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House of Commons
Wednesday 12 June 2013
The House met at half-past Eleven o’clock
Prayers
[Mr Speaker in the Chair]
Oral Answers to Questions
International Development
The Secretary of State was asked—
Tax Avoidance
1. Katy Clark (North Ayrshire and Arran) (Lab): What proposals her Department has to tackle tax avoidance by multinational companies operating in developing countries. [159145]
2. Dr Thérèse Coffey (Suffolk Coastal) (Con): What steps she is taking to help developing countries improve their tax systems. [159146]
The Secretary of State for International Development (Justine Greening): The UK Government are committed to ensuring that developing countries have the ability to collect the tax that they are owed. The UK is using our G8 presidency to promote tax transparency, tackle tax avoidance and ensure tax compliance.
Katy Clark: The Secretary of State will be aware that developing countries lose more than £160 billion each year through tax avoidance, more than one and a half times what they receive in aid. What is she doing to ensure that we get country-by-country reporting so that we see how much those multinationals are taking from developing countries?
Justine Greening: Addressing tax avoidance and encouraging tax compliance will be one of the key elements of the G8 agenda, and transparency sits alongside that. We will look at how we can obtain more transparency, including sectoral transparency through measures such as the extractive industries transparency initiative. All those measures together have the potential to ensure that we can help developing countries to collect the tax they are owed.
Dr Thérèse Coffey: Does my right hon. Friend agree that developing countries will be able to end their dependence on aid only if they can raise enough revenues through the tax system?
Justine Greening:
My hon. Friend is absolutely right. If we are to have sustainable development and developing countries are to have the tax revenues to fund and invest in their own public services, we need a thriving economy that creates those revenues. That is why economic development is such a key part of what my Department is now focusing on. Along with Her Majesty’s Revenue
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and Customs, we are investing to ensure that developing countries have the tax expertise they need to collect the taxes that are due.
Anas Sarwar (Glasgow Central) (Lab): I back the call from my hon. Friend the Member for North Ayrshire and Arran (Katy Clark) for country-by-country reporting by all multinational companies. Can the Secretary of State guarantee that no money from DFID goes to any organisation or company that is not fully tax transparent?
Justine Greening: We are very clear that we want companies to behave responsibly across the board, including on tax, and I can assure the hon. Gentleman that there is such due diligence. We cannot simply ignore those problems, and if we are to shape private sector investment in the developing world so that it can help drive development, as I think we should, we will have to engage with the private sector more in the future than we have in the past.
Mrs Cheryl Gillan (Chesham and Amersham) (Con): The Secretary of State will know that the OECD has been charged with coming up with a scheme to tackle base erosion and profit shifting and to consider corporate taxation. Last week in a meeting with the organisation it confirmed to me that it is working to a timetable of just two years. Does she agree with that timetable, or does she agree with me that it is an over optimistic timetable for trying to get a multilateral convention to replace 3,000 tax treaties?
Justine Greening: My right hon. Friend is right that the timetable is ambitious and that is why we need to put the political momentum behind it that the G8 meeting can bring. The work that the OECD is doing has been commissioned by the G20 and it shows that if we are to reach a sustainable solution, leading economies and world leaders must come together. That is precisely why we have put the subject on our G8 agenda.
Mr Ivan Lewis (Bury South) (Lab): The Prime Minister and the Secretary of State have said that the main objective of this weekend’s summit on tax and transparency and next week’s G8 meeting is for G8 countries to put their houses in order. That would strengthen the moral authority of the G8 and send a strong message to the rest of the world that the time has come to get serious about tax dodging. Will the Secretary of State ask the Chancellor today to bolster the Prime Minister’s moral authority and undertake an urgent review of the changes he made to the UK’s controlled foreign company rules, which are estimated to have cost developing countries £4 billion in lost tax revenue?
Justine Greening:
I should have thought that the hon. Gentleman would ask me about the success of the G8 event on nutrition we held last Saturday, which saw huge progress on providing funding for that issue. Let me answer the question he has asked, however. I reassure him that we are taking a structured approach to the discussions at the G8. We are looking at addressing tax avoidance—in other words, dealing with the problem. We are looking at developing better approaches to tax evasion—in other words, once the problems happen we need to ensure that we can sort them out. We are also looking at how we can ensure that developing countries,
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once they have made progress, are in a position to collect tax. Our Government has put the question on the agenda and I think the hon. Gentleman should congratulate us on that.
Mr Lewis: I do not know about tax dodging but the Secretary of State is getting a reputation for question dodging—we will try this one, Mr Speaker. The Government have identified the public registration of beneficial company owners as one of their top priorities for the G8. There can be no excuse for this basic information about company directors being shrouded in secrecy. Does that remain the Government’s priority? Will she confirm that if they are unable to secure agreement, the UK will take unilateral steps on the issue of public registration?
Justine Greening: We have made beneficial ownership one of the key elements of our G8 agenda, and it is right to do so. I do not recall the hon. Gentleman’s Government particularly pushing on the issue during their 13 years in office. I can assure him that the best way to make a difference for developing countries is to get international agreement. That is what they want and that is why we are trying to get it.
Sir Malcolm Bruce (Gordon) (LD): In the light of the Select Committee on International Development’s recent report, and following the election, will the Secretary of State engage with the Government of Pakistan to ensure that Ministers, MPs and the leaders of the community there pay their fair share of taxes to match the contribution that British development aid is making to Pakistan?
Justine Greening: We have a question on the Order Paper later about Pakistan, Mr Speaker. I have already spoken with Ministers in the Pakistani Government, and the Committee’s report was right to highlight this issue.
Syria
4. John Robertson (Glasgow North West) (Lab): What recent assessment she has made of the humanitarian situation in Syria. [159148]
The Secretary of State for International Development (Justine Greening): The humanitarian situation in Syria has now reached catastrophic proportions. More than 80,000 people have been killed—that is nearly 1,000 a month—6.8 million are in need, including at least 4.25 million internally displaced persons, half of whom are children, and a further 1.6 million refugees are in the region, of whom 75% are women and children. UK support is providing food, health care, water and shelter for refugees, both inside and outside Syria.
John Robertson: I thank the Secretary of State for her answer, and I am pleased to see that she is well up with what is happening. She will also be well up with what is being done by the UN commission of inquiry, which mentioned the killing of 13 children because of lack of food and medication. Will she confirm that the Government will press for an agreement at the G8 summit on improving humanitarian access for the estimated 4 million people who need it in Syria today?
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Justine Greening: I am sure we will be raising those issues at the G8, as I did when I was at the UN a couple of weeks ago. It is simply unacceptable that the Syrian Government continue to refuse to allow humanitarian deliveries across the border from Turkey, and we need all sides in this conflict to agree to give unfettered access to humanitarian agencies and to do that free from violence.
Dame Angela Watkinson (Hornchurch and Upminster) (Con): The number of refugees coming across the border from Syria into Turkey is way beyond Turkey’s ability to provide for them. Has my right hon. Friend had any discussions with her counterparts in Turkey, the European Union or the wider international community on how these refugees might be catered for?
Justine Greening: My hon. Friend is right to recognise the impact that refugees are having on several countries in the region. Some 370,000-plus refugees have arrived in Turkey, and we have spoken with the Turkish Government about what we can do to provide support. They have played a leading role in providing humanitarian support to those refugees, and that should be acknowledged, too.
Mr Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab): In addition to the information that the right hon. Lady has just given the House, is she aware that World Vision estimates that 1.5 million people are displaced? Does she agree that in the event of any removal of arms embargoes, there will be no less emphasis on the crucial need for humanitarian aid?
Justine Greening: I think I can absolutely reassure the right hon. Gentleman on that point. My Department is looking at what needs to happen in not only the immediate time frame, but the far longer term. We know that more than half the hospitals in Syria have been damaged, and that the water and sanitation systems are essentially no longer working. There needs to be not only a short-term plan to examine humanitarian needs in all circumstances—he is right about that—but a longer-term plan to examine what Syria’s needs will be afterwards.
Mr Philip Hollobone (Kettering) (Con): With the Council for European Palestinian Relations, I recently visited Palestinian refugees in Lebanon who had fled from Syria. Is the Secretary of State satisfied that the United Nations Relief and Works Agency is doing all that it can to help those people, who are living in miserable conditions?
Justine Greening: I thank my hon. Friend for that question, because that important aspect of the crisis is often not recognised. We have provided £5 million to UNRWA particularly to support its work with Palestinian refugees. That will support more than 350,000 Palestinian refugees in Syria, and will go on food parcels and other relief items.
Rushanara Ali (Bethnal Green and Bow) (Lab):
I wish to declare an interest: I have just returned from a visit to Lebanon, courtesy of World Vision, on which I witnessed at first hand the impact of the heavy influx of Syrian refugees on that country. The number of refugees
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in Lebanon has reached half a million and is set to reach 1 million by Christmas. Last week, the UN appealed for £3.2 billion to deal with the humanitarian emergency. Will the Secretary of State tell the House how much the UK Government will contribute to this appeal?
Justine Greening: I thank the hon. Lady for that question. We are looking now at what we can do to continue playing a leading role in providing humanitarian support, but I think that all Members of the House would agree that we need to put pressure on other countries in the region, and the international community more broadly, to step up to the plate and provide support, and we need to make sure that they fulfil commitments that they have already made.
Official Development Assistance
5. Stephen Doughty (Cardiff South and Penarth) (Lab/Co-op): When the Government plan to bring forward legislative proposals to enshrine in law their commitment to spend 0.7% of gross national income on official development assistance. [159149]
The Minister of State, Department for International Development (Mr Alan Duncan): This Government will be the first in the G8 to reach 0.7%, and we are doing so this year.
Stephen Doughty: The Minister wants us to believe the Government’s 0.7% aid promise, but first we find no Bill in the Queen’s Speech, and secondly we see a massive underspend in the Department in the last few months of last year. Who made the decisions to omit the Bill and to underspend? Was it the Secretary of State, the Chief Secretary to the Treasury, or the Prime Minister?
Mr Duncan: Very nice try, but there is not a massive underspend. Previous mentions in the Queen’s Speech were about the objective of meeting the target, and if the hon. Gentleman wants the proof to be in the pudding, that is exactly what we are doing.
Mr Peter Bone (Wellingborough) (Con): Would the excellent Minister agree with me that we should not set targets for overseas aid? We should give what is required.
Mr Duncan: We are doing both, because as the United Nations’ objective of 0.7% established, the continuity that comes from countries meeting it ensures that aid is delivered in the best possible way, and that is why the objective is so important for the poorest people in the world, whom we are all trying to help.
Mr Gregory Campbell (East Londonderry) (DUP): Now that we are the first of the G8 nations to reach 0.7%, perhaps the Prime Minister will make that declaration in the magnificent surroundings of County Fermanagh next week. When he has done that, will he ensure that we target that aid, that it is free from corruption, that people can see that there is a point behind the aid, and that it goes to those most in need?
Mr Duncan:
I am confident that not only would the Prime Minister enjoy making such a commitment, but that he could do so truthfully and accurately, because
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my right hon. Friend the Secretary of State, and indeed all of us in the Department for International Development, ensures that the money that we spend on behalf of taxpayers goes to people in need, and not into the pockets of anyone who might be corrupt.
Mr Tobias Ellwood (Bournemouth East) (Con): May I invite the Minister and the Secretary of State to look at the Ministry of Defence’s stabilisation activities, such as mine clearance, police training in Afghanistan, and the replacement of the Kajaki dam turbine? Those activities are not claimed as going towards the ODA target of 0.7%; if they were, I believe that we would be exceeding it.
Mr Duncan: One of the great achievements of this Government is the great co-ordination between the Ministry of Defence, the Foreign Office and DFID, under the auspices of the National Security Council. When it comes to spending, we work very closely with those two Departments, but we must stick within the OECD rules that govern the definition of official development assistance.
Keith Vaz (Leicester East) (Lab): How much of that percentage will be made available to the people of Yemen? Only yesterday, Jamal Benomar, the UN special representative, said that 1 million children were dying from malnutrition there. How can we save those children?
Mr Duncan: Our focus on Yemen is acute, and I take charge of that personally. The right hon. Gentleman is absolutely right. Indeed, one of the comments at the nutrition event at the weekend, attended by Ministers from Yemen, was that more than half of their children under five are stunted. We have to focus on that need, and I assure the right hon. Gentleman and the House that through our programmes in Yemen, that is exactly what we are doing.
Spending Priorities
6. Alun Cairns (Vale of Glamorgan) (Con): What her Department’s spending priorities are for 2012-13. [159150]
The Secretary of State for International Development (Justine Greening): In 2012-13, the Department focused its investment on poverty reduction through improving the lives of girls and women, boosting economic development and creating jobs, building open societies and institutions, combating climate change, responding to humanitarian emergencies, and building peaceful states and societies.
Alun Cairns: The Government have rightly prioritised money for some of the most deprived people around the globe, but can my right hon. Friend reassure me that the Government will also prioritise the ungoverned states in the conflict-affected areas around the world?
Justine Greening: I can; 30% of our bilateral aid by 2014-15 will be invested in precisely those states. When the multilateral investment is added, that comes to about half the Department’s budget.
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Mark Lazarowicz (Edinburgh North and Leith) (Lab/Co-op): As the Secretary of State will be aware, the Nutrition for Growth event in London last weekend highlighted the importance of investing in nutrition. The Secretary of State will also know that in the countries with which DFID has a bilateral relationship, only about half have an investment in nutrition programme. Will the Department be expanding its commitment to invest in nutrition in developing countries?
Justine Greening: We made our own commitments, alongside those of many other countries last Saturday. In total that brought in $4.1 billion of investment between now and 2020, and we will be looking to work with developing countries to develop nutrition plans where there are none, but interestingly, last Saturday we saw many countries with existing plans in which they are already investing.
Martin Horwood (Cheltenham) (LD): In the year when we will achieve the historic 0.7% target, does the Secretary of State agree that her Department can get more bang for its development bucks by also championing development right across Government—for instance, with the Department for Business, Innovation and Skills, on tackling the issue of modern-day slavery in the business supply chain?
Justine Greening: We need to make sure that all Departments are pulling in the same direction on this agenda, as I am trying to do. The hon. Gentleman is right. Modern-day slavery is a disgrace and my Department will look at what role we can play in relation to human trafficking.
Pakistan
7. Andrew Selous (South West Bedfordshire) (Con): What recent contact she has had with the Pakistani Government about UK aid. [159151]
The Secretary of State for International Development (Justine Greening): Following Pakistan’s historic elections on 11 May, I have spoken with incoming Government Ministers about their priorities, as have my officials. The federal and provincial governments made clear manifesto commitments to reform and now have a clear democratic mandate. The people of Pakistan have put their faith in democracy and they now want to see Governments delivering on those promises.
Andrew Selous: Tax collection is very weak in Pakistan, with apparently 70% of its MPs not even filing a tax return. Given that Pakistan promised back in 2008 to close its tax loopholes as a condition of an International Monetary Fund loan, why should we believe Pakistan on this occasion that it will be better at collecting the taxes due to it?
Justine Greening: My hon. Friend is right to raise the issue, as the International Development Committee did. The incoming Government have a clear-cut manifesto commitment to increase the proportion of GDP from tax collected. We support that, and we hope and expect that they will get on with it.
Jim Shannon (Strangford) (DUP):
There have been reports from Pakistan of Christian groups who say they have not had access to the aid coming from the United
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Kingdom Government. What steps have the Government taken to address that issue directly with the Pakistani Government to ensure that Christian groups get the aid that they should get?
Justine Greening: We intend to make sure that our aid reaches all the people who need it, irrespective of ethnic background or anything else. We raised all such issues with the Pakistani Government in the past and will continue to do so with the new Government, now that they are in place. I hope I can do that when I visit Pakistan in the coming weeks.
West Bank
8. Mr David Ward (Bradford East) (LD): What research her Department has undertaken into the humanitarian effects of the occupation of the west bank. [159152]
The Minister of State, Department for International Development (Mr Alan Duncan): We are deeply concerned by the impact of the occupation on the lives of Palestinians in the west bank. DFID assesses this constantly. Reports from the UN and others clearly document poverty, displacement, constrained growth and the demolition this year alone of 247 Palestinian structures.
Mr Ward: Those who have been to the west bank and to Gaza will be frustrated constantly to see international aid used to pay for buildings which are promptly knocked down by the Israeli regime. Is the Minister aware that according to figures in the United Nations “Humanitarian Monitor” monthly report for April, there was a 30% rise in the number of Palestinians displaced by house demolitions, with a total of 46 structures demolished by the Israeli army, which included five paid for by international donors?
Mr Speaker: We are grateful to the hon. Member, but we need to have time for the answer.
Mr Duncan: The Government share the hon. Gentleman’s concerns about the nature and scale of the demolitions. I am pleased to say, however, that we have contributed to the construction of a number of schools in Gaza, where we hope children will be educated without their premises ever being demolished.
Topical Questions
T1. [159160] Chris Evans (Islwyn) (Lab/Co-op): If she will make a statement on her departmental responsibilities.
The Secretary of State for International Development (Justine Greening): Since the last International Development questions, I have attended the high-level panel meeting in New York, met the CBI to discuss how DFID can work with business on development and attended the G8 social impact forum last Thursday. You, Mr Speaker, will recall the parliamentary reception we held last weekend in advance of the G8 Nutrition for Growth event, where we secured commitments of up to £2.7 billion to tackle under-nutrition between now and 2020.
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Mr Speaker: Order. There are far too many noisy private conversations taking place. The Secretary of State and Members are addressing extremely important matters, and they should be discussed in an air of respect and consideration.
Chris Evans: Last year the Secretary of State said that her top priority was women and girls. What steps is she taking to tackle violence against women and girls, especially in the Democratic Republic of the Congo?
Justine Greening: My hon. Friend the Under-Secretary of State visited that region comparatively recently. We are looking at how we can scale up our work on tackling violence against women and girls. The hon. Gentleman will be aware that we are also working hand in hand with the Foreign Office on tackling violence against women and girls in conflict.
T2. [159161] Neil Carmichael (Stroud) (Con): In recognition of her achievement in securing the 0.7% of gross domestic product target, will the Secretary of State indicate just how many of her investments are leading to improved trade opportunities for the United Kingdom?
Justine Greening: We invest around £1 billion in wealth-creating projects, but I would like us to do more in the area of economic development. We need only look at the increase in our exports to China to see how other countries developing their economies will ultimately benefit us, too.
T9. [159168] Diana Johnson (Kingston upon Hull North) (Lab): Following the excellent WaterAid campaign on world water day earlier this year, what progress has the Secretary of State made on ensuring that access to clean water and sanitation remains a central part of the post-2015 development goals?
Justine Greening: The hon. Lady will have been as pleased as I was to see that sanitation and water feature strongly in the high-level panel’s report passed to the UN Secretary-General a couple of weeks ago. It is really important that we keep that proposed target, which is precisely what the Government will be pressing for.
T3. [159162] Dr Thérèse Coffey (Suffolk Coastal) (Con): May I commend the Secretary of State and the Prime Minister for last Saturday’s Nutrition for Growth summit, which showed that improving nutrition is not only about state aid, but about bringing the private sector and philanthropists together to solve the problem of over 1 billion people going hungry?
Justine Greening: I am grateful to my hon. Friend for that question, because it shows that if we are to make a real difference, we need ultimately to see Governments working in partnership with business and encouraging responsible investment. If we can work together and bring in the best science, we will have a real chance of tackling under-nutrition.
T10. [159169] Jim McGovern (Dundee West) (Lab):
A member of my staff, Lee Butcher, recently visited Palestine. He was shocked and stunned to see how
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Palestinians are treated by the Israelis, for example having no water for weeks on end. What can the Government do to help those Palestinians who are suffering such pain?
The Minister of State, Department for International Development (Mr Alan Duncan): We put as much pressure and argument as we can to improve the condition of Palestinians in Area C, and we very much hope that such issues will be addressed in the peace process, which we wish every success, as it continues over the next few weeks.
T4. [159163] Rehman Chishti (Gillingham and Rainham) (Con): What discussions have been had with the Government of Pakistan to tackle the issues of population growth, lack of family planning and high maternity deaths?
Justine Greening: This Government have focused on family planning; indeed, we hosted a conference on it last year. As regards Pakistan, we have a successful programme in relation to health workers. Of course, the ultimate way to tackle the issues that my hon. Friend talks about is through education. If girls stay in school longer, they get married later and have fewer children and, indeed, healthier children.
Mr Michael McCann (East Kilbride, Strathaven and Lesmahagow) (Lab): On a recent delegation to the west bank, we met President Abbas, who confirmed that the Palestinian Authority pays the families of convicted criminals a salary dependent on the length of time they spend in prison. Since DFID provides direct budget support which is indivisible from the Palestinian Authority’s funds, will the Minister explain and justify how British taxpayers’ money can be spent on paying criminals?
Mr Duncan: We have dealt with this issue on many occasions in written and oral parliamentary questions. I can assure the hon. Gentleman that British funding is ring-fenced and does not in any way go to purposes of that sort.
T5. [159164] Richard Graham (Gloucester) (Con): Does my right hon. Friend agree that it would be possible to link our large aid presence in the British embassy in Jakarta more effectively with our trade presence in order to promote new energy solutions like the first biodiesel plant in the country from Gloucestershire’s Green Fuels?
Justine Greening: That sounds like a very sensible thought. We work closely with UK Trade & Investment in Whitehall, and I would like that to happen more on the ground in developing countries such as Indonesia.
Prime Minister
The Prime Minister was asked—
Engagements
Q1. [159125] Alex Cunningham (Stockton North) (Lab): If he will list his official engagements for Wednesday 12 June.
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The Prime Minister (Mr David Cameron): This morning I had meetings with ministerial colleagues and others. In addition to my duties in this House I shall have further such meetings later today.
Alex Cunningham: Because of this Government’s incompetent management of the NHS, 256,000 patients were forced to wait in the back of ambulances because accident and emergency departments could not admit them. Why does the Prime Minister think that the best way to deal with this is to fine hospitals £90 million for his Government’s failure?
The Prime Minister: This Government are putting £12.7 billion extra into the NHS—money that would be cut by Labour. Because of that extra money and because of the reforms, waiting times for in-patients and out-patients are both down, hospital-acquired infections are right down, and mixed-sex wards have almost been abolished in our NHS. That is a record we can be proud of.
Mr Graham Stuart (Beverley and Holderness) (Con): Surely the shadow Chancellor is right when he says that the Labour party will look ridiculous if it refuses to give the people a say on our future in Europe. Can my right hon. Friend confirm the Conservative party’s commitment to renegotiation and a referendum and can he explain why a Labour leader so weak that he can resist the shadow Chancellor on nothing else refuses to do what the shadow Chancellor says on the one occasion that he is right?
The Prime Minister: On behalf of the whole House, may I welcome my hon. Friend back to the House of Commons? It is good to see him making such a strong recovery and being in such strong voice as well. He makes a very important point. On this side of the House, within this party, we are committed to renegotiation and an in/out referendum before the end of 2017, but there has been a staggering silence from Labour Members. Apparently half the shadow Cabinet support a referendum and the other half do not. Well, they will have their chance on 5 July—they can turn up and vote for a referendum in the United Kingdom.
Edward Miliband (Doncaster North) (Lab): On Syria, the Prime Minister has our support to use the G8 in the coming week to push all members to provide humanitarian assistance to alleviate the terrible crisis that is happening there. On the arms embargo and supplying weapons to the rebels, he said last week:
“If we help to tip the balance in that way, there is a greater chance of political transition succeeding.”—[Official Report, 3 June 2013; Vol. 563, c. 1239.]
Given that Russia seems ready to supply more weapons to Syria, does he think it is in any sense realistic for a strategy of tipping the balance to work?
The Prime Minister:
First of all, I thank the right hon. Gentleman for raising this issue. He is absolutely right. We should use the G8 to try to bring pressure on all sides to bring about what we all want in this House, which is a peace conference, a peace process, and the move towards a transitional Government in Syria. I am delighted to tell the House that, in advance of the G8, President Putin will be coming for meetings in Downing street on Sunday, when we can discuss this. Because we
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have recognised that the Syrian national opposition are legitimate spokespeople for the Syrian people, it is important that we help them, give them technical assistance, give them training, and give them advice and assistance. We are doing all those things, and I think, yes, that that does help to tip the balance to make sure that President Assad can see that he cannot win this by military means alone and that negotiations should take place for a transitional Government.
Edward Miliband: I thank the Prime Minister for that answer, but my question was specifically on the lifting of the arms embargo and the supply of weapons to the Syrian rebels.
Last week, the Prime Minister also told the House that
“there are clear safeguards to ensure that any such equipment would be supplied only for the protection of civilians”.—[Official Report, 3 June 2013; Vol. 563, c. 1234.]
Will he tell us what those safeguards are and how in Syria they would be enforced?
The Prime Minister: First, let me say again that the point about lifting the arms embargo, which applied originally to both the regime and the official Syrian opposition, is to send a very clear message about our intentions and our views to President Assad, but we have not made a decision to supply the Syrian opposition with weapons. As I have said, we are giving them assistance, advice and technical help.
To answer the right hon. Gentleman’s second question, we have systems in place—of course we do—to make sure that that sort of non-lethal equipment, such as transport, does not get into the wrong hands.
Edward Miliband: Two things: first, I think we all support the idea that we should focus on the peace conference, Geneva II, and on making it happen, but the problem is that the Government have put their energy into the lifting of the arms embargo, not the peace conference.
Secondly, I quoted the Prime Minister’s words not about non-lethal equipment, but about the supply of lethal equipment. He gave an assurance to this House that, in the circumstances of supplying lethal equipment, there would be end-use safeguards. My question was what those safeguards would be, but I did not hear an answer. Perhaps when he next gets up he will tell us.
When the Prime Minister replies, will he also confirm that if he takes a decision to arm the rebels in Syria, there will be a vote of this House on a substantive motion, in Government time, with a recall of Parliament from recess if necessary?
The Prime Minister: First, as I have said, we all want to see a peace conference come about. The question is: how are we most likely to put pressure on the parties to attend that peace conference? I have to say, going back to the very first thing that the right hon. Gentleman said about the Russian decision to arm the regime, the Russian regime has been arming it for decades and, frankly, it is naive to believe anything else. That is important.
On safeguards, we are not supplying the opposition with weapons. We are supplying them with technical
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assistance and non-lethal equipment. We have made no decision to supply the opposition with weapons, so that is the answer to that question.
On the issue of the House of Commons, as the Foreign Secretary and I have made clear, I have always believed in allowing the House of Commons a say on all these issues. I think that was right when it came to Iraq, it was right when we made the decision to help the opposition in Libya, and it would be right for it to happen in the future as well. Let me stress again, however, that we have made no decision to arm the rebels in Syria.
Sir Nick Harvey (North Devon) (LD): On the Government plan to double the size of our reserve forces, has the Prime Minister considered the role that retired Ghurkhas might play? Now that they are allowed to settle here, many Ghurkhas have told me that they would welcome an ongoing connection with the British Army, but there is no real routine or tradition of recruiting them. I do not think there is any impediment, but it will not happen by magic. Will the Prime Minister authorise an initiative to recruit them?
The Prime Minister: My hon. Friend makes an excellent suggestion. One of the ways that we can best build up the fully funded and fully equipped larger reserve of 30,000 that we want to see is to make sure that there are better opportunities for those who have served in the regular Army to serve in the reserves. I am sure that my right hon. Friend the Defence Secretary will look at my hon. Friend’s point about the Ghurkhas and see what can be done.
Q2. [159126] Jim McGovern (Dundee West) (Lab): I do not know whether the Prime Minister watched the “Panorama” programme on Monday night, but I am sure he will be aware of the subject of blacklisting. The programme confirmed what many of us, particularly members of the Scottish Affairs Committee, already knew: that thousands of people in this country have been subjected to blacklisting. It has been compared to McCarthyism, but I think it is worse than that: it is secretive, behind closed doors and many people who are on a blacklist do not even know that they are on one. Will the Prime Minister call for an urgent inquiry into this practice, which I refer to not as McCarthyism, but as McAlpinism?
The Prime Minister: To answer the question very directly, I did not see “Panorama” on Monday night, but I will ask for a report on it. As the hon. Gentleman knows, the Government do not support blacklisting and have taken action against it.
Q3. [159127] Jessica Lee (Erewash) (Con): I thank the Prime Minister for his recent visit to Erewash to support the historic furniture making industry. Does he agree that we can best help the hard-working staff he met at Duresta in these tough times by protecting their pensions and capping benefits, rather than by protecting benefits and cutting pensions, as the Labour party would do?
The Prime Minister:
I well remember my visit to my hon. Friend’s constituency. She is right that people in this country want to know that we will cap welfare and
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get on top of the welfare bill, but protect pensioners who have worked hard all their lives and saved for their retirement. I have done a little due diligence on the Opposition’s policy. Last week, they announced that they wanted a welfare cap. I thought, “That’s interesting. That’s progress.” However, when you look at it, would they cap the welfare bill for those in work? No they would not. Would they cap housing benefit? No they would not. The one thing that they want to cap, apparently, is pensions. So there we have it: protect welfare, punish hard workers and target pensioners—more of the same “something for nothing” culture that got this country into the mess in the first place.
Edward Miliband: Today’s fall in unemployment of 5,000 people is welcome, but will the Prime Minister explain why today’s figures also show that three years into his Government, living standards continue to fall?
The Prime Minister: First, it is worth announcing to the House what today’s unemployment figures show. They show that employment—the number of people in work in this country—is going up, that unemployment is going down, and that—[Interruption.] I know that the Labour party does not want to hear good news, but I think it is important that we hear it. The claimant count—the number of people claiming unemployment benefit—has fallen for the seventh month in a row. It is interesting that over the past year, while we have lost 100,000 jobs in the public sector, we have gained five times that amount in private sector employment.
The figures show some increase in wages, but real wages have obviously been under huge pressure ever since the calamitous boom and bust over which the right hon. Gentleman presided. What is good for people is that this Government are cutting their income tax this year.
Edward Miliband: The right hon. Gentleman is into his fourth year as Prime Minister and his excuse for falling living standards is, “Don’t blame me, I’m only the Prime Minister.” It is simply not good enough. He does not understand that because of his failure to get growth in the economy, wages are falling for ordinary people. He wants to tell them that they are better off, but actually they are worse off. Will he confirm that today’s figures show that, after inflation, people’s wages have fallen since he came to power by more than £1,300 a year on average?
The Prime Minister: The right hon. Gentleman might have noticed that the figures announced by the Institute for Fiscal Studies are from 2008, when he was sitting in the Cabinet. It is worth remembering that while he was Energy Secretary, sitting in the Cabinet, the economy got smaller—it shrank month after month after month. Under this Government, there are 1.25 million more private sector jobs and there has been good growth in private sector employment this year. That is what is happening. Of course living standards are under pressure. That is why we are freezing council tax. [Interruption.] The shadow Chancellor is shouting away, as ever. [Interruption.]
Mr Speaker: Order. There is excessive noise in the Chamber. Members must not shout at the Prime Minister any more than anyone should shout at the Leader of the Opposition. Let the answers be heard.
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The Prime Minister: The answer is that there are 1.25 million more private sector jobs under this Government, and that is a good record.
Edward Miliband: There is no answer from the Prime Minister on the living standards crisis that is facing families up and down the country. It is no wonder what his side is saying about him. This is what the hon. Member for North West Leicestershire (Andrew Bridgen) wrote about him at the weekend—[Interruption.] I know that Government Members do not want to hear it, but he said:
“It’s like being in an aeroplane. The pilot doesn’t know how to land it. We can either do something about it…or sit back, watch the in-flight movies and wait for the inevitable.”
I could not have put it better myself about this Prime Minister. The reality is that day in, day out, what people see—[Interruption.] Calm down, just calm down. The crimson tide is back. Day in, day out, people see prices rising and wages falling, while the Prime Minister tells them that they are better off. He claims that the economy is healing, but for ordinary families life is getting harder. They are worse off under the Tories.
The Prime Minister: Only someone who wants to talk down our economy could pick a day like today—more people in work, unemployment down, youth unemployment down, the claimant count down, yet not one word of respect for that good agenda on jobs. The right hon. Gentleman talks about aeroplanes. Never mind getting on aeroplanes, this is what the former Home Secretary, the right hon. Member for Sheffield, Brightside and Hillsborough (Mr Blunkett) said about his leadership:
“we are literally going nowhere”.
He has not even got on the aeroplane because he has not got a clue.
Mark Pritchard (The Wrekin) (Con): Last December, the whole of Shropshire welcomed the Government’s support for a new direct rail link from Shropshire to London. This week, however, Network Rail has blocked Virgin’s bid. Does the Prime Minister agree with me that Network Rail should not get in the way of the will of the Shropshire people or economic progress?
The Prime Minister: We want to see more direct rail links such as the one my hon. Friend mentioned, and there is also a need for better links to Lancashire and Blackpool. One issue that the rail industry is battling with is the shortage of capacity, and High Speed 2 will help bring that freeing up of capacity to make more of those direct links possible. I was discussing that yesterday with the Transport Secretary, and we should be making some progress.
Q4. [159128] Seema Malhotra (Feltham and Heston) (Lab/Co-op): Last week the Prime Minister could not confirm that taxpayers would not subsidise foreign buyers of property in the UK. Perhaps he can instead clarify whether his Help to Buy scheme will see taxpayers help fund purchases of second homes and holiday cottages.
The Prime Minister:
Let me try to give the hon. Lady some satisfaction. First, this scheme is for people’s only home and it will have a mechanism in place to ensure
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that is the case. The second important thing is that in order to take part in the scheme, a person must have a credit record in this country. So no, the scheme will not do what she says it would.
Q5. [159129] Richard Graham (Gloucester) (Con): As a former pensions manager I was proud that this Government introduced a new triple lock formula—[Interruption.]
Mr Speaker: Order. This is very discourteous. The hon. Gentleman, like every Member, should be treated with courtesy. Let us hear what he has to say.
Richard Graham: As a former pensions manager I was proud when this Government introduced a new triple lock formula on our state pension that increased by £234 in its first year for every pensioner in the land. Does the Prime Minister share my concern that under the shadow Chancellor’s plans to cut or cap pensions, all our pensioners will lose that increase and their standard of living will fall sharply?
The Prime Minister: My hon. Friend is absolutely right. This Government have put a cap on the welfare that families can receive, but we have been as generous as we can with pensioners who have worked hard during their lives and want to have dignity and security in old age. That is why we have the triple lock. Very interestingly, we now know that the Labour party wants to cut the pension because it is putting a cap on pensions but not on welfare. Just this morning the shadow Foreign Secretary was on television—the right hon. Member for Doncaster North (Edward Miliband) may not know this as he might not have been following it—and when challenged about the triple lock he said that it was Labour’s policy “at present”. Given all the U-turns we have had in the last week from the Labour party, I do not think “at present” will last very long.
Q6. [159130] Mr David Crausby (Bolton North East) (Lab): Will the Prime Minister congratulate Bolton Wanderers football club for doing the right thing by rejecting sponsorship from a payday loan firm, and will he also join in, do the right thing, and give local authorities the power to ban those predatory loan sharks from our high streets?
The Prime Minister: I hear what the hon. Gentleman says and I wish Bolton Wanderers well for the future. We must give more support to credit unions in our country, which I think is one of the best ways of addressing the whole problem of payday loans and payday lending. I also hope the hon. Gentleman will welcome the fact that over the past year unemployment has fallen fastest in the north west of our country.
Q7. [159131] Dr Julian Huppert (Cambridge) (LD): This is national carers week. Will the Prime Minister join me in paying tribute—[Interruption.]
Mr Speaker: Order. If the session has to be extended to accommodate the democratic rights of Members, it will be extended. The hon. Gentleman will—I repeat will—be heard.
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Dr Huppert: This is national carers week, so will the Prime Minister join me in paying tribute to the huge commitment that thousands of carers make day in, day out, caring for ill, frail and disabled family members, friends and partners, often unrecognised and without financial assistance? Will he sign up to the carers week recommendations in “Prepared to Care?”
The Prime Minister: On this one, the hon. Gentleman speaks for the whole House and the whole country in praising Britain’s carers. They do an amazing job. If they stopped caring, the cost to the taxpayer would be phenomenal, so we should do what we can to support our carers, and to ensure they get the proper respite breaks from caring that they need to be able to go on doing the wonderful work they do.
Q8. [159132] Graham Jones (Hyndburn) (Lab): Why has the number of supply teachers in secondary schools in the past year increased by a staggering 17%?
The Prime Minister: I do not have the figures for that, but we have protected the amount of money that goes into schools per pupil so that schools have the money to employ the teachers they need.
Mary Macleod (Brentford and Isleworth) (Con): Since 2010, unemployment in Brentford and Isleworth has fallen by 6.9% and youth unemployment has fallen by 19%. I will do my part as an organiser—I held my jobs and apprenticeships fair in Isleworth recently—but does that not show that our economic plan is working?
The Prime Minister: My hon. Friend is absolutely right. We see today a growth in employment, a fall in the claimant count and a fall in youth unemployment. As I have said, we are losing jobs in the public sector because we had to make cuts to it, but, most importantly of all, while we lost more than 100,000 jobs in the public sector in the past year, we gained five times as many in the private sector—[Interruption.] The shadow Chancellor, as ever, wants to give a running commentary, but let me remind the House what he has said, because this is one of the most important quotations in the past 10 years of British politics. He said:
“Do I think the last Labour government spent too much, was profligate, had too”
“national debt? No, I don’t think there’s any evidence for that.”
That phrase will be hung around his neck for ever.
Q9. [159133] Chris Ruane (Vale of Clwyd) (Lab): Five hundred homes in my constituency were flooded in November. Residents in my constituency are terrified that their homes and businesses are now worthless because this Government have failed to replace the flood insurance scheme. They have also cut more than £200 million from flood defence works. Why has the Prime Minister sold my constituency down the river?
The Prime Minister: I can give the hon. Gentleman welcome news. We had to extend the period of the scheme so that we could continue negotiations, but I am confident that we will put in place a proper successor to it. An announcement will be made quite soon.
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Annette Brooke (Mid Dorset and North Poole) (LD): Mathmos makes lava lamps in my constituency—it has been making them for 50 years. It has very large exports to Germany, but has run into a problem with the reclassification of the product. May I send the information to the Prime Minister and enlist his support for this innovative company operating so well within our country?
The Prime Minister: I am happy to receive the information from my hon. Friend. It is important that we get Britain’s exports up. If we moved from one in five of our small and medium-sized enterprises exporting to one in four, we would wipe out our export deficit altogether, so I am happy to get my office to look at the information she has.
Q10. [159134] Mr Virendra Sharma (Ealing, Southall) (Lab): The accident and emergency department at Ealing hospital is one of four that the Prime Minister is closing in north-west London. I welcome the Health Secretary’s review, but with waiting times at a nine-year high, ambulances being diverted and the risk of unnecessary deaths, will the Prime Minister acknowledge that the closures are not a serious option if the NHS is safe in his hands?
The Prime Minister: As the hon. Gentleman knows, the Health Secretary has asked the Independent Reconfiguration Panel to conduct a full review of the proposals, and it will submit its advice to him no later than mid-September. Let us be absolutely clear: whatever decision is reached, the proposals will not be due to lack of central Government funding. North-west London will receive £3.6 billion, which is £100 million more than the previous year. Of course, if we had listened to the Labour party, which said that more NHS spending was “irresponsible”, his hospitals would be receiving £100 million less.
Richard Harrington (Watford) (Con): Will the Prime Minister join me in congratulating the China-Britain Business Council, which, under its inspirational vice-chairman, Mr Peter Batey, organised a seminar on exporting to China that was attended by more than 60 businesses in Watford last Friday? I think it should be congratulated on that initiative.
The Prime Minister: I am very happy to extend my praise to the China-Britain Business Council. If we look at the evidence of the past few years, we see there is now a significant increase in British exports to China, and a big increase in Chinese direct investment into the UK. All of that is welcome and we need to see it grow even further.
Q11. [159135] Jim Dowd (Lewisham West and Penge) (Lab):
Will the Prime Minister confirm that he understands the importance of the creative industries to the economy of this country, and that they need to be buttressed by adequate intellectual property rights? Is he also aware, however, that his intellectual property Minister, that horny-handed son of toil, the fifth Viscount Younger of Leckie, recently told the Culture, Media and Sport Committee, in relation to Google, that
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“I am very aware of their power…I am also very aware…that they have access, for whatever reason, to higher levels than me in No. 10”.
Is that not a disgraceful comment on the way this Government—
[
Interruption.
]
Mr Speaker: Order. The hon. Gentleman’s question, which refers to a distinguished constituent of mine, suffered from the disadvantage of being too long.
The Prime Minister: First, I agree with the hon. Gentleman that our creative industries are incredibly important for Britain’s future. The music industry has had a record year in terms of sales. One in every four albums sold in Europe is made here in the UK, which is something we can be very proud of. We have to get the intellectual property regime right, which is why we are legislating on it. We have already taken action to extend the life of copyright protection to 75 years, which has been welcomed across the music industry. I simply do not accept what he says about my Ministers. Indeed, the Minister with most responsibility for this matter is the Under-Secretary of State for Culture, Media and Sport, the hon. Member for Wantage (Mr Vaizey), and I think his father was ennobled by Harold Wilson, so that does not really fit.
Q12. [159136] Sheryll Murray (South East Cornwall) (Con): Will the Prime Minister join me in praising the hard work of the right hon. Member for South Holland and The Deepings (Mr Hayes) and the Secretary of State for Communities and Local Government for ensuring that planning decisions taken at local level concerning wind turbines remain local? However, many of my constituents in South East Cornwall are becoming increasingly concerned that our green fields are becoming solar fields. Should decisions on solar fields be subject to the same planning rules as wind turbines?
The Prime Minister: I absolutely join my hon. Friend in praising the excellent work done by the right hon. Member for South Holland and The Deepings, which has been carried on by the Minister of State, Department for Business, Innovation and Skills, my right hon. Friend the Member for Sevenoaks (Michael Fallon). They have both done a very good job at bringing some sanity to the situation concerning onshore wind. On solar panels, the Government of course substantially reduced the feed-in tariffs to ensure that this industry was not over-subsidised, because all subsidies end up on consumers’ bills and we should think very carefully about that.
Liz Kendall (Leicester West) (Lab): Glenfield hospital has the second best survival rates from children’s heart surgery in the country. Will the Prime Minister ensure that the quality of care—including survival rates, which are what matter most to parents—is central to any decision on the future of these services?
The Prime Minister:
The hon. Lady is absolutely right. My right hon. Friend the Health Secretary will make an announcement shortly about Safe and Sustainable and children’s heart operations. We have to be frank with people: we cannot expect really technical surgery, such as children’s heart operations, to be carried out at every hospital in the country. As the parent of a desperately
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ill child wanting the best care for that child, you need to know that you are getting something that is world best when it comes to really technical operations, but you cannot have that everywhere. Clearly, however, the conclusion is that this process, which started in 2008, has not been carried out properly, so we need to make a restart.
Q13. [159137] Mr Henry Bellingham (North West Norfolk) (Con): Is the Prime Minister aware that last year Britain became a net exporter of cars for the first time since 1976? If this trend continues, the UK will produce an all-time record of 2 million cars in 2017. Is this not a really good example of a high added-value sector upskilling and putting the “great” back into British manufacturing and exports?
The Prime Minister: My hon. Friend is absolutely right that this is a good example of a British industry that is succeeding. If we look at Honda, Nissan, Toyota or Jaguar Land Rover, we see really good news in our automotive sector. We now need to get behind it and encourage it to have as much of its supply chain onshore as possible. That is beginning to happen in these industries, and I hope for further progress in the months ahead.
Q14. [159138] Catherine McKinnell (Newcastle upon Tyne North) (Lab): This week, Newcastle city council has revealed that rent arrears have increased by more than £550,000 since the bedroom tax was introduced in April. Furthermore, 60% of affected households are falling into arrears. When will the Prime Minister admit that this devastating policy risks costing more than it saves?
The Prime Minister: We ended the spare room subsidy because we did not think it was fair to give to people in council houses a subsidy that those in private rented accommodation did not have. There is now a question for the Labour party: if it is to have this welfare cap, will it now tell us whether it will reverse this change? Will you? [Interruption.] The shadow Chancellor is shaking his head. Is that a no? That is right. After all the talk of the last few weeks—the iron discipline we were going to hear about, the welfare cap they were telling us about—they have failed the first test.
Q15. [159139] Karl McCartney (Lincoln) (Con): Tax avoidance is rightly at the heart of the G8 agenda. Will my right hon. Friend the Prime Minister tell the House what advice he might have received on this issue from either the leader of the Labour party or the international, pizza and expensive curry-loving shadow Chancellor?
The Prime Minister: My hon. Friend makes a good point. It is this Government who are putting aggressive tax avoidance at the heart of the G8 agenda, and what do we hear this week from the Labour party? It gives tax avoidance advice to its donors. That is what it has been doing: £700,000 of tax has been avoided because of what Labour advised its donor to do.
Ed Balls (Morley and Outwood) (Lab/Co-op): Calm down.
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The Prime Minister: The shadow Chancellor asks me to calm down. Frankly, I cannot calm down because this is money that ought to be going into our health service, education and training young people. Let me challenge the Opposition: will you give the money back? Yes or no? It is very simple. On 2 April, the Labour leader said—according to The Guardian, so it must be true—that
“tax avoidance is a terrible thing”.
“If everyone approaches their tax affairs as some of these companies have approached their tax affairs we wouldn't have a health service, we wouldn't have an education system.”
That is the shameful state of the Labour party today.
Debbie Abrahams (Oldham East and Saddleworth) (Lab): This week is carers week. Will the Prime Minister show support for the 7 million unpaid carers across the country and invest £1.2 billion from last year’s NHS under-spend in social care, as we have pledged to do, so averting the Government-made crisis in accident and emergency and social care?
The Prime Minister: We could start with the money from Labour’s tax avoiding. That is money that should be going into the care system and the NHS. The Government have put £12.7 billion extra into our NHS. That is how we are supporting carers and hospitals, but the hon. Lady can have a word with the shadow Chancellor and her leader and say, “Pay the taxes you owe.”
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Sir Malcolm Bruce (Gordon) (LD): As we approach the 25th anniversary of the Piper Alpha disaster, will the Prime Minister join me in recognising the challenges we face in continuing to bring oil and gas ashore from the North sea, the skills and dedication of those who do it and the paramount importance of safety in ensuring that we can continue to exploit these resources?
The Prime Minister: I certainly join my right hon. Friend in praising the North sea oil and gas industry. It is a real jewel in the crown of the United Kingdom economy. What is encouraging is that this year we are seeing a growth in production, as a number of new fields and projects come on stream, but he is absolutely right to say that at all times safety and security are absolutely paramount.
Pete Wishart (Perth and North Perthshire) (SNP): On a point of order, Mr Speaker.
Mr Speaker: Order. The hon. Gentleman is a very experienced Member of the House. Points of order come after statements. I feel sure that he will be just as keen at that point and will spring up from his seat to favour the House with his thoughts.
We shall now have a statement from the Secretary of State for Health, who is at this moment beetling towards the Dispatch Box.
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Children’s Heart Surgery
12.35 pm
The Secretary of State for Health (Mr Jeremy Hunt): With permission, Mr Speaker, I would like to make a statement on the Safe and Sustainable review of children’s congenital heart services.
On average, around 3,700 heart procedures are carried out each year on children who have been diagnosed with congenital heart conditions. The mortality rates at Bristol royal infirmary identified as far back as 1989 indicated that we are not as successful as we should be in such operations. The Safe and Sustainable review began in 2008 and set out to ensure that children’s heart services are the best they can be for all children across the country. Whatever the controversy about the location of such services, we all have a responsibility to ensure the best possible outcomes for children and their families, who must always come first in any decision about service provision.
Sir Ian Kennedy, in his Bristol inquiry report in 2001, recommended the concentration of medical and nursing expertise in a smaller number of centres. Subsequent working groups and reports have endorsed that recommendation, including the Royal College of Surgeons in 2007. The public consultation on the Safe and Sustainable review received more than 75,000 responses. This was the largest review of its kind, conducted independently of Government by the NHS. In July 2012, the then Joint Committee of Primary Care Trusts, on behalf of local NHS commissioners, decided that children’s heart surgery networks should be formally structured around specialist surgical centres in Bristol, Birmingham, Liverpool, Newcastle and Southampton, as well as Great Ormond Street and the Evelina children’s hospital in London. The JCPCT recommended that services should no longer be provided in Leicester, Leeds and Oxford or at the Royal Brompton or Harefield in London.
Following the JCPCT’s announcement, three local health overview and scrutiny committees formally referred its decision for me to review. I wrote to the Independent Reconfiguration Panel asking it to undertake a full review of the proposals. I received that report on 30 April, and I would like to thank the IRP for producing such a comprehensive review of such a challenging topic. It strongly agrees with the case for change—specifically, that congenital cardiac surgery and interventional cardiology should be provided only by specialist teams large enough to sustain a comprehensive range of interventions, round-the-clock care, specialist training and research. I agree with the IRP’s analysis.
However, the report also concludes that the outcome of the Safe and Sustainable review was based on a flawed analysis of the impact of incomplete proposals and leaves too many questions about sustainability and implementation. This is clearly a serious criticism of the Safe and Sustainable process. I therefore accept the recommendation that the proposals cannot go ahead in their current form, and I am suspending the review today. NHS England will also seek to withdraw its appeal against the judicial review successfully achieved by Save Our Surgery in Leeds. None the less, the IRP is clear that the clinical case for change remains, and its report is helpful in setting out the way forward in terms of broadening the scope of the discussion and looking
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in detail at the affordability and sustainability of the proposals. The IRP says, and I agree, that this is not a mandate for the status quo or for going back over all the ground already covered during the last five years. The case for change commands widespread support, and we must continue to seek every opportunity to improve services for children.
The recommendations in the report set out the IRP’s view of what needs to be done to bring about the desired improvements in services in a way that addresses the gaps and weaknesses in the original proposals. Specifically, they include better co-ordination with the review of adult heart surgery services; expanding the detailed work on the clinical model and associated service standards for the whole pathway of care, beyond surgery; services to be fully modelled, and their affordability re-tested; NHS England to establish a systematic, transparent, authoritative and continuous stream of data and information about the performance of congenital heart services; NHS England and the relevant professional associations to put in place the means to continuously review the pattern of activity and optimise outcomes for the more rare, innovative and complex procedures; NHS England to reflect on the criticisms of the JCPCT’s assessment of quality and to learn lessons to avoid similar situations in its future commissioning of specialist services; and NHS England to use the lessons from this review to create with its partners a more resource-effective and time-effective process for achieving genuine involvement and engagement in its commissioning of specialist services.
NHS England now must move forward on the basis of these clear recommendations and the Leeds court judgment. I have therefore written today to NHS England, and to the local overview and scrutiny committees that originally referred the JCPCT’s decision to me, to explain that the IRP’s report shows that the proposals of the Safe and Sustainable review clearly cannot go ahead in their current form. It is right to give all the parties some time to reflect on the best way forward, now that the IRP report is in the public domain, so I have asked NHS England to report back to me by the end of July on how it intends to proceed. In the meantime, it is important to stress that I believe that care for children with congenital heart conditions is safe in the NHS, and that ensuring it continues to be will be the top priority for all involved in this process.
I know that many families have found the Safe and Sustainable review to be a traumatic experience. People are rightly proud of the hospitals and the staff that have saved, or tried their very best to save, the lives of their children. However, there is overwhelming consensus that we cannot stick with the model of care that we have now. To do so would be a betrayal of the families who lost loved ones in Bristol and who want nothing more than for the NHS to learn the lessons from their personal tragedies. So it is right we continue with this process, albeit in a different way. But it is also essential that the process should be performed correctly so that any decisions, as difficult as they might ultimately be, carry the confidence of the public. I commend the report and this statement to the House.
12.42 pm
Andy Burnham (Leigh) (Lab):
I thank the Secretary of State for giving me early sight of his statement. He was right to begin by reminding the House of the events
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that led to the Safe and Sustainable review. Terrible failings in the care of very sick children at the Bristol royal infirmary in the 1980s and 1990s led Sir Ian Kennedy to call for expertise to be concentrated in fewer surgical sites—a call supported by more recent events, including those at the John Radcliffe hospital in 2010. Since Bristol, Sir Ian’s important conclusion has had the full support of the health professions and of those on both sides of this House. As we digest what the Secretary of State has just said, two considerations must remain at the forefront of our minds. First, that this issue must continue to transcend party politics. Secondly, that the complexity it presents should not derail our determination to deliver the safest possible care for children in England.
That said, changes of this magnitude must be able to command public confidence and consensus, but that has not emerged since the decision on site selection by the Joint Committee. I fully support the reduction in sites, but when the decision was published I expressed concern about the distribution of the seven sites, which was skewed towards the western half of England and left a large swath of the east, from Newcastle to London, without a surgical centre. For a family in Hull or Lincoln, already at their wits’ end with worry, the wrench of leaving home to travel hundreds of miles, along with the cost of accommodation and time off work, would add to high levels of stress and anxiety. That is why the issue has aroused such strength of feeling, particularly across Yorkshire, the Humber and the east midlands—a concern well voiced and represented by Members throughout the House.
Although clinical safety must predominate, does the Secretary of State agree that the NHS needs to give more consideration to public access and travel times when reconfiguring services? The truth is that the NHS has a habit of minimising these concerns in all reconfigurations—in this case, as the IRP report points out, the Joint Committee considered access the least important factor. The IRP concluded, surely rightly, that
“the decision used a flawed and incomplete analysis of accessibility”.
Going forward, will the Secretary of State ensure that this is corrected and that access is made a significant factor in any future decision?
Turning to the review itself, the Secretary of State will know that one of the main concerns has been that the mortality data were not given enough weight. Although decisions of this kind cannot be based on death rates alone, we agree with John Deanfield, director of the National Institute for Cardiovascular Outcomes Research, who wrote in his letter to NHS England in April:
“Mortality is only one measure of quality, but currently is the most…available outcome.”
Will the right hon. Gentleman confirm that these data will feature more prominently in the further process of review announced today?
My main concern with what the Secretary of State has just announced is the proposal to link the children’s review with the review of adult heart services, and the implications that might have for the timetable. The Secretary of State will know that there are around 30 centres across England carrying out adult heart surgery. The seven selected children’s centres are not all co-located with adult heart surgery and, indeed, a number of them are on specialist children sites, so the link
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between children’s and adult heart surgery is not clear. Is there not a real danger that by linking the review with adult heart surgery, the Secretary of State is introducing more complexity and, potentially, controversy, risking a loss of focus and more delay? By broadening out in this way, is there not a danger that we will lose the consensus that has already been gained over the future of children’s heart surgery? I would be grateful if the right hon. Gentleman would say more on those points.
This decision will also have implications for the timetable of the children’s review and it will not have escaped the House’s notice that that Secretary of State has not announced a clear timetable. Can he set out more precisely a timetable for the decision making that will now follow? He says that the review will be concluded by the autumn. What people will want to know is when the decisions will be made and implemented. Can he say more about that? The statement sets out a major role for NHS England and questions may be asked about the independence of the review he has announced. What guarantees can he give that NHS England will operate independently of vested interests linked to the 10 sites?
Finally, I am sure the right hon. Gentleman will agree that we cannot risk any loss of confidence in the process, damaging confidence in all 10 existing sites. Will he say more about what he will do in the interim to support all existing units and ensure that there is no loss of expertise?
In conclusion, it is, of course, essential that the public have confidence in the process and the final decision. Balanced against that, however, is the fact that unnecessary delay will not bring the best results for the children who most need our help. The Secretary of State is right to say that we need a process that is seen to be fair by all concerned, but, equally, a point will come when decisions must be made. In the end, I want to assure the Secretary of State that when he comes to face up to those difficult decisions, he will have our support in doing so.
Mr Hunt: I thank the right hon. Gentleman for the tone of his comments and the bipartisan way in which he has approached these issues. I particularly welcome his last point. We have many debates in this House, but this is one issue where we are completely at one. If there is a difficult decision to be made that will save children’s lives, we must have the courage to take it. I am grateful for the right hon. Gentleman’s support on that.
I think that the right hon. Gentleman will also agree with me that while this issue transcends party politics, it is one from which all of us—on both sides of the House, throughout the NHS and indeed in local authorities—have things to learn. I think that the biggest issue for us all to consider is the sheer amount of time that it has taken. The original concerns about what happened in Bristol were raised in 1989. I am pleased to say that they have been dealt with, but there are broader, system-wide lessons to be learnt. It took until 2001 for Sir Ian Kennedy’s report to be completed, it took until 2008 for the Safe and Sustainable review to begin, and now, in 2013, we are having to suspend the process yet again. What has happened is not the right outcome for children, and we must all learn the lessons from that.
The right hon. Gentleman mentioned site selection. I consider that to be one of the most crucial areas in which the process was flawed. Whether we should involve
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adult heart services is a difficult question, but one of the key recommendations in the IRP’s report is that they should be taken into account. I think that we should pay attention to that recommendation, because the panel thought about it very carefully. The reason for its view was that the same surgeons often operate on children and on adults. Adults also have congenital heart conditions that require operations. The panel also says that if the best outcomes are to be achieved for children, services must be concentrated in teams that have four full-time surgeons, provide specialist training, and conduct research. The knock-on impact of what is happening in adult heart services is relevant.
I agree with the thrust of what the right hon. Gentleman said about mortality data, but I know that he will also understand the difficulty of publishing such data on a very small number of cases when they may not be statistically significant. That was one of the great debates that we had over the temporary suspension of services at Leeds. We must be careful not to publish data that could lead the public to make the wrong conclusions. In principle, however, transparency is the most important thing for us to bring about.
I entirely agree with the right hon. Gentleman about the timetable. I think that we must get on with this process: I do not want to delay it any more than is necessary. I have talked extensively to NHS England about how it should be approached. NHS England—along with all the stakeholders involved—needs time in which to digest the contents of the IRP report, which was published only today. I consider that the minimum period that I need to allow it to come up with the timetable is until the end of next month. I appreciate that that is six weeks, but I think that it is a sensible period. I certainly want to be able to publish an indicative timetable by then, so that people can understand how the process will continue and how we will learn the lessons.
I also agree with the right hon. Gentleman that nothing in my statement should undermine the public’s confidence in the brilliant work being done by heart surgeons all over the country for adults and children. Our heart surgery survival rates have improved so much that they are now some of the best in Europe, and we can be very proud of the work that those surgeons do, day in, day out. However, that does not mean that we cannot strive to be even better.
Mr Stephen Dorrell (Charnwood) (Con): I welcome the statement, although, in a sense, I welcome it with a heavy heart. Does my right hon. Friend agree that the Safe and Sustainable process could not go ahead because it had fundamentally lost the confidence of patients and clinicians, and therefore did not form a proper basis for necessary change?
Given that it is now more than 12 years since the publication of Sir Ian Kennedy’s report, does my right hon. Friend agree that this is not a success for the NHS? Does he agree that it is a real challenge for NHS England to put a proper time frame around necessary change for these services, and then to use that as a basis for changes that we know to be needed in other specialist services in the national health service?
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Mr Hunt: I agree with my right hon. Friend on both those points, as, indeed, on many others. It is true that the Safe and Sustainable process did not have the confidence of the public. It should be emphasised that when a controversial and difficult change is proposed, there is always likely to be public opposition. However—as I am sure we shall hear from Leeds Members in particular—this process did not command confidence in Leeds, or in other centres, because there was a sense that the outcome had been determined before the start of the consultation. The public found that totally unacceptable, and indeed it is unacceptable. The point of a consultation is for those who initiate it to listen genuinely, and to engage with stakeholders. That must be one of the most important lessons to learn.
My right hon. Friend was also right to suggest that, in general, this is not a success for the NHS. We need a much better process to enable us to face difficult decisions about reconfigurations of services, and, in particular, carrying the public with us when we must make a difficult change that will save lives. We have not done that as well as we need to.
Hilary Benn (Leeds Central) (Lab): It has been clear to many of us for a long time that this process was flawed, and that has now been recognised by the IRP. I pay tribute to the extraordinary campaign in support of the Leeds children’s heart surgery unit in my constituency, which has helped to bring us to this day.
I welcome the Secretary of State’s statement, but does he agree that it is important for the process to be open and transparent this time, and to focus on what it is meant to be about, namely ensuring that the very best surgery is available for our very sick children?
Mr Hunt: That is entirely right. On this occasion, it is clear that the concerns of the campaigners were valid, and that the process was not conducted as it should have been. Interestingly, the campaigners commented that they felt that their engagement with the IRP was a much more open process than their engagement with the NHS.
Many people in the NHS believe passionately, and for absolutely the right reasons, that we need to change the way in which services are delivered. I agree with them, and specialised services such as those that we are discussing today provide a very good example of that. We know that the more operations a heart surgeon performs, the better he or she will become at his or her job, and the more likely a successful outcome is. However, if we are to carry the public with us—and they are, after all, the people whom the NHS is there for—we must do a much better job of genuine engagement.
Sir Edward Garnier (Harborough) (Con): I thank the Secretary of State for an intelligent and thoroughly considered statement which will have brought great joy to many people in Leicestershire. I also commend the shadow Secretary of State for dealing with the matter on a cross-party basis. We in Leicestershire have dealt with it on that basis as well: my hon. Friend the Member for Loughborough (Nicky Morgan) and the hon. Member for Leicester West (Liz Kendall) have been, if I may say so, the leading ladies in the Glenfield hospital campaign.
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I am grateful for the respite that we are being given by the Secretary of State. What advice can he give us to give to the clinicians, nurses and parents of patients at Glenfield hospital about how best to present, or re-present, their case between now and the time at which he and his advisers will reach a final conclusion about the disposition of children’s heart services?
Mr Hunt: We must all engage with the process thoroughly and fully. We, as Members of Parliament, have a responsibility to engage with our constituents about some of the complexities involved. The issue of mortality rates, which was raised by the right hon. Member for Leigh (Andy Burnham), is one of those complexities. They are very important, but they are not the only consideration, and, when it comes to specialised services, they are extremely difficult to interpret properly. We must engage in an intelligent and constructive way, and reassure our constituents that all of us—Government and Opposition—want the best outcome for children, the outcome that will save the most children’s lives.
Let me return to what the Prime Minister said earlier. I have no problem with explaining to my constituents that in the case of certain services, they are better off travelling further. I did not respond earlier to the right hon. Gentleman’s point about travel, so let me say now that I agree with him that it must be taken into consideration. According to the IRP’s report, the whole care pathway needs to be examined. That means not just the visit to the hospital for surgery, but follow-up care and early assessments. In that context, travel becomes much more important.
If we are honest with our constituents about the fact that there may be a difficult decision at the end of the process, we are much more likely to earn their trust.
Mr Nicholas Brown (Newcastle upon Tyne East) (Lab): How much public money has been spent on taking us to the point that we have now reached? Is the IRP report available to Members of Parliament? Will the Secretary of State say a little more about the process that will take place between now and the day on which he must come to the Dispatch Box and announce very difficult and controversial decisions to the House, and will his decisions stick?
Mr Hunt: The cost to date of the Safe and Sustainable process is about £6 million and Members of this House will rightly ask whether that money has been spent well, given the flaws in the process identified today by the IRP. I would also say, however, that it is right to spend money on carrying out such processes properly. It would be the wrong approach to say that, based on the cost of the process, we are not prepared to consider how we can improve services.
On the timetable, now that the report is public—it is available to Members of the House and the public as of today—I have given NHS England and all stakeholders until the end of next month to come back to me with a revised plan.
Jason McCartney (Colne Valley) (Con):
I agree with the Secretary of State that families must come first. For me, that means the families of Ben Pogson and Joel Bearder, young constituents of mine who have been treated at the wonderful Leeds unit. Will my right hon. Friend give an assurance that the new review will be
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based on the fundamental principle of patient choice and that doctors should go where the patients are, rather than the other way around?
Mr Hunt: Patient choice is very important, but it is also fair to say that there are other considerations in such a review, such as clinical best practice and what outcomes will get the best results for children. We need to be up front with the public that that will not mean specialist children’s heart surgery being offered in every major city in this country. There will be some difficult decisions at the end of the process. The broader point about patient choice, when it comes to considering mortality rates, is that it ties in very well with the concept of peer review. The way we can get better outcomes for children is by being able to compare what happens in different centres, and that is a very important part of the process.
Mr John Denham (Southampton, Itchen) (Lab): Will the Secretary of State acknowledge one fact that has complicated this process? A foundation trust that loses children’s heart surgery will probably lose paediatric intensive care and, therefore, all the rest of its paediatric service activities, doing potentially catastrophic damage to the budgets of some trusts. Are the institutional pressures on individual trusts not one reason why it has been so hard to get a collaborative approach to that fundamental change? How does the Secretary of State intend to resolve that issue as he moves forward with the review?
Mr Hunt: The independent review says that the knock-on effects on adult heart surgery, and the interrelationship between the two, need to be considered. There are always knock-on effects of a service reconfiguration. Within reason, one must consider them, but one must also bear in mind what the right hon. Member for Leigh said: one must ensure that one does not overcomplicate the reviews. If we consider every single knock-on effect of every single change, the danger is that we end up not being able to change anything at all, which on this occasion would be an abdication of our important responsibilities.
Greg Mulholland (Leeds North West) (LD): I have called consistently for leadership and accountability. I believe that we have had those things today, and I thank the Secretary of State and his colleagues in the Department for that. I have said consistently that there was something wrong with the decision-making process. We were right, whereas those who told us that we should be quiet and ignore the serious flaws, clear bias and utter lack of transparency were wrong. May we have a full investigation into the clear maladministration in the course of the review? Will the Secretary of State assure the House that lessons will be learned, which is key, and that those conflicted people who have let children down and wasted taxpayers’ money will play no part in any further review in the NHS?
Mr Hunt:
I can confirm that a thorough process of learning the lessons will happen. As I said earlier, we must learn big lessons about the time it takes to make very important service changes in the NHS, not just in children’s heart surgery but in many other areas. We need to learn those lessons. The person who was responsible
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for the JCPCT, Sir Neil McKay, is no longer responsible and has retired from the NHS. We need to look at everyone who was involved in the process and see where the right calls were and were not made. If we do not, we will never be able to make important changes in the NHS—and we have a big responsibility to make those changes.
Mrs Mary Glindon (North Tyneside) (Lab): The proposed reconfiguration of children’s heart surgery has gone on for years. Meanwhile, children are suffering and even dying. Why cannot the Secretary of State have a more rigorous timetable based on the lessons learned from the review so far?
Mr Hunt: That is what I absolutely want to do. One huge frustration for those on both sides of the House has been how the process has dragged on. If I could have come to the House today with a detailed timetable, I would have. Although we had internal access to the report before today while I considered its findings and reached a judgment, we believed that it was necessary for external stakeholders to see the report and give their view of how the timetable should proceed. That is why I have given NHS England until the end of July to come back with that timetable.
Nicola Blackwood (Oxford West and Abingdon) (Con): The Health Secretary is absolutely right that parents in my constituency have found this process deeply destabilising. Although they also want to see quality, they felt that their concerns about building up a good relationship with their medical teams and about accessibility and co-located services were simply dismissed. Will the Health Secretary assure me that that will not be the case in the future, and will he look more closely at the networking solution we have in Oxford and Southampton, which strikes a good balance between having a quality site further away and providing aftercare in an accessible site with trusted medical teams?
Mr Hunt: That is a very interesting thought. My hon. Friend will be pleased to note that the IRP report states that the whole care pathway, not just the surgery on its own, needs to be considered when we make this very difficult decision. I agree with her that this has been a very distressing process for every family involved and although we are suspending the process today, we have a responsibility to be honest with people. At the end of the process, there will be a difficult decision to take and we will honestly do our duty as Members of this House.
Fabian Hamilton (Leeds North East) (Lab): I know that all the families of children affected throughout Yorkshire will welcome today’s statement from the Secretary of State. Will he reassure the House that any future review panel, following whatever timetable he decides, will comprise representatives fairly and equally chosen from all the centres that will be affected by any decisions? Secondly, what assurances can he give that rather than the data used in flawed reports, such as the now infamous National Institute for Cardiovascular Outcomes Research 8 April report on mortality data in children’s heart surgery units, we will use data that are consistent and reliable?
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Mr Hunt: On the hon. Gentleman’s second point, we need to be very careful about how we use any mortality data, particularly on specialist services where distortions can be based on just one or two operations. I know that he will agree, however, that we have a responsibility to act if we have genuine concerns. That is what happened and the process over Easter was very difficult. One lesson we have learned in the NHS is that in Bristol it took a very long time—years—before anything was done about the higher mortality rates and we do not want to make that mistake again. I take on board the hon. Gentleman’s other point, too.
Jane Ellison (Battersea) (Con): I know that many of the staff and patients at the Royal Brompton hospital will very much welcome my right hon. Friend’s statement today. Although the hospital is not in my constituency, many of the staff live in my constituency and other hon. Members have been extremely active in making the Royal Brompton’s case over recent months. There was particular concern about the possible impact on other specialisms of any decision to withdraw children’s heart surgery, so can my constituents be assured that such concern will be taken into account in any future process?
Mr Hunt: The IRP report says that we must consider the broader impact of any changes beyond the narrow question of children’s heart surgery, so I am sure that that is one of the lessons that will be learned.
Mr Speaker: Order. On the assumption that Dr Lee has now put his phone away, may I say to Members that they should not stand to speak while at the same time fiddling with a phone? It is multi-tasking in a way that is perhaps a tad discourteous. We do, however, want to hear from Dr Lee, who is a distinguished physician, so let us hear from him.
Dr Phillip Lee (Bracknell) (Con): My apologies, Mr Speaker. As someone who has long argued for the reconfiguration of acute and surgical services, I consider the management of this clinical consolidation to be of great importance. Does the Secretary of State agree that best clinical outcomes should be the primary driver of any reconfiguration and that there is a need for a national plan for the reconfiguration of all acute and emergency services? If such a plan were drawn up, it should receive cross-party support.
Mr Hunt: May I commend my hon. Friend, because he is one of the few Members of this House who has been prepared to campaign for changes in acute services in his own constituency, which might not necessarily be what his constituents would want? He has shown considerable bravery on this issue. I will mention his idea of a national plan for acute and emergency services to Sir Bruce Keogh, who is carrying out the review of emergency services as part of the vulnerable older people plan. We definitely need to have a different national approach to service reconfigurations.
John Healey (Wentworth and Dearne) (Lab):
What a waste of everybody’s time. Why should anyone believe that the new review process will be better than the last one or that the Secretary of State will make decisions at
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the end of it? Will he apologise now to the parents, the families and the staff for allowing this flawed and failing process to go on for so long and for the anguish that they have suffered during it?
Mr Hunt: I think we have been having a constructive discussion about an extremely difficult issue, in which I hope I have spoken for the whole House in saying that there are things that we need to learn on all sides, as the earliest signs went back as far as 1984 and still, in 2013, we have not been able to make the progress we should. It is important that we maintain that bipartisan approach, because at the end of this process there will be difficult decisions to make and we need to maintain public confidence that we are thinking about this in a non-party-political way.
Stuart Andrew (Pudsey) (Con): I think I can hear the cheers in Leeds as I speak. May I put on the record my thanks to the IRP and to my right hon. Friend the Secretary of State for listening to our concerns in a very difficult situation? These findings clearly vindicate what we have been saying all along, but as we move forward will he agree to meet me and clinicians to maximise confidence in the future review? Will he assure us that co-location of services, accessibility and patient experience are paramount and that all units will have the same scrutiny as the one in Leeds has undergone? May I invite him to visit the unit in Leeds, so that he can meet the patients, families and staff with whom it has been my privilege to work?
Mr Hunt: I congratulate my hon. Friend on campaigning for children’s heart surgery in Leeds in an exemplary way, and he deserves huge credit for the responsible approach he has taken throughout. I would be delighted to meet him and clinicians from Leeds. Many things need to be learned, but his points about the importance of the patient experience, of clinical outcomes and of an impartial process in site selection, which is at the heart of the concerns people had about this process, are ones we need to reflect on very hard indeed.
Mr Kevin Barron (Rother Valley) (Lab): I welcome the statement that the right hon. Gentleman has made today. Notwithstanding the fact that we would all want the best possible outcomes from this surgery, wherever it takes place, site selection or geography is a concern for us, for the health service and for patients and their families, so can we make sure it is taken into account? If skills are seen to be weak in certain geographical areas of the UK, we should improve those skills, not think about moving people elsewhere.
Mr Hunt: The right hon. Gentleman makes an important point. Site selection needs to be done by people who are completely independent of any local interest in where the surgery should happen. That is the crucial point we need to learn, but the point about skills is also important.
Andrew Bridgen (North West Leicestershire) (Con):
May I praise my right hon. Friend for his brave and eminently sensible statement today on this most emotive of topics? However, will he assure the House that any future plans to remove children’s cardiac services from the Glenfield hospital in Leicester will take full account of the world-leading extra corporeal membrane oxygenation
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services which will also have to be moved? The Secretary of State is completely right on this issue and many others: we do not need a quick solution; we need the right solution.
Mr Hunt: I agree with my hon. Friend, but I would actually like a solution that happens as quickly as possible, provided the process is done properly. He will be pleased to know that the IRP report does say that the impact of suspending the review and thinking again should be borne in mind in respect of decisions that have already been made as to the siting of ECMO services, and I know that NHS England will be reflecting on that.
Dr Alan Whitehead (Southampton, Test) (Lab): Does the Secretary of State appreciate the sheer difficulty in respect of recruitment, retention, planning and maintenance of an excellent service that has been incurred by the units affected, particularly the one in Southampton? Is he prepared to look at the possibility of providing additional resources to those trusts affected to enable them to maintain those excellent services during a continued period of uncertainty? Not only is it a continued period of uncertainty, but there has been continued oscillation between near certainty, uncertainty, no certain and possible certainty as a result of this interminable review and the way it has been conducted.
Mr Hunt: I actually agree with the hon. Gentleman: one of the biggest casualties of the length of time it is taking to resolve this very difficult issue is morale at the excellent children’s heart units that we have across this country, and recruitment is one of the biggest concerns in that regard. Resources are now allocated independently by NHS England, but I know that its priority is to ensure the safety of services.
Steve Brine (Winchester) (Con): May I thank the Secretary of State for his statement? Once he received the IRP report, he had little choice but to make this decision. I feel sure that it will be met with a deep sigh in Southampton, just because of the lack of certainty that it now extends for the trust there. To what extent will the Safe and Sustainable process now be rolled back? How far will it be rolled back? Is the number of centres now back in the “not sure” box? As he has said, we still face an incredibly difficult decision and there is still a reduction in the number of centres—or is there?
Mr Hunt: There will be a reduction in the number of centres at the end of this process, as is clear from what the IRP report says. It thinks we would have better outcomes for children if we concentrated surgery in fewer places, with more comprehensive facilities offered in all those places. However, we need to get the process right in order to get there.
Mr George Mudie (Leeds East) (Lab): I thank the Secretary of State for, and congratulate him on, his decision. However, as an outsider I watched this process descending into almost a medical beauty contest, with comparing and deciding. Surely if we are rationalising the centres, the key starting point should be their placement for the maximum benefit of the populations, the patients and the parents, not this business of who has the lowest mortality rate. Doctors can move, but populations cannot.
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Mr Hunt: The answer is this needs to be a mix of both; this needs to be about clinical excellence and issues such as accessibility and travel. A wide range of factors are involved. I accept, and this is widely accepted, that it is particularly difficult with specialist services to interpret mortality rates in a meaningful way, but that does not mean we should not look at them and seek to learn what we can.
David Tredinnick (Bosworth) (Con): My right hon. Friend’s statement will have given great hope to all those in and around Leicestershire who campaigned to keep Glenfield hospital, and we welcome the acceptance that the original site selection was flawed and the implicit acceptance of bias against the east midlands and against the east of the country in general. On a positive note, if we are going to have the clinical case for change accepted and consolidation in the future, what is his understanding of the number of lives that would be saved if we have to go through this painful process?
Mr Hunt: I do not want to pluck a number out of the air; I want to listen to the clinical evidence on that. However, it is important to say that as a result of the excess mortality identified at Bristol the Kennedy report said that up to 170 lives could have been saved over a 10-year period in just one location. That is why it is so important that we get this decision right.
Nic Dakin (Scunthorpe) (Lab): The Secretary of State is right to say that, sadly, the process did not have the confidence of the public. I very much welcome his statement. In moving forward, will he ensure that any data used are independent, transparent and credible, and that patient experience and access are given the right priority in the decision making?
Mr Hunt: Those are all things that the IRP talked about in its review, and I very much accept its recommendations in those areas.
Mr Philip Hollobone (Kettering) (Con): I congratulate the Secretary of State on calling in the Independent Reconfiguration Panel, which has successfully exposed this shambles. I imagine that my constituents strongly suspect that the thick end of the £6 million cost of the exercise has gone on fat fees for management consultants. Given that the IRP concludes that there was flawed analysis and too many questions left unanswered, surely those management consultants should be banned from taking part in any further NHS reviews?
Mr Hunt: If there are management consultants responsible for what went wrong, I am sure that the NHS will draw the appropriate conclusions.
Diana Johnson (Kingston upon Hull North) (Lab): I am pleased to hear that care pathways as a whole will be looked at and given consideration. Will the Secretary of State confirm, as he made clear in response to a number of questions, that the genuine concerns of constituents, including mine in Hull, will be listened to? Transport and access are very important to my constituents because of the city’s geographical location. Whoever makes these decisions should fully understand the geography of the country and be able to make a proper decision.
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Mr Hunt: I completely accept what the hon. Lady says, and obviously transport and access do matter; that comes out in the IRP report. However, we have to be honest about the fact that if we are conducting surgery at fewer sites, the end result is that some people in the country will have to travel further than they currently do. That is why this is such a difficult decision. She will understand that a choice has to be made in that respect.
Bob Stewart (Beckenham) (Con): Last Saturday I attended the funeral of a girl, with my wife and my daughter Delphine. The girl was a 16-year-old in my daughter’s class. A month ago, she suddenly dropped dead. She had not been aware of any problem. Arabella Campbell was a beautiful, highly intelligent, vivacious girl who had everything to live for, and nothing was known about her problem. Can Arabella’s death, and the death of hundreds of other children and young adults, be used as a spur to reinvigorate the NHS campaign to identify young people who may suffer a heart attack as a result of a problem that has not been detected before, difficult as that may be?
Mr Hunt: I know that the whole House will want to send its condolences to Arabella Campbell’s family, and the way that my hon. Friend has brought the issue to the attention of the House shows the seriousness of the issues that we are considering. Part of what the IRP talks about is a proper review of the screening process for people who have congenital heart failure. Yesterday I met a group of campaigners on sudden adult death syndrome who had an equally tragic story, and I am waiting for advice from the national immunisation and screening committee on the right way forward in this respect. I thank my hon. Friend for his comments.
Jonathan Ashworth (Leicester South) (Lab): Clinicians at Glenfield hospital, and people across Leicester and the wider east midlands, will welcome what the Secretary of State said today on the suspension of Safe and Sustainable, but I want to ask him a further question on the point that the hon. Member for North West Leicestershire (Andrew Bridgen) made about the future of the extra corporeal membrane oxygenation centre. The decision to move ECMO from Leicester to Birmingham was a direct consequence of Safe and Sustainable. That decision is now suspended—I hope that is what the Secretary of State is saying. Will he reconfirm that the future of ECMO provision will be fully taken into account by NHS England?
Mr Hunt: I can confirm that. One of the recommendations of the review was that the ECMO decision be linked to what is decided under Safe and Sustainable, and I know that NHS England will want to consider that carefully. I hope to be able to come back to the House to report what it decides as soon as possible.
Martin Vickers (Cleethorpes) (Con): My Cleethorpes constituency is on the very edge of the area served by the Leeds unit, and I particularly welcome the acknowledgement that future investigations will consider geography, but as well as feeling isolated geographically, many of my constituents felt somewhat isolated from the whole process. We do not want to prolong the process unnecessarily, but will the Secretary of State assure me that there will be some mechanism allowing input from individual constituents?
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Mr Hunt: I can absolutely give that assurance. The fact that the engagement with the public in this process was not as genuine as it should have been is one of the biggest lessons for the NHS to learn.
Catherine McKinnell (Newcastle upon Tyne North) (Lab): Two years ago, almost to the day, we debated the issue in the House. I said at the time, and reiterate today, that the issue must be resolved as quickly as possible to end the damaging delay and uncertainty, and to secure the safety of children and the best clinical care for them. The Secretary of State has given a variety of reassurances, but I would like to hear a cast-iron reassurance, for my constituents, that in any future decision, clinical expertise and care will be paramount, and that this will be resolved as quickly as possible.
Mr Hunt: I am very happy firmly to give both those assurances.
Julian Smith (Skipton and Ripon) (Con):
The Health Secretary is absolutely right to push ahead with specialisation in cardiology services. I represent one of the most rural constituencies in England, and I thank
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him for taking on board the need for more focus on access. In the future, I recommend that more money and time be spent working with members of review panels, because about a year and a half ago, when MPs met them, it was clear that some of them were out of their depth. It would do everybody a lot of good if we spent more money and time helping them.
Mr Hunt: I thank my hon. Friend, and I am sure that that lesson will be learned.
Julian Sturdy (York Outer) (Con): I very much welcome the Secretary of State’s statement, as will concerned families across my constituency of York Outer, and across the county of Yorkshire. Will he ensure that the new review recognises that units where paediatric and maternity services are located on a single site offer the optimal patient experience?
Mr Hunt: I think we need to be guided by the clinical evidence in that respect, but I urge my hon. Friend and his constituents, if they have a strong representation to make in that respect, to make it to the review when it re-proceeds.
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Point of Order
1.27 pm
Pete Wishart (Perth and North Perthshire) (SNP): On a point of order, Mr Speaker. Apologies for my over-eagerness just after Prime Minister’s questions. Last night, the Labour party did not submit the motion for today’s debate until about 7 o’clock in the evening. Do you not think that is a gross discourtesy to the House? It does not allow Members time to prepare and reorganise their schedules. What can you do, through your office, to encourage the Labour party to get its act together and get its motions in on time?
Mr Speaker: I am grateful to the hon. Gentleman for his point of order. To be fair, I think that the motion was in on time, to use his words. However, I note what he says, and I think others will have noted it. Obviously, it is helpful to the House to have maximum notice of these things, so that people who wish to table amendments have the opportunity to do so. I emphasise that nothing disorderly has occurred, but the hon. Gentleman has drawn attention to his concern in his characteristically rumbustious fashion.
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Opposition Day
[2nd Allotted Day]
Protecting Children Online
1.28 pm
Helen Goodman (Bishop Auckland) (Lab): I beg to move,
That this House deplores the growth in child abuse images online; deeply regrets that up to one and a half million people have seen such images; notes with alarm the lack of resources available to the police to tackle this problem; further notes the correlation between viewing such images and further child abuse; notes with concern the Government’s failure to implement the recommendations of the Bailey Review and the Independent Parliamentary Inquiry into Online Child Protection on ensuring children’s safe access to the internet; and calls on the Government to set a timetable for the introduction of safe search as a default, effective age verification and splash page warnings and to bring forward legislative proposals to ensure these changes are speedily implemented.
The motion is in the name of my right hon. Friend the Member for Doncaster North (Edward Miliband).
The whole country was shocked and revolted by the trials of Mark Bridger and Stuart Hazell, the two men who brutally murdered April Jones and Tia Sharp. They sent a shiver of horror down the spine of every parent in the land. In both cases, they were found to have huge libraries of child abuse images on their computers. In both cases, this was the first known offence against children. Surely it is now beyond doubt that what a person sees influences how they behave.
Let us be clear: there is no such thing as child pornography. There is child abuse online. Any image depicting a sexual act with or on a child under 18 is illegal. Child abuse images are illegal under international law and in every country on the globe. The Internet Watch Foundation is the UK hotline for reporting child abuse. It has pioneered this work since 1996. It can disrupt and delete content on the web within an hour and it protects child victims by working in co-operation with the police at the Child Exploitation and Online Protection Centre. It also aims to prevent people from stumbling across such images. We all owe an immense debt of gratitude to the IWF.
However, the surge in the scale of the problems threatens to overwhelm both the IWF and the police. The IWF’s independent survey by ComRes found that up to 1.5 million people have stumbled on child abuse images, yet last year the IWF received only 40,000 notifications and some 13,000 web pages were taken down as a result. Its latest figures show a 40% rise on last year.
Dr Julian Huppert (Cambridge) (LD): I support the hon. Lady’s opening words. I declare an interest as an IWF champion; the IWF does great work. Does she accept that her figure of 1.5 million people having seen child pornography is based on a sample of 2,000 people, of whom about 50 said that they seen such images? We do not know how much people have seen, or if they have seen anything. To extrapolate that far may be misleading.
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Helen Goodman: Yes; I discussed the numbers with the IWF, of course. It says that the survey on which it based that estimate was typical of surveys it has been doing over several years, so I think the problem is widespread and that we should not argue too much. It is clear that the numbers are far, far too big.
Up to 88% of the child victims appear to be 10 years old or under, and 61% of the images depicted sexual activity between adults and children, including rape and sexual torture.
Ann Coffey (Stockport) (Lab): Google is one of the biggest hosts of child sexual abuse images, albeit inadvertently, and it should therefore accept the major responsibility for proactively monitoring and removing those images. Does my hon. Friend agree that if Google spent as much money on monitoring and removing illegal child sexual abuse images as it does on paying accountants to avoid tax in the UK, it might go some way towards living up to its motto, “Don’t be evil”?
Helen Goodman: My hon. Friend makes a good point. By a happy co-incidence I received an e-mail at 12.35 pm announcing that Google is increasing its contribution to the IWF to £1 million.
Mrs Madeleine Moon (Bridgend) (Lab): My hon. Friend spoke about the number of reported cases. As an Internet Watch Foundation champion, I went into every one of my primary schools, spoke to the 10 and 11-year-olds at every one of those schools, and asked those children how many of them had seen indecent images online. Every child in every class had been exposed to such material. Is that not a national disgrace?
Helen Goodman: My hon. Friend is obviously doing great work in her constituency and what she says is truly shocking. It is confirmed by the statistics which the NSPCC has been collecting.
Alun Cairns (Vale of Glamorgan) (Con): Reference has been made to Google. I do not defend that or any other search engine other than to say that this debate is highly technical and we need to be accurate. Google does not host anything; nor does any other search engine. Google merely provides the means of finding a site, and the hosting, which is an international problem, needs to be addressed appropriately.
Helen Goodman: This is not an occasion for nit-picking—[Interruption.] It is important to take an international approach and I am disappointed in the Government for, among other things, not taking any international initiatives.
The police say their resources are inadequate to the task. Peter Davies, the head of CEOP, said that the police are aware of 60,000 people swapping or downloading images over peer-to-peer networks but they lack the resources to arrest them all. In any case, the IWF currently deals only with images on the web, not peer-to-peer images.
In answer to my parliamentary question last week, the Minister of State, Home Department, the hon. Member for Taunton Deane (Mr Browne) revealed that in 2012, despite the fact that the police are aware of those 60,000 people, only 1,570 were convicted of such
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offences. What do Ministers intend to do about the problem? I hope that in his winding-up remarks the Home Office Minister will tell us. There is no point huffing and puffing about the problem if Ministers do not take the necessary action. It is obvious to the whole country that the current situation is totally unacceptable. It is obvious that Ministers have not got a grip. It is obvious that we need a change.
That is why our motion proposes a complete shift in approach from a reactive stance to a proactive strategy. We are calling for three things—first, safe search as the default option. The industry has already made the filters that are needed to screen out not just child abuse but pornography and adult content generally. We are saying that the filters should be the default, either on all computers and devices connected to the internet or by requiring internet service providers to install them by default. Then we can institute the second part of an effective system: robust age verification. A person seeking to cross the filter would be asked to confirm their name, age and address, all of which can be independently checked. Again, we know that this works. It is what Labour did for gambling sites in 2005. It is what mobile phone companies do when someone opens an account and gets a SIM card. It is what people do when they get a driving licence.
Dr Huppert: Does the hon. Lady accept that if we had safe search and such controls, young people would not be able either to access information about homophobic bullying, about how to deal with child abuse and about a range of other subjects? Indeed, such things are already filtered out by mobile phone providers, to the great detriment of many children.
Helen Goodman: No, I do not accept that. I shall go on to explain why that is a misconception on the part of the hon. Gentleman.
The approach that we are suggesting would cut demand for sites as well as reducing the supply of them. It would tackle child abuse online and the other major issue addressed by the Bailey review and the independent parliamentary inquiry—children accessing unsuitable material online. In recent days I have had the benefit of energetic lobbying from Google in particular, pressing its view that except for child abuse images, which are illegal, all other images should be available unfiltered on the internet. I have heard its views and come to my own conclusion.
I hope the Government’s vacillation on this point is not because they cannot put children before powerful vested interests. I say safe search filters are not a free speech issue. This is not censorship. This is about child protection and reproducing online the conditions established over a long period in the real world.
Geraint Davies (Swansea West) (Lab/Co-op): Is my hon. Friend aware of the Council of Europe One in Five campaign, which is built on the fact that one in five children across Europe is likely to be a victim of sexual violence? Does she agree that the magnitude of sexual violence is enormously inflamed by the open gateway of internet child abuse?
Helen Goodman: My hon. Friend makes a powerful point. Once again, he emphasises the importance of the international dimension.
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What we are proposing is aimed at reproducing the conditions that we have already established in the real world. The distinction between legal and illegal content is far too simplistic. For cinemas we have the highly respected independent British Board of Film Classification. It produces age ratings—12, 15 or 18. Any cinema found to be regularly flouting the age restrictions would lose its local authority licence. Furthermore, material classified as R18 can be seen only in certain cinemas, and some material deemed obscene is cut entirely. Yet on the internet it is all freely accessible to every 12-year-old. Indeed—this relates to what my hon. Friend the Member for Bridgend (Mrs Moon) said a moment ago—the NSPCC believes that one quarter of nine to 16-year olds have seen sexual images online. We are not talking about young women baring their breasts—that is like something from Enid Blyton compared with the Frankenstein images now available.
The dangers are clear. On average, 29% of nine to 16-year-olds have contact online with someone they have never met face to face. Of course there is a real difference between child abuse online and extreme pornography, but unfortunately in the real world people who become addicted to pornography look for more and more extreme images, and that sometimes tips into child abuse images. Addiction is the issue. Users are found to have literally millions of images on their computer, and child abuse sites are signposted on pornography sites. Both are shared peer to peer.
Therefore, an effective age verification system would mean that paedophiles would lose the anonymity behind which they currently hide, and the denial of what they are really doing would be addressed by the third proposal in the motion, which is to have splash warnings before entering filtered sites. Work by Professor Richard Wortley at University College London suggests that that might halve the numbers viewing child abuse online.
Of course, those measures would have a cost to industry. TalkTalk, which has led the way in offering filters, has spent over £20 million. Some in the industry tell us that they do not want to lose their competitive edge, and some say that they do not want to act as censors. That is why the Government should act by putting a clear timetable for those reforms into law in order to speed up change, level the playing field and support parents. We know that most parents want to do what is right by their children, because 66% of people, and 78% of women, want an automatic block, according to a YouGov poll conducted last year, but the industry is not helping them enough. At the moment, some still require people to download their own filters—a near-impossible task for many of us—some see it as a marketing device, and others want to give the option of filters only to new customers. At the current rate of turnover, it would be 2019 before that approach had any hope of reaching total coverage. It simply is not good enough. [Interruption.] Does the hon. Member for Devizes (Claire Perry) wish to intervene?
Claire Perry (Devizes) (Con) indicated dissent.