to just one core recommendation, which is that there needs to be a fundamental culture change through the whole of the national health service. With respect to the shadow Secretary of State, that is the sense in which challenges are posed for the health service way beyond Staffordshire. We have to learn the lessons of Staffordshire and apply them beyond it, as well as demonstrating that we understand what we mean—in the modern jargon, we “get it”—when we talk about the need for a culture change.

My hon. Friend the Member for Bristol North West (Charlotte Leslie) encapsulated that when she used the words “accountability” and “transparency”. I will not follow her down the route that she took in her speech. I want to focus exclusively on what we mean by those two words. They seem to trip too easily off the tongue, without anyone understanding what they mean, and that must change if we are to sustain a culture change in the health service.