15 Oct 2014 : Column 402

I was extremely grateful to receive incredible care for my wife and child when Ruby, my daughter, was born last year, and got to see, incredibly and movingly, the dedication of NHS midwives, doctors and other staff as well.

I am hugely moved as well by the fact that locally in the seat I represent in Luton we receive fantastic NHS care. We have Luton and Dunstable hospital, and we were pleased to welcome the Darlington mums who had marched down to Whitehall to protest about the changes to the NHS when they came through Luton. They made many of the points I want to make today. They, as members of the general public, were able to articulate what I do not believe many Members across this House could: the depth of passion people feel for the NHS.

I would just say this. A number of different contributors today have talked at length about statistics and churned out figures, but for me there is one stand-out statistic from this Parliament: the level of patient satisfaction in the NHS. We can talk until we are blue in the face about which target should be met and which target should be missed, but it speaks volumes to me that the highest ever level of patient satisfaction was in 2010 when this Government came to power and it has dropped since then. That should cause us to ask profound questions, because we understand that a new top-down reorganisation of the NHS can only do one thing, which is distract from patient care. That is the experience in this Parliament.

People forget that the NHS is not a series of services that can easily be bolted together. It is more a network or a system, and just as Beeching wielded his axe and chopped up different parts, compartmentalising and fragmenting the railways, so we must be aware of the lessons of history when it comes to fragmentation in our NHS system. It is the role of us in this Parliament not just to protect our own local services or seek to move forward with the amazing new treatments that exist now, but to protect the legacy of the NHS over the last 70 or 75 years.

Will this Government talk about the massive error that was the reorganisation of the NHS in this Parliament and allude to two others? The starvation of funds by the Tories in the ’80s and ’90s that had to be put right by a Labour Government in 1997, who saved the NHS, is the second, and opposing its creation in the first place was the Tories’ original sin on the NHS, but they seem not to have learned that lesson. They continue to make this mistake, and it has led to 440 new organisations in the NHS, tying up hospitals in competition law, with 4,000 staff laid off and then rehired. Is this not the waste we have talked about in our system—the waste that could be repurposed for better patient care, and a rise in patient satisfaction as well?

We need a clear plan for putting this system back on track, because of the many shortages and the rationing we have seen in the system. The first plank of that plan, advocated by my right hon. Friend the Member for Leigh (Andy Burnham), is to be clear about our plans to repeal this damaging Tory NHS Act that has done so much damage in this Parliament. I am glad to hear that in five weeks each of us in this Parliament will be asked to cast our votes for the repeal of the most damaging aspects of this legislation, and I pledge to my constituents that I will not be found wanting when that comes. We must also exempt the NHS from the transatlantic trade and investment partnership, make

15 Oct 2014 : Column 403

sure the extension of competition law that has led to a massive acceleration in privatisation is curbed, increase NHS spending by £2.5 billion a year in a sustainable way to make sure the NHS has time to care, and hire 36,000 new nurses, doctors and midwives.

That is the expectation that will fall to us in the next Parliament, but in this Parliament there is also something that needs to be done. Government Members must admit publicly, not just privately, their error in going about this reorganisation, and commit to the funding that is going to be required. We all accept that there are no easy solutions, and politicians can sometimes get wound up in all sorts of knots trying to defend services that should be reconfigured. I fully accept that. But, fundamentally, we are the custodians and the guardians of the greatest mechanism against social inequality and the greatest mechanism to attack health inequality head on. The national health service is an institution rightly held in high regard by the people who believe they own it, not those who are asked to be its custodians. It is the crowning achievement of the 1945 Labour Government. It needs to be rescued by successive Labour Governments after Tory Administrations. The NHS demands nothing less.

6.40 pm

Liz Kendall (Leicester West) (Lab): It is a pleasure to close today’s debate and to follow my hon. Friend the Member for Luton South (Gavin Shuker), who spoke very powerfully. In fact, hon. Members on both sides of the House have spoken with great passion and commitment about the NHS and the vital role it plays in their constituents’ lives and in their families’ lives. Many hon. Members, including the hon. Members for South West Devon (Mr Streeter), for Bosworth (David Tredinnick) and for Morecambe and Lunesdale (David Morris), have rightly praised NHS staff for working tirelessly to deliver good quality services despite all the challenges they face.

However, we have also heard countless examples of what the Alzheimer’s Society, the Multiple Sclerosis Society, the Royal College of Nursing, the Royal College of Midwives, the Royal College of General Practitioners, the Royal College of Physicians, the Royal College of Paediatrics and Child Health, the British Medical Association and many others said in their letter to The Independent last week. It stated that

“Signs of a system buckling...are everywhere…The NHS and our social care services are at breaking point and things cannot go on like this.”

We heard from my hon. Friends the Members for Corby (Andy Sawford) and for Worsley and Eccles South (Barbara Keeley) about how more and more people are struggling to get an appointment with their GP, with one in four waiting at least a week and thousands waiting more than two weeks.

Hon. Members, including my hon. Friend the Member for Nottingham South (Lilian Greenwood), spoke about how the huge cuts to local council care budgets mean half a million fewer older and disabled people, some of the most vulnerable people in society, are getting vital services, such as home care visits or home adaptations. This is leaving their families struggling to cope and to pick up the pieces.

15 Oct 2014 : Column 404

Fewer services in the community mean that increasing numbers of frail, elderly people end up ringing 999, going to A and E and getting stuck in hospital when they do not need to be there, causing them and their families distress and costing the taxpayer far more. Ambulance services are under huge pressure, as my hon. Friend the Member for North Durham (Mr Jones) said. Hospital A and Es have now failed to meet the Government’s lower four-hour waiting target for 63 weeks in a row. A and E performance over the summer has been worse even than at the height of last winter. Delayed discharges from hospital are at a record high and cost more than £250 million in the last 12 months alone—money that could have paid for a year’s home care for 37,000 older or disabled people. Where on earth is the sense in that?

Rising emergency admissions and delayed hospital discharges mean planned operations are going backwards, too. More than 3 million people are now on the waiting list. The 18-week maximum wait target has been missed for the last two months in a row, and the NHS has missed the 62-day wait for vital cancer treatment—

David T. C. Davies: Will the hon. Lady give way?

Liz Kendall: I will not. [Interruption.] If the hon. Gentleman is going to talk about Wales, 90% of patients get their treatment within that target, compared with 84% here, so let me save him some time and bother.

The Government’s failure to keep people out of hospital and keep waiting lists under control, means the NHS is facing a looming financial crisis, too. Two-thirds of all acute hospitals are already in deficit to the tune of £500 million. They predict they will end the year £1 billion in the red, piling on the pressure for even greater service cuts and worse standards of care in future.

The tragedy is that it did not have to be this way. After 13 years of investment and reform, the previous Labour Government left the NHS with the highest ever patient satisfaction rates and the lowest ever patient treatment waits. But we were not complacent. We understood that the NHS had to face up to even bigger challenges: our ageing population, the increase in long-term conditions and huge medical advances, at a time when there is far less money around. For that reason, we had a plan in every region to reform front-line services, through Lord Ara Darzi’s NHS next stage review, by delivering some services in specialist centres so that patients got expert treatment 24/7 and by shifting other services out of hospitals and into the community. It was a move towards prevention joined up with social care to help people stay living at home. Instead of going ahead with our reforms, however, the Government scrapped them and forced through the biggest backroom reorganisation in the history of the NHS, wasting three years of time, effort and energy, and £3 billion of taxpayers’ money that should have gone on patient care.

The Health Secretary told the House today, and said on the “Today” programme, that the Government had saved £1 billion.

Mr Jeremy Hunt: The NAO said it.

Liz Kendall: I actually picked up the copy of the report he left behind, and I found his highlight. It reads:

“The estimated administration cost savings outweigh the costs of the reforms”,

15 Oct 2014 : Column 405

but it does not mention the £1 billion figure. In fact, paragraph 4.10, on the reliability of the Department of Health, states “we found…limited assurance” in the figures. It also states that

“strategic health authority staff did not verify the figures submitted to them by primary care trusts”

and that it

“saw no evidence that the”


“challenged these figures.”

Far from being independently verified, as the Health Secretary claims, they have been made up on the back of an envelope. [Interruption.]

Government Members can complain, but we have constantly argued that the NHS reorganisation has been the single biggest mistake made by the Government, and now we find out that members of the Cabinet agree. An ally of the Chancellor told The Times:

“George kicks himself for not having spotted it or stopped it”.

A former No. 10 adviser says that

“no one apart from Lansley had a clue what he was really embarking on—certainly not the prime minister”.

So we have a Chancellor, who is meant to safeguard public money, failing to stop billions of pounds of waste and a Prime Minister who claimed the NHS was his top priority, but was too confused or complacent to bother to understand his own plans. The Conservative party still does not get it. One Downing street adviser is quoted as saying:

“A lot of work had gone into persuading people that David Cameron believed in the NHS, had personal experience and cared about it. Then the Conservatives came in and forgot all about reassurance. Lansley managed to alienate all the professional people in Britain who were trusted on the NHS.”

The Government’s NHS reorganisation was not just terrible politics; it is terrible in practice for patients, taxpayers and NHS staff. I remind hon. Members that the Health and Social Care Act 2012 did not just create 221 CCGs, 152 health and wellbeing boards, NHS England, Public Health England and Health Education England; it also created four regional NHS England teams, 27 local area NHS England teams, 16 specialist commissioning units—well, there were 19, but at least two have already been merged—and 10 specialist commissioning units. That is on top of Monitor and the Care Quality Commission. It is a system so chaotic and confusing that no one knows who is responsible or accountable for leading the changes patients want and taxpayers need.

And now, just when we thought it could not get any worse, another major new reorganisation is under way. NHS England was commissioning primary care and specialist services, but in May it announced it wanted to give primary and specialist commissioning back to CCGs to try and patch up the fragmentation created by the Government's own plans. How much will this second reorganisation cost patients and staff?

Patients, staff and taxpayers cannot afford another seven months, let alone another five years, of this Government. They need a clear plan to restore care standards and restore care services so that they are fit for the future. Opposition Members would use the savings from scrapping the cost of competition in the NHS to guarantee new rights for patients to see their GP at a time that is convenient for them. We would raise £2.5 billion from a mansion tax, clamping down on tax

15 Oct 2014 : Column 406

avoidance and a levy on the tobacco companies to fund more GPs, nurses, midwives and homecare workers to transform services, particularly in the community. We will support carers with new duties on the NHS to identify family carers, a single point of contact for information and services and ring-fenced funding for carers’ breaks. Our plan for whole-person care would ensure the full integration of physical and mental health and social care services into one service with one team to meet all of a person’s needs.

At the next election, there will be a real choice on the NHS: a choice between care going backwards and money wasted under the Conservatives or Labour’s plans to fully join up services to get the best results for patients and the best value for money. It will be a choice between the Conservatives who have broken their promises to protect the NHS, throwing the system into chaos and blaming staff, or Labour who will make the real reforms we need so that people get personalised care in the right place at the right time. It will be a choice between the Conservatives’ unfunded plans to cut taxes for the wealthiest or Labour’s fully funded plans to reform the NHS and care services on which we all rely. I commend the motion to the House.

6.50 pm

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): It is a pleasure to conclude this debate and to speak to the contributions of hon. Friends and hon. Members. It is a pity that when we have NHS debates, they sometimes become unnecessarily tribal and partisan. Some Labour Members often seek to talk down the local NHS rather than to stand up for their hard-working NHS staff who deliver high-quality services on the ground.

I want to talk about some of the successes this Government have delivered for our NHS and then I shall address some of the points raised in the debate. We know that even in these difficult economic times, this Government have protected our NHS budget with £12.7 billion more during this Parliament. That was something that the shadow Secretary of State, the right hon. Member for Leigh (Andy Burnham) called “irresponsible”, but it is not irresponsible to make sure that we continue to support and protect the NHS front line. We have stripped out over £5 billion-worth of bureaucracy and reinvested that money into front-line patient care. That has been audited by the National Audit Office, but the hon. Member for Leicester West (Liz Kendall) did not choose to highlight that point in her remarks. It has been confirmed and we know it is true.

I make no apology for the fact that we as a Government have focused ruthlessly on having a more efficient health service that frees up as much money as possible for front-line patient care. We have reduced the number of administrative staff by around 20,000, increased front-line clinical staff by over 12,500 and set up a cancer drugs fund that has helped 55,000 people who would not have received cancer drugs to receive them. There has been an unrelenting focus on promoting a more joined-up approach to care, to help deliver more care in the community for people with long-term medical conditions, particularly the frail elderly.

Let me deal with some of the comments and contributions to the debate. I would like to reassure my hon. Friend the Member for Morecambe and Lunesdale

15 Oct 2014 : Column 407

(David Morris) that the hospital in his constituency is, of course, not going to close and that any local scaremongering by the Labour party is wrong and misplaced. I would also like to reassure the hon. Member for North Durham (Mr Jones), who raised concerns about the north-east ambulance service, that the service has generally been performing well. In 2013-14, it met all its national targets. I urge the hon. Gentleman to write to me if he has any further concerns on behalf of local patients.

We heard strong contributions from my hon. Friend the Member for Norwich North (Chloe Smith), who made important remarks about the services delivered at the Norfolk and Norwich hospital, and I look forward to accepting her invitation to visit that hospital once again in the near future, and from my hon. Friend the Member for Bosworth (David Tredinnick) who made one of his regular pleas for more alternative medicine in the NHS. Importantly, he talked about the benefits of clinically driven commissioning. Under this Government, we have put doctors and nurses in charge of our NHS to make sure that services are delivered at local level. Patient services are run by doctors and nurses, not by bureaucrats, which has been a tremendous step forward. My hon. Friend the Member for St Ives (Andrew George) made a considered contribution about the previous Government’s record on encouraging private sector providers in the NHS—a point to which I shall return.

Lilian Greenwood: What does the Minister think about what happened to the clinical commissioning group in North Staffordshire, which decided not to allow people with mild to moderate hearing loss to have hearing aids, even though that was clearly not the view of the local health scrutiny committees or local patients? Is that not precisely putting in jeopardy preventive services, which would keep people in work and keep them active in the community rather than being isolated? It is stopping those people from participating.

Dr Poulter: If the hon. Lady has concerns about local commissioning decisions, she should take them up with local commissioners. Time forbids me from going into the rationing of services by the previous Labour Government. It is important that clinical services are now designed and delivered by front-line health care professionals, and if she is concerned about them, I am sure she will take that up with her local CCG.

The right hon. Member for Leigh (Andy Burnham) referred to a work force crisis in GP training. It is clear that under this Government 1,000 more GPs are now in training and working in the NHS than in 2010 when we came into government. If it is not accepted that that is good start, we have committed to training an extra 5,000 because we want more people working in general practice.

We have ensured that 1.3 million more people are being treated in A and E compared with the number in 2009-10. We have halved the time that people must wait to be assessed, and every day we are treating nearly 2,000 more people within the four-hour target compared with the number in 2010.

Competition was introduced into the NHS not by the Health and Social Care Act 2012 but by the previous Labour Government, of whom the right hon. Member

15 Oct 2014 : Column 408

for Leigh was a Minister. The Labour Government opened the door to private sector providers when they opened the first independent sector treatment centres in 2003. The Labour Government gave £250 million to private companies and independent sector treatment centres, regardless of whether they delivered that care. Labour was more concerned about giving money to the private centres than about ensuring that quality care was delivered. Labour paid independent private sector providers 11% more to provide the same care as NHS providers. That is Labour’s record on the private sector in the NHS—a record that shows that it is more committed to the private sector than any previous Conservative Government.

Kevin Barron: If that is the case, will the Minister—as a Back Bencher, he sat on the Health Committee—tell us why there were so many clauses in the Bill that introduced the Competition Commission and the Office of Fair Trading into our national health service?

Dr Poulter: The right hon. Member will be aware that Labour’s legislation, which gave the private sector the opportunity to tender for contracts, saw 5% of NHS activity—I believe that figure is correct—provided by the private sector at the end of the last Labour Government. In the Health and Social Care Bill, we wanted to stop the unregulated approach. We wanted greater emphasis on integration of health care services. It was not just about the private sector provider fixing someone’s hip and forgetting what sort of care was available when their hip had been repaired and they had gone home. It was about ensuring greater emphasis not just on competition and what was best for patients, but on integrated and joined-up services to ensure that people were properly looked after when they left a treatment centre. We stopped the cherry-picking of services that happened under Labour, and we are proud of that.

We will take no lessons from the Labour party on NHS finances. Labour was the party that crippled the finances of so many NHS trusts with PFI deals, and it was the party that during its final year in government saw the number of managers rise six times as fast as the number of nurses.

I am proud of this Government’s record on the NHS and I am proud of our record on integration. There will be a clear choice at the general election next year: a Conservative-led Government who have delivered for patients, a Conservative-led Government who have delivered on cancer services and a cancer drugs fund, and a Conservative-led Government who will continue to ensure better care for people with long-term medical conditions. We have a proud record on the NHS and I urge my right hon. and hon. Friends to oppose the motion.

Question put.

The House divided:

Ayes 222, Noes 300.

Division No. 57]


6.59 pm


Abrahams, Debbie

Ainsworth, rh Mr Bob

Alexander, rh Mr Douglas

Alexander, Heidi

Ali, Rushanara

Allen, Mr Graham

Austin, Ian

Bailey, Mr Adrian

Bain, Mr William

Balls, rh Ed

Banks, Gordon

Barron, rh Kevin

Beckett, rh Margaret

Begg, Dame Anne

Benn, rh Hilary

Berger, Luciana

Betts, Mr Clive

Blackman-Woods, Roberta

Blears, rh Hazel

Blenkinsop, Tom

Blomfield, Paul

Bradshaw, rh Mr Ben

Brennan, Kevin

Brown, rh Mr Gordon

Brown, Lyn

Brown, rh Mr Nicholas

Brown, Mr Russell

Bryant, Chris

Buck, Ms Karen

Burden, Richard

Burnham, rh Andy

Byrne, rh Mr Liam

Campbell, rh Mr Alan

Campbell, Mr Ronnie

Caton, Martin

Champion, Sarah

Chapman, Jenny

Clarke, rh Mr Tom

Coaker, Vernon

Connarty, Michael

Cooper, Rosie

Cooper, rh Yvette

Crausby, Mr David

Creagh, Mary

Creasy, Stella

Cruddas, Jon

Cryer, John

Cunningham, Alex

Cunningham, Mr Jim

Cunningham, Sir Tony

Curran, Margaret

Danczuk, Simon

David, Wayne

Davies, Geraint

Denham, rh Mr John

Dobson, rh Frank

Docherty, Thomas

Donohoe, Mr Brian H.

Doran, Mr Frank

Dowd, Jim

Doyle, Gemma

Dromey, Jack

Dugher, Michael

Durkan, Mark

Eagle, Ms Angela

Eagle, Maria

Edwards, Jonathan

Efford, Clive

Elliott, Julie

Ellman, Mrs Louise

Engel, Natascha

Esterson, Bill

Evans, Chris

Farrelly, Paul

Field, rh Mr Frank

Fitzpatrick, Jim

Flello, Robert

Fovargue, Yvonne

Gapes, Mike

Gardiner, Barry

Gilmore, Sheila

Glass, Pat

Glindon, Mrs Mary

Godsiff, Mr Roger

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

Harman, rh Ms Harriet

Healey, rh John

Hendrick, Mark

Heyes, David

Hillier, Meg

Hilling, Julie

Hodge, rh Margaret

Hodgson, Mrs Sharon

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

Jowell, rh Dame Tessa

Kane, Mike

Kaufman, rh Sir Gerald

Keeley, Barbara

Kendall, Liz

Khan, rh Sadiq

Lazarowicz, Mark

Leslie, Chris

Lewell-Buck, Mrs Emma

Llwyd, rh Mr Elfyn

Long, Naomi

Love, Mr Andrew

Lucas, Ian

Mactaggart, Fiona

Mahmood, Mr Khalid

Mahmood, Shabana

Malhotra, Seema

Mann, John

Marsden, Mr Gordon

McCabe, Steve

McCann, Mr Michael

McCarthy, Kerry

McDonagh, Siobhain

McDonald, Andy

McFadden, rh Mr Pat

McGovern, Alison

McGovern, Jim

McGuire, rh Mrs Anne

McInnes, Liz

McKechin, Ann

McKenzie, Mr Iain

McKinnell, Catherine

Meacher, rh Mr Michael

Miliband, rh Edward

Miller, Andrew

Mitchell, Austin

Moon, Mrs Madeleine

Morden, Jessica

Morrice, Graeme


Murphy, rh Mr Jim

Murphy, rh Paul

Murray, Ian

Nandy, Lisa

Nash, Pamela

O'Donnell, Fiona

Onwurah, Chi

Osborne, Sandra

Owen, Albert

Paisley, Ian

Pearce, Teresa

Perkins, Toby

Phillipson, Bridget

Pound, Stephen

Powell, Lucy

Raynsford, rh Mr Nick

Reed, Mr Jamie

Reed, Mr Steve

Reeves, Rachel

Reynolds, Emma

Reynolds, Jonathan

Robinson, Mr Geoffrey

Rotheram, Steve

Roy, Mr Frank

Roy, Lindsay

Ruane, Chris

Ruddock, rh Dame Joan

Sawford, Andy

Seabeck, Alison

Shannon, Jim

Sharma, Mr Virendra

Sheerman, Mr Barry

Sheridan, Jim

Shuker, Gavin

Skinner, Mr Dennis

Slaughter, Mr Andy

Smith, Angela

Smith, Nick

Smith, Owen

Stringer, Graham

Stuart, Ms Gisela

Sutcliffe, Mr Gerry

Tami, Mark

Thomas, Mr Gareth

Thornberry, Emily

Timms, rh Stephen

Turner, Karl

Twigg, Derek

Twigg, Stephen

Umunna, Mr Chuka

Vaz, rh Keith

Vaz, Valerie

Walley, Joan

Watts, Mr Dave

Whitehead, Dr Alan

Williams, Hywel

Williamson, Chris

Wilson, Phil

Winnick, Mr David

Winterton, rh Ms Rosie

Wood, Mike

Woodcock, John

Woodward, rh Mr Shaun

Wright, David

Wright, Mr Iain

Tellers for the Ayes:

Nic Dakin


Stephen Doughty


Adams, Nigel

Afriyie, Adam

Amess, Mr David

Andrew, Stuart

Arbuthnot, rh Mr James

Bacon, Mr Richard

Baker, rh Norman

Baldry, rh Sir Tony

Barclay, Stephen

Barker, rh Gregory

Baron, Mr John

Barwell, Gavin

Bebb, Guto

Beith, rh Sir Alan

Bellingham, Mr Henry

Benyon, Richard

Beresford, Sir Paul

Bingham, Andrew

Binley, Mr Brian

Blackman, Bob

Blackwood, Nicola

Blunt, Crispin

Bone, Mr Peter

Bottomley, Sir Peter

Bradley, Karen

Brady, Mr Graham

Brake, rh Tom

Bray, Angie

Brazier, Mr Julian

Bridgen, Andrew

Brine, Steve

Brokenshire, James

Brooke, rh Annette

Browne, Mr Jeremy

Bruce, Fiona

Bruce, rh Sir Malcolm

Buckland, Mr Robert

Burns, Conor

Burns, rh Mr Simon

Burrowes, Mr David

Burstow, rh Paul

Burt, Lorely

Byles, Dan

Campbell, rh Sir Menzies

Carmichael, rh Mr Alistair

Carmichael, Neil

Cash, Sir William

Chishti, Rehman

Chope, Mr Christopher

Clappison, Mr James

Clark, rh Greg

Clarke, rh Mr Kenneth

Clegg, rh Mr Nick

Clifton-Brown, Geoffrey

Collins, Damian

Colvile, Oliver

Cox, Mr Geoffrey

Crabb, rh Stephen

Crockart, Mike

Crouch, Tracey

Davies, David T. C.


Davies, Glyn

Davies, Philip

Davis, rh Mr David

de Bois, Nick

Dinenage, Caroline

Djanogly, Mr Jonathan

Dorrell, rh Mr Stephen

Doyle-Price, Jackie

Drax, Richard

Duncan, rh Sir Alan

Duncan Smith, rh Mr Iain

Dunne, Mr Philip

Ellis, Michael

Ellison, Jane

Elphicke, Charlie

Eustice, George

Evans, Graham

Evans, Jonathan

Evans, Mr Nigel

Evennett, Mr David

Fabricant, Michael

Farron, Tim

Featherstone, rh Lynne

Field, Mark

Foster, rh Mr Don

Fox, rh Dr Liam

Francois, rh Mr Mark

Freeman, George

Freer, Mike

Fullbrook, Lorraine

Fuller, Richard

Gale, Sir Roger

Garnier, Sir Edward

Garnier, Mark

Gauke, Mr David

Gibb, Mr Nick

Gillan, rh Mrs Cheryl

Glen, John

Goodwill, Mr Robert

Gove, rh Michael

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

Hague, rh Mr William

Halfon, Robert

Hames, Duncan

Hammond, rh Mr Philip

Hammond, Stephen

Hancock, rh Matthew

Hancock, Mr Mike

Hands, rh Greg

Harper, Mr Mark

Harris, Rebecca

Hart, Simon

Harvey, Sir Nick

Haselhurst, rh Sir Alan

Hayes, rh Mr John

Heald, Sir Oliver

Heath, Mr David

Heaton-Harris, Chris

Hemming, John

Henderson, Gordon

Hendry, Charles

Herbert, rh Nick

Hinds, Damian

Hoban, Mr Mark

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

James, Margot

Jenkin, Mr Bernard

Jenrick, Robert

Johnson, Joseph

Jones, Andrew

Jones, rh Mr David

Jones, Mr Marcus

Kawczynski, Daniel

Kelly, Chris

Kirby, Simon

Knight, rh Sir Greg

Kwarteng, Kwasi

Lancaster, Mark

Lansley, rh Mr Andrew

Latham, Pauline

Laws, rh Mr David

Leadsom, Andrea

Lee, Dr Phillip

Leech, Mr John

Lefroy, Jeremy

Leigh, Sir Edward

Leslie, Charlotte

Letwin, rh Mr Oliver

Lewis, Brandon

Lewis, Dr Julian

Liddell-Grainger, Mr Ian

Lidington, rh Mr David

Lilley, rh Mr Peter

Lloyd, Stephen

Lopresti, Jack

Loughton, Tim

Luff, Sir Peter

Lumley, Karen

Macleod, Mary

Main, Mrs Anne

Maude, rh Mr Francis

Maynard, Paul

McCartney, Jason

McCartney, Karl

McIntosh, Miss Anne

McLoughlin, rh Mr Patrick

McPartland, Stephen

Menzies, Mark

Metcalfe, Stephen

Miller, rh Maria

Mills, Nigel

Milton, Anne

Mitchell, rh Mr Andrew

Moore, rh Michael

Mordaunt, Penny

Morgan, rh Nicky

Morris, Anne Marie

Morris, David

Morris, James

Mosley, Stephen

Mowat, David

Mulholland, Greg

Munt, Tessa

Murray, Sheryll

Murrison, Dr Andrew

Neill, Robert

Newton, Sarah

Nokes, Caroline

Norman, Jesse

Nuttall, Mr David

Offord, Dr Matthew

Ollerenshaw, Eric

Opperman, Guy

Ottaway, rh Sir Richard

Paice, rh Sir James

Parish, Neil

Patel, Priti

Pawsey, Mark

Penning, rh Mike

Penrose, John

Perry, Claire

Phillips, Stephen

Pickles, rh Mr Eric

Pincher, Christopher

Poulter, Dr Daniel

Prisk, Mr Mark

Pritchard, Mark

Raab, Mr Dominic

Randall, rh Sir John

Redwood, rh Mr John

Rees-Mogg, Jacob

Reid, Mr Alan

Robathan, rh Mr Andrew

Robertson, rh Sir Hugh

Robertson, Mr Laurence

Rosindell, Andrew

Ruffley, Mr David

Russell, Sir Bob

Rutley, David

Sandys, Laura

Scott, Mr Lee

Selous, Andrew

Sharma, Alok

Shelbrooke, Alec

Shepherd, Sir Richard

Simmonds, Mark

Simpson, Mr Keith

Skidmore, Chris

Smith, Chloe

Smith, Henry

Smith, Julian

Smith, Sir Robert

Soames, rh Sir Nicholas

Soubry, Anna

Spelman, rh Mrs Caroline

Spencer, Mr Mark

Stephenson, Andrew

Stevenson, John

Stewart, Bob

Stewart, Iain

Streeter, Mr Gary

Stride, Mel

Stuart, Mr Graham

Stunell, rh Sir Andrew

Sturdy, Julian

Swales, Ian

Swayne, rh Mr Desmond

Swinson, Jo

Swire, rh Mr Hugo

Syms, Mr Robert

Teather, Sarah

Thornton, Mike

Timpson, Mr Edward

Tomlinson, Justin

Tredinnick, David

Turner, Mr Andrew

Tyrie, Mr Andrew

Uppal, Paul

Vickers, Martin

Walker, Mr Charles

Walker, Mr Robin

Wallace, Mr Ben

Ward, Mr David

Watkinson, Dame Angela

Weatherley, Mike

Webb, rh Steve

Wharton, James

Wheeler, Heather

White, Chris

Whittaker, Craig

Whittingdale, Mr John

Wiggin, Bill

Willetts, rh Mr David

Williams, Mr Mark

Williams, Roger

Williamson, Gavin

Willott, Jenny

Wilson, Mr Rob

Wright, rh Jeremy

Wright, Simon

Yeo, Mr Tim

Young, rh Sir George

Tellers for the Noes:

Dr Thérèse Coffey


Harriett Baldwin

Question accordingly negatived.

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15 Oct 2014 : Column 410

15 Oct 2014 : Column 411

15 Oct 2014 : Column 412

Business without Debate

Delegated Legislation

Madam Deputy Speaker (Mrs Eleanor Laing): With the leave of the House, we shall take motions 3 and 4 together.

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


That the draft Copyright and Rights in Performances (Certain Permitted Uses of Orphan Works) Regulations 2014, which were laid before this House on 7 July, be approved.

That the draft Copyright and Rights in Performances (Licensing of Orphan Works) Regulations 2014, which were laid before this House on 7 July, be approved.—(John Penrose.)

Question agreed to.

15 Oct 2014 : Column 413

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

Constitutional Law

That the draft Scotland Act 1998 (Transfer of Functions to the Scottish Ministers etc.) Order 2014, which was laid before this House on 7 July, be approved.—(John Penrose.)

Question agreed to.

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Public Sector Executive Pay and Governance

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

7.16 pm

Mr David Amess (Southend West) (Con): The Economic Secretary to the Treasury and I are both Members of Parliament and politicians, and, as such, we are under no illusion as to how politicians are regarded. We are blamed when things go wrong and, from time to time, we are praised when things go right, and we make no apology for any of that. As Members of Parliament, we are paid £67,060, and the pay for the Prime Minister is £142,500. Some people would say that that is a lot of money, and it is compared with the pay of all sorts of people, but the Minister and I are judged by the electorate every five years. If they do not like us, they can get rid of us, and if they do not like our party, we may pay the price for that too, so we are constantly judged.

What I am increasingly angered by is the way public sector governance and executive pay are not working. I am sick to death of the relationship between chief executives and the chairmen of local authorities. There seems to be, in all sectors, a very cosy relationship, and there is no rigorous scrutiny whatever. The late Baroness Thatcher once famously stated:

“There is no such thing as public money; there is only taxpayers’ money.”

I called for this debate because there is, and has been under previous Governments, a huge problem with the ease with which taxpayers’ money is spent.

There are many hard-working people in the public sector, and I praise all of them, including those in the health service, the police and education, for doing a fantastic job under difficult circumstances. Thirty-one years ago, when I became a Member of Parliament, I did not think that I would be making this speech. I now think that the management of some public services is not up to scratch, and the salaries paid to the executive directors are in many cases absolutely outrageous and unjustifiable.

I have, of course, touched on this subject in previous debates, but I am sadly not sure that any action has been taken as a result of what I said. I have been looking very closely at how the management of my local public services function and to say that I have been unsatisfied with them would be an understatement. Of course, Madam Deputy Speaker, you are a fellow Essex Member and are proud to be so, and I am well aware that some of these organisations serve your constituency as well.

I have raised the issue of my local mental health trust, the South Essex Partnership University NHS Foundation Trust—or SEPT—my local hospital and probation services on many occasions in the House. Let me repeat once again that I will not let the matter drop when it comes to any of those services until I see a satisfactory and radical change of management.

This is not just about Essex and my constituency of Southend West. It is a nationwide issue. At 48.5% of our GDP, we have one of the highest public spending levels in the world. We spend more on public services than Germany, Japan, Canada, the USA, Brazil, Russia,

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Australia, Switzerland, South Africa or Singapore. Whereas I wholeheartedly support our hard-working medical staff and our wonderful police officers, taxpayers’ money could be managed much more efficiently and fairly.

Many aspects of our public expenditure need to be addressed. For instance, we contribute a net amount of €9.2 billion to the European Union—when the Prime Minister renegotiates things I know that that will be at the top of his agenda. We subsidise trade unions with the stunning amount of £113 million per annum, and lose 2.6% of total hours on sickness leave in the public sector, as opposed to just 1.6% in the private sector. However, I am going to concentrate more specifically on the problems that should be addressed in public sector governance and the salaries of public sector executives. When what I have to say is reported in Hansard, some of the individuals concerned will not like it.

My major concern about executive pay is not the amount of money directly paid to the director, but rather how in many cases it seems inversely proportional to the quality of service provided. We seem to be rewarding failure, which is absolutely and totally unacceptable. I have done some numerical comparisons of my own and the figures at which I have arrived are shocking. I attempted to compare the ratio of directors’ pay to the income from activities at various hospitals. For this reason, I compared my local NHS foundation trust’s management, with which I am very unhappy, and Salford Royal NHS Foundation Trust, which appears to provide exemplary service to patients and has displayed some excellent management.

It turns out that Salford hospital spends only 0.2% of its income from activities on directors’ pay, whereas SEPT spends 0.5% and Southend hospital 0.6% of their income from activities on directors’ pay. Let me reiterate: both SEPT and Southend hospital have management boards that are not suitable for their roles and yet they spend twice and three times as much respectively on rewarding their directors. That is absolutely unacceptable.

I want to provide some examples. The departing chief executive of Southend University Hospital NHS Foundation Trust—we do not know whether the individual has gone voluntarily or what has gone on, but we have been saddled with a huge amount of debt—took a pay rise of £20,000 in the last year. When I challenged the individual on that, because I had been told that it was £25,000, they said, “David, you’ve got it completely wrong. It’s £20,000.” That is absolutely ridiculous: a £20,000 pay increase, and the deputy took a £15,000 pay increase in the past year.

It gets worse. The commercial director at Southend university hospital trust, who is paid £112,500, took a pay rise of £40,000 last year. The former deputy chief executive, currently chief executive at SEPT, is on a salary of £167,500 plus £22,500 employers’ pension contribution. I know that my hon. Friend the Member for Colchester (Sir Bob Russell) is served by the same trust.

The former chief executive at SEPT—I have talked about the trust many times in the House—received a salary of £217,500. That is crazy. What on earth was the chairman of the board thinking? It gets worse, because they also received £32,500 in employers’ pension

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contributions. That is absolutely outrageous. While all that was going on, the then deputy got the job of chief executive.

The former executive director of strategy and business development at SEPT, who has a close relationship with the former chief executive—I believe that individual was hired in contempt of the non-fraternity policy and am following up the issue with Monitor—does a totally unnecessary middle-management job with a salary of £147,500 and £22,500 in employers’ pension contributions. Most shockingly of all, when that individual left SEPT—coincidentally with the chief executive—in October 2013, he received an exit package of £470,000. That is absolutely outrageous, and I will not shut up about it or allow a line to be drawn under the matter simply because it happened last year. I will keep going on about it until those responsible for this outrageous abuse of taxpayers’ money are held to account.

The executive chief finance officer at SEPT received a salary of £207,500 and £22,500 in employers’ pension contributions. It is marvellous that at the Liberal party conference we were guaranteed certain waiting times for mental health appointments and all that, but the reason I get so many complaints about mental health services from my constituents is the appalling mismanagement of SEPT.

The executive director of corporate affairs at SEPT, another unnecessary middle-management person—why the trust needs someone in that role, I do not know—received a salary of £132,500 and £17,500 in employers’ pension contributions. That is more or less the same as the Prime Minister. Whatever anyone thinks of the current or previous Prime Ministers, as far as I am concerned it is the toughest job in the public sector.

It is also outrageous that the chief executive of Essex county council receives a salary of £210,000 and total remuneration of £254,769—over £100,000 more than the Prime Minister. That is absolutely ridiculous and totally unacceptable. It is a matter that I think Essex county council should address pretty quickly.

The TaxPayers Alliance’s list of the highest-paid council employees ranks Essex as the place in England with the greatest number of council employees who earn more than £100,000—there are 30 such employees in Essex. That is crazy. Those officers might turn up to the House of Commons to brief us on an issue, yet they are earning a hell of a lot more than we are. The director-general of the BBC, which is publicly owned and, frankly, has not had a great record over the past years, is paid £450,000. That is absolutely ridiculous and totally unacceptable.

I am not going to name names, but Essex MPs were lobbied today by a number of individuals, and at one of those meetings three of those officials turned up, which I think was ridiculous, as one would have been quite sufficient. When I asked about their salaries, I found that one was on £140,000 and the other two were on £111,000. It is absolutely ridiculous. I have been in contact with the Royal College of Nursing, which is calling on all NHS senior managers to demonstrate the kind of pay restraint that nursing staff have been forced to accept in recent years.

I have identified a number of unnecessary jobs in the public sector, such as the overpaid “commercial director” position at Southend hospital and the “executive director

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of strategy and business development” at SEPT. However, this is just the tip of the iceberg, as lots of unnecessary, middle-management positions are created across the country in the public sector, and it is the taxpayer who pays for this arrogant self-indulgence.

The TaxPayers Alliance has tried to scrutinise public expenditure, and it has identified 1,129 unnecessary jobs in the NHS alone, costing £46 million. According to its report, taking the east of England as an example, there are 52 unnecessary public relations jobs in the NHS. Why we need to have all these public relations people, I do not know. If the organisation is doing such a marvellous job, I would have thought that the media would cover it in any case, and it would be self-evident. I should think it is more like having 52 apologists. There are also four unnecessary equality jobs, six green jobs, and three other unnecessary jobs.

Among other non-jobs in my constituency, the TaxPayers Alliance lists two “communications managers” and an “estate and environment manager” at SEPT, as well as an “equality and diversity manager” and “head of communications and engagement” at Southend hospital. I am sure we would agree that equality, diversity and the environment are all very important, but they should somehow be incorporated into the daily duties of the top management instead of creating a number of full-time, very well-paid managerial positions to deal specifically with such issues. This is all happening at a time when Southend hospital’s management is facing a £8.5 million deficit. How has this been allowed to happen? Where is the governance? It is absolutely outrageous. To make matters worse, Southend hospital is now hiring an external consultant and has the nerve to ask hospital staff for ideas on how the hospital should manage its own finances. That really is taking the mickey, frankly.

Governance in the public sector should be addressed. The general guidance provided to the public sector services—for instance, NHS trusts—is that boards of directors have responsibility for the quality of care and for the ongoing financial stability of their organisations. In NHS foundation trusts such as Southend hospital’s South Essex Partnership University NHS Foundation Trust—or SEPT—boards of directors are held to account by the council of governors, which is elected by the foundation trust’s membership of various stakeholders, including the local public, patients, carers and staff. The council of governors is led by the chairman. Whereas that form of governance appears reasonable in theory, in practice we encounter many problems on various levels in terms of whether the dog is wagging the tail or the other way round.

It is simply unbelievable that the chairman of SEPT remains in position—she has been there since 2008— having allowed a number of scandalous developments, which I have articulated this evening, to take place. Where was the governance there? It was under her leadership that the former chief executive appointed his partner to a very highly paid middle-management job, and under her leadership that the latter employee left with an exit package of nearly half a million pounds. If Monitor is worth anything, I want it to do something about it.

How it is possible that the chief executive of the former Essex probation service, currently Essex community rehabilitation company, is still in her position? I remember that 10 years ago the probation service was judged to be

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failing. She hung on to her job, and now she and the chap who had been chairman for two and a half years seem to be setting up another organisation, hoping to be one of the successful bidders.

I have serious concerns regarding chairmen’s independence from the chief executives, as illustrated by Southend hospital. The chair of the foundation trust is supposed to overlook the work of executive directors. In the case that I am concerned about, the individual seems impotent and unaware of what is happening at his hospital. Indeed, I was there with an Essex colleague who was meeting the hospital chairman for the first time and did not know who he was, even though he had been chairman for three years.

Problems and irregularities at the top management level are adversely affecting other members of staff. Morale was affected as a result of the £20,000 pay rise. Guidance was given that people paid more than £100,000 should receive no pay rise at all. At the same time, staff morale seems to be at an all-time low, as the management fails to retain and motivate the hard-working medical and non-medical staff.

It recently hit the headlines that the hospital faces a £8.5 million deficit, and it is justifiable to believe that a bulk of that sum is due to the fact that the hospital’s management fails to attract and hire permanent staff and instead relies heavily on agency staff. It is estimated that the hospital spent as much as £6.9 million in just five months on agency staff. There are a huge number of vacancies at the hospital. The situation is absolutely ridiculous. What is wrong with the recruitment?

The internal financial crisis at Southend hospital is serious, but it could have been avoided. Clear guidance needs to be provided to the public sector management to boost its knowledge of skilful management as well as its ethical approach to excessive pay.

The use of external consultants should be looked at very carefully. It is outrageous that Southend hospital has just hired an external consultant to look at its financial problems, despite already having a highly paid full-time director of finance. The services of the external consultant will come with a cost of hundreds of thousands of pounds to the taxpayer. If Southend hospital needs to resort to external financial advice, what is the point of having a full-time financial director?

I apologise to my hon. Friend the Economic Secretary for bombarding her with all these facts and figures, but she will realise that I am somewhat frustrated. This is not the first time that I have raised the matter in the House. I will end with what I said at the start: my hon. Friend and I are both politicians and we are blamed for most things, but I think we are being badly let down with regard to the matters under discussion. I know that I can rely on her to do her best to address those problems.

7.37 pm

The Economic Secretary to the Treasury (Andrea Leadsom): I sincerely congratulate my hon. Friend the Member for Southend West (Mr Amess) on securing this debate. He is clearly incredibly passionate about the subject and I agree with the quote he gave from Lady Thatcher at the start. In fact, I would add:

“The larger the slice taken by government, the smaller the cake available for everyone.”

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My hon. Friend is right to highlight the important point that at a time of austerity the Government need to be committed to taking as small a slice as we can for ourselves.

As a Government we do, of course, greatly value the very important work that senior managers and executives perform in the public sector. I am sure my hon. Friend will agree that the rewards we give them should reflect the work they do, not least because we need talented individuals in those jobs. However, I am very sympathetic to his cause. The examples that he has given of high pay will lead many, including me, to question the fairness of so many in just one county earning as much or more than our own Prime Minister, who I am sure nobody in this House or, indeed, the country would argue does not do an extremely demanding job.

Of course, we live in difficult economic times. There are few households in the country that have not been affected by the financial crisis. Government absolutely cannot be profligate when our citizens are having to make difficult spending decisions themselves.

My hon. Friend has raised a number of important points, including pay in the public sector and its link to performance, especially in the NHS, and the excessive use of middle-management jobs and consultants. I want to address each of those, but before I do so, I want to say that I am aware that my hon. Friend has raised with Monitor, the regulator for health services in England, a number of issues relating to the South Essex Partnership University NHS Foundation Trust. I assure him that I will make sure that what he has said today is passed on to the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) to review. This Government take allegations of abuse of the system extremely seriously, so we will make sure that these matters are examined and that we get an answer.

Public sector pay restraint is one of the many difficult choices we had to make to help to put the UK’s public finances back on track. Of course, we expect senior public sector managers and executives to lead by example. For the senior civil service, pay is set by the Government within nationally determined pay scales following recommendations from the independent Review Body on Senior Salaries. Like all public sector workers, senior civil servants have therefore been subject to pay restraint. Their pay was frozen in 2010-11, 2011-12 and 2012-13, and it was subject to increases of just 1% in 2013-14 and 2014-15. The number of senior civil service bonuses has also been reduced by two thirds, cutting the bill by £15 million.

For all Departments and public bodies where appointments are made by Ministers, any salary over the Prime Minister’s salary of £142,500 and any bonus arrangement over £17,500 must be approved by the Chief Secretary to the Treasury. Those measures have reduced the number of individuals earning more than £150,000 from 372 in 2010 to 243 now, which is a 35% reduction. That has been accompanied by greater transparency, as the Government have increased public scrutiny of senior salaries. For executive pay in the wider public sector, the Review Body on Senior Salaries makes recommendations on the pay of judges, very senior managers in the NHS, senior members of the armed forces, and police and crime commissioners.

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At this point, I will say a little more about NHS organisations. The position depends on whether such organisations are NHS or foundation trusts. NHS trusts are subject to supervision and performance management by the NHS Trust Development Authority, whose responsibilities include appointing chairmen and non-executive directors, agreeing their remuneration and influencing decisions on executive pay. Very senior managers in the Department of Health arm’s length bodies received no pay increase in 2014-15, and their pay will be frozen next year. NHS foundation trusts have greater autonomy over their affairs. They can make their own board appointments and determine their own pay, but they are expected to take full account of Treasury guidance, as well as the state of the trust and market pay for the role.

As part of its regulatory function, Monitor regularly assesses trusts’ governance and financial risk through its risk assessment framework. Where a foundation trust provides poor-quality care or fails to meet national waiting time requirements, it is likely to open an investigation into the trust. Specifically on pay, Monitor does not set executive or non-executive pay at foundation trusts—that is the role of the board remuneration committee—but it does have powers. For example, if it considers board remuneration to be excessive, the governors can remove the chair and/or the non-executive directors responsible. I understand that, to date, Monitor has yet to take serious action against any individual trust. I assure my hon. Friend that I will urge the health team to investigate exactly why that is, and that I will get an answer on that point.

Let me turn to the excessive use of middle-management jobs. Public service is an honourable activity—whether someone does it as a volunteer or a paid private sector employee, theirs is a high calling—but public service must at all times emphasise the service, not the bureaucracy, which means emphasising front-line staff, not the officials and managers. The Government have introduced significant reforms regarding the number of senior staff employed across the public sector and their pay. Since 2010, overall numbers of senior civil servants have been reduced by 13%, and the senior civil service pay bill has been reduced by 18.5%. Specifically, the NHS now has more than 7,400 fewer managers and more than 12,500 more clinicians than in 2010. All Members will be glad about that. The savings from administration costs arising from the reforms to the NHS from 2010-11 to 2014-15 are expected to free up at least £6.4 billion for patient care.

We have slashed the amount of money that is spent on central Government consultants from £1.2 billion in 2009-10 to £0.3 billion in 2013-14. At the same time, we have introduced a consultancy controls process, which ensures that any spend on a central Government consultant that exceeds £20,000 and lasts for longer than nine months is approved by the Minister for the Cabinet Office and the Chief Secretary to the Treasury. The amount of money that is spent on consultants in the NHS has also decreased during this Parliament from £636.9 million in 2009-10 to £584.7 million in 2013-14.

We are not complacent. I hope that I have illustrated to Members that we have taken enormous steps to improve the fiscal restraint among senior bodies. We have done what we can. The Government have in place effective controls over executive pay and governance. I hope that I have assured Members that we do not spend taxpayers’ money in an excessive or frivolous manner.

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Through our policies, we are ensuring that we protect taxpayers’ money, because we will never go back to the bad old days when money was no object.

Question put and agreed to.

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7.46 pm

House adjourned.