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Westminster Hall
Wednesday 5 June 2013
[John Robertson in the Chair]
111 Telephone Service
Motion made, and Question proposed, That the sitting be now adjourned.—(Karen Bradley.)
9.30 am
Miss Anne McIntosh (Thirsk and Malton) (Con): May I welcome you to the Chair, Mr Robertson, and say what a pleasure it is to serve under your chairmanship? I also welcome the Minister and her shadow, the hon. Member for Copeland (Mr Reed), to their places, as well as other colleagues. I am delighted to have secured this debate on the operation of the 111 telephone service and its effects on emergency services. The service is still in its early days of operation. It has yet to be introduced in my own area of North Yorkshire, although the roll-out is expected to commence in early July.
My starting point is that I believe that the 111 telephone service could be a useful tool for out-of-hours services and patient treatment, but that some alarm bells have already been set ringing in areas where it has been rolled out. It is not my intention to go through all aspects of the general practitioner contract and out-of-hours services; I want to look at the narrower point of the potential impact where the 111 telephone service is not working.
In my view, the service might offload problems on to accident and emergency and, indeed, the ambulance service. A lot depends on the content of the script that is used and who sets the script, because the time taken should be as short as possible to allow the swiftest access to nurses and medical advice for those in palliative care, terminal care and other regular patient care, such as catheter patients. The length of time before a patient, or someone acting on their behalf, is passed to a medically qualified adviser—a nurse or doctor—is absolutely crucial.
I want to refer to my family history to illustrate the very real problems being experienced. It relates to one of the pilot areas, County Durham, where my father was a GP, but had long been retired. The carers looking after him in his home, or occasionally me, had had consistent recourse to the 111 service. The last occasion when we used the service in relation to my father was on Sunday 4 November last year. I had reason to call the number, and I explained that my father showed worrying signs of a urinary tract infection. Being a doctor’s daughter, I was well qualified to talk about such infections, which my father had had, on and off, for some two or three years.
When I called 111, I got the ritual reply of sticking very closely to a script, which I found completely inappropriate at times. I explained my father’s condition, but the responder insisted on sticking religiously to the script—asking whether the patient was breathing, whether they were bleeding—and I kept saying that I was not reporting an accident but a regular condition, the symptoms of which were extremely plain, and asking whether I could, please, just be passed to a nurse or doctor. I said
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that we probably needed a doctor to attend to confirm that there was an infection and to administer the relevant antibiotics.
I have to say that in the end I hung up in sheer frustration, 10 or 15 minutes into the call, because I could tell that I was not getting anywhere quickly. I had previous experience of using the 111 service, and I like to think that I am not prone to flap unnecessarily, but I found that the system failed. I then called 999, and an ambulance was dispatched immediately and attended to my father within half an hour. The paramedics confirmed my suspicion that the condition was an infection, and said that the patient was too ill and frail to travel some 25 miles on country roads in an ambulance, so that was not an option. They used their direct line to call a doctor, but even then, it took three hours for one to attend. In that case, from first calling 111 to the doctor’s arrival, about three and a half to four hours had passed.
My father subsequently died on the Thursday of that week, 8 November, and I believe that the infection had obviously taken such a grip that his death would have been very difficult to prevent. He had lived to a very grand age, and we were just grateful for the treatment he did receive. However, that example shows the pressure points that need to be addressed and which, I regret to say, have not been addressed, even though I have raised the issue, in relation to my family experience, on two or three occasions.
For the 111 service to work effectively a degree of flexibility has to be built into the system and the script. It would be helpful if the Minister told us who is responsible for setting the script. I would argue that doctors, working with community or district nurses—those medically qualified—must work out the script, so that it diverts regular patients who can be taken off it at the earliest possible stage.
What is particularly poignant for me and my family is that my father had been a local GP in that area for some 30 years. He retired as a senior partner, ironically through ill health. He attended patients in all weathers and at all hours. My father was from a generation of GPs who worked all hours: he worked every other night on call and every other weekend on duty, and he always put his patients first. It is obviously a source of some regret that he did not have similar access to a GP in his own hour of need.
The 111 service was piloted in several areas, and I am drawing on my experience of the one in County Durham before the service was rolled out nationally. I want to make some suggestions and pose some questions. It would clearly make sense for regular patients—such as those in palliative care, terminal care and catheter care—to be diverted to nursing or other medically qualified staff as early as possible in the process. In North Yorkshire, the intention is that that will happen when the service is rolled out, but I want confirmation that, now the problem has been identified, it is being addressed in all areas, including pilot areas and ones opting for early roll-out. That would save more time for those who were in urgent need of care, short of the 999 service.
We must all be aware that if a patient or someone on behalf of a loved one phones, they tend to be quite distressed and distraught, and they do not want an automatic responder to stick blindly to some script that does not fit their or their loved one’s condition. If calls are not responded to quickly, those calling will simply
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divert to other emergency services, such as the ambulance service and accident and emergency—I am the first to admit that that is what I did in those circumstances—because people are just desperate to get medical care.
The key to the success of the 111 service is the speed and efficiency with which one’s calls are responded to and with which access is given to medical advice from doctors or nurses, so I want to take this opportunity to ask some questions. What is the average ratio of call responders—those reading out the script—to GPs and nurses on duty? It would be helpful to know that average ratio in each area where the 111 service is in use. What is the average response time to the initial call? What is the worst response time and what is the best? What is the average time before a caller is transferred to a medically qualified person? Is it normal to expect a delay of up to two hours before a medically qualified person or even the initial responder returns the call? Is it normal to face a delay of three and a half to four hours, which is what we experienced, before a doctor is dispatched, even if it truly is an emergency?
What has been the knock-on effect on the ambulance and the accident and emergency services in those areas where 111 is operating? Is my reaction typical of those who feel they are being let down by 111? If someone dials 111 in North Yorkshire, they get through to the out-of-hours service, so it would be helpful to know how, in areas where 111 is being introduced, the roll-out will be operated smoothly.
In areas where 111 has not been seen to work effectively, what have been the implications for the local hospital, ambulance service and GP practices?
Alison McGovern (Wirral South) (Lab): We are often at our best when we are sharing personal experiences, and I pay tribute to the hon. Lady’s father for his many years of service. The questions she is asking seem to be the right ones. I know from the clinical commissioning group in my area that GPs themselves have expressed frustration at the operation of this service. Does she therefore agree that, from each locality, we need to get their input and listen to their answers to those questions?
Miss McIntosh: I entirely agree, and I welcome the hon. Lady’s intervention. One reason why the 111 service has not yet been rolled out in North Yorkshire is that GPs have expressed their concerns, which leads me to my next question, on the involvement of GPs in areas where the service is being rolled out. How are the legitimate concerns of GPs, such as those in her area and in mine, being addressed and met?
Concerns have been raised in North Yorkshire about the governance framework. How are those are being addressed? A key issue in my area is funding, and I would like to know how 111 is being funded and from whose budget the funding has come. The service is replacing NHS Direct, which caused similar concerns when it was rolled out, so this is not unknown territory for us as parliamentarians or for the Department. It is a little depressing that we are seeing the same problems being played out now, because they were clearly not addressed when NHS Direct was rolled out.
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Let me express a very personal view—it is not a view I have picked up locally. As a GP’s daughter, a GP’s sister and the niece of a late surgeon, I believe that people just want to see their GP. They want to walk in to the surgery or phone up and speak to their own GP. Sometimes 111 can be seen as a barrier, as NHS Direct was, to seeing one’s own GP.
We have an historic debt of £12 million built up by North Yorkshire’s primary care trust. There is real concern locally that that debt will affect the funding of GP practices, and especially of the new 111 service. The funding issues are absolutely the key to 111 going forward.
Mr Andrew Turner (Isle of Wight) (Con): Does my hon. Friend agree that one of the questions is at what level the 111 service should be sorted out? Is it something, for example, for Hampshire and Isle of Wight or for the south-east, or should it be sorted out nationally? There has been very little concern over this matter on my island, but that is perhaps because it is dealt with more locally.
Miss McIntosh: I believe a local solution should be found. A question I will come to is whether there is a difference in the roll-out of the service in rural and urban areas—in my hon. Friend’s case, an island. Local solutions must be found. To me, the best solution will always be for someone to see their own GP on the day they are ill.
I hope that my hon. Friend the Minister will put our minds at rest and say that the story in the newspapers about rationing our visits to GPs is a myth. We cannot dictate how often we will be ill. If an elderly person has a chronic condition, they cannot limit the number of times they might have to call on a medical service in one year.
Barbara Keeley (Worsley and Eccles South) (Lab) rose—
The Parliamentary Under-Secretary of State for Health (Anna Soubry) Will my hon. Friend give way?
Miss McIntosh: If I may, I will give way first to the hon. Member for Worsley and Eccles South (Barbara Keeley).
Barbara Keeley: I thank the hon. Lady; she is being very generous with her time. Dr Clare Gerada of the Royal College of General Practitioners told the Health Committee yesterday that many GPs’ books are now full at 8.30 in the morning, and that if they have open slots there are often queues down the street, which she said she had not seen for years. I agree with the hon. Lady that we need more GPs, because that is what most patients want.
Miss McIntosh:
I know what I am going to say is controversial but perhaps I, as a woman, can say it. Some 70% of medical students are women and they are well educated and well qualified, but when they go into practice, many marry and have children—it is the normal course of events—and they then often want to work part time. Training what effectively might be two GPs
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working part time obviously puts a tremendous burden on the health service. I will now give way to my hon. Friend the Minister.
Anna Soubry: On the point my hon. Friend made about any rationing of or charging for GP appointments, let me assure her that that was an idea floated on a website and is not Government policy. It is reasonable for people who have an interest in such issues to be able to debate whatever they wish to debate, but it is certainly not Government policy, and I know of no good reason why it ever should be. She makes a very important point when talks about, rightly, the good number of women who are training to be doctors, but the unintended consequences.
Miss McIntosh: The problem is similar in other professions, such as my original profession of law. The Chamber will welcome the Minister’s confirmation that it is not Government policy to ration or to charge for GP appointments, as we have heard under successive Governments. We are very reassured to hear that it is not their policy to ration GP visits.
How is the interface with GP out-of-hours providers being addressed? In the rural area of North Yorkshire, three and a half clinical commissioning groups cover one constituency, which poses some real practical problems. Where there are multiple GP out-of-hours providers, what regard has the Department had to the potential difficulties of rolling out the 111 service? Furthermore, are there any issues relating to delivery in rural as opposed to urban areas? I am talking in particular about the distances that GPs or nurses might have to travel to respond to calls under the 111 system.
Most worryingly, there seems to be a political vacuum here. Will my hon. Friend the Minister reassure us that there will be political accountability? Where does the political responsibility and accountability lie for any potential failings or successes of the 111 service? Does the Department plan to review the system further? I ask that because my own experience in the pilot area of County Durham has not convinced me that the review has borne any fruit. Does the Department plan to review the system after three or six months?
Guy Opperman (Hexham) (Con): I congratulate my hon. Friend on securing what is a very important debate and thank her for sharing with us her genuine and very sad experiences. Does she agree that, while everybody would accept that 111 is the way ahead in reducing the burden on A and E, it is all about integration—be it urban areas or deeply rural areas such as those that she and I represent—and that there will be future improvements in GP, 111, A and E, and other services?
Miss McIntosh: The 111 service is a tool and should never be a substitute for the ability visit a GP. I accept that we cannot expect GPs and their families to put up with the antisocial hours of GPs of my father’s generation, who were leaving the profession in droves. I see 111 as a useful tool—an appendage, not a substitute. There are issues that must be addressed in that regard.
Will the system be reviewed, and if so will it be within three or six months? I repeat: is 111 really geared up to deal with sparsely populated rural areas such as those that a number of us here today represent? North Yorkshire
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has a sparsely populated rural area—one of the largest in the country—and a high number of older patients with complex medical needs, which the GPs are very cognisant of.
I welcome the Health Committee’s inquiry into 111 and NHS emergency care. We will all doubtless follow the proceedings, and look forward to its conclusions and recommendations with some interest.
This debate has been a wonderful opportunity to get a number of issues off my chest; to pay tribute, I hope, to my father; and to note my disappointment at how he and others were treated in the pilot scheme. I hope the issues I have raised can be addressed. The 111 service may be a useful tool—an appendage—but we need to look closely at what more needs to be done, and I invite the Government to do so. I am fearful of delegating the operation of all emergency services outwith political control, and I return to the point about where the political accountability for 111 lies. I look forward to hearing the Minister’s considered response to the debate.
John Robertson (in the Chair): I thank the hon. Lady for her speech and I offer her my condolences on the loss of her father, which I am sure applies to every colleague here.
9.53 am
Barbara Keeley (Worsley and Eccles South) (Lab): It is a pleasure to speak under your chairmanship, Mr Robertson. I congratulate the hon. Member for Thirsk and Malton (Miss McIntosh) on securing this debate and on the way that she has opened it, which has been really helpful.
The British Medical Association has consistently expressed serious concerns about the transition from NHS Direct to NHS 111. I understand that the BMA wrote to the then Health Secretary—the Leader of the House of Commons, the right hon. Member for South Cambridgeshire (Mr Lansley)—in February and April 2012, to warn
“of the dangers of rushing implementation of NHS 111.”
It also wrote to Earl Howe, the Health Minister, and to the chief executive of NHS England, David Nicholson, urging them
“to delay the launch of NHS 111 beyond April 2013, due to concerns that many areas were not ready for the transition.”
Those concerns were borne out when the service was launched in Greater Manchester on 21 March, prior to the national launch one week later. I have collected information on the launch in Greater Manchester from the chief executive of Salford Royal NHS Foundation Trust. He told me:
“Significant operational problems were experienced when 111 first launched at the end of March and these problems persisted for the first two weeks of operation. 111 did not equip their call centre with the required levels of trained staff and were therefore unable to deal with the volume of calls received; some patients were left waiting up to an hour to get through on the phone lines and as a result patients just turned up at A&E/GP Out Of Hours Service causing significant capacity and demand issues.”
That is just the point that the hon. Member for Thirsk and Malton made about what people would do if they could not get through to 111.
Senior staff of the Salford clinical commissioning group told me that NHS Direct had given assurances that it had the capacity to handle calls, but after the failures that we experienced in Greater Manchester,
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NHS Direct admitted that it had insufficient call handlers in place. Apparently, when these problems occurred, 111 asked all GP out-of-hours providers to return to their pre-launch call-handling service. However, that was not an option for us in Salford, as our previous call handlers had transferred all their staff over to 111 under TUPE arrangements. So the problems with NHS 111 continued. Salford CCG staff also told me that the out-of-hours service in Salford came under pressure owing to this NHS 111 failure, and that pressure had to be met with increased staff capacity.
Salford Royal NHS Foundation Trust has commented that further improvement to the service is still required. It feels that
“the care pathways still need further modification to reflect local services”
“there are currently gaps in alternative routes of care”,
which the 111 service is showing up. If there are issues with social care, the community team, the district nurse or self-care, that becomes apparent. The trust also said—this is important for our debate this morning—that
“there are also concerns that what we have done with this service is to replace clinician triage in Out of Hours service with computer or non-clinician advice.”
To give an example of the problems that this change has caused in Salford, I will quote the trust again:
“This has led to patients being brought to the emergency department when they are actually on end-of-life pathways”
and should have “community input”. That is just the problem that the hon. Lady talked about—that situation has happened in Salford. It is distressing to think of people who are in their last few days of life being dragged into hospital, when they should really receive care in their own community and in their own home, which is the care that they probably desire.
Salford CCG has reported that feedback forms on NHS 111 have been received from clinicians and that two “significant events” were recorded, which are under formal investigation. The feedback tends to relate to delays in treatment. The CCG also says that its
“immediate priority has been to stabilise the service after a disappointing start. Some positive improvement has occurred but long term there are serious doubts, with NHS Direct identifying the need for extra investment about the contract level to make the service effective.”
I was also told by staff at Salford Royal NHS Foundation Trust that they felt that expectations were set too high about the outcomes that 111 would deliver. They commented that NHS 111 was operating at a level and in a role that an “experienced grandmother” might historically have achieved. That is an important point; my local NHS trust thinks that is what it is getting from the service. That advice—that of an “experienced grandmother”—could be seen as helpful, but staff told me that their preference was for
“an alternative service which had at its core clinically trained primary care staff available over an extended working day, 7 days per week.”
“that this service would be better if it was included within a single integrated urgent care service, incorporating responsibility for GP out-of-hours triage.”
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Guy Opperman: I am listening to the hon. Lady’s contribution, and given her background, it is clear that she is a specialist in this area. Like her, I met staff from my local CCG and local ambulance service last week to discuss the development of this system. I note that she talks about integration. Does she agree that the integration of those various parts of the NHS system is the absolutely crucial thing going forward?
Barbara Keeley: Indeed. We talk a lot about integration, but the feedback that I have received from both my local CCG and my local NHS trust is that we have just taken a backward step. We had a nurse-led service that was working fairly well, although it was not as integrated with other services as it should have been. We now have a system that is led by computer scripts and non-clinicians, in which the patients calling the service—if they get through to it—do not have confidence, and as a result, they are falling back on visiting their GPs or going straight to A and E. My point was that that single, integrated urgent care service—the single service that the hon. Gentleman just talked about—should include responsibility for GP out-of-hours triage, and at the moment it does not. The system could have been set up that way, but it was not. Does the Minister believe that the alternative that I have just put forward is the right direction for an improved NHS 111?
Beyond our experience in Greater Manchester, there have been many criticisms of the NHS 111 service and the shambolic transition to it from NHS Direct. Dr John Hughes, a GP from Manchester, said the service had been withdrawn in his area hours before the launch, owing to problems. He told the BBC that it was “an omnishambles” and
“a waste of public money.”
Dr Hughes has called for a full public inquiry into the procurement of that service, because he feels that it was
“forced forward to meet a political objective.”
Janet Davies of the Royal College of Nursing has argued that nurses from NHS Direct have been running NHS 111. She told the BBC for a report:
“Staff from NHS Direct, the service being abandoned, are supplementing the work of 111—staff that were being made redundant and still are at the end of this month… Specialist nurses that can talk to patients have not left and they are propping up that service.”
She felt that, unlike the nationally run NHS Direct, NHS 111 was a
“fragmented service with local contracts”,
which in her view was “very, very chaotic”. She also said that NHS 111 was an attempt to cut the cost per call, by using non-clinical staff to handle the majority of call time, and that it was
“not using qualified nurses, people with the skills to talk to people and make a sensible decision”.
She felt that the Government had thought about costs but not value. As we have seen, NHS 111 is offering poor value if patients turn away from that service, because it is far more expensive to go to A and E or a GP than to have a conversation with a trained nurse.
In Salford, patients were left waiting on phone lines for up to an hour and then turned to the more expensive options of a GP visit or A and E. Our out-of-hours service came under pressure and extra staff capacity had to be brought in. The opinion of staff at Salford
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Royal NHS Trust is that NHS 111 operates at a level and in a role that an “experienced grandmother” might achieve. Surely, we can and should do better.
10.1 am
Jim Shannon (Strangford) (DUP): I had not expected to be called quite so early. First, I should like to put on the record that health in Northern Ireland is a devolved matter—I understand that—but I am observing the 111 system from my position as a parliamentarian. I congratulate the hon. Member for Thirsk and Malton (Miss McIntosh) on securing this debate. She has encapsulated many people’s concerns. I appreciate the Minister’s efforts on health issues. I am sure that she will, in her response, deal with some people’s issues.
I support the idea behind this phone call triage, as it is called, and its being free to contact, bearing in mind that many GP surgeries have an 0844 number, which costs a great deal from mobiles—we have discussed that in Westminster Hall previously on many occasions, and will continue to do so—but there are clearly major issues with it. Although I accept that sometimes the girls in my office have to stay on the phone for an hour or more to fix some computer glitch with the printer or scanner, we are talking about lives in respect of this service. There have been too many difficulties to ignore.
We have background information on many areas, including those the hon. Lady touched on. Yorkshire and Humber provide examples of the figures and information, which state that there were three deaths and 19 potentially serious incidents coming through the system, clearly underlining the problems.
Mr Gregory Campbell (East Londonderry) (DUP): Does my hon. Friend agree that NHS 111 should immediately answer the phone to all those who contact it—that is obvious—offer direct, accurate communication and provide people with reassurance that they are getting an accurate diagnosis? Those things will be the judgmental touchstones upon which people will base the success, or otherwise, of 111.
Jim Shannon: I thank my hon. Friend for his intervention, which clearly outlines exactly what the 111 system should be trying to achieve. Sometimes, when hon. Members ask if I will take an intervention, they are looking over my shoulder to see what I am going to say next. My hon. Friend made exactly the point that I was going to make.
There have been lots of complaints about calls going unanswered and poor advice being given, which reiterates the point made by my hon. Friend. That follows concerns prior to the national roll-out, after pilot schemes showed disastrous results, with tales of patients waiting hours for advice and others being asked to call back later. That situation is quite unsatisfactory and must be addressed. NHS England stated:
“The safety of patients must be our paramount concern”.
So it should be, and if it is not, we want to ask why. It also said:
“NHS England will keep a careful eye on the situation to ensure NHS 111 provides not only a good service to the public, but one which is also safe.”
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Examples mentioned by all hon. Members—we have them in front of us—provide information that contradicts that. In Greater Manchester, the 111 service was started and then abandoned. Dr Mary Gibbs, a GP providing out-of-hours cover when the system crashed there, said:
“Calls just weren’t coming through.”
Quite clearly, that is the issue. She stated:
“It was totally inadequate. Patients’ health was put at risk.”
The 111 service tends to be busiest when local surgeries are closed. Dr Laurence Buckman, chairman of the British Medical Association GPs committee, stated:
“We are still receiving reports that patients are facing unacceptably long waits to get through to an NHS 111 operator and suffering from further delays when waiting for calls back with medical advice should they manage to have their call answered… The quality of some of the information being given out appears, from anecdotal sources, to be questionable in some instances.”
The advice that people are being given does not always seem to have been up to scratch and is not of the quality that it should be. He added:
“If any area of the country is failing to meet high standards of care, then its NHS 111 service needs to be suspended.”
This is what the experts in the field are saying. NHS England needs to be more transparent about how the system is functioning across the country.
Andrew Percy (Brigg and Goole) (Con): I met one of my local ambulance service chief executives just last Friday, who told me that, in his experience, the implementation of NHS 111 was going well and was helping to reduce demand on the ambulance service locally—and they were quite happy with the service. Although there have been problems, which the hon. Gentleman is right to highlight, plenty of people have been treated well and professionally by this service, and some health service professionals think that the service is working okay.
Jim Shannon: I thank the hon. Gentleman for his intervention. I have stated that the focus of the new system was on trying to make it better. Every hon. Member accepts that. The idea behind it is great, if it works. We elected representatives will always get the complaints. Not often do we get the wee card saying, “Thank you very much for what you’ve done for us,” but we always get the ones saying, “It’s not working well.” The hon. Gentleman is right. I accept that there will be many examples throughout the United Kingdom where the system has, perhaps, worked, but equally there are a lot of examples of where it has not worked. That is the point that I am trying to make.
We highlight such issues for a purpose, not to be dogmatic, angry or always to be negative in our comments, but to try to look towards improvement. I always try to think that my comments will be constructive criticism, which can be taken on board to make things better. My idea as an elected representative over the years, as a councillor and a Member of the Legislative Assembly in a previous life, has always been to try make comments in that way.
I am conscious of my position as a Northern Ireland Member of Parliament, because health is a devolved matter and I am ever mindful of the cuts in funding faced by all Departments in an effort to reduce the deficit—every pound spent must be well spent—but, from my perspective, I urge that the Northern Ireland
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Direct system continue until the kinks are ironed out here. On health, we will follow, as we often do, what happens here on the UK mainland, so, from a Northern Ireland perspective, I want to make sure that the system’s fall downs and problems are ironed out and sorted out before we take on the system—if we take it on.
I have been looking at the system with great interest, because one of my jobs here as MP for Strangford and my party’s health spokesman is to consider the systems across on the mainland. Many of my queries to Ministers here in questions on health and to my Health Minister back in Northern Ireland come from what colleagues say to me and from what these debates bring out. I am interested in seeing how this system works or will work, or does not work. If it does not work, I will convey that to my Minister in Northern Ireland, to ensure that when making a decision there we will look at how it can happen. I will certainly not be urging our Health Minister in Northern Ireland to use his precious funding to implement this scheme as it stands.
10.9 am
Mr Jamie Reed (Copeland) (Lab): It is a pleasure to be called to speak under your chairmanship for what I think is the first time, Mr Robertson. I extend my most sincere thanks to the hon. Member for Thirsk and Malton (Miss McIntosh) for securing this important debate. We have worked closely on a number of issues during my time in Parliament, and she is rightly respected across the House as an independently minded Member. I must express my most sincere sympathies to her, but also my profound thanks for the real courage she has shown in sharing her family’s experiences with us.
It is a mark of the severity of the crisis our A and Es are experiencing that Members of all shades of political persuasion have spoken at some length about their constituents’ experiences. It is no exaggeration to state that members of the public are very concerned about the situation regarding NHS 111. A and E is arguably the most visible part of our NHS, and what happens there is felt throughout the system. From the patient waiting at home for an ambulance to the person waiting on a trolley for a bed, what happens in A and E touches every patient in the NHS.
The crisis in A and E has happened on this Government’s watch. When Labour left office, A and E was performing well, with 98% of patients seen within four hours. However, the number of patients waiting for more than four hours has now doubled, and ambulance queues have doubled too. Let us not forget that the target for the number of patients seen within four hours in A and E has been reduced under this Government, from 98% to 95%. Today’s debate is therefore extremely important, and the Government must finally offer some real solutions to address the crisis they have caused.
Andrew Percy:
I find it incredible that the shadow Minister states that the issue was caused by this Government. A lot of my constituents are having to ring 999 because 50,000 beds were taken out of our hospitals nationally on his party’s watch; wards were closed in my local hospital on his party’s watch. Elderly,
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vulnerable patients who do not have local hospital beds to go to are now forced to ring 999 to get access to emergency services, so it is pretty shameless of the hon. Gentleman to attempt to politicise the issue.
Mr Reed: I have to say I am staggered by the hon. Gentleman’s manufactured indignation. I do not know how long he has been a Member of the House, but he will recall that, between 1997 and 2010, the Labour party took the NHS budget from about £30 billion to £110 billion. However, on every occasion the budget was put before the House of Commons, the Conservative party voted against an increase. He should think again about his manufactured indignation.
Mr Reed: I am going to make some progress, because I want to get on to the substantive issues in play.
When Labour first suggested a new NHS 111 service, we were clear—the hon. Gentleman should listen—that it would not replace NHS Direct. Our manifesto in 2010 said:
“A new national 111 telephone number will make nonemergency services far easier for people to access and book.”
The 111 service was planned to help people find an emergency dentist, a late-night pharmacy or an out-of-hours primary care GP. This Government scrapped that and instead pressed ahead with the botched implementation of a system that just could not cope with what it was expected to do. They were warned, but, as usual, they did not listen.
There is no doubt that the 111 service is not fit for purpose. The statistics show it, the examples given by Members today show it and, most importantly, patient testimonies show it. Indeed, the Minister herself acknowledged it in response to the right hon. Member for Mid Sussex (Nicholas Soames) in late May, when she stated:
“We recognise that the service has not been good enough and we are working closely with NHS England to ensure improvement in performance. NHS England have put a number of measures in place already.”—[Official Report, 21 May 2013; Vol. 563, c. 740W.]
I hope the Minister will outline what those measures are and what their effects have been, because the contributions we have heard today suggest they are having a negligible effect.
The implementation of the system has undoubtedly caused serious problems; indeed, in my area, NHS Direct is having to be maintained alongside the 111 service to cope with demand. The Minister must explain in detail how a botched, fragmented implementation was allowed to happen despite there being a significant pilot scheme.
Barbara Keeley: On the issue of propping up NHS 111, I wonder whether this is the point at which to give credit to the NHS Direct nurses whom Janet Davies of the Royal College of Nursing cited. Even though some of them are being made redundant, they were prepared to prop up the service during its few weeks in places such as Greater Manchester. We really should give those nurses credit. What a dreadful experience, just before they were made redundant, to have to prop up the service that was replacing them.
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Mr Reed: I could not agree more. We must give credit to all the people in the NHS coping and labouring under a creaking system right now. The case of the NHS Direct nurses my hon. Friend draws our attention to, who are about to be made redundant but are propping up the system, speaks volumes about their commitment to the ethos underpinning the NHS. I thank my hon. Friend for that contribution.
The 111 service data for March published by NHS England show that only 122 patients responded to the NHS 111 patient experience survey. When the Minister responds in a few minutes, I hope she will not try to justify the implementation of a system that needs to serve millions of people on the basis of the experiences of just 122 patients.
The main purpose of the debate is to look at the implementation of NHS 111 and its impact on A and E attendances. There is no better place to look than the Isle of Wight—the hon. Member for Isle of Wight (Mr Turner) was present earlier. The 111 service there went live on 25 October 2011. The area has had a long time to address teething problems and to ensure that the service operates properly. What has A and E performance looked like over the past few months? Since the end of September, almost 2,000 patients have waited more than four hours, and the trust has missed its target for 23 out of 35 weeks. That is hardly a ringing endorsement of the system, even when it has had a chance to bed in.
Consultants on the Isle of Wight have even said that although patient numbers would be falling and the pressure would be easing if NHS 111 was working as intended, that is not happening—patient numbers are rising, and the pressure on the NHS is increasing. Indeed, Chris Smith, the director of NHS 111 on the Isle of Wight told the BBC that the service is fragmented and that that has led to problems. In response to the hon. Member for Tewkesbury (Mr Robertson), the Minister said that every NHS 111 provider is able to handle inquiries from any part of the UK, but I would challenge her to repeat that assertion today, given Mr Smith’s comments. If a system is fragmented, and CCGs are commissioning different providers, it will be almost impossible for those trained to handle calls to work within different systems. For example, the process for referring people through the system in an area with which they are unfamiliar will be totally alien to them, which is bound to cause further problems.
That brings me to my final point about the system. Following Labour’s A and E summit in Westminster last week, it was revealed to us that 111 call handlers do not necessarily have clinical backgrounds, as my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) said. Even more shockingly, it was revealed that some areas have an enforced threshold on how many calls nurses can answer, and that that was as low as one in five. The fragmentation of the system means that the figure varies from area to area, because it would have been negotiated in local contracts. Therefore, the service provided is not universal. That is in stark contrast to NHS Direct, under which 60% of calls were directed to nurses. Under 111, however, the figure stands at less than 20%. Does the Minister believe that the low level of engagement between trained medical practitioners and patients in the service is contributing to A and E pressures?
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The chaotic reorganisation of the NHS is clearly producing a deteriorating experience for patients. In the last week of March, one patient in the south-east waited for 11 hours and 29 minutes for a call back. In the area covered by NHS Gloucestershire and NHS Swindon, 43% of calls lasting longer than 30 seconds were abandoned by the patient before they were answered. Will the Minister outline the lessons that have been learned from that experience and explain what measures will be put in place to ensure it is not repeated on a national scale?
In four weeks, the 111 service will be live across the country, and the Government need to be more honest about how the service is performing before wider implementation. Royal colleges, patient groups and other stakeholders have long warned the Government that the health and social care reforms brought about by the Health and Social Care Act 2012 would be distracting and cause chaos, and that such top-down reforms would stop the clinically driven reforms needed to help address the crisis in A and E.
That there is now a crisis engulfing accident and emergency services is beyond doubt. It was caused by the Government. We have heard today of a political vacuum and we have heard legitimate fears about the lack of accountability. Patients deserve better; we all do. If the hon. Member for Thirsk and Malton will allow me to say so, her family and her father deserve better. I hope that the Minister will take the time to address all the issues, and to outline the Government’s plan to deal with the current A and E crisis that they have caused.
10.20 am
The Parliamentary Under-Secretary of State for Health (Anna Soubry): It is a pleasure to serve under your chairmanship, Mr Robertson, for what I believe is the first time.
My hon. Friend the Member for Thirsk and Malton (Miss McIntosh) made an admirable speech, raising many points and asking many questions—some of which, I will say bluntly, I will not be able to answer in my speech. I assure her that she will receive an answer to those by way of a letter. Before I discuss her speech, I want to deal with the points raised by the hon. Member for Copeland (Mr Reed). It does neither him nor his party any credit to use the serious problem in A and E as a political device to attack the coalition Government. It is not as simple as that. To suggest that the problem has been caused by the Government is plain, simple rubbish. It is accepted that there are many complex reasons for the situation, although I am reliably informed that the number of people being seen within the four-hour target is improving and that many accident and emergency departments are achieving the target, and have been doing so for some weeks. Some, indeed, are exceeding it.
There is much evidence emerging that a firm grip is being taken on the situation, but things are complex. There is no magic bullet. It does not matter which party is in power, the Government would face the problem that we have, because there are many causes. One of them, which people on all sides of the argument have identified, is the fact that we do not have the out-of-hours service we want.
Barbara Keeley:
The Minister says that the issue is complex and accuses the shadow Health Minister of making political points. It is about time that Health
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Ministers stopped making excuses. They have been in office three years and it is time they started to take responsibility for what they are doing.
I have gathered evidence, and the causes of what has happened clearly include insufficient call handlers, which is not complex—it is just a shortage of staff. Another factor is the replacement of trained nurses and trained clinician input for phone triage with computer-led or non-clinician advice. Those things are not complex. They are just wrong.
Anna Soubry: I am not for a moment saying that there are not difficulties and problems in 111. We know there are, but if only the issue were as simple as solving the 111 problems. The out-of-hours service is just one of many factors. [Interruption.] I want to make some progress on this point: 111 is one factor among the failings in relation to the sort of out-of-hours service that people want. We have also had the difficulty of a long, cold winter, which has added pressures—that is something that often happens. Also, there are 1 million more people attending A and E. That is not the fault of the Government. We have not suddenly caused it. It is because of changes—
Anna Soubry: I will take interventions, but I want to make these points first.
The population is also living considerably longer. That is good and welcome, but there are many frail elderly people with complex illnesses and diseases, so they attend A and E in a way they did not previously. In addition, we suffered under the previous Government from a lack of integration between health and social care. That was one of the things that the Health and Social Care Act 2012 addressed, and will solve. It is about better integration. The hon. Member for Copeland sneers at that.
Mr Jamie Reed: I do not sneer; I laugh.
Anna Soubry: He laughs at it, Hansard will record. It is not a laughing matter at all. What I was describing is one of the achievements of the Act. I am confident it will deliver.
Andrew Percy: The Minister is making sensible points. As to manufactured indignation, if that is what it is, mine comes from the fact that I spend 30 to 40 hours a week volunteering in the NHS as a first responder, and I spent 30 hours doing so last weekend.
A big issue that creates pressure in the NHS is the lack of integration between social care and health services, and a lack of proper intermediate care facilities. We do not have the step-up, step-down facilities that we need to deal with the ageing population. That is one of the biggest problems in my area and a reason for increased pressure.
Anna Soubry:
I, too, know that it does no one any favours to make out that someone forcefully and passionately giving a view based on their experience is
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manufacturing it. I know that that is not true of my hon. Friend, and I thank him for his valuable contribution. He is right.
Mr Jamie Reed: I think casual outside observers will struggle with the concept that politicians from different political parties should seek to have different political opinions about the services and Department for which the Minister is responsible. She makes an almost Kafkaesque defence of the Government’s NHS record, but will she accept that the awful implementation of the 111 scheme, the collapse of adult social care, the closure of walk-in centres and the huge pressures on the NHS elsewhere in the system have resulted in the crisis in A and E?
Anna Soubry: I will not accept any of what the hon. Gentleman says, because he does his cause no service when he makes cheap political points. The matter is hugely complex, but it is wrong to say that the Government caused the problems in A and E. He is wrong in that. It is difficult and complex.
Barbara Keeley: Will the Minister give way?
Anna Soubry: No, I will not. The responsibility, if we are honest—would not it be refreshing if we could for once have an honest debate about the national health service?—probably goes back 10 or 20 years, a period encompassing Governments of different political colours. I am happy to say that—by which I do not mean I am happy that those Governments have failed, but people may think the honesty is refreshing.
I want to deal now with the excellent speech of my hon. Friend the Member for Thirsk and Malton. I pay tribute to her and her work in this place, but also to the considerable efforts and work of her late father. I am sure that if he could have heard his daughter’s speech he would have been very proud. I remember my own father saying that out of all evil comes some good, and perhaps some good may come from her late father’s terrible experience of 111 and the fact that he died shortly thereafter.
I pay tribute to all GPs. There are huge difficulties with the GP contract, which was introduced in, I think, 2004. The consequences have included the loss of the out-of-hours service that I enjoyed as a child, teenager and young woman. With few exceptions, we have wonderful general practitioners, and many whom I know, including my own, and others who are friends of mine, work long, difficult hours. It is important to make that point.
As you know, Mr Robertson, during the recess, far from enjoying holidays, as the popular press makes out, we go back to our constituencies and use the time to make or renew contact with, for example, our local clinical commissioning group or ambulance trust. Alternatively we just go out and about, as I have done, knocking on doors and talking to people. One of the things I did during my recess was meet the head of the A and E department of the Queen’s medical centre, which is the local hospital in my constituency of Broxtowe in Nottingham. The head happens to be one of my constituents, and they tell me that there is much improvement at the Queen’s medical centre, as I know from the stats and so on. I also talked to GPs, and the
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CCG in my constituency now opens its doors for Saturday morning surgeries, which do not replace any other surgeries; they are extra facilities. The CCG has done that for two simple reasons: first, to improve the service it gives to its patients, and, secondly, in recognition of the need to reduce the pressure on the A and E department of the Queen’s medical centre.
It is right and fair to say that many GPs look with concern at what is happening in many of our A and Es, and with 111, which is commissioned in some areas by CCGs and in other parts of England by clusters of GPs. They are by no means fools. What motivates anyone to enter the medical profession, in my experience, is a real desire to serve people. They want to help and treat people. They are motivated by the very best of motives, so of course our GPs are concerned about the situation.
There is much work to be done with the GP contract to improve out-of-hours service, but we also have to be honest in this debate. There are often urban myths and anecdotes, but it is a fact that many GPs have already said that, far too often, people who come to see them in their surgeries, who attend A and E or who dial 999 or 111, are calling when they do not need to make that call or that appointment. They might be better off making their pharmacist their first port of call.
Miss McIntosh: I thank my hon. Friend for allowing me to intervene and for recognising not only the work my father did, but the work that all GPs do in very trying circumstances. May I bring her back to the Government’s framework, to which I referred, and the very real issues that GPs have raised in North Yorkshire about different GP out-of-hours providers suddenly working with one 111 provider? How will those issues be resolved?
Anna Soubry: Indeed. I will answer as many of my hon. Friend’s questions as I can. There are some questions I will not be able to answer, but I will certainly write to her.
One of the reasons we introduced pilot schemes was to learn from them, and I can tell my hon. Friend a few things as a result. The university of Sheffield did an evaluation report, which said that there was “no statistically significant” impact on services in most of the pilot areas. Importantly, NHS England is collecting data on 111 and its impact on other services, especially, as one would imagine, on A and E. NHS England is in a position to monitor that, and it will report in due course. I am told that the April data will be published this Friday.
I am reliably informed that the A and E performance of York Teaching Hospital NHS Foundation Trust, which serves my hon. Friend’s constituency, is that in 2013-14 so far, 96.1% of people have been seen within the four-hour target. That is above target. I think the average across England for people being seen in A and E is some 55 minutes.
Mr Jamie Reed:
This question is not a trap in any way, shape or form. The Minister just said that NHS England is assessing data on the performance of 111 thus far, which will be made available in due course. This is an empirical question: will the system be rolled
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out across the country without the data on the effect of the 111 service on the rest of the system being fully understood?
Anna Soubry: I do not know the answer, and I will not start speculating because it invariably gets one into terrible trouble.
Mr Reed: Will the Minister write to me?
Anna Soubry: I am more than happy to write to the hon. Gentleman with some sort of answer from either NHS England or the Department.
I should say, of course, that we know that 111 has not been successful in the way it should have been in many parts of the country, and we know that there were particular problems over the bank holiday and Easter periods, but we also know that it has now been rolled out to 90% of England. NHS England is monitoring, overseeing and collecting the data, as we would all hope.
I will do my very best to respond to the content of today’s debate and the questions that have been raised, with apologies for those questions that I do not answer.
The ratio of call handlers to professionals, about which my hon. Friend the Member for Thirsk and Malton asked, is 4:1. That ratio is not specified, however. There is no prescription that it must be 4:1. As 111 is locally commissioned in the way that I have explained, it is for local commissioners to decide whether to change that ratio, depending on the particular needs of the people in their area. One of the great benefits of the 2012 Act is that we have enabled local commissioners, either as a CCG or as a cluster, to commission services to meet the specific needs of their patients. I hope that will mean that a cluster or CCG in a rural area, obviously knowing that its patients live in a rural area, will ensure that its service is tailor-made to suit the needs of those patients, which may be different from the needs of patients in, say, a city and its surrounding suburbs. That is one of the joys of local commissioning.
My hon. Friend asked whether the three to three-and-a-half hours—in truth, I think it was really four hours—before her father was seen is normal, and the unequivocal answer is no. Is it acceptable? In my view, it is certainly not acceptable.
My hon. Friend then asked who pays. She is concerned about whether the debt in which her primary care trust found itself will have an impact. The 111 service is paid for by CCGs, which is one reason why CCGs are involved in the local commissioning of the service.
How are the concerns of GPs being addressed? The NHS is having a review in the way that I described. My hon. Friend the Member for Brigg and Goole (Andrew Percy), who must be a member of the Select Committee on Health—that shows my profound ignorance, and I apologise to him—has helpfully reminded me that Dr Gerada, who is the chair of the Royal College of General Practitioners, said in her evidence yesterday that she has not seen such queues since the flu epidemic of two to three years ago. She said that the reasons for the high demand are mixed and complex, including the nasty flu virus that went around earlier this year and at the end of last year. I reiterate my point: if only it were so simple to cure the problems in A and E.
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Barbara Keeley: The Minister talked earlier about the issue being about out-of-hours service. The NHS 111 problems in Greater Manchester put greater pressure on our out-of-hours service. She said there was a long winter, but 111 was rolled out at the end of March. Does she think that was a sensible time? It was not even the end of a very hard and long winter. Finally, she said that we have had more A and E attendances, but the problems have caused further pressure on A and E. The point many hon. Members have made, which I hope she accepts, is that the chaotic launch of NHS 111 in the end part of winter caused more problems than it solved.
Anna Soubry: Again, I do not think it is as simple as that. Of course we have not been happy with the roll-out of 111, which is accepted. The service has not been the success that we had hoped. We agree on that.
Barbara Keeley: Will the Minister give way?
Anna Soubry: No; forgive me. The most important thing, though, is that things are improving.
Andrew Percy: We on the Health Committee were provided with figures yesterday showing that referrals to A and E from NHS 111 were about half the amount of those from NHS Direct, but that there had been an increase in referrals to out-of-hours and GP services. The link between NHS 111 and pressures on A and E is perhaps not proven.
Anna Soubry: I am grateful for that intervention. I know that the university of Sheffield specifically examined the pilot and found that in most pilot areas, there was no impact. However, we also know that NHS England is monitoring the situation, reviewing the data and analysing all the different, complex problems causing pressure on A and E to ensure that we make the improvements that we want.
My right hon. Friend the Member for Thirsk and Malton—[Interruption.] Well, I am going to make her right hon. for the moment. It will not be put into Hansard, so no one will know; it is just between us. She made an important point about providing for people receiving palliative care, catheter treatment and so on. She said that perhaps they needed a different script. There is much merit in that. Again, I would hope that the commissioning services would put that aspect in the script. She asked specifically about the script. I am reliably informed that it has been written by clinicians at the highest levels, but I also know that there is
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concern at a senior level about the fact that it takes an average of 20 minutes to go through a prescriptive script.
There is a wider problem here. We live in an age in which it is increasingly difficult to rely on common sense. When somebody rings up and says, “My father is a retired GP. We’ve been here before, and he has all the symptoms of a urinary tract infection,” they should not be asked whether he is still breathing. A large dose of common sense would mean that that question would not be asked, nor would “Is he bleeding?” and so forth. That is the stuff of nonsense.
Margot James (Stourbridge) (Con): I apologise for not being here at the beginning of this excellent debate, and I congratulate my hon. Friend the Member for Thirsk and Malton (Miss McIntosh) on securing it. I have been in regular correspondence with the 111 service in the west midlands region, and with the other related services. I am satisfied that some of the teething problems will be resolved, but my local hospital asked me to raise one question with the Minister. Will she look into the treatment algorithms used by 111? There is a belief in the hospital that they are more likely to result in a referral to A and E than those used by the previous service.
Anna Soubry: I am grateful for that intervention, because I have heard that anecdotally as well. It is an important question. I cannot give my hon. Friend a full answer, but I will do all that I can to provide it in a letter if she will allow me. That concern has been raised with me on a constituency basis.
As I said from the outset, 111, which is a good service in theory and should be of considerable benefit to health professionals and, most importantly, to patients and all others concerned in the national health service, has not gone as smoothly as we had hoped. That is conceded, and one should not make party political points from it. However, the service has improved, it continues to improve and it is being monitored. I am grateful to my hon. Friend the Member for Thirsk and Malton for bringing this matter to the attention of the House, and I apologise to her for any questions that remain unanswered. I will reply to her and will address all the other points raised by hon. Members in this debate.
10.44 am
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UK Manufacturing Sector
11 am
Caroline Dinenage (Gosport) (Con): It is a great pleasure to serve under your chairmanship, Mr Robertson.
I want to talk about strengthening the UK manufacturing sector through innovation. UK manufacturing is going from strength to strength. We have a rich heritage of advanced manufacturing, companies in a range of sectors that are competing with the very best internationally and a world-class reputation for quality innovation. There is certainly widespread recognition by business and Government that research and innovation are essential to global competitiveness and future economic growth. Despite the obvious global economic challenges, the Government stepped up to the plate and invested in science, research and development, infrastructure and skills—all the things that innovation needs to flourish. I also hope to expand on how the Government could use their enormous purchasing power to help draw the most economic benefit from such investment.
Most manufacturers understand that their future success depends on the ability to be innovative in their thinking, ways of working and approach to business, as well as in their new product development. It is all about changing, adapting and anticipating the demands of their marketplace and their customers. Huhtamaki is one of the biggest employers in my constituency. It has a dynamic attitude towards innovation—which it has to, because its industry makes paper and plastic cups, loads of them: a staggering 2 billion a year for many well-known coffee houses and fast-food establishments. Its business motto is to “lead change before you have to”, and the company is continually innovating to maintain its position as a market leader, which means embracing new print technology, experimenting with colours and textures and introducing products that are recyclable, renewable and even compostable. The managing director told me that that philosophy gives the company the edge in such a changing industry.
Innovation can be the key to a virtuous circle: investment leads to growth and efficiency, which generates revenue that can be used to achieve change and to support further innovation. The difficulty is that innovation not only requires long-term investment, but introduces a certain element of risk that some manufacturers find difficult to justify, particularly in a tough economic environment. In fact, forward-thinking innovators might even put themselves at a disadvantage in the short term compared with their competitors, who let others take the lead and then hang on to their coat tails.
For the UK to remain a world-class manufacturing hub, it is essential for the Government to do all they can to support the innovators. Where that works best is where Government and business work together in the development of and support for new technologies, and that has made a big difference in some sectors. Thus, since 2007 successive Governments have invested support in the space sector, helping British companies to become the world-leading innovators in the field. For example, Astrium, a major employer in the Portsmouth area, specialises in the mind-blowing satellite technology that has made it No. 1 in Europe and No. 3 in the world.
Stephen McPartland (Stevenage) (Con):
Astrium is a huge employer in my constituency, and Stevenage is now the capital of the UK space industry. Will my hon.
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Friend join me in celebrating Astrium’s success a couple of days ago, when it launched into space a satellite that in a few months will be responsible for beaming broadcast and communications signals back to the UK?
Caroline Dinenage: My hon. Friend makes an excellent point. Astrium does real James Bond stuff of the future, which is incredibly impressive. In fact, the UK space industry turns over £9 billion a year and is predicted to grow by 7.5% each year in an increasingly demanding global marketplace.
Another British success story is the aerospace sector, which is the largest in Europe and the second largest in the world, after the USA. It is worth more than £23 billion to the UK economy, and 70% of its output is exported worldwide. The sector employs directly nearly 100,000 people in the UK. Its biggest challenge is that the long-term returns from research and development make it an unattractive capital market investment.
Chris White (Warwick and Leamington) (Con): I congratulate my hon. Friend on securing this debate. During the recess, I was pleased to be present at the opening of Bosch’s new technology centre at Warwick university’s science park. I am pleased to see the hon. Member for Coventry South (Mr Cunningham) present; he was also at that opening.
The centre will support around 30 engineers and is a perfect example of bringing together our universities and businesses to help spur innovation in our manufacturing sector. Does my hon. Friend agree that the Government must look closely at such centres, how they are formed and how we can put in place more incentives for business to commit to the long-term cost of supporting innovation?
Caroline Dinenage: My hon. Friend is absolutely right. It is imperative that the Government work to facilitate business development and innovation as much as is humanly possible.
Mr Jim Cunningham (Coventry South) (Lab): I congratulate the hon. Lady on securing this debate. In addition to what the hon. Member for Warwick and Leamington (Chris White) said about Bosch, Jaguar Land Rover has been a success story, creating not only direct but indirect jobs in the west midlands. Anyone who knows anything about industry knows that for every direct job, there are probably two or three indirect jobs, so there is a multiplying factor. Does the hon. Lady agree that in the west midlands, and particularly in Coventry, slowly but surely, manufacturing is beginning to come back? The process under successive Governments has been slow, but it is encouraging to see companies such as Bosch and Jaguar Land Rover. Not so long ago, the Minister helped out with the London Taxi Company, and that maintained an anchorage for manufacturing in the midlands and nationally.
Caroline Dinenage: The hon. Gentleman makes a good point. Manufacturing is growing apace, and Government intervention is key to continuing that progress. That is why their recent funding commitments through the aerospace growth partnership have been so widely welcomed.
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I have given some examples of how the Government have overseen initiatives to help what might be called the push or supply side of business innovation.
Jim Sheridan (Paisley and Renfrewshire North) (Lab): Will the hon. Lady give way?
John Robertson(in the Chair): Order. I point out that interventions should be short.
Jim Sheridan: I welcome this debate, which is long overdue. The hon. Lady may be aware of the National Audit Office report on the contract that Bombardier lost to Siemens and the resulting loss of jobs. There is still time to retrieve that contract, so can she do anything to convince her Government that it should stay in the UK?
Caroline Dinenage: The perfect Minister is in the Chamber, and I hope he will speak about that when he has the chance to respond.
Businesses I have spoken to are really positive about some of the incentives the Government are introducing to help with innovation, including R and D tax credits and the financial incentives to innovate. Will the Minister assure me that his Department will continue to push for such incentives to be high on the Government’s priority list?
Mr Iain McKenzie (Inverclyde) (Lab): The hon. Lady is being most generous with her time. I congratulate her on securing this important debate, but I just wish it had been longer than half an hour. I am sure she will agree that innovation in British manufacturing is nothing new. An example is an illustrious son of Inverclyde, James Watt, who innovated and dominated the market for 10 years. He is a prime example showing that innovation is nothing new for British industry.
Caroline Dinenage: Absolutely. We have a proud history of innovation and manufacturing going back centuries, and it is important that it be allowed to continue.
Jason McCartney (Colne Valley) (Con): Will my hon. Friend give way?
Caroline Dinenage: May I make a little progress? I will then be more than happy to give way.
The other catalyst for business innovation is the pull effect, and I want to say a little more about how public procurement could be used better to drive the demand side of the innovation equation. This is an area where the strategic spend of public money on goods and services has the potential to drive innovation and to create more efficient, cost-effective, high-quality public services, as well as to unleash economic benefits. The Associate Parliamentary Manufacturing Group recently held a seminar on this issue, where it listened to the manufacturing sector’s concerns about how the Government buy products, as well as hearing about current academic work on procurement as a tool to drive innovation. Many bodies, from the CBI to the foresight team at the Department for Business, Innovation and Skills, see public procurement as one of the most powerful policy levers at the Government’s disposal.
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Globally, the UK is second only to the US in its scientific knowledge base, but both the US and Germany outstrip the UK in turning that knowledge into economic profit. Is that because the Americans and Germans have a greater desire to be cutting edge, or are they simply less risk averse? Either way, it seems highly inefficient to invest heavily in a knowledge base at the start of an innovation process and not capitalise on the potential economic benefits. With that in mind, will the Minister tell me what efforts we are making to learn from other nations about maximising the economic fruits of our innovation? That is something the US invests heavily in—the virtuous circle again. Demand for a product creates more jobs; more science, technology, engineering and maths-based graduates; more high-value-added companies; greater economic prosperity; and, in theory, more tax returns.
The Treasury clearly recognises that, which is why, in the 2013 Budget, the Chancellor of the Exchequer announced that all Departments must engage in the small business research initiative process and vastly increased the amount of money available through it. The Technology Strategy Board’s SBRI encourages the private sector to develop solutions to problems identified by the public sector. So far, it has had great success: 120 competitions have awarded 1,200 contracts to a value of £100 million. Those have involved 40 public sector bodies. SBRI therefore shows that in identifying new problems, the public sector has a mechanism through which it can procure innovative solutions.
However, despite its great success and even greater potential, the programme has not fully solved the procurement puzzle. It appears to be asking for solutions to new problems that are identified, but not looking for new and innovative solutions to age-old problems that cost the country so much money. Will the Minister say to what extent the SBRI encourages Departments to look again at problems that may already have a stove-pipe solution?
Let me give an example: QinetiQ has a subsidiary company called OptaSense, which has developed a way to use fibre-sensing technology to deliver real-time information to monitor assets such as pipelines or railways. In layman’s terms, that means turning fibre-optic cables into thousands of highly sensitive microphone devices capable of distinguishing between human footsteps and animal tracks. They are capable, in fact, of hearing someone walking alongside a railway track and then sawing through the railway cable, enabling the transport police to catch them red-handed before the damage has been done. That seems a good solution to all those wasted commuter hours resulting from rail cable theft.
The German railways and the north American oil and gas industry seem to think so. The technology has secured significant export contracts, and the number of employees has grown from three to 160 in the past few years. In fact, 99% of the company’s revenue comes from overseas. The problem is that, given that those countries are spending the money that is effectively sponsoring most of the ongoing research and development, OptaSense is under increasing pressure to move both that and the manufacturing overseas. The UK’s competitive tax regime for R and D is one of the main things keeping it here. Despite that world-leading solution being developed and manufactured here, Britain is in danger of being left behind by its own technology.
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Other companies would be tempted to move their ideas and their most brilliant scientists to where the market was, meaning that if we decided to buy back the product at some point in the future, we would effectively be buying back our own ideas, without all the economic benefits to the UK economy.
Realising the power of procurement to effect change in industrial competitiveness is a big challenge. It represents a step change in the way public bodies and Departments think about their budgets, and I think it is fair to say that risk taking—and, as a result, innovation—is not encouraged in public procurement. Public procurement still has a tendency to opt for low-risk solutions and mature technology, and innovation is not routinely welcomed or rewarded. In part, that is due to the competing objectives and bureaucratic barriers that public procurers face, which discourage risk-taking.
As we have seen, the fear of failure from doing nothing drives innovation in the private sector. My next question for the Minister is, what lessons can be learned from business to try to encourage that mentality in public sector procurement?
Mr McKenzie: Will the hon. Lady give way?
Caroline Dinenage: I will make a little more progress first. Some Departments, such as the Ministry of Defence, are more culturally competitive, more innovative in their approach to innovation, happy to manage technological risk, and have a more open architectural approach to procurement.
We should not be surprised that the procurement system produces the results that it does. If the discussions around procurement remain too closely linked to buying, without being linked to interaction with the private sector and horizon-scanning, procurers will simply keep buying as they always have. That behaviour has been compounded by the positioning of austerity policies against procurement; in the mission to try to cut costs, procurers should include in their calculations how, through the pursuit of innovation, money may be saved long-term, taking whole-life costs into account. Will the Minister tell me what more he thinks the Department can do to encourage Government bodies to be early adopters of innovation?
Jason McCartney: I thank my hon. Friend for giving way and for securing this fantastic debate. The contributions so far show that we could have had a good hour and a half on the topic. Last night, Huddersfield and Colne Valley featured on the BBC 2 TV programme, “Town”, which showcased some of the innovative engineering and textile work going on in my historic part of the world. The Enterprise and Innovation Centre has opened at Huddersfield university. Does my hon. Friend agree that skills and education blending with innovative companies is a fantastic way forward for our innovative organisations in this country?
Caroline Dinenage:
My hon. Friend makes an excellent point. One of the key issues seems to be communication between Government and business. The Manchester Institute of Innovation Research reported that, following a survey of 800 businesses, two thirds believe that engaging with the public procurement process had a
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positive effect on their innovation, with a quarter saying that an innovation had come about directly as a result of engaging with the public body.
With that in mind, a commissioning academy has been set up by the Cabinet Office that will bring commissioners from different parts of the public sector together to learn from best practice. In recognition of the fact that we need capable, confident and courageous people in the public sector to deliver more efficient and effective public services, it says that success will mean commissioners embracing new and innovative forms of delivery. It is interesting to note that, of the supporting Departments for the commissioning academy, the Department for Business, Innovation and Skills is not mentioned. Will the Minister tell me why, and to what extent BIS is liaising with the Cabinet Office work on procurement?
If we are to maximise the economic potential of the Government’s enormous purchasing power, there should be pressure on suppliers to come up with new ideas and innovative solutions to problems, while still meeting the requirement to show value for money.
Mr McKenzie: I thank the hon. Lady for again taking an intervention. Does she share my frustration that public procurement has not embraced, and moved as quickly as it should into, e-procurement, which the private sector has been using for 10 or 12 years?
Caroline Dinenage: That is an example of how we are a little slow to adapt to new technologies and innovative ideas, which is one of the problems we are trying to address today. There should be more opportunity for unsolicited, novel approaches to meeting public sector needs, particularly where new technology is involved.
Andrew Bingham (High Peak) (Con): I thank my hon. Friend for giving way; she is being characteristically generous. Does she agree that many innovators and entrepreneurs, including in my constituency, lament the level of paperwork and bureaucracy in public sector performance, and that that is what prevents them from offering fantastic products to the public sector that can save money and increase the quality of services?
Caroline Dinenage: The Government are doing excellent work on addressing the problem. Some of the pre-qualifying questionnaires that companies used to have to undertake were horrific. The Cabinet Office now has a mystery shopper service to which small and medium-sized enterprises can feed examples of bad practice in Government commissioning.
It is important to conclude by saying that if central and local government encourage innovation through their procurement processes, more UK suppliers will invest in innovation, which will help the British economy and open up UK export opportunities, so that we can play our full part in this global race.
11.17 am
The Minister of State, Department for Business, Innovation and Skills (Michael Fallon): On behalf of us all, I welcome you to the Chair this morning, Mr Robertson, and I congratulate my hon. Friend the Member for Gosport (Caroline Dinenage) on securing this brief debate on an extremely important subject.
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It was good to hear my hon. Friend’s support for manufacturing and her recognition that the Government are doing what we can to support it. I know that a number of my colleagues are doing so in their constituencies. She might like to know that QinetiQ is based in my constituency, too, as well as down on the Solent, and I was very privileged to promote the OptaSense technology that she referred to on a recent ministerial visit to Kazakhstan. We are backing that technology and ensuring that our posts overseas are doing what they can to support QinetiQ.
Innovation is a key driver of economic growth. It improves business competitiveness, GDP growth and wider welfare. We are fully committed to improving our innovation performance as an essential component of our growth plan. We encourage research and development in businesses across the country to enable that growth to happen.
At a local level, my hon. Friend’s constituency is home to the Solent local enterprise partnership, which is a dynamic, well-led, business-involved organisation that has already secured three successful regional growth fund bids and is fully involved in the Daedalus enterprise zone and in the round 2 Southampton and Portsmouth city deal. I had the pleasure of talking to Doug Morrison again on my most recent visit to the Solent.
What else are we doing? We are working with manufacturers and their supply chains and taking the steps that we can in government to strengthen and grow modern manufacturing by encouraging innovation, business investment, technology, more commercialisation, skills and exports.
Manufacturing now generates more than half the UK’s export of goods and almost three quarters of our business R and D and thus the innovation that drives growth. It also, of course, benefits other sectors through demand for raw materials, energy and services such as research, design and finance.
We have implemented the 2011 advanced manufacturing growth review and announced further measures to support the sector, including the advanced manufacturing supply chain initiative—two more rounds were announced for this year—the talent retention solution, the See Inside Manufacturing programme, a package of support for energy-intensive industries and a further £2.6 billion of investment in the regional growth fund to spend on projects such as capital investment, R and D or training.
We obviously want to keep as many jobs as we can in the UK and we do that by maintaining the science base, by providing support for technology commercialisation through the Technology Strategy Board—my hon. Friend referred to that—through investment in skills and through action to reform credit markets and to get bank lending moving again, as well as through very specific support through the industrial strategy for some of the sectors that she mentioned, such as the aerospace and automotive sectors, where we can do more to strengthen UK supply chains.
The Technology Strategy Board is the Government’s prime channel for supporting business-led technology innovation. It provides opportunities for innovative businesses through the growing network of Catapult
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centres. The High Value Manufacturing Catapult opened for business in October 2011. It will receive £155 million for the period up to 2016-17. It supports businesses to bridge the gap between early innovation, where the UK has traditionally been quite strong, and industrial-scale manufacturing to take the projects forward. Building on the capacity of its seven partner centres, that Catapult can cut across sectors, giving its customers access to world-class expertise, equipment and processes invested in and supported by the UK Government. I was also privileged to break ground at the expansion of the National Composites Centre in Bristol recently. My hon. Friend might like to know that since April 2010 the Technology Strategy Board has provided almost £1 billion in support for businesses across the UK, ranging from pre-start-up businesses to large multinationals.
My hon. Friend posed at least three specific questions; there may have been more than three. I hope that if I do not cover them all, she will allow me to write to her with a fuller reply.
Jim Sheridan: Will the Minister clarify whether he will indeed refer to the National Audit Office report regarding Bombardier versus Siemens?
Michael Fallon: I have not yet seen that report, which I think has only just emerged. What I can do is undertake to look at it immediately this debate concludes, but I cannot refer to it today, for the very basic reason that I have not yet read it. I hope that the hon. Gentleman will forgive me for that.
The first question that my hon. Friend the Member for Gosport asked was about tax credits. Research and development tax credits are providing the single biggest Government financial incentive for business investment in R and D, and take-up has increased steadily during the 12 years of the scheme. In the last financial year for which I have figures—2010-11—tax relief claims of £1.1 billion supported approximately 72% or £10.9 billion of all R and D revenue expenditure by business. Additionally, the patent box allows companies to claim a reduced corporation tax rate of 10% on profits from qualifying patents and certain other innovations.
My hon. Friend’s precise question, as I recall it, was whether we will guarantee to go on doing that. Nothing in this life is certain, but I am determined to go on supporting research and development tax credits. We have made some of the qualifying rules easier. What I think is more important now about R and D, in addition to committing to the funding, is ensuring that those credits work further down the company sizes, so that small businesses realise that they are just as eligible for them as much larger businesses. I do not think that tax reliefs naturally are things that Her Majesty’s Revenue and Customs would market, but certainly we need to spread the word that all kinds of business can qualify for help with research and development.
My hon. Friend’s second question was a really good one: how much are we learning from other countries about translating some of the innovation into commercially applicable projects? We do learn from other countries. For example, the German Fraunhofer centres provided much of the model for the Catapult centres that we have now established. We are not too proud to learn from or to pick up on what is happening in other countries, particularly Germany, which has always had a much
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higher proportion of its GDP in manufacturing. There are things that we can learn from other countries, and I assure my hon. Friend that we continue to do so. Ministers continue to visit other countries and to pick up on ideas, although of course those other countries have picked up on some of our more imaginative ways of funding as well.
The third question posed by my hon. Friend was on the small business research initiative. I am glad that she asked about that. It provides 100% R and D funding for technology-based companies that develop potential solutions to specific problems faced by the public sector where there is no readily available solution on the market. That is done on a much larger scale in the United States; it is fully supported through federal funds. That is another good example of where we can learn from the success of a scheme in another country and apply the lessons here.
My hon. Friend will recall that in the most recent Budget—Budget 2013—we announced that we will substantially expand the SBRI among key Departments, so that the value of contracts through this route increases from £40 million in 2012-13 to more than £100 million in the current year and more than £200 million by 2014-15. I hope that she will welcome that, but I fully accept that we have more to do to spread knowledge and use of the SBRI right across the Whitehall landscape to ensure that those Departments that have not yet thought of it as a potential route to solving some of the problems that they face do so. A number of Departments are already making good use of the SBRI, but I would like all Departments to consider it automatically as a source of particular strength.
I hope that my hon. Friend will forgive me if I have not answered all the other questions that she posed, but I want to conclude by saying a word or two about what is happening on skills. She suggests that we should learn from other countries. There is no doubt that countries such as Germany have been able to draw on a much wider pool of school leavers, apprentices and college leavers with the engineering, mathematical and technical skills that we still lack in this country.
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Mr McKenzie: On skills and innovation not only in products but into new markets, Promedics in my constituency has taken the existing skills of sewing machine technicians and moved them into a totally new market, supplying the NHS and others across Europe with surgical supports. It has taken that skill and applied it to a new market. What recognition or support can the Minister give such businesses?
Michael Fallon: I am delighted to hear that and would certainly like to hear more details and to see whether there are ways in which Government can recognise that kind of development more officially.
A skilled work force is the key to providing the innovation that business needs. Apprenticeship starts in engineering and manufacturing have increased from 26,000 10 years ago to more than 49,000 last year. There were more than 2,000 apprenticeship starts in the constituency of my hon. Friend the Member for Gosport last year. The number was up by 18% on 2010-11. She will be interested to know that nearly 900 of those apprenticeship starts were in the engineering and manufacturing sector—an increase of 32% on 2010-11, so we are making changes.
The Daedalus enterprise zone members group, which I think my hon. Friend chairs, includes the provision of a new skills training centre that is due to be built on the site from 2013. The first students are due through the doors in September 2015. That is a major achievement in my hon. Friend’s area and shows that the enterprise zone there is open for business.
I thank all hon. Members who have attended the debate and those who have contributed to it through their questions. I thank again my hon. Friend for raising this subject for debate. Let me assure her and you, Mr Robertson, that this Government are fully committed to realising the growth of manufacturing through innovation, which we see as essential to building a better balanced, more resilient economy for the future.
11.30 am
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East Coast Main Line
[Dr William McCrea in the Chair]
2.30 pm
Andy McDonald (Middlesbrough) (Lab): It is a great privilege to serve under your chairmanship, Dr McCrea, in this vital debate on the future of the east coast main line. I am sure you will keep us on track and on time. Debates between hon. Members on nationalisation and democratic control of industry often stall due to an obstinate adherence to our political prejudices. All of us, on both sides of the House, have political prejudices about the relative merits of private and national ownership of basic industries. At the outset, I invite Members to disregard all preconceived theories and consider the future of the east coast main line objectively, as a technical problem with hard facts.
According to a written answer from the then Minister of State for Transport in 1996, the total gross proceeds to the taxpayer from selling off our rail infrastructure were £5.28 billion. Adjusted for inflation, that would be slightly more than £8 billion today—equivalent to only the past two years of taxpayer subsidy. According to the Office of Rail Regulation, the east coast main line is the only line in the country that comes close to paying for itself. Government subsidy makes up only 1% of East Coast’s income, against an industry average of 32%. The total cost to the Exchequer of the east coast main line was only £9 million in 2011-12; by comparison, Northern Rail, jointly owned by Serco and the Dutch Government, cost the taxpayer £685 million. Since the UK Government put the franchise under the publicly owned Directly Operated Railways, financial stability has been restored. The total premium, plus operating profit, amounted to £647.6 million in the four years to 31 March 2013; that is more in both cash and real terms than any previous franchise on the line, and all that money is available for reinvestment in our railway network.
East Coast has seen revenue growth of 9% over three full years, with 4.3% growth in 2012-13. The Minister of State described that growth to the Select Committee on Transport as a “plateau”. One wonders what word he would use to describe the Chancellor’s performance over the same period.
The Minister of State, Department for Transport (Mr Simon Burns): Very good.
Andy McDonald: Thank you very much.
Journey numbers have grown from 18.1 million in 2009-10 to 19.1 million in 2012-13. An estimated £800 million will have been generated by the franchise for the taxpayer by April 2014. All that has resulted in a £40 million surplus: money that would otherwise be providing the profit to shareholders, if the line were privatised, and which East Coast has reinvested in its greatest asset, its staff. The fruits of that investment are clear to see: employee engagement is now at an all-time high of 71%—up from 66% in 2011 and 62% in 2010—which is the highest score of the eight train operators that is currently available. The average number of sick days has fallen from 14 to nine. Investors in People accreditation has risen from “standard” in 2009 to “silver” in 2012.
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Impressively, East Coast was the only train company to have achieved “Britain’s top employer” status in 2012 and 2013. Most importantly, on-board passenger-attributed accidents have reduced by 20% and staff accidents by 23% in the past year.
East Coast has also introduced a new timetable—the biggest change on the east coast main line in 20 years—seamlessly launched in May 2011. It introduced 117 extra services a week; a four-hour Flying Scotsman express from Edinburgh to London, calling only at Newcastle; and new direct services between London and Lincoln and Harrogate, and I hope that it will soon restore the link to Middlesbrough, the largest conurbation in the country without a direct link to the capital.
Karl McCartney (Lincoln) (Con): Does the hon. Gentleman not see that it is a shame that the seven daily services that Lincoln was promised ended up being only one service?
Andy McDonald: I am not sure that I have picked up on that seven turning into one, but I will mention the performance issues, so an answer may emerge as we proceed.
Mr Stephen Hepburn (Jarrow) (Lab): My hon. Friend is making a persuasive case. The east coast main line has flourished since it came back into public ownership. This is an example of privatisation for privatisation’s sake. The only people who will benefit from it are that small number of Tory pals—those profiteers who will bung their pockets with taxpayers’ money.
Andy McDonald: I thank my hon. Friend. He makes a valid point, and I hope to return to it.
Stephen Phillips (Sleaford and North Hykeham) (Con) rose—
Andy McDonald: If I can make some progress, I will come back to the hon. and learned Gentleman.
I have laid out reforms that it might be thought would cause disruption. In oral evidence to members of the Transport Committee on 24 April this year, the Minister made the following comment about punctuality on the east coast main line:
“If you look at the latest monthly figures for reliability and punctuality, it is the worst of the 19 franchises.”
Were that the whole story, it would be extremely concerning, but East Coast during the latter half of 2012 achieved the best train punctuality on the east coast franchise since records began in 1999. In recent months, some challenging external circumstances, such as the weather and overhead wire problems on the southern part of the route, affected performance, and East Coast is implementing a joint action plan with Network Rail to ensure that operational performance on the line returns to the record levels achieved in the autumn. The results the Minister cited are completely atypical. One has only to look at Network Rail’s moving annual average for punctuality, which puts the east coast main line in the top three of the seven long-distance franchises, to see that. The encouraging performance improvements in period 1 and to date in period 2 of this year are an early reflection of that collaboration with Network Rail. The latest available figures show that nine out of every
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10 East Coast trains were on time, according to the industry’s public performance measure—up considerably on the previous quarter and up year on year.
Alex Cunningham (Stockton North) (Lab): I am grateful to my hon. Friend and near neighbour on Teesside for giving way and I congratulate him on securing the debate. Does he have any idea why the new managers who were put in by the state to run the east coast main line have done so well? They are using the same people, the same equipment and the same everything else as the private company, National Express, which failed miserably, reneged on its contract and walked away.
Andy McDonald: I wish I could put my finger on it. My hon. Friend highlights a key issue, but it is useful to note that the way East Coast operates is a good comparator for the other services operating in this country.
The improvements are reflected in two key metrics. First, under public ownership East Coast achieved a record-breaking 92% overall customer satisfaction rating in the autumn 2012 national passenger survey conducted by the independent transport watchdog, Passenger Focus. That is the highest score on the franchise since the survey was launched in autumn 1999. It is 5% ahead of the score achieved in 2011 and three percentage points higher than the 89% average for all long-distance train operators. Indeed, in 2012, East Coast received the highest customer satisfaction score of any long-distance franchise operator.
Secondly, complaints stand at a rate of 150 per 100,000 journeys according to the Office of Rail Regulation’s latest available figures—down considerably on the previous quarter and back to the level prior to the disruption from the end of last year. Although that figure is relatively high compared with those of other train operating companies, it is just one third of where it stood when the east coast main line was in private ownership in 2007-08. A higher-than-average complainant rate might be due, in part, to the nature of the line regardless of its ownership, but since it is the publicly owned and publicly operated London Overground that has the lowest rate, at just two complaints per 100,000 journeys, it is difficult to claim a direct relationship between public ownership and complaints.
In addition, perhaps because of the unprecedented investment in staff that I have mentioned, there has been a 78% reduction in threats to staff in the past year. The apparent contradiction between a rise in customer satisfaction and a relatively high complaint rate dissolves entirely when we look at the Office of Rail Regulation’s breakdown of the reasons behind the grievances. Complaints about train service performance are down, year on year, from 38% to 29%, but what are on the increase and make up more than a fifth of all complaints are criticisms of the quality of the trains themselves. That comes directly from the fact that the rolling stock, which East Coast inherited from National Express, is eight years older than the industry average, at 27 years as opposed to 19.
That East Coast has achieved better customer satisfaction than any of its long-distance rivals, while running the oldest rolling stock of any franchise bar Merseyrail Electrics, is a testament to the workers and the management, and that the trains are still running at all after 30 years or more of continuous use is a testament to the brilliance
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of the engineers of British Rail Engineering Ltd who designed them and the factory workers of the north of England who built them.
Some elements of on-train comfort have also seen a marked increase. Of particular interest to certain hon. Members will be the new first-class complimentary at-seat food and drinks service, which has reversed historical losses of £20 million per annum and which contributed to a 21% rise in the number of first-class journeys in 2011-12, compared with the preceding 12 months. East Coast now serves a million meals per annum, which is a tenfold increase on the previous service, and its first class has certainly looked very nice on the occasions when I have walked through it.
Sheila Gilmore (Edinburgh East) (Lab): I am very pleased that my hon. Friend succeeded in securing this debate. The first-class service, which, as MPs, we do not of course use, is important because of the environment. For many business travellers, it can make a considerable difference to their choice between flying—certainly from Scotland—and travelling by train. If we want to make the modal shift that we need for our environment, we need a service that will attract that kind of business traveller.
Andy McDonald: I agree entirely with my hon. Friend. The carbon footprint that we all imprint upon this planet is a vital issue, and she makes that point eloquently.
Ministers have admitted in the House of Commons that new investment in both rail infrastructure and new rolling stock on the east coast will come through taxpayer-funded support and not from franchisees. Funding for the 2014-19 upgrade of the east coast main line will be delivered through the Office of Rail Regulation approving a £240 million increase in the value of Network Rail’s regulatory access base. Regardless of whether the refranchising of the east coast main line goes ahead, the public, through Network Rail, will still be paying for the track. We will still be paying for the rolling stock, and we will still be paying for any upgrades, extensions or electrification that might ensue. None of the upgrades is dependent on whether the trains going along the track are painted Virgin red or Stagecoach orange. There is no deadline by which the franchise must take place, except, of course, the next election.
Sir Alan Beith (Berwick-upon-Tweed) (LD): I congratulate the hon. Gentleman on bringing this matter forward. The Labour Government set a deadline for re-privatising the line, and even when they were unable to meet it, they continued to have it as their policy that the line should be re-privatised. Has the Labour party changed that policy?
Andy McDonald: I thank the right hon. Gentleman for his intervention. We are where we are, and we have to look at the matter on the facts of this specific franchise, examining it carefully to see whether it is working, right at this moment. Comments have been made in the context of reports that had only half the story, so when we have better information we should read it, consider it and judge accordingly, but I hear what the right hon. Gentleman says.
It is absurd for the Government to be pressing ahead with another franchise proposal when the previous franchise offering, of the west coast main line, was such a debacle and will have cost the taxpayer £100 million by the time it is resolved.
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Karl McCartney: I thank the hon. Gentleman for giving way to me once again, and I take this opportunity to congratulate him on securing the debate and on the fact that so many of his colleagues—from both sides of the House—who have an interest in the franchise are present. Thank you, Dr McCrea, for chairing—I forgot to say that the first time I intervened.
The Labour Government before 2010—in fact, before 2005—acted perhaps with undue haste, in desperately getting back into the private sector the southern franchise that had been taken off Connex. They made many mistakes at that time. Does the hon. Gentleman not feel that this Government should be credited with ensuring that such mistakes are not made in re-awarding this franchise to the private sector?
Andy McDonald: I am grateful to the hon. Gentleman for highlighting the weaknesses of the entire structure of these private franchises. He does so eloquently.
A serious overhaul of the franchise process is necessary. The Minister may well claim that, following the Brown review, a new process is indeed in place. In that case, one has to wonder why existing private sector franchises, which would be the ideal testing ground for the process, are instead receiving extensions of up to 50 months. The Government’s haste to extricate themselves from running trains is all the more baffling when more than half the rail franchises in Britain are to some extent state-controlled already; it is just not the British state that is in control.
Ian Murray (Edinburgh South) (Lab): Will my hon. Friend give way?
Andy McDonald: I will in a moment.
Putting aside East Coast and London Overground, there are 17 franchises in the UK, of which 10 are operated, to a greater or lesser extent, by the Governments of our European neighbours. Chiltern, CrossCountry and Wales & Borders franchises are operated by Arriva—a wholly owned subsidiary of Deutsche Bahn, the majority shareholder of which is the German Government. Greater Anglia is run by Abellio, the international arm of the Dutch Government’s rail operator Nederlandse Spoorwegen, which also runs Merseyrail Electrics and the aforementioned Northern franchise in partnership with Serco. The South Eastern, Southern and West Midlands franchises appear at first sight to be privately run and are operated by Govia—a joint venture between Go-Ahead Group and Keolis. Keolis, the largest private sector French transport group, is, however, majority owned by SNCF, the French state rail operator. Keolis also runs TransPennine Express, in collaboration with First Group. Are hon. Members, particularly those of a Eurosceptic bent, content that when they pay an extortionate sum for a ticket on Southern, South Eastern, TransPennine or West Midlands trains, their money is on the TGV to Monsieur Hollande? Why does this Government believe that other countries can run our rail services, but that Britain cannot?
The remaining seven franchises are hardly a model of laissez-faire, split as they are between three and a half private companies: Stagecoach, National Express, FirstGroup, and Virgin Trains, which is half-owned by its alleged competitor Stagecoach. New entrants cannot possibly afford to take on these mammoth projects and
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the risks that may accrue. The original 25 franchises offered in 1995 have shrunk to just 17 today, following mergers, making the barriers even higher.
The previous Conservative Government themselves recognised the barriers to new entrants when they banned British Rail from bidding for franchises in the wake of privatisation. The then Minister for Public Transport, now Baron Freeman, said:
“I am concerned that it would be very difficult to have a fair and equal competition if British Rail was a bidder.”—[Official Report, 26 July 1993; Vol. 229, c. 578W.]
The current debate is about not a free market versus a state monopoly, but whether a public asset, for which the taxpayer will remain liable, should be managed by the British Government, a foreign Government or one of a handful of private companies that are large enough to meet the criteria of the bid.
Such companies will always underestimate costs and overestimate revenue when they bid for contracts, because they know that, if they do not, their competitors will win the bid. They are looking to their next set of quarterly reports and their next shareholder annual general meeting; Governments are looking to the next century. The truth is that no Government can afford to let the rail network go to rack and ruin. The state will always have to intervene to protect that vital national asset and the lives of its citizens. As the saying goes, it is too big to fail.
Train operating companies know that, and they also know that if it all goes wrong, the taxpayer will be left holding the line. Christopher Garnett, the former chief executive of the train operator Great North Eastern Railway—the first franchise operators of the east coast main line—said during the failure of that company:
“The market will self-destruct as bidders bid to win on ever-tighter margins. When it goes wrong, it’s going to come right back to the Department for Transport.”
Since privatisation in 1996, both companies that have run inter-city services on the east coast have failed or walked away from the franchise mid-contract. Passengers will rightly be worried that history might repeat itself under a re-privatised service.
Many of those who are now Government Members once supported keeping the east coast main line in public hands. Before he held his current office, the Deputy Prime Minister said in 2009:
“Our railways should not be a plaything for private companies and we think giving it the stability of public ownership during the next franchise period would be much better”.
“it’s not an industry, it’s a public service. Our rail services are public services.”
If you will forgive the phrase, Dr McCrea, “I agree with Nick,” but as is ever the case nowadays, we are unsure whether the Deputy Prime Minister agrees with himself.
As many hon. Members whose constituents have lobbied against High Speed 2 know, railways do not affect just those whom the Government call “customers”. Stan Higgins, the chief executive of the North East of England Process Industry Cluster—the hon. Member for Redcar (Ian Swales) knows that confederation of the leading process businesses in our region well—told me the view of his members:
“We’re running railways for profit, as opposed to as a service to our industries and our communities.”
By the franchising process, the public are being disfranchised.
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I want to quote the Conservative Secretary of State for Transport who moved the Second Reading of the Railways Bill that carved up and sold off British Rail. He said that that company had
“too little responsiveness to customers’ needs, whether passenger or freight; no real competition; and too little diversity and innovation…; an insufficiently sharp awareness on the part of employees that their success depends on satisfying the customer—indeed, on attracting more customers; and an instinctive tendency to ask for more taxpayers’ subsidy and to feel that public subsidy will always be there as a crutch whenever things look difficult.”—[Official Report, 2 February 1993; Vol. 218, c. 156.]
Those were the reasons for privatisation, and I will look at them one by one. East Coast has increased services in response to customer demand. It has successfully increased revenue in the face of competition from not only road transport, but domestic flights that are far cheaper than anything faced by British Rail. It has innovated with new services for first-class carriages and sold more than 1 million e-tickets. It has the highest rates of customer satisfaction of any long-distance franchise, and staff who are engaged with the company and with passengers. A million more journeys take place on East Coast now than when the franchise became public. Far from crying for subsidy, it makes the lowest demands on the public purse of any rail franchise.
Mr George Strauss, the Parliamentary Secretary to the Ministry of Transport at the time of nationalisation in 1946, said:
“I am sure that Parliament would not tolerate paying a permanent subsidy to a particular section of privately owned industry when, plainly, that industry as a whole, if properly organised, could be self-supporting.”—[Official Report, 18 December 1946; Vol. 431, c. 1975.]
The choice before us is between an unending subsidy to private interests and continued public ownership of a line that, in public hands, is 99% self-supporting. The question that I must ask the Government, and Members who oppose keeping the line in the hands of those who have managed it so well, is whether any evidence would get them to drop their prejudice that private is always better than public.
Dr William McCrea (in the Chair): Order. I am endeavouring to be helpful, given that well over 20 Back Benchers are in the Chamber. Ten Members have put down their names to speak and we have only a short period, so with the authority that has been given me, I must impose a time limit of four minutes, which I hope will allow them all to speak.
2.55 pm
Martin Vickers (Cleethorpes) (Con): It is a pleasure to serve under your chairmanship, Dr McCrea. I congratulate the hon. Member for Middlesbrough (Andy McDonald) on securing this useful debate. We can sing the praises of East Coast—I am happy to do so as someone who uses its services every week; it does not provide a bad service at all—but the idea that this is some way towards being a golden age compared with GNER, which first took over the line and provided an excellent service, is a myth.
As I have said, I am happy to congratulate East Coast, which gets us here every week, usually on time. Passengers want a clean, reliable, safe and reasonably
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priced service. When they sit back in their seat, they do not care whether the track is operated by Railtrack, Network Rail or a private operator, or whether their seat is in a private coach or a publicly owned one.
Grahame M. Morris (Easington) (Lab): To set the record straight, is it not the case that both GNER and National Express had to hand back the franchise, but this nationalised, directly operated rail service has handed £602 million back to the Treasury?
Martin Vickers: The fact that there is one failure—whether in the private sector, the public sector or wherever—does not automatically indicate a flaw in the system. The hon. Member for Jarrow (Mr Hepburn) said that the change would be privatisation for privatisation’s sake, but the opposite is equally true: do we want nationalisation for nationalisation’s sake? That is certainly what Opposition Members seem to want.
In his opening remarks, the hon. Member for Middlesbrough referred to Northern Rail, but to compare it with East Coast is to compare apples with oranges—a regional operator with an inter-city one. Northern Rail provides a perfectly adequate service in my constituency, between Cleethorpes and Barton-on-Humber, but it does not serve such great metropolises as York, Darlington and Doncaster. The station at Thornton Abbey—in a beautiful, idyllic setting—actually serves two farms and an ancient ruin, and I think it had 13 passengers during 2009. East Coast is fine; it provides a perfectly adequate service, but it does not dash up and down between Newcastle and King’s Cross, so there is no comparison whatever.
I am happy to criticise East Coast when it makes mistakes, which it did when it redesigned its timetable last year.
Stephen Phillips: On the timetable, does my hon. Friend agree that although the increased frequency and number of trains is welcome, the lack of joined-up thinking between those trains and local ones has caused constituents real problems that East Coast needs to deal with? If the line is retendered, the Minister must ensure that that factor is included in the tendering process, as I hope my hon. Friend agrees.
Martin Vickers: I welcome that intervention by my hon. and learned Friend, who highlights a particular problem. My point is that the station in my home town of Cleethorpes has been removed from the timetable—because there is no through train to it, it is no longer shown as having a connecting service. I think that Middlesbrough was another destination that was removed from the timetable. Regrettably, despite my protests, East Coast did not correct that in its new summer timetable.
The Government show every sign of moving ahead with the new franchise to a good timetable, which I welcome. I hope that the company will put in place services that British Rail removed in 1991, namely the direct services from King’s Cross to Cleethorpes, which I know the Minister is keen to restore in the new timetable.
Karl McCartney:
Does my hon. Friend agree that spending some money on electrifying the line between Newark and Cleethorpes might well give the east coast
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an option for diverted trains? The west coast has a multitude of such options whereas the east coast does not.
Martin Vickers: My hon. Friend raises a valid point. The important thing for the Cleethorpes constituency in relation to electrifying the line is that 25% of the country’s rail freight, when measured by tonnage, starts or ends at Immingham dock. The line must therefore be a potential candidate for electrification.
The hon. Member for Middlesbrough used, as I suspect all politicians do occasionally, selective statistics, especially ones that were critical of private operations. For example, he omitted the statistic that showed that the west coast main line, in private operation, generates more passenger income than the east coast main line— £820 million in 2011-12 compared with £587 million on the east coast main line.
I hope that the Minister will confirm that we are going ahead with the new franchise, that we are on course to deliver it and that the new franchise will deliver a better service than the existing east coast main line, which is, to be honest, just treading water at the moment. I know that the Minister will also want to ensure that there is a service to Cleethorpes.
3.2 pm
Mr Frank Doran (Aberdeen North) (Lab): I congratulate my hon. Friend the Member for Middlesbrough (Andy McDonald) on securing this important debate. The east coast main line is a vital artery for all of us, running between London and Aberdeen. My principal interest is of course Aberdeen. In the debates that we have had on this issue, it is clear that the east coast main line is generally thought to run simply from London to Edinburgh, but it runs another 130 miles further north. When the line was completed in the 1880s, it was part of the Victorian engineering miracle, producing both the Tay bridge and the Forth bridge. It allowed royalty to get away for their summer holidays, brought to London the fish and the textiles that were produced in Aberdeen and opened up the whole country to tourism in the highlands. It was an important line then, but it is even more important now, which is not always recognised.
Aberdeen is now the hub of the oil and gas industry in Europe. Over the past few decades, it has poured billions of pounds into the Exchequer, but we have a railway line, certainly the last past of it from Edinburgh to Aberdeen, that has been forgotten about. I have raised that issue in the House many times. There has been a failure to construct proper infrastructure to support the oil and gas industry. The same can be said, I think, of Norfolk, which has difficult contacts as well, but perhaps not to the same extent.
I have done a little bit of arithmetic for the debate. The journey time from London to Edinburgh, which is about 400 miles, is four hours and 20 minutes at an average speed of 92 miles an hour. Edinburgh to Aberdeen is only 130 miles, and it takes two hours and 39 minutes at 45 miles an hour. When I have raised those issues in the past, they were usually coupled with problems on the road network and with air transport. I used to be able to say that someone could travel from Aberdeen to
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Rome by car and find only 70 miles of single track, which was on the road between Aberdeen and Dundee. That has now been sorted. Air transport has improved dramatically as well, but we still have the same problem on the rails. One part of the east coast main line, just north of Montrose, is single track. The Minister will rightly point out that the responsibility for that lies with the Scottish Government, but for a couple of centuries it was the responsibility of Westminster, and nothing was done about it.
I also want to raise a specific issue with the Minister because it relates not just to this particular line, but to High Speed 2. In the economic evaluation for HS2, there is a suggestion on page 9 that the Government are retaining an option for removing through-trains from stations north of Edinburgh to London once phase 2 of the new high-speed rail is built post-2033. That has caused some consternation. The Minister is looking slightly bemused; he has probably not read the evaluation thoroughly.
Mr Simon Burns: indicated assent.
Mr Doran: The Minister is nodding his head. It is a matter of some concern, which I hope he will clarify.
Dr William McCrea (in the Chair): Order. The hon. Gentleman’s time is up.
3.6 pm
Ian Swales (Redcar) (LD): I congratulate the hon. Member for Middlesbrough (Andy McDonald) on securing this debate and on his excellent speech, which fully covered many of the issues. I have been a regular traveller on the east coast main line for more than 25 years for business purposes. It seems hard to believe that it is the most successful and profitable line in the country, because the bungled franchises under both Governments and under-investment have left us with old trains, poor punctuality and high fares.
Arriving at Darlington station to come to Parliament, I have a choice: buy a standard return ticket, or get back in my car, drive to London and do the return trip that way. At 45p a mile, I save the taxpayer £60 if I drive. Is there anywhere else in the world where a mass transit system is so much more expensive than each passenger recovering in full the cost of driving a car?
In the year to March 2012, East Coast made a profit before tax and payments to the Department for Transport of £196 million on a £666 million turnover; that is more than 29%. It is high time that some of that money was used both to reduce the fares and to upgrade the rolling stock. Until then, users of the line are bound to feel that they are being ripped off and, in effect, used to subsidise the rest of the network.
Iain Stewart (Milton Keynes South) (Con): My hon. Friend makes an important point about the quality of the rolling stock, but is he not aware that the inter-city express programme, which will be built in the north-east, will introduce new trains on the east coast main line?
Ian Swales: Indeed, and I hope they will be built in the north-east at the new Hitachi factory. Let us hope the public procurement produces the right answer.