The House divided:
Ayes 217, Noes 265.
Division No. 225]
[
8.50 pm
AYES
Abbott, Ms Diane
Abrahams, Debbie
Ainsworth, rh Mr Bob
Alexander, rh Mr Douglas
Alexander, Heidi
Ali, Rushanara
Allen, Mr Graham
Ashworth, Jonathan
Austin, Ian
Balls, rh Ed
Banks, Gordon
Barron, rh Kevin
Beckett, rh Margaret
Begg, Dame Anne
Benn, rh Hilary
Benton, Mr Joe
Berger, Luciana
Betts, Mr Clive
Blears, rh Hazel
Blunkett, rh Mr David
Brennan, Kevin
Brown, Lyn
Brown, rh Mr Nicholas
Brown, Mr Russell
Bryant, Chris
Buck, Ms Karen
Burden, Richard
Burnham, rh Andy
Burstow, rh Paul
Campbell, rh Mr Alan
Campbell, Mr Ronnie
Caton, Martin
Champion, Sarah
Chapman, Jenny
Clark, Katy
Clarke, rh Mr Tom
Clwyd, rh Ann
Cooper, Rosie
Cooper, rh Yvette
Corbyn, Jeremy
Crausby, Mr David
Creasy, Stella
Cruddas, Jon
Cryer, John
Cunningham, Alex
Cunningham, Mr Jim
Cunningham, Sir Tony
Danczuk, Simon
De Piero, Gloria
Denham, rh Mr John
Dobbin, Jim
Dobson, rh Frank
Docherty, Thomas
Donohoe, Mr Brian H.
Doran, Mr Frank
Doughty, Stephen
Dowd, Jim
Doyle, Gemma
Dromey, Jack
Dugher, Michael
Eagle, Maria
Edwards, Jonathan
Efford, Clive
Elliott, Julie
Ellman, Mrs Louise
Engel, Natascha
Esterson, Bill
Evans, Chris
Field, rh Mr Frank
Fitzpatrick, Jim
Flello, Robert
Flint, rh Caroline
Flynn, Paul
Fovargue, Yvonne
Francis, Dr Hywel
Gapes, Mike
Gardiner, Barry
Gilmore, Sheila
Glindon, Mrs Mary
Goodman, Helen
Greatrex, Tom
Green, Kate
Greenwood, Lilian
Griffith, Nia
Gwynne, Andrew
Hain, rh Mr Peter
Hamilton, Mr David
Hamilton, Fabian
Hanson, rh Mr David
Harris, Mr Tom
Havard, Mr Dai
Healey, rh John
Hendrick, Mark
Hepburn, Mr Stephen
Heyes, David
Hillier, Meg
Hilling, Julie
Hodge, rh Margaret
Hood, Mr Jim
Hopkins, Kelvin
Howarth, rh Mr George
Hunt, Tristram
Irranca-Davies, Huw
Jackson, Glenda
James, Mrs Siân C.
Jamieson, Cathy
Jarvis, Dan
Johnson, rh Alan
Johnson, Diana
Jones, Graham
Jones, Helen
Jones, Mr Kevan
Jones, Susan Elan
Kane, Mike
Kaufman, rh Sir Gerald
Keeley, Barbara
Kendall, Liz
Khan, rh Sadiq
Lammy, rh Mr David
Lavery, Ian
Lazarowicz, Mark
Leslie, Charlotte
Leslie, Chris
Lewell-Buck, Mrs Emma
Llwyd, rh Mr Elfyn
Love, Mr Andrew
Lucas, Caroline
Lucas, Ian
Mactaggart, Fiona
Malhotra, Seema
Marsden, Mr Gordon
McCabe, Steve
McCann, Mr Michael
McCarthy, Kerry
McClymont, Gregg
McCrea, Dr William
McDonagh, Siobhain
McDonald, Andy
McDonnell, John
McFadden, rh Mr Pat
McGovern, Alison
McGovern, Jim
McGuire, rh Mrs Anne
McKenzie, Mr Iain
McKinnell, Catherine
Meacher, rh Mr Michael
Meale, Sir Alan
Mearns, Ian
Miller, Andrew
Mitchell, Austin
Moon, Mrs Madeleine
Morrice, Graeme
(Livingston)
Morris, Grahame M.
(Easington)
Mudie, Mr George
Munn, Meg
Murphy, rh Paul
Murray, Ian
Nandy, Lisa
O'Donnell, Fiona
Onwurah, Chi
Osborne, Sandra
Owen, Albert
Pearce, Teresa
Perkins, Toby
Phillipson, Bridget
Pound, Stephen
Powell, Lucy
Qureshi, Yasmin
Raynsford, rh Mr Nick
Reed, Mr Jamie
Reed, Mr Steve
Reeves, Rachel
Reynolds, Emma
Reynolds, Jonathan
Riordan, Mrs Linda
Robertson, John
Robinson, Mr Geoffrey
Roy, Mr Frank
Roy, Lindsay
Ruane, Chris
Ruddock, rh Dame Joan
Sarwar, Anas
Sawford, Andy
Seabeck, Alison
Shannon, Jim
Sharma, Mr Virendra
Shuker, Gavin
Skinner, Mr Dennis
Slaughter, Mr Andy
Smith, Angela
Smith, Nick
Smith, Owen
Spellar, rh Mr John
Stringer, Graham
Stuart, Ms Gisela
Tami, Mark
Thomas, Mr Gareth
Thornberry, Emily
Timms, rh Stephen
Trickett, Jon
Turner, Karl
Twigg, Derek
Twigg, Stephen
Umunna, Mr Chuka
Vaz, Valerie
Watson, Mr Tom
Watts, Mr Dave
Whitehead, Dr Alan
Williamson, Chris
Wilson, Phil
Wilson, Sammy
Winnick, Mr David
Winterton, rh Ms Rosie
Woodcock, John
Woodward, rh Mr Shaun
Wright, David
Wright, Mr Iain
Tellers for the Ayes:
Tom Blenkinsop
and
Nic Dakin
NOES
Adams, Nigel
Afriyie, Adam
Aldous, Peter
Amess, Mr David
Andrew, Stuart
Arbuthnot, rh Mr James
Baker, Norman
Baker, Steve
Baldry, rh Sir Tony
Baldwin, Harriett
Barclay, Stephen
Baron, Mr John
Bebb, Guto
Beith, rh Sir Alan
Bellingham, Mr Henry
Benyon, Richard
Berry, Jake
Bingham, Andrew
Birtwistle, Gordon
Blackwood, Nicola
Blunt, Mr Crispin
Boles, Nick
Bottomley, Sir Peter
Bradley, Karen
Brady, Mr Graham
Brake, rh Tom
Bray, Angie
Brazier, Mr Julian
Brine, Steve
Brokenshire, James
Brooke, Annette
Browne, Mr Jeremy
Bruce, Fiona
Bruce, rh Sir Malcolm
Buckland, Mr Robert
Burns, rh Mr Simon
Burrowes, Mr David
Burt, Lorely
Cable, rh Vince
Campbell, rh Sir Menzies
Carmichael, Neil
Carswell, Mr Douglas
Cash, Mr William
Chishti, Rehman
Clappison, Mr James
Clark, rh Greg
Clarke, rh Mr Kenneth
Clifton-Brown, Geoffrey
Coffey, Dr Thérèse
Colvile, Oliver
Davey, rh Mr Edward
Davies, David T. C.
(Monmouth)
Davies, Glyn
Djanogly, Mr Jonathan
Dorrell, rh Mr Stephen
Dorries, Nadine
Doyle-Price, Jackie
Drax, Richard
Duddridge, James
Duncan Smith, rh Mr Iain
Dunne, Mr Philip
Ellis, Michael
Ellison, Jane
Ellwood, Mr Tobias
Elphicke, Charlie
Evans, Graham
Evans, Jonathan
Evennett, Mr David
Fabricant, Michael
Fallon, rh Michael
Farron, Tim
Foster, rh Mr Don
Freer, Mike
Fullbrook, Lorraine
Fuller, Richard
Garnier, Mark
Gauke, Mr David
George, Andrew
Gibb, Mr Nick
Gilbert, Stephen
Gillan, rh Mrs Cheryl
Glen, John
Graham, Richard
Grant, Mrs Helen
Gray, Mr James
Grayling, rh Chris
Green, rh Damian
Greening, rh Justine
Grieve, rh Mr Dominic
Griffiths, Andrew
Gummer, Ben
Gyimah, Mr Sam
Halfon, Robert
Hames, Duncan
Hammond, rh Mr Philip
Hammond, Stephen
Hancock, Matthew
Hands, rh Greg
Harper, Mr Mark
Harrington, Richard
Hart, Simon
Harvey, Sir Nick
Haselhurst, rh Sir Alan
Hayes, rh Mr John
Heald, Oliver
Heath, Mr David
Heaton-Harris, Chris
Hemming, John
Henderson, Gordon
Hendry, Charles
Herbert, rh Nick
Hoban, Mr Mark
Hollingbery, George
Hollobone, Mr Philip
Holloway, Mr Adam
Horwood, Martin
Howarth, Sir Gerald
Howell, John
Hughes, rh Simon
Hunt, rh Mr Jeremy
Huppert, Dr Julian
Hurd, Mr Nick
James, Margot
Jenkin, Mr Bernard
Johnson, Gareth
Johnson, Joseph
Jones, Andrew
Jones, rh Mr David
Jones, Mr Marcus
Kawczynski, Daniel
Kelly, Chris
Kirby, Simon
Kwarteng, Kwasi
Lamb, Norman
Lancaster, Mark
Lansley, rh Mr Andrew
Latham, Pauline
Laws, rh Mr David
Leadsom, Andrea
Lee, Jessica
Lee, Dr Phillip
Lefroy, Jeremy
Letwin, rh Mr Oliver
Lewis, Brandon
Lewis, Dr Julian
Liddell-Grainger, Mr Ian
Lidington, rh Mr David
Lilley, rh Mr Peter
Lopresti, Jack
Loughton, Tim
Luff, Sir Peter
Lumley, Karen
Maude, rh Mr Francis
Maynard, Paul
McCartney, Jason
McIntosh, Miss Anne
McPartland, Stephen
McVey, rh Esther
Menzies, Mark
Mercer, Patrick
Miller, rh Maria
Mills, Nigel
Milton, Anne
Mitchell, rh Mr Andrew
Moore, rh Michael
Mordaunt, Penny
Morgan, Nicky
Morris, Anne Marie
Morris, David
Morris, James
Mosley, Stephen
Mowat, David
Mulholland, Greg
Munt, Tessa
Murray, Sheryll
Murrison, Dr Andrew
Neill, Robert
Newmark, Mr Brooks
Newton, Sarah
Nokes, Caroline
Norman, Jesse
O'Brien, rh Mr Stephen
Ollerenshaw, Eric
Opperman, Guy
Ottaway, rh Sir Richard
Paice, rh Sir James
Parish, Neil
Paterson, rh Mr Owen
Penning, rh Mike
Penrose, John
Percy, Andrew
Perry, Claire
Phillips, Stephen
Pickles, rh Mr Eric
Pincher, Christopher
Poulter, Dr Daniel
Pugh, John
Raab, Mr Dominic
Randall, rh Sir John
Reckless, Mark
Redwood, rh Mr John
Rees-Mogg, Jacob
Rifkind, rh Sir Malcolm
Robertson, Mr Laurence
Rogerson, Dan
Rudd, Amber
Rutley, David
Sanders, Mr Adrian
Sandys, Laura
Scott, Mr Lee
Selous, Andrew
Shelbrooke, Alec
Simpson, Mr Keith
Skidmore, Chris
Smith, Chloe
Smith, Henry
Smith, Julian
Smith, Sir Robert
Soames, rh Nicholas
Spelman, rh Mrs Caroline
Spencer, Mr Mark
Stephenson, Andrew
Stewart, Bob
Stewart, Iain
Stewart, Rory
Streeter, Mr Gary
Stride, Mel
Stuart, Mr Graham
Sturdy, Julian
Swales, Ian
Swayne, rh Mr Desmond
Syms, Mr Robert
Teather, Sarah
Thornton, Mike
Thurso, John
Timpson, Mr Edward
Tomlinson, Justin
Truss, Elizabeth
Turner, Mr Andrew
Tyrie, Mr Andrew
Uppal, Paul
Vaizey, Mr Edward
Vara, Mr Shailesh
Villiers, rh Mrs Theresa
Walker, Mr Charles
Wallace, Mr Ben
Ward, Mr David
Watkinson, Dame Angela
Weatherley, Mike
Webb, Steve
Wharton, James
Wheeler, Heather
White, Chris
Wiggin, Bill
Williams, Mr Mark
Williams, Roger
Williams, Stephen
Williamson, Gavin
Willott, Jenny
Wilson, Mr Rob
Wollaston, Dr Sarah
Wright, Jeremy
Wright, Simon
Yeo, Mr Tim
Young, rh Sir George
Tellers for the Noes:
Gavin Barwell
and
Mark Hunter
Question accordingly negatived.
10 Mar 2014 : Column 125
10 Mar 2014 : Column 126
10 Mar 2014 : Column 127
9.2 pm
Proceedings interrupted (Programme Order, this day).
The Speaker put forthwith the Question necessary for the disposal of the business to be concluded at that time (Standing Order No. 83E).
10 Mar 2014 : Column 128
Reviews and performance assessments
Amendment proposed: 19, page 81, line 27, at end insert—
‘(2A) The Commission must, in respect of such English local authorities as may be prescribed—
(a) conduct reviews of the provision of such adult social services provided or commissioned by the authorities as may be prescribed;
(b) assess the performance of the authorities following each such review; and
(c) publish a report of its assessment.
(2B) Regulations under subsection (2A) may prescribe—
(a) all adult social services of a particular description; and
(b) all local authorities or particular local authorities.’.—(Mr Jamie Reed.)
Question put, That the amendment be made.
The House divided:
Ayes 220, Noes 282.
Division No. 226]
[
9.2 pm
AYES
Abbott, Ms Diane
Abrahams, Debbie
Ainsworth, rh Mr Bob
Alexander, rh Mr Douglas
Alexander, Heidi
Ali, Rushanara
Allen, Mr Graham
Ashworth, Jonathan
Austin, Ian
Balls, rh Ed
Banks, Gordon
Barron, rh Kevin
Beckett, rh Margaret
Begg, Dame Anne
Benn, rh Hilary
Benton, Mr Joe
Berger, Luciana
Betts, Mr Clive
Blears, rh Hazel
Blunkett, rh Mr David
Brennan, Kevin
Brown, Lyn
Brown, rh Mr Nicholas
Brown, Mr Russell
Bryant, Chris
Buck, Ms Karen
Burden, Richard
Burnham, rh Andy
Campbell, rh Mr Alan
Campbell, Mr Ronnie
Caton, Martin
Champion, Sarah
Chapman, Jenny
Clark, Katy
Clarke, rh Mr Tom
Clwyd, rh Ann
Cooper, Rosie
Cooper, rh Yvette
Corbyn, Jeremy
Crausby, Mr David
Creasy, Stella
Cruddas, Jon
Cryer, John
Cunningham, Alex
Cunningham, Mr Jim
Cunningham, Sir Tony
Danczuk, Simon
Davidson, Mr Ian
De Piero, Gloria
Denham, rh Mr John
Dobbin, Jim
Dobson, rh Frank
Docherty, Thomas
Donohoe, Mr Brian H.
Doran, Mr Frank
Doughty, Stephen
Dowd, Jim
Doyle, Gemma
Dromey, Jack
Dugher, Michael
Eagle, Maria
Edwards, Jonathan
Efford, Clive
Elliott, Julie
Ellman, Mrs Louise
Engel, Natascha
Esterson, Bill
Evans, Chris
Field, rh Mr Frank
Fitzpatrick, Jim
Flello, Robert
Flint, rh Caroline
Flynn, Paul
Fovargue, Yvonne
Francis, Dr Hywel
Gapes, Mike
Gardiner, Barry
Gilmore, Sheila
Glindon, Mrs Mary
Goodman, Helen
Greatrex, Tom
Green, Kate
Greenwood, Lilian
Griffith, Nia
Gwynne, Andrew
Hain, rh Mr Peter
Hamilton, Mr David
Hamilton, Fabian
Hanson, rh Mr David
Harris, Mr Tom
Havard, Mr Dai
Healey, rh John
Hendrick, Mark
Hepburn, Mr Stephen
Heyes, David
Hillier, Meg
Hilling, Julie
Hodge, rh Margaret
Hoey, Kate
Hood, Mr Jim
Hopkins, Kelvin
Howarth, rh Mr George
Hunt, Tristram
Irranca-Davies, Huw
Jackson, Glenda
James, Mrs Siân C.
Jamieson, Cathy
Jarvis, Dan
Johnson, rh Alan
Johnson, Diana
Jones, Graham
Jones, Helen
Jones, Mr Kevan
Jones, Susan Elan
Kane, Mike
Kaufman, rh Sir Gerald
Keeley, Barbara
Kendall, Liz
Khan, rh Sadiq
Lammy, rh Mr David
Lavery, Ian
Lazarowicz, Mark
Leslie, Chris
Lewell-Buck, Mrs Emma
Llwyd, rh Mr Elfyn
Long, Naomi
Love, Mr Andrew
Lucas, Caroline
Lucas, Ian
Mactaggart, Fiona
Malhotra, Seema
Marsden, Mr Gordon
McCabe, Steve
McCann, Mr Michael
McCarthy, Kerry
McClymont, Gregg
McCrea, Dr William
McDonagh, Siobhain
McDonald, Andy
McDonnell, John
McFadden, rh Mr Pat
McGovern, Alison
McGovern, Jim
McGuire, rh Mrs Anne
McKenzie, Mr Iain
McKinnell, Catherine
Meacher, rh Mr Michael
Meale, Sir Alan
Mearns, Ian
Miller, Andrew
Mitchell, Austin
Moon, Mrs Madeleine
Morrice, Graeme
(Livingston)
Morris, Grahame M.
(Easington)
Mudie, Mr George
Munn, Meg
Murphy, rh Paul
Murray, Ian
Nandy, Lisa
Nash, Pamela
O'Donnell, Fiona
Onwurah, Chi
Osborne, Sandra
Owen, Albert
Pearce, Teresa
Perkins, Toby
Phillipson, Bridget
Pound, Stephen
Powell, Lucy
Qureshi, Yasmin
Raynsford, rh Mr Nick
Reed, Mr Jamie
Reed, Mr Steve
Reeves, Rachel
Reynolds, Emma
Reynolds, Jonathan
Riordan, Mrs Linda
Robertson, John
Robinson, Mr Geoffrey
Roy, Mr Frank
Roy, Lindsay
Ruane, Chris
Ruddock, rh Dame Joan
Sarwar, Anas
Sawford, Andy
Seabeck, Alison
Shannon, Jim
Sharma, Mr Virendra
Shuker, Gavin
Skinner, Mr Dennis
Slaughter, Mr Andy
Smith, Angela
Smith, Nick
Smith, Owen
Spellar, rh Mr John
Stringer, Graham
Stuart, Ms Gisela
Tami, Mark
Thomas, Mr Gareth
Thornberry, Emily
Timms, rh Stephen
Trickett, Jon
Turner, Karl
Twigg, Derek
Twigg, Stephen
Umunna, Mr Chuka
Vaz, rh Keith
Vaz, Valerie
Watson, Mr Tom
Watts, Mr Dave
Whitehead, Dr Alan
Williamson, Chris
Wilson, Phil
Wilson, Sammy
Winnick, Mr David
Winterton, rh Ms Rosie
Woodcock, John
Woodward, rh Mr Shaun
Wright, David
Wright, Mr Iain
Tellers for the Ayes:
Nic Dakin
and
Tom Blenkinsop
NOES
Adams, Nigel
Afriyie, Adam
Aldous, Peter
Amess, Mr David
Andrew, Stuart
Arbuthnot, rh Mr James
Bacon, Mr Richard
Baker, Norman
Baker, Steve
Baldry, rh Sir Tony
Baldwin, Harriett
Barclay, Stephen
Baron, Mr John
Barwell, Gavin
Bebb, Guto
Beith, rh Sir Alan
Bellingham, Mr Henry
Benyon, Richard
Berry, Jake
Bingham, Andrew
Birtwistle, Gordon
Blackman, Bob
Blackwood, Nicola
Blunt, Mr Crispin
Boles, Nick
Bottomley, Sir Peter
Bradley, Karen
Brady, Mr Graham
Brake, rh Tom
Bray, Angie
Brazier, Mr Julian
Bridgen, Andrew
Brine, Steve
Brokenshire, James
Brooke, Annette
Browne, Mr Jeremy
Bruce, Fiona
Bruce, rh Sir Malcolm
Buckland, Mr Robert
Burley, Mr Aidan
Burns, rh Mr Simon
Burrowes, Mr David
Burstow, rh Paul
Burt, Lorely
Cable, rh Vince
Campbell, rh Sir Menzies
Carmichael, Neil
Carswell, Mr Douglas
Cash, Mr William
Chishti, Rehman
Chope, Mr Christopher
Clappison, Mr James
Clark, rh Greg
Clarke, rh Mr Kenneth
Clifton-Brown, Geoffrey
Coffey, Dr Thérèse
Colvile, Oliver
Cox, Mr Geoffrey
Davey, rh Mr Edward
Davies, David T. C.
(Monmouth)
Davies, Glyn
Djanogly, Mr Jonathan
Dorrell, rh Mr Stephen
Dorries, Nadine
Doyle-Price, Jackie
Drax, Richard
Duddridge, James
Duncan Smith, rh Mr Iain
Dunne, Mr Philip
Ellis, Michael
Ellison, Jane
Ellwood, Mr Tobias
Elphicke, Charlie
Evans, Graham
Evans, Jonathan
Evennett, Mr David
Fabricant, Michael
Fallon, rh Michael
Farron, Tim
Foster, rh Mr Don
Francois, rh Mr Mark
Freeman, George
Freer, Mike
Fullbrook, Lorraine
Fuller, Richard
Garnier, Mark
Gauke, Mr David
George, Andrew
Gibb, Mr Nick
Gillan, rh Mrs Cheryl
Glen, John
Goldsmith, Zac
Graham, Richard
Grant, Mrs Helen
Gray, Mr James
Grayling, rh Chris
Green, rh Damian
Greening, rh Justine
Grieve, rh Mr Dominic
Griffiths, Andrew
Gummer, Ben
Gyimah, Mr Sam
Halfon, Robert
Hames, Duncan
Hammond, rh Mr Philip
Hammond, Stephen
Hancock, Matthew
Hands, rh Greg
Harper, Mr Mark
Harrington, Richard
Harris, Rebecca
Hart, Simon
Harvey, Sir Nick
Haselhurst, rh Sir Alan
Hayes, rh Mr John
Heald, Oliver
Heath, Mr David
Heaton-Harris, Chris
Hemming, John
Henderson, Gordon
Hendry, Charles
Herbert, rh Nick
Hoban, Mr Mark
Hollingbery, George
Hollobone, Mr Philip
Holloway, Mr Adam
Horwood, Martin
Howarth, Sir Gerald
Howell, John
Hughes, rh Simon
Hunt, rh Mr Jeremy
Hunter, Mark
Huppert, Dr Julian
Hurd, Mr Nick
James, Margot
Jenkin, Mr Bernard
Johnson, Gareth
Johnson, Joseph
Jones, Andrew
Jones, rh Mr David
Jones, Mr Marcus
Kawczynski, Daniel
Kelly, Chris
Kirby, Simon
Knight, rh Sir Greg
Kwarteng, Kwasi
Lamb, Norman
Lancaster, Mark
Lansley, rh Mr Andrew
Latham, Pauline
Laws, rh Mr David
Leadsom, Andrea
Lee, Jessica
Lee, Dr Phillip
Lefroy, Jeremy
Leslie, Charlotte
Letwin, rh Mr Oliver
Lewis, Brandon
Lewis, Dr Julian
Liddell-Grainger, Mr Ian
Lidington, rh Mr David
Lilley, rh Mr Peter
Lopresti, Jack
Loughton, Tim
Luff, Sir Peter
Lumley, Karen
Maude, rh Mr Francis
Maynard, Paul
McCartney, Jason
McIntosh, Miss Anne
McPartland, Stephen
McVey, rh Esther
Menzies, Mark
Mercer, Patrick
Miller, rh Maria
Mills, Nigel
Mitchell, rh Mr Andrew
Moore, rh Michael
Mordaunt, Penny
Morgan, Nicky
Morris, Anne Marie
Morris, David
Morris, James
Mosley, Stephen
Mowat, David
Mulholland, Greg
Munt, Tessa
Murray, Sheryll
Murrison, Dr Andrew
Neill, Robert
Newmark, Mr Brooks
Newton, Sarah
Nokes, Caroline
Norman, Jesse
O'Brien, rh Mr Stephen
Offord, Dr Matthew
Ollerenshaw, Eric
Opperman, Guy
Ottaway, rh Sir Richard
Paice, rh Sir James
Parish, Neil
Paterson, rh Mr Owen
Pawsey, Mark
Penning, rh Mike
Penrose, John
Percy, Andrew
Perry, Claire
Phillips, Stephen
Pickles, rh Mr Eric
Pincher, Christopher
Poulter, Dr Daniel
Pugh, John
Raab, Mr Dominic
Randall, rh Sir John
Reckless, Mark
Redwood, rh Mr John
Rees-Mogg, Jacob
Reid, Mr Alan
Rifkind, rh Sir Malcolm
Robertson, Mr Laurence
Rogerson, Dan
Rutley, David
Sanders, Mr Adrian
Sandys, Laura
Scott, Mr Lee
Selous, Andrew
Shelbrooke, Alec
Simpson, Mr Keith
Skidmore, Chris
Smith, Chloe
Smith, Henry
Smith, Julian
Smith, Sir Robert
Soames, rh Nicholas
Spelman, rh Mrs Caroline
Spencer, Mr Mark
Stephenson, Andrew
Stevenson, John
Stewart, Bob
Stewart, Iain
Stewart, Rory
Streeter, Mr Gary
Stride, Mel
Stuart, Mr Graham
Stunell, rh Sir Andrew
Sturdy, Julian
Swales, Ian
Swayne, rh Mr Desmond
Syms, Mr Robert
Teather, Sarah
Thornton, Mike
Thurso, John
Timpson, Mr Edward
Tomlinson, Justin
Truss, Elizabeth
Turner, Mr Andrew
Tyrie, Mr Andrew
Uppal, Paul
Vaizey, Mr Edward
Vara, Mr Shailesh
Villiers, rh Mrs Theresa
Walker, Mr Charles
Wallace, Mr Ben
Ward, Mr David
Watkinson, Dame Angela
Weatherley, Mike
Webb, Steve
Wharton, James
Wheeler, Heather
White, Chris
Wiggin, Bill
Williams, Mr Mark
Williams, Roger
Williams, Stephen
Williamson, Gavin
Willott, Jenny
Wilson, Mr Rob
Wollaston, Dr Sarah
Wright, Jeremy
Wright, Simon
Yeo, Mr Tim
Young, rh Sir George
Tellers for the Noes:
Anne Milton
and
Amber Rudd
Question accordingly negatived.
10 Mar 2014 : Column 129
10 Mar 2014 : Column 130
10 Mar 2014 : Column 131
10 Mar 2014 : Column 132
The Health and Social Care Information Centre: restrictions on dissemination of information
‘(1) Chapter 2 of Part 9 of the Health and Social Care Act 2012 (the Health and Social Care Information Centre) is amended as follows.
(2) In section 253(1) (general duties), after paragraph (c) (but before the “and” after it) insert—
“(ca) the need to respect and promote the privacy of recipients of health services and of adult social care in England,”.
(3) In section 261 (other dissemination of information), after subsection (1) insert—
“(1A) But the Information Centre may do so only if it considers that disseminating the information would be for the purposes of—
(a) the provision of health care or adult social care;
(b) the promotion of health.”.
“262A Publication and other dissemination: supplementary
In exercising any function under this Act of publishing or otherwise disseminating information, the Information Centre must have regard to any advice given to it by the committee appointed by the Health Research Authority under paragraph 8(1) of Schedule 7 to the Care Act 2014 (committee to advise in connection with information dissemination etc).”’.—(Dr Poulter.)
Brought up, and read the First time.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): I beg to move, That the clause be read a Second time.
Mr Speaker: With this it will be convenient to discuss the following:
Amendment (a) to Government new clause 34, in subsection (3), after ‘of’, insert ‘improving’.
Amendment (b) to Government new clause 34, in subsection (3), after ‘adult social care’, insert
‘; and if it has satisfied itself that the recipient is competent to handle the data in compliance with all statutory duties and to respect and promote the privacy of recipients of health services and adult social care.”.’.
New clause 25—Misuse of data provided by the Health and Social Care Information Centre: offence—
‘(1) A person or entity commits an offence if they misuse, or negligently allow the misuse of information they have requested and received from the Health and Social Care Information Centre.
(a) using information in a way that violates the agreement with the Health and Social Care Information Centre;
(b) using information in a way that does not violate the agreement with the Health and Social Care Information Centre, but that gives rise to use that is outside the agreed limits of use; or
(c) using information supplied by the Health and Social Care Information Centre in such a way as to allow or enable individual patients to be identified by a third party.
(3) A person who is guilty of an offence under subsection (1) is liable—
(a) on summary conviction, to an unlimited fine;
(b) on conviction on indictment, to imprisonment for not more than two years or a fine, or both.
10 Mar 2014 : Column 133
(4) An entity who is guilty of an offence under subsection (1)—
(a) is liable to an unlimited fine; and
(b) must disclose the conviction on all future applications to access data from the Health and Social Care Information Centre.’.
Amendment 29, in clause 116, page 100, line 29, after ‘Authority’, insert
‘and the Secretary of State’.
Government amendments 17, 18, 15 and 16.
Dr Poulter: The Government are fully committed to the care.data programme and to the core principles that underpin its use, which are to present and promote transparency in the quality of health and care services to patients and the public, while protecting their privacy and confidentiality; to promote health and care research to help us to understand how to fight disease, cure illness and improve care; and to better integrate health and care services by using the data and information to understand what good, joined-up and integrated care looks like.
9.15 pm
The data that are collected across the health and care system in England are the envy of the world. The care.data programme, which draws on the new Health and Social Care Information Centre, offers the ability to link existing data securely and safely to produce information that can save lives, quickly find new treatments and cures, and support research to benefit us all.
I want to say at the outset that, in my view, the care.data programme is good news and offers a great deal to help to improve our country’s health and care system in a gradual and progressive way. Care.data is evolution and not something fundamentally new. We started to collect hospital episode statistics for in-patient data in 1989, for out-patient data in 2003 and for accident and emergency data in 2007-08. The aim is to add primary care data to that list in 2014.
Grahame M. Morris: Will the Minister give way?
Dr Poulter: I have not said anything controversial yet, so if the hon. Gentleman will let me make some progress, I will happily give way later.
To realise the huge potential of health care data, patients and professionals must have absolute trust in the way that the data will be protected and used, together with an understanding of why collecting the data on such a scale is important. I absolutely understand that many people have concerns about how the process might work, but I am confident that the Government amendments will bring further reassurance to the House about the care.data programme.
The Government fully support NHS England’s decision to delay the start of the care.data programme so that more work can be done to build understanding and confidence. NHS England will be leading that work. In parallel, having listened to key stakeholders and to discussions in this place, the Government have brought forward a package of measures, including amendments to the Bill, to respond to concerns and to give the public greater clarity and reassurance that their data are safe.
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The Health and Social Care Act 2012, which established the Health and Social Care Information Centre, introduced a raft of safeguards to balance the huge benefits that linking health and care data can bring. That offered people greater protection than was previously available. It is worth highlighting some sections of the 2012 Act as examples of that.
Under section 260, the Health and Social Care Information Centre must not publish the information that it obtains in a form that would enable an individual, other than a provider of care, to be identified. Similarly, under section 261, the HSCIC cannot disseminate share data that could be used to identify an individual, other than a provider of care, except when there is another legal basis for doing so, which could happen in the event of a civil emergency or public health emergency, such as a flu pandemic. Under section 263, the HSCIC must publish a code of practice that makes it clear how it and others should handle confidential data. Under section 264, the HSCIC must be open and transparent about the data it obtains by publishing a register with descriptions of the information. Indeed, the HSCIC is currently working to ensure that it is transparent about all the data it has released to others.
Moreover, the Government have made the commitment that if someone has concerns about data being used in this way, they can ask their general practice to note their objection and opt out of the system. Following that, no identifiable data about them will flow from their GP record to the HSCIC. Directions to the HSCIC under section 254 of the 2012 Act—separate from the amendments that the House is considering—will ensure that that commitment to patients has legal force.
We are going further than that. Having listened to key stakeholders and to discussions in Parliament, we have a further package of measures that, in parallel with NHS England’s further engagement activity, will respond to the concerns that we have heard and give the public additional reassurance that their data are safe. Of course, aggregated and anonymised data, which cannot be used to identify any individual person, should and will be made generally available. Indeed, a great deal of research relies on data of this type, where researchers do not need to see any data at the individual person level. Such aggregated and anonymous data are available now, and were available previously through the predecessor body to the HSCIC.
New clause 34 sets out a number of changes to the 2012 Act which, taken together, clarify when the HSCIC can and cannot release data. The new clause expressly prevents the HSCIC from using its general dissemination power where there is not a clear health care, adult social care or health promotion purpose—for example, for commercial insurance purposes. I am happy to confirm that the new clause enables anonymised information to be disseminated under the HSCIC’s general dissemination power for a wide range of health and care-related purposes, including for commissioning for a wide range of public health purposes and for research relating to health and care services such as the epidemiological research that is needed at the earliest stages of developing new treatments.
Jim Shannon (Strangford) (DUP):
Can the Minister reassure us that there will be no possibility of private companies obtaining the data and using them for
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their own purposes, instead of their being used for their original purposes in accordance with NHS data protection regulations?
Dr Poulter: I hope that I have already given the hon. Gentleman some reassurance that the data will have to be used for the benefit of the health and care service, or for the purposes of public health. They are not to be used for insurance purposes, for example. I will go on to outline some of the safeguards involved.
Barbara Keeley: Would the Minister like to comment on an announcement made at the launch of the MedRed BT health cloud—a cloud data system that is using our hospital episode statistics data—in the United States? At the launch, it was stated:
“People are using foreign data because it’s available. The UK made some gutsy decisions about data liberation. There’s political risk associated and they have a more tolerant climate over there.”
Will the Minister comment on the fact that we apparently have such a tolerant climate that MedRed and BT are now charging for access to our data on that cloud system in the United States?
Dr Poulter: I am not going to be drawn into commenting on an American system. The point is that there are strong safeguards under the 2012 Act to ensure that confidential data can be used only for the benefit of the health and care system. Of course, data that do not identify patients need to be used in a transparent way that can help to drive up care and services.
Dr Poulter: I have been generous in giving way to the hon. Lady; I hope that she will let me address her point. It is important that we have data that are open and transparent and that are used to expose the quality of care that is available from different health care providers. We are one year on from the Francis inquiry, and we need open and transparent data in order to understand and compare the quality of care services in hospitals and in different NHS health and care providers. This is about helping us to recognise what good care looks like, so that we can extend it throughout the system. It is also about exposing the few examples of bad care in an open and transparent way. If we had—
Dr Poulter: I am not going to give way. I am still addressing the hon. Lady’s point, and I am not saying anything controversial. If we had had better, more joined-up data that could have been used in a more transparent way beforehand, we might have been able to head off the events that we saw at Mid Staffs much earlier. This is about protecting patients and the public, and about using population-level data in an open and transparent way. Under the safeguards that we are introducing in the new clause, data will not be used for commercial insurance purposes. Let me give that reassurance.
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Andy Burnham (Leigh) (Lab): Where in the new clause does it say that? Nowhere does it say that the data cannot be passed to private health insurance companies. Proposed new subsection 1A states that such information could be passed on
“for the purposes of…the provision of health care or adult social care”.
This is a very wide provision, and I see no clarity in it that delivers on the commitment that the Minister is giving to the House.
Dr Poulter: Hopefully, if I am allowed to make some progress and address the points that have been raised, I will give further reassurances a little later. It would be useful—[Interruption.] I will answer the question a little later, so there is no point in heckling or being abusive. If the right hon. Gentleman will wait, I will talk him through the Government’s amendments so that he can gain a better understanding —
Grahame M. Morris: Will the Minister give way?
Grahame M. Morris: Are you afraid?
Dr Poulter: No, I am not afraid to give way. The hon. Gentleman should sit down, because he often has quite enough to say, and it is not always a very valuable contribution. In this context, he may do well to listen to some of the purposes of the amendments. As I have already outlined, there are strong safeguards set out in the 2012 Act on how data can be used. Data can be used only for the benefit of the health and care system. In order to reassure the public, we have tabled amendments to clarify further how data may be used.
Speaking to a great many people in recent days, as well as considering amendments tabled by other Members, has prompted the Government to re-table the new clause in order to clarify that these kinds of data may also be disseminated for other wider public health purposes, such as research into environmental factors associated with asthma, or for healthy eating. We have ensured that those other kinds of research can benefit from the data by changing the wording in the new clause to make it clear that information may be disseminated for the purposes of
“the provision of health care or adult social care”
or “the promotion of health”. I am sure that the House will agree that it is essential that that valuable data resource is available to support a broad range of health research.
New clause 34 clarifies that in disseminating information, and indeed in carrying out any of its functions, the Health and Social Care Information Centre must have regard to the need to promote and respect the privacy of those receiving health services and adult social care in England. It also requires the HSCIC to take into account advice from the advisory committee that the Health Research Authority is required to appoint under paragraph 8 of schedule 7 to the Bill. The advice from that committee, known as the confidentiality advisory group, will provide a new level of independent scrutiny of the HSCIC’s decisions to publish or disseminate information.
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Amendment 17 would also enable the confidentiality advisory group to advise the HSCIC on the exercise of functions conferred in regulations under section 251 of the National Health Service Act 2006, or more generally on decisions to disseminate information that could be used to identify individual patients. For example, when new regulations are made under section 251 of the 2006 Act that confer functions on the HSCIC, the confidentiality advisory group could advise the HSCIC on proposals to release data. New clause 34 requires the HSCIC to have regard to that external advice on its exercise of any function under the 2012 Act of publishing or otherwise disseminating information.
Amendment 18 gives the Secretary of State regulation-making powers to set out the specific criteria that the confidentiality advisory group will be required to take into account in giving advice to the Secretary of State, the Health Research Authority or the HSCIC in carrying out their duties. That provision is intended to enable regulations which would require that the confidentiality advisory group considers: that the purpose for which the data will be used should be in the public interest and for the provision of health and care services; that any approved processing must respect and promote the privacy of patients and care service users; that the purpose cannot be achieved using suitably anonymised data, rather than identifiable data; that it is not reasonably possible to gain explicit patient consent to achieve that purpose; and that the applicant requesting the data has not misused those kinds of data in the past.
That last criterion would effectively introduce a new “one strike and you’re out” deterrent. Potentially, for some organisations, the risk of no longer being able to access those kinds of data may prove a more effective sanction than the current maximum monetary penalty of £500,000 that can be imposed under the Data Protection Act 1998. Taken together, those measures provide an additional level of scrutiny and assurance to the processes of the HSCIC in publishing or disseminating information. The Government’s amendments—new clause 34 and amendments 17 and 18—provide robust assurance that those kinds of data cannot be disseminated for purposes such as commercial insurance or for assessing an individual’s mortgage application.
Andy Burnham: Before the Minister sits down, I would be very appreciative if he could direct me to the precise part of new clause 34 that prevents a private health insurance company accessing data.
9.30 pm
Dr Poulter: It is clear that the information can be used only for the benefit of the health and care service or for the purposes of promoting health. It is about benefits to the NHS or to the health and care system. That is also what the 2012 Act identifies regarding provision of data. Let us not forget that we had to put safeguards in place because at no point did the previous Government place any restrictions on the use of data. Under the previous Government’s regulations, before this Government came to power, there was greater potential for abuse of the system. Although I am sure the previous Government would not have intended data to be used by private health care companies for insurance purposes or by others, less rigid safeguards were in place to prevent that from happening.
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This Government, both with the amendments and the 2012 Act, have clearly stipulated that the information can be used only for the benefit of the health and care system or the health service. That is very clear and the previous Government never put such a provision in place. This Government have also given patients an opt-out in the use of data—something the previous Government never properly put in place. We have introduced good provisions about protecting confidentiality and using information in the NHS in a responsible manner. If the previous Government had been concerned about the use of data, they should have put in place more robust safeguards when they were in power, but they did not.
Barbara Keeley: Will the Minister give way?
Dr Poulter: No, the hon. Lady has had many interventions; I have been very generous—[Interruption.] I know she does not like hearing about Labour’s record in government on these issues, but I am afraid she needs to. This Government are putting in place safeguards to protect patient confidentiality. The previous Government failed on that agenda, and I am proud that we are able to table these amendments, which will lead to greater reassurance.
The amendments also help to clarify how data can be disseminated to support research for health and care commissioning, health and public health purposes, medical purposes, or other purposes relating to the provision of health care, adult social care or the promotion of health.
Government amendment 8 relates to the remit of the Health Research Authority. It has always been our intention that the HRA’s functions relate to health research and adult social care research, and the amendment clarifies that remit. It makes explicit that the HRA’s functions do not generally extend to research that relates to children’s social care, if that research is solely for the purposes of children’s social care. We must recognise that research may take place across the boundaries between health or adult social care and children’s social care, and the amendment will not inhibit such research. Although the HRA’s functions will not generally extend to children’s social care, the research ethics committees that the HRA establishes or recognises under clauses 113 and 114 will be able to consider children’s social care research in the round when considering a study that also involves health research or adult social care research.
A lot of research crosses health and social care, and some of it involves children. Where such research includes health elements, it already comes to the HRA special health authority for ethical consideration. Many university ethics committees accept HRA ethics committee approval and do not require separate approval by their own ethics committees. That will continue when the HRA becomes a non-departmental public body.
Paragraph 12(5) of schedule 7 gives the HRA a general power to do anything that appears to be necessary or desirable for the purposes of, or in connection with, the exercise of its functions. That power means that HRA can, if it feels it necessary or desirable, publish guidance that relates to children’s social care research where there is also an adult social care element or a health element that falls within the HRA’s remit.
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Barbara Keeley: On a point of order, Mr Speaker. I understood that this debate was scrutiny of the remaining stages of an important Bill. The Minister seems to be reading his speech into the record, which for me does not stack up as a debate on the remaining stages of a very important Bill, and an aspect of it—care data—that is crucial to every NHS patient in the country.
Mr Speaker: The Minister is certainly in order and there is a continuation of Report stage tomorrow. I am sure he will want to be sensitive to the fact that other Members wish to contribute.
Dr Poulter: Indeed, Mr Speaker, and I hope that other Members will also be sensitive to that. The more interventions I take, the less opportunities there are for Members to speak. I have been very generous. I have taken interventions on a number of occasions from those on the shadow Front Bench, and from the hon. Member for Worsley and Eccles South (Barbara Keeley) and others. I have been generous with my time, but I want to preserve time for other Members to contribute to the debate, as I see you are keen for me to do, Mr Speaker.
Although the HRA amendments are important in ensuring that its remit is clearly and accurately defined, it will be able to work with those with an interest in children’s social care research when research crosses boundaries, to seek consistency in standards and to avoid unnecessary duplication.
Government amendments 15 and 16 are minor and technical. Amendment 15 is consequential to the addition of provisions on the better care fund—part 4—in Committee. It ensures that provisions on commencement cover the better care fund. Amendment 16 removes the privilege amendment inserted in the other place in accordance with the Commons’ sole privilege to deal with monetary matters.
The Government’s proposals ensure that we correct the difficulties we inherited from the previous Government in preserving confidential patient data. They ensure that we have in place a system in which NHS and care data must be used for the benefit of the health and care system and for public health purposes. They put us in a much better place to ensure that we enhance transparency and better use information to benefit patients. They ensure that we have a better basis on which to understand the basis of disease. If in the first place we had had the Health and Social Care Information Centre and the benefits we know will come from care.data, we would have been able to deal with and better combat many diseases while protecting patient confidentiality. We would have understood much more quickly the dangers of thalidomide and other drugs that were harmful to babies in utero. We would have been in a much better place to expose those examples of poor care, such as Mid Staffs; to develop national frameworks for treating diseases such as chronic obstructive pulmonary disease and heart disease; and to understand what good care looks like in the treatment of those conditions by collecting data in a fundamentally better and joined-up way.
The Health and Social Care Information Centre will, for the first time, provide us with a repository for joined-up, integrated data across health and care. Hon. Members often rightly talk of integrated care, and of the benefits of joining up health and care. Unless we
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have the data collected to understand what good integrated care looks like, and unless we understand what measures of integration are right, we will not be able properly to inform the debate on delivering integrated care or break down the silos that have sometimes existed to the detriment of patients across the health and care system. I hope hon. Members on both sides of the House can support that. I hope they decently recognise that this Government have put in place not just a patient opt-out if they do not want their data to be shared, but strong safeguards—much stronger safeguards than the previous Government —to protect patient confidentiality.
Grahame M. Morris: In principle, I support the utilisation of truly anonymised patient data sharing for the purposes of improving public health, but I take issue with a number of the Minister’s points, not least in relation to new clause 25, tabled by my hon. Friend the Member for Copeland (Mr Reed). Accountability is important. If the Minister and the Government are serious about addressing the public’s concern, they would ensure that the Secretary of State and Ministers are responsible rather than an unelected quango. Frankly, the Minister’s assurances at the Dispatch Box this evening, and those given to the Health Committee just a week or two ago, need to be in the Bill, so that there is a level of accountability and some comeback.
When we debated patient data sharing in Committee and, more recently, in Westminster Hall, my impression was that Ministers have tended to conflate legitimate patient privacy concerns, which are shared by hon. Members and members of the public, with the general lack of support for the utilisation of patient data for further research. They are mistaken, because right hon. and hon. Members are more or less unanimous in supporting any move that can lead to better research, improved care and increased safety.
Barbara Keeley: I am grateful to my hon. Friend for giving way, because the Minister was clearly frightened of answering questions from me and from my right hon. Friend the shadow Health Secretary. The Minister refused even to listen to the question, so I shall ask my hon. Friend: does he think that there is scope for confusion because some companies are in the market of insurance products and health and social care? The Minister would not take the question, so we do not have any answers on how a firm such as BUPA, which is already involved in research and already using the data, could be dealt with.
Grahame M. Morris: That is a perfect example and an important question that the Minister and the Government should answer. If we are to ensure that we have public trust in the data and who will use them, such questions must be answered and people be given the opportunity to consider what the Government propose.
It has become clear in recent months that the public lack confidence that the implementation of the care.data scheme as currently proposed would protect the data from inappropriate use, not least because of the point that my hon. Friend has just made. I am sure she would recall that we recently had a Health Committee session on this issue—in fact, the Minister was present—and certain assurances were given, not by the Minister but by one of his officials, that companies outside the
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United Kingdom would not have access to such data. The thought ran through my mind that many private health companies are global in their operations.
Andy Burnham: To add to the theme that my hon. Friend is developing, is not one of the problems with care.data that we have had so many statements from Ministers and officials that have not in the end come to be true? At the last Health questions, the Secretary of State said that a leaflet would be sent to every home in the land to explain what was happening. That also was not true. Does my hon. Friend agree that this is bringing the whole scheme into disrepute?
Grahame M. Morris: My right hon. Friend has hit the nail on the head, because there has been a catalogue of mismanagement. What we need to do if we believe in the importance of such a database is to ensure that we rebuild public trust. The Government have an opportunity to do that, but it will not be a simple matter. We have to look carefully at the implications of what the Government propose and give the necessary assurances.
The assurance that the official gave to the Health Committee had a gap that a coach and horses could be driven through. Several multinational companies could get round it by establishing a subsidiary based in the UK that would have access to the data, if that were the only safeguard.
Mr Dorrell: I want to return to a theme that we were discussing in an earlier debate this evening. The true nature of the hon. Gentleman’s concern is unclear. If his concern is that sensitive patient information should be made available only on the basis that the identity of the individual can never be traced and the data remain properly anonymised and confidential, I think that concern would be shared on both sides of the House. But is that his real concern, or is it that the information might be used by a private sector body for the purpose of improving the delivery of health care? I am not clear, provided that the information is anonymised and patient identity is properly secured, what his objection could be.
Grahame M. Morris: I thought I was being fairly clear. In the debate on the earlier group of amendments, we discussed the privatisation of the clinical commissioning function. My concern is that that would lead to greater fragmentation, not greater co-operation. On data sharing, I think it was my hon. Friend the Member for Leicester West (Liz Kendall) who gave the example of a questionnaire she was asked to fill in by her GP, which contained questions relating to alcohol consumption, smoking and so on. If that information was made available to a private health care company and, as a consequence, premiums were increased, people would have concerns. The Minister said that that has been ruled out and that it would not happen, but it is an example of why such concerns have been raised.
Oliver Colvile (Plymouth, Sutton and Devonport) (Con):
It is very important for there to be as much protection for the individual and the patient as possible. I assure the hon. Gentleman that my medical records are particularly uninteresting, but I would not want them to be leaked to an insurance company seeking
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to make money out of them or trying to change my premium. I am sure that that is very important in people’s minds.
Grahame M. Morris: The hon. Gentleman makes an interesting point which echoes a point made on the Labour Benches a few moments ago. The problem is that a number of private health care companies are also insurance companies, so it would be quite a task to ensure that data are not shared with companies that might have a commercial interest in them. To restrict access in the way we would all want is not as simple as the Government would have us believe.
Andrew George: The hon. Gentleman and I often agree on these issues, but I am slightly concerned. Of course we want reassurances, and while we have the pause we should seek further reassurances on the anonymisation of data and that they will not be misused. How far is he prepared to push this point? Is he prepared to push it to the extent that the initiative falls, with all the consequences for the lack of progress in advances in medical care? In 10 years’ time we could be talking about hundreds of thousands of lives that could have been saved as a result of pressing on with this very important development.
Grahame M. Morris: The hon. Gentleman makes an excellent point. It is not my intention to do that, but we have to recognise that the public awareness campaign—the Government’s early assurances about leaflets and letters—has been wholly inadequate. At a time when it is important for the Government to instil public confidence in the scheme, they keep doing things that undermine public confidence, for example by giving the hated company Atos—if you do not mind me using the term, Mr Speaker, because of the debacle in the Department for Work and Pensions—the contract to extract the data. There seems to have been a catalogue of errors.
I accept that this proposal has the potential to be a huge step forward. The Minister said it was not revolutionary, but I am quite often in favour of things that are revolutionary. It is revolutionary, because previous data collections from a hospital-based setting, from secondary care, have been largely episodic. This scheme will harvest data from GPs and primary care to follow the whole of the patient journey, and to identify trends and follow-ups. That is a revolutionary step forward, provided we have the necessary safeguards and assurances, and that we rebuild public trust. I am not suggesting that the scheme is unworkable and cannot be reformed, but there is a huge job to do to ensure that we restore public confidence.
Barbara Keeley: Will my hon. Friend give way?
Grahame M. Morris: I wanted to mention an example that has been presented to me in relation to rare illnesses. It is suggested that a patient could never be identified from the data, but identification might be possible in the case of very rare conditions, particularly if pharmaceutical companies had their own databases. We need some form of protection to cover those circumstances as well.
Barbara Keeley:
I thank my hon. Friend: he is being very generous in giving way. Does he agree that scope is an issue? The Hospital Episode Statistics database was
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an administrative database, and that is what our data were being used for. My hon. Friend has made an important point about the loss of trust. When did any of us sign up to having our data used to recalculate the cost of insurance cover for long-term illness? When did we sign up to have it sold on a chargeable basis by BT and by MedRed, on its cloud system in the United States? Once control has gone, it is possible for the scope to vary all over the place.
Grahame M. Morris: That is a good point. It is very important for the Government to lay down parameters for the scope.
The sharing of medical data has a fantastic potential to do good, as long as the necessary safeguards are there, but if it is mishandled, it also has the potential to do great harm. Patient data consist of very confidential information, which could prove damaging to the public if it were to end up in the wrong hands. We have already seen examples of that. I share the public’s fear that the Government are not seeking appropriate safeguards in respect of highly personal and sensitive information. Despite the Minister’s assurances about new clause 34, I do not think that it goes far enough.
Let me return to the issue of accountability. The benefits for companies that seek to misuse or leak patient data, for example, are considerable. The Minister has ruled out insurance companies, but I am worried about private health care firms. The pharmaceutical industry could profit from the re-identification of patient records, and I believe that the absence of parliamentary accountability to which I referred earlier, and a lack of clear and harsh penalties for those who misuse data, are undermining trust in what could be a highly beneficial scheme. Subsection (2) of new clause 25 defines misuse, and subsection (3) gives an indication of the penalties that would be applied. I think that they might act as a deterrent.
Mr Jamie Reed: My hon. Friend is making an excellent, intelligent and informed speech. The charge has been made that pushing our proposals too far risks scuppering the project, but is it not the case that the more safeguards we can introduce to reassure the public, the better the prospects of its success will be—and, moreover, the greater the data sample will be, and the better the system will be as a result?
Grahame M. Morris: I entirely agree. I think that that is vital, because, as we have seen in the case of politicians following the expenses scandal, once public trust has been lost, it is a huge task to win that trust back. There is a mountain to be climbed. I therefore think it important that we get this right.
The Government have an opportunity to pause the implementation of the Bill in order to consult properly, and, in the Bill itself, to address issues that have been raised by Members in all parts of the House and by other interested parties. I believe that if there is to be public confidence in the scheme, the Government should make a gesture by supporting Labour’s new clauses, particularly new clause 25. Given that the misuse and identification of data are the prime concerns of the public, I think that it would be eminently sensible to
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make them an offence. That is not rocket science, is it? If that is the problem, why do we not address it directly by creating an offence? Similarly, if an organisation makes applications for data from the Health and Social Care Information Centre, it should have to disclose any previous convictions under that offence. I am a big supporter of transparency and the extension of freedom of information. Private health care companies should disclose information that is relevant in those circumstances.
It seems bizarre to insist that the public should allow their private information to be shared with organisations that are allowed to hide their chequered pasts in some cases behind the cloak of commercial confidentiality. Parliamentary accountability, too, should be introduced to the decision-making process. The Secretary of State should retain the duty to approve any applications. The buck should stop with the Secretary of State. If there is a serious commitment to win back the public’s trust on care.data, the buck should stop with the Secretary of State, rather than with a big and unaccountable quango.
It would be of great benefit to the public if data sharing were exercised in an accountable and secure manner. I have always been an advocate of investment in public health. For that to be effective, we need an evidence base on which to plan interventions. The scheme is set to be disrupted unless the Government can demonstrate that they are serious about protecting patients’ privacy.
Oliver Colvile: Does the hon. Gentleman think that there will be a problem with patients sharing that information with their pharmacists if that meant that they were going to get better more quickly?
Grahame M. Morris: On an individual basis, I do not see a problem with that. The problem arises when dealing with large volumes of harvested data that include not just primary care records of patients in the community but hospital records, where pharmaceutical companies are perhaps able to benefit. Whether that is in patients’ best interests needs further consideration. I do not think that there is any such concern about individual conversations with GPs or pharmacists, but there are still major holes in the Government’s proposals. They need to be tightened further. A good starting point would be Labour’s new clause 25.
Paul Burstow: The hon. Gentleman has been incredibly gracious in giving way on several occasions. He has said that new clause 25 should be commended. I wonder whether he has considered amendment (b), which suggests that one of the other issues about safeguarding data is people being satisfied of the competence of the organisations that will receive that data and that they comply fully with the data protection obligations.
Grahame M. Morris: I have considered that, and that is an important point. Compliance is important. Those issues should be addressed in the Bill. If we are to ensure that there is public trust, those points must be addressed.
Mr Jamie Reed:
Does my hon. Friend share my concern and that of many GPs that the lack of necessary safeguards in the Bill may have an unintended consequence, particularly among the hardest to reach groups in society?
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Fear about the lack of safeguards in the Bill may stop them from accessing GPs and sharing their details and problems with them.
Grahame M. Morris: That is a huge danger. We have an opportunity to address that in this House this evening and when we consider the Bill further tomorrow. I personally am not advocating that people sign up to the opt-out clauses. That is important, but we need assurances to be able with confidence to support the Bill and the data collection proposals.
Mr Speaker: Order. One might have thought the intervention of the hon. Member for Copeland (Mr Reed) was exquisitely timed.
Bill to be further considered tomorrow.
Business without Debate
Delegated Legislation
Motion made, and Question put forthwith (Standing Order No. 118(6)),
Pensions
That the draft Automatic Enrolment (Earnings Trigger and Qualifying Earnings Band) Order 2014, which was laid before this House on 15 January, be approved.—(John Penrose.)
Motion made, and Question put forthwith (Standing Order No. 118(6)),
Electricity
That the draft Warm Home Discount (Amendment) Regulations 2014, which were laid before this House on 20 January, be approved. —(John Penrose.)
Mr Speaker: With the leave of the House, we shall take motions 5 and 6 on family proceedings together.
Motion made, and Question put forthwith (Standing Order No. 118(6)),
Family Proceedings
That the draft Access to Justice Act 1999 (Destination of Appeals) (Family Proceedings) Order 2014, which was laid before this House on 27 January, be approved.
Family Proceedings
That the draft Crime and Courts Act 2013 (Family Court: Consequential Provision) Order 2014, which was laid before this House on 27 January, be approved. —(John Penrose.)
Motion made, and Question put forthwith (Standing Order No. 118(6)),
Family Court
That the draft Justices’ Clerks and Assistants Rules 2014, which were laid before this House on 27 January, be approved. —(John Penrose.)
10 Mar 2014 : Column 146
European Union Documents
Motion made, and Question put forthwith (Standing Order No. 119(11)),
Gender Equality and Women’s Empowerment in Development
That this House takes note of European Union Document No. 17432/13, a Commission Staff Working Paper: 2013 Report on the Implementation of the EU Plan of Action on Gender Equality and Women’s Empowerment in Development 2010–2015; welcomes the document as a frank assessment of the EU’s implementation of its Action Plan; and supports the Government’s efforts in encouraging the European Commission to address the weaknesses identified in the Report in order to ensure further integration of gender equality in EU development assistance.—(John Penrose.)
Administration
That Karen Bradley, David Morris and Nicholas Soames be discharged from the Administration Committee and Harriett Baldwin, Conor Burns and Mr Mark Harper be added.—(Geoffrey Clifton-Brown, on behalf of the Committee of Selection.)
Statutory Instruments (Joint Committee)
That Mr Robert Buckland be discharged from the Joint Committee on Statutory Instruments. —(Geoffrey Clifton-Brown, on behalf of the Committee of Selection.)
Welsh Affairs
That Hywel Williams be discharged from the Welsh Affairs Committee and Jonathan Edwards be added.—(Geoffrey Clifton-Brown, on behalf of the Committee of Selection.)
Petitions
North Corner Quay and Landing Stage, Devonport
10.1 pm
Oliver Colvile (Plymouth, Sutton and Devonport) (Con): It is with great delight that I take this opportunity of presenting Parliament with a petition by about 1,000 of my constituents within the Plymouth travel-to-work area who are concerned about the north corner quay and landing stage in Devonport.
The Petition of residents of Devonport and Plymouth, and others,
Declares that the Petitioners are concerned about the condition of the North Corner Quay and Landing Stage, Devonport.
The Petitioners therefore request that the House of Commons urges the Secretary of State for Communities and Local Government under his powers contained in Part IV, Clause 48 of the Plymouth City Council Act (1987) to encourage Plymouth City Council to restore and repair North Corner Quay and Landing Stage as contained in Part IV, Clause 26 of the said Act.
And the Petitioners remain, etc.
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South Stoke Plateau (Bath and North East Somerset)
10.2 pm
Jacob Rees-Mogg (North East Somerset) (Con): Her Majesty’s Government have been fantastic in saving my constituency from development in the green belt, and the Communities and Local Government Minister, my hon. Friend the Member for Grantham and Stamford (Nick Boles), has been particularly good in recently stopping these incursions, but my constituents in South Stoke are especially concerned about development that may take place there and I have 1,386 signatures to this petition. That number is easy to remember because, 1386 was the year of the treaty of Windsor.
The Humble Petition of the residents of the parish of South Stoke and its neighbouring parishes and wards of Bath and North East Somerset, here represented by South Stoke Parish Council and The South of Bath Alliance,
Sheweth that it is the intention of Bath and North East Somerset District Council's Amended Core Strategy to develop the land known as the Odd Down/ South Stoke Plateau with the building of 300 new homes.
Wherefore your Petitioners pray that your honourable House ask Her Majesty’s Government to recognise the importance of the openness of this land, which forms part of the Setting of the Bath World Heritage Site and of the Wansdyke Scheduled Ancient Monument, and to maintain the current Statutory protections of the Green Belt and Area of Outstanding Natural Beauty designations for all of the South Stoke Plateau and so maintain the site free of development in perpetuity.
And your Petitioners, as in duty bound, will ever pray, &c
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St Helier Hospital
Motion made, and Question proposed, That this House do now adjourn.—(John Penrose.)
10.5 pm
Siobhain McDonagh (Mitcham and Morden) (Lab): At the beginning of this month, on a crisp, cold Saturday morning, I joined a group of residents outside our local St Helier hospital to mark a sad moment in its history. For the past four years, St Helier has been adorned by a 1,000-square-feet banner, proudly saying, “Coming soon—We’re spending £219m on a major development of St Helier hospital”. The residents and I were there to see that banner taken down, and to mark the promise of a better hospital finally being taken away. The story of St Helier is a long one. I have raised it in this House on several occasions. This was a low point, but I fear that it may get lower, and the result of today’s debate does not exactly inspire confidence.
St Helier was built in the 1930s, at the same time as the St Helier housing estate that encompasses it. At that time, it was the biggest housing estate in Europe. The hospital was built there for a reason: it was where the health needs of the surrounding community were. St Helier hospital has had an interesting history. In the second world war, its bold white exterior was painted green owing to concerns that German bombers would use it for target practice or to line up their bombing missions on London. Although neighbouring buildings were destroyed by bombers, St Helier thankfully survived and has continued to serve the community ever since.
St Helier has had its troubles. In the mid-1990s, there was outrage when it was discovered that people were left to die on trolleys abandoned in the corridor. Back then, under-investment in the NHS of the John Major Government was not unusual. If it was bad on the wards, however, what was happening behind the scenes was almost as disturbing.
Even though Mitcham and Morden has always been the most deprived part of the old health area of Sutton, Merton and Surrey, it has always been the poor relation. In my almost 17 years as an MP, and for many before that, I have never known of anyone living in Mitcham and Morden to sit on the board of any NHS body. As a result, we have always had a Cinderella service. No one speaks up for our patients, and we are always first to lose out and last to gain. It was no surprise, therefore, when I discovered recently that health bosses had held secret meetings in the mid-1990s to discuss plans to close St Helier and move services to Croydon. Thankfully, once Labour came to power in 1997, this went no further, but the tone was set.
Not long afterwards, it was suggested that St Helier should merge with the hospital in Epsom. Such a merger was a little unusual, but Epsom was struggling financially, and we were persuaded that a merger would make both hospitals more resilient. The two hospitals were not a great match. People living in Epsom are relatively wealthy, and a little older. The area around St Helier is more urban, ethnically mixed, younger and has more health problems associated with poverty. Nevertheless, we accepted the advice, but it soon became clear that we had been sold a pup.
A new review, “Better Healthcare Closer to Home” was launched. This was in a time of plenty, the early 2000s, when health spending was on the rise, so a grand
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scheme was drawn up, in which St Helier and Epsom would both close, replaced by a new state-of-the-art hospital in Belmont, a very leafy, very wealthy community two miles south of Sutton. Aside from the terrible impact of closing St Helier, I never thought that the scheme was workable; it was too big, too unrealistic and lacked one key ingredient—any public demand for it.
Various bureaucrats argued that the site of a hospital is not important, because new community primary care services, such as GPs and local care centres, would see the patients that normally go to hospitals instead. The public never agreed, and in fact the reverse has happened: the number of people who would rather go to hospitals is rising. The public consultation at the time clearly showed that the most popular site for a hospital with an A and E was St Helier. The public knew that the people who need hospital the most are the most disadvantaged, with the worst health. They are the most likely to need A and E and the most likely to need acute maternity services.
Everyone could see that St Helier was the best location for a hospital if we wanted to reduce health inequalities, and it was backed by all the MPs in Sutton, Merton and Wandsworth. Local managers overruled us and, even though their initial assessments showed that St Helier was a 7% better option than Belmont, they voted for Belmont instead. Thankfully, in those days we had a Secretary of State for Health who was prepared to step in and stand up for the NHS. The health managers’ decision was finally called in by Labour councillors in the London borough of Merton, and the then Secretary of State decided to save St Helier, recognising that the area around St Helier had the greatest health needs in the whole catchment area and people there had up to 10 years’ less life expectancy. In contrast, Belmont is one of the wealthiest areas in the country. Indeed, people living there also made it clear they did not want a major new hospital built in their backyard. So we were all delighted when the then Government came down firmly on the side of reducing health inequalities and chose St Helier.
In early 2010, that decision was further boosted when a subsequent Health Secretary, my right hon. Friend the Member for Leigh (Andy Burnham), announced the £219 million renovation. At the time, we were all very aware that the economy could no longer afford the same generous public sector funding we had in the mid-2000s. Decisions had to make financial sense and, in the case of the £219 million, the numbers stacked up. As well as improving people’s health, the scheme was shown to offer value for money. It would mean new wards, with single rooms to cut down on infections and improve patient privacy, along with various other improvements. The scheme was so well thought out that just months later it also gained the support of the new coalition Government—the Chancellor still includes the funding in the Treasury’s books—but it was not long before St Helier’s future was again at risk.
In 2011, the local NHS admitted that it had received Government instructions
“to deliver £370 million savings each year...a reduction of around 24% in their costs.”
A new body was soon set up, this time called Better Services Better Value, or BSBV— it might properly be abbreviated to just BS for all the good it has done. Its task soon became clear: to close services such as accident
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and emergency, and maternity units, in one or more hospital. At the same time, finally recognising that they served different demographic groups, the St Helier and Epsom hospitals started to de-merge from the trust. Both had found new trusts willing to merge with them, St Helier with St George’s Healthcare NHS Trust and Epsom with Ashford and St Peter’s Hospitals NHS Trust, but, thanks to BSBV, those new mergers soon broke down. Nobody wanted to merge with a hospital that was under threat, particularly when it was revealed that Epsom’s debts were far worse than originally thought.
Originally, BSBV would look only at south-west London, covering St Helier, Kingston, Croydon and St George’s in Tooting; one of the four would lose its accident and emergency unit. But after the de-merger fell apart, the review was extended into Surrey, and two out of five hospitals were to be downgraded—inevitably, BSBV recommended that St Helier should be one. Not only would its A and E and maternity units go, but so, too, would its intensive care unit, paediatric centre, renal unit and 390 in-patient beds.
I have always said that the sums do not add up. Some 82,000 patients go to St Helier’s A and E each year, with the NHS saying that figure will rise by 20%—100 emergency patients are admitted every day. Neighbouring hospitals are already overcrowded, and are more expensive per patient, so it was never clear how the other hospitals could meet clinical targets, let alone cut costs, if they had to treat St Helier’s patients as well as their own. Figures quoted by BSBV—that an astonishing 60% of patients would use primary care instead of A and E departments—were ridiculed by the National Clinical Advisory Team, who said:
“Elsewhere in the UK a consistent finding is...far lower, usually...15-20%. Reconfiguration based on the higher figure may not achieve the anticipated benefits.”
In fact, NCAT went a lot further than that, saying:
“Successful implementation...depends on a multitude of supporting improvements...that are not well defined in the proposals.”
Given the growing birth rate and the higher cost of giving birth in all other hospitals, closing St Helier’s maternity unit was also never going to deliver clinical targets or cut costs. Experts say that maternity units should not deliver more than 6,000 babies per year. However, if St Helier closed, the remaining hospitals would have to deliver 6,500 babies each per year, plus 2,500 in midwife units and nearly 1,000 home births. It was no surprise, therefore, that NCAT said the plans were
“based on an optimistic view of capacity.”
Everyone in my local community knew the plans were bonkers. Local campaigners such as Sally Kenny, a former deputy head and Lower Morden resident, set up local groups to fight the plans. Sally has printed thousands of “Save St Helier” posters that are currently in windows across Morden and St Helier. People cannot drive through the area without seeing the words “We Love St Helier” displayed on garden stakes.
As well as a petition signed by more than 30,000 people, thousands of local residents attended a protest picnic organised by local mums, where the leader of Merton council, Stephen Alambritis, a former football referee, waved a red card at the plans. Merton council has always shown its support. Last year, it passed a strongly worded motion backed by Labour, Liberal Democrat, Conservative and Independent councillors, saying any
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decision on St Helier must go to the Secretary of State. Thankfully, salvation came from an unlikely source—a clinical commissioning group in Surrey.
In Merton, the new system of CCGs has not been a great advert for the Government’s reforms. Last May, I attended one of the worst public meetings I have ever been to—and that is really saying something. Merton’s CCG was due to decide St Helier’s future, but it would allow only a handful of the hundreds of people who came to the meeting into the public gallery. The chair would not allow cameras or recordings, and the microphones did not work. Members of the CCG refused to register their personal interests, even though it was alleged that some would gain personally if St Helier were shut and services were moved to other providers such as private companies or GP surgeries. Then, just as they were due to make a decision, they suddenly walked out of the room to boos and shouts of “cowards”. Some said that they had adjourned the meeting to a quiet staircase, others that they went to the kitchen. Wherever they went, they made the decision there, in secret, without any public witnesses, to accept plans to close services at St Helier and to go to public consultation.
If Merton’s CCG was not exactly the blueprint of an open, transparent community service, thankfully others did not follow suit. Having seen the power of GPs in Lewisham, the CCG in Surrey Downs, recognised that BSBV was barking up the wrong tree and voted no. As a result, earlier this year, BSBV was wound up; it will not be mourned. However, the threat still hangs over us.
I have been shown a letter from NHS England to the CCGs complaining about their decision not to approve closures at St Helier. The letter says:
“Your approach carries significant and unacceptable risk, both financially and clinically.”
Castigating the CCGs for their decision, it goes on:
“We consider your proposed approach would make it difficult for South West London CCGs to formulate a coherent strategic plan.”
According to NHS England, the decision
“carries unacceptable risks to your ability to develop and deliver a strategic plan. We also believe the approach carries significant operational risks. Firstly that your providers will not be able to meet the London Quality Standards...Secondly, that providers will not be able to recover their costs against income and therefore...will be unable to become Foundation Trusts.”
“This could be interpreted as commissioners planning for clinical and financial failure in some of its providers.”
That letter is very revealing. It proves that those in charge still cannot bring themselves to rule out the possibility of St Helier closing. They are planning to fail, and if they do not fail, they will not allow St Helier to become a foundation trust anyway. Either way, the hospital will fail. That indicates that the announcement not to close St Helier is not real. As if we needed more evidence that the Government are not committed to St Helier, we heard, just a few weeks later, that the £219 million had been withdrawn. After I had repeatedly asked about the lack of progress, the head of Merton’s CCG finally conceded the truth. Ruefully, she admitted that the work was now “probably unaffordable” and no longer featured as
“one of the...scenarios being worked up by the Trust at this stage.”
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The whole community knows what is going on. St Helier is not “safe”. It does not have the Government’s backing. If the Government truly still supported St Helier, why is it not full steam ahead with a scheme that has funding from the Treasury and that has proven its clinical value? They are failing to plan, and planning to fail. All this ends in one place: the demise of St Helier. If St Helier loses emergency services, 200,000 people will face longer journeys in an emergency. A and Es across south London will struggle to cope with the extra workload, and that will affect millions of patients, including the Minister’s constituents.
The Minister has a chance today to offer some hope. She is a significant person. A word from her could make all the difference. All she has to say is that St Helier will stay open and that she will not allow it to lose its A and E, its maternity unit or any of its other services. She can say today that the £219 million must be spent. When that money was announced four years ago, construction was due to begin in 2012. Nothing has happened, but this evening she can turn nothing into something with just a word. She will probably say it is for others to decide, but that is her decision. A decision not to act is just as much a decision as any other. What she should do is show leadership, because leaders decide. Without ministerial commitment to St Helier, it is clear where this will end. They are planning to fail, and that is why the fight goes on.
All the while, the population in south London is rising, demand for hospital services is increasing, demand for A and E is going up by 20%, and the birth rate is rocketing. Doctors oppose the closure of services, Merton council unambiguously opposes any closure, and all parties want to save St Helier. We thought things were bleak before; they are just as bleak now.
All the while, instead of focusing on improving the NHS, this Government have focused on top-down reorganisations. The UK Statistics Authority has made it clear that the Prime Minister has broken his election pledge to increase health spending. If St Helier loses its A and E or countless other services, my constituents will know why. They are angry. In Mitcham and Morden we demand nothing less than a moratorium on A and E closures. We want our hospital, St Helier, to continue. The German bombers never destroyed it, nor should this Government. The Minister needs to say, “Yes, the £219 million is still there, and yes, the building work will start now.”
10.22 pm
The Parliamentary Under-Secretary of State for Health (Jane Ellison):
I congratulate the hon. Member for Mitcham and Morden (Siobhain McDonagh) on securing one of a number of debates that she has led in the House on this issue. I know that it is important to her—we have had many private conversations about it over the past few years—and to her constituents. She has great faith in my powers, but I fear that so soon after the collapse of Better Services Better Value, I am inevitably not in a position to say anything particularly definite to her tonight. However, I will try to respond to some of the points she makes and explain to the House what the road map ahead now looks like. Overall, although I understand her frustration, which is felt by many of us who represent south-west London, I think her analysis is a little bleak, but I will try to give her
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some assurance about the potential for the future, if not about some of the specific points that she asked me to address.
Before I comment on the issues that the hon. Lady has raised, I want to pay tribute to all those who work in the NHS in her constituency and in all our constituencies in south-west London. Throughout all the uncertainties of the past few years, they have continued to show their commitment to providing first-class services to all those in their care. For that, we thank them.
As I said, I share the hon. Lady’s frustration about this programme—I say that straight away on the record—as, I am sure, do all those of us affected in the area covered by the six clinical commissioning groups. For many of us, having spent so much time in consultations, meetings and discussions, it is, to say the least, very frustrating to find ourselves in this position on BSBV.
I give the hon. Lady the assurance that the Department of Health remains committed to investing in NHS infrastructure. The most recent Government spending review has ensured that capital spending in the NHS is protected in real terms. That means that the NHS will be getting a real-terms increase in spending in 2015-16 compared with 2014-15. There is, therefore, money available for capital infrastructure, but I realise that the hon. Lady’s interest is in her own local capital investment.
At the same time, I fully understand the hon. Lady’s disappointment that Epsom and St Helier University Hospitals NHS Trust has been unable to progress its plans for developing St Helier. However, as the hon. Lady knows, the problem is that in the absence of a local agreed strategy for south-west London and a decision on which services will be located at the redeveloped site, the trust has recently decided to reconsider the scheme.
As the hon. Lady is also aware, the proposed redevelopment has been closely linked to Better Services Better Value and the review of clinical services right across south-west London. That has gone on for so long that, in many ways, events have overtaken it and there is now a need to look at it afresh.
The six clinical commissioning groups in south-west London announced on 18 February that they did not propose to continue with the BSBV programme or to consult on the options that emerged from it, so they have now been withdrawn. As a result of that decision by the CCGs, the trust now needs to reconsider the business case for the hospital redevelopment and it plans to work with the local CCGs to see whether they can agree a level of investment in the hospital that is affordable and that ensures that the services provided are sustainable.
The trust has confirmed that over the next five years it plans to invest up to £78 million in modernising its estate, improving facilities for patients and updating IT systems and equipment. I think, therefore, that the picture the hon. Lady painted was a little bleak, because it suggested that there was to be no investment at all, when in fact the trust has announced that it intends to go ahead with plans that will enhance some of the services for her constituents.
Siobhain McDonagh:
It is my understanding that any capital works of that size would have to be approved by the Department of Health and the Treasury, and as yet
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I do not believe they have been drawn up to the extent that they have any such permission, so at the moment this is wishful thinking on the part of the trust.
Jane Ellison: The trust has announced its intentions, and a proper process will be followed. I am trying to make the point that it is wrong to suggest that there are no plans to invest in and enhance services at St Helier. That process will be followed and we will respond in due course. That is my understanding of the trust’s plans and it wants to progress with them.
Paul Burstow (Sutton and Cheam) (LD): I am grateful to the hon. Member for Mitcham and Morden (Siobhain McDonagh) for calling for this debate. Will the Minister use her good offices to ask the trust to set out very clearly to all hon. Members representing constituencies with an interest in St Helier its plans and the timeline for this capital investment?
Jane Ellison: That is an entirely reasonable request and I will, of course, convey it to the trust following this debate.
The local CCGs have listened to feedback from local people and they have now told us that they want to look at local health services in a more holistic way. Although they have decided against proceeding with BSBV, the local CCGs have unanimously supported the clinical case for change in south-west London and propose to use the detailed analysis provided by that exercise to plan their future strategy. I accept that that is a broad-brush explanation and that we have yet to see the detail, but that is essentially the direction of travel. Obviously we are not as far forward as we would have wanted to be after all the consideration given to the issue over the past few years.
The CCGs have also made it clear that if they do not address the challenges identified under BSBV or, at a national level, those in NHS England’s “Call to Action”, local services might decline in quality and not be able to meet the required safety standards. The CCGs have agreed that all future hospital services should be commissioned against the London quality standards and that all hospitals must provide seven-day-a-week, consultant-led services.
I referred earlier to events overtaking the BSBV programme, and the CCGs need to take into consideration some of the more recent developments, not least Sir Bruce Keogh’s review of urgent and emergency care. We need to look at the whole of the south-west London health economy in the light of those new expectations, particularly that for seven-day-a-week, consultant-led services. That is a challenge right across the NHS, not least for those of us in south-west London. Hospitals are expected to comply fully with the recommendations set out in the Keogh review and, of course, to be financially sustainable.
Should the outcome of discussions mean major changes at any trust in south-west London, proposals will, of course, be subject to public consultation. Most importantly, the local NHS has stated that it will involve local people in the work to develop these new solutions to the longer-term challenges faced by the NHS in the area.
As well as involving local people, it is absolutely essential to involve local Members of Parliament. I take the point made by the right hon. Gentleman in his intervention. Whenever I meet representatives of NHS London, as I do from time to time—another meeting is
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in the diary—I always stress the importance of liaising very closely with Members of Parliament so that they can best represent their constituents and make sure that they are fully in the picture about developments. For the record, I was not particularly impressed by the notice I got of BSBV not going forward, given that I have to respond in this House about it, and I have made that view clear to some of the people in my local area.
Epsom and St Helier trust has made it clear that the broad range of in-patient, out-patient and day services remains available at its two hospital sites. Local CCGs will work together—the new umbrella name is South West London Collaborative Commissioning—to develop a five-year commissioning strategy. The trust will work with its commissioners in the coming months to contribute to those plans. I understand that the trust expects to see the strategy in June, which will give it a clear idea of the future direction of local health services and its role in delivering them. As local Members of Parliament, we all expect to see the strategy at the same time.
Once a decision has been made on which services will be located at St Helier, the trust will need to revisit its original business case for the redevelopment of the site. I realise that that is frustrating, after everything that local people have campaigned on, but that is in its nature: it was only ever an outline business case. Any
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new or updated business case for redeveloping St Helier would initially need to be considered by the NHS Trust Development Authority, which is responsible for approving capital funding and ensuring that the repayments are affordable for the trust. As much is likely to have changed in the four years since the business case was last considered, it will probably be reviewed again by the Department of Health and the Treasury.
It is obviously essential that any options must be sustainable in the long term, both financially and, as I mentioned in relation to the Keogh review, clinically. When local consultations have taken place and have determined a sustainable service configuration for the locality and the hospital, we anticipate that requests for capital funding will be submitted to the Department of Health for consideration.
In conclusion, I urge the hon. Lady and other Members of the House to continue to represent their constituents, engage with the process and participate in future consultations. What we all want to emerge from the process is a sustainable, safe and excellent local health economy for south-west London that works to the most modern standards of care and is sustainable for the long term.