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House of Commons

Wednesday 7 January 2015

The House met at half-past Eleven o’clock

Prayers

[Mr Speaker in the Chair]

Oral Answers to Questions

Cabinet Office

The Minister for the Cabinet Office was asked—

London-based Civil Servants

1. John Pugh (Southport) (LD): What plans he has to reduce the number of London-based civil servants; and if he will make a statement. [906843]

The Minister for the Cabinet Office and Paymaster General (Mr Francis Maude): As part of our long-term economic plan to save taxpayers money and to pay off the deficit, this Government have reduced the size of the civil service like for like by 21%—that is after adjusting for machinery of government changes. That has increased productivity and saved the taxpayers £2.4 billion last year alone compared with spending in 2009-10. The reduction includes a substantial cut in the number of London-based civil servants.

John Pugh: I thank the Minister for his positive answer. Given the pace and scale of devolution in the UK, is there not more scope for merging and moving London-based Departments?

Mr Maude: There is a lot of scope for us to get out of properties that we do not need and we have done that already. We have released a huge amount of property into the private sector where it can be used for the purpose of creating jobs, and there is more that we can and will do in that respect.

Mr Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab): Does the right hon. Gentleman agree that an outstanding example of civil service dispersal is the Department for International Development in East Kilbride. As long as Scotland remains in the UK, which I believe it will for a very long time, can such an example be emulated?

Mr Maude: I completely share the right hon. Gentleman’s hope about the United Kingdom, and wish to add my thanks and congratulations to the civil servants at DFID who do such a fantastic job in Scotland. There is scope for civil servants to work in many places other than central London and we will continue to pursue that.

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Mr Bernard Jenkin (Harwich and North Essex) (Con): Although transferring civil servants to other locations and downsizing are necessary, do they not make the whole business of managing the personnel in the civil service much more difficult? Will my right hon. Friend give full backing to the new chief executive of the civil service to strengthen the data held by the Cabinet Office on the skills and capabilities among civil servants so that we do not disrupt the training and career paths of the people on whom we depend?

Mr Maude: As my hon. Friend well knows, the quality of data in central Government that we inherited was not good. It is getting better, but there is much more that needs to be done. The new chief executive of the civil service, who has got off to a terrific start, has a lot of experience in the management of big, complex dispersed organisations from his business background and I am sure that he will want to discuss that further with my hon. Friend.

Mr Barry Sheerman (Huddersfield) (Lab/Co-op): Is the Minister not aware that there is a great deal of disillusionment in the civil service? Is it not our job in this House to support really good people with the highest level of skills coming into the civil service so that they are happy and motivated in their job? What will he do about morale in the civil service?

Mr Maude: I agree with the hon. Gentleman about the need to support the development and skills of civil servants and to provide them with rewarding jobs. Obviously, the purpose of the civil service is not to provide jobs but to serve the public. I am happy to tell him that morale in the civil service, as measured in the annual people survey, has held up very well—it has certainly not fallen since the last year that his Government were in office—despite the very considerable demands made on it and the downsizing to which I have referred.

Sir Alan Beith (Berwick-upon-Tweed) (LD): Jobs are lost from rural communities under the shared services project, as has happened at Alnwick. Can we have a more determined cross-Government effort to relocate out of London work, such as archives, that could be done in rural communities?

Mr Maude: The right hon. Gentleman and I have discussed that in the Chamber before, and I completely understand his concern, particularly about the shared service staff in Alnwick. The machinery is not always as simple as it might be, but there is more that we can and should do to ensure that jobs are located in places where they can be undertaken efficiently and effectively with good results for the taxpayer and the citizen.

Miners Dispute (Outstanding Documents)

2. Ian Lavery (Wansbeck) (Lab): What progress his Department has made on releasing outstanding documents relating to the miners dispute in 1984-85. [906844]

The Minister for the Cabinet Office and Paymaster General (Mr Francis Maude): The documents, other than sensitive or personal papers, were released in the usual way under the law that was passed by the previous Government.

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Ian Lavery: What have this Government got to hide with regard to the miners strike, because only 30 out of 500 digitised documents relating to the strike were released last week? There was no mention of Orgreave, but there was an admission that the Government tapped National Union of Mineworkers members’ phones. When will the documents that have not been released be released, and will they be released unredacted?

Mr Maude: I really have nothing to add to what I have already said and what has been said on previous occasions. The same considerations were applied to these papers as apply to the release of Government papers generally, which means that those that are personal or sensitive are not released in the normal time scales. I know that there are very strong feelings about this. I was a Member of Parliament for a coal mining constituency during the mining strike, and the mining community was deeply divided during that period. I am well aware of the sensitivities of that period.

Jonathan Evans (Cardiff North) (Con): Will my right hon. Friend note that the appetite for everything to be disclosed is shared by some Government Members, most particularly because I can recall the unlawful killing of the taxi driver David Wilkie and the recent revelations from the former right hon. Member for Pontypridd that following the event a number of papers at the NUM offices in south Wales were deliberately burnt and destroyed?

Mr Maude: My hon. Friend makes a powerful point. I am a strong supporter of transparency and am proud of what this Government have done to make us the most transparent Government in the world. There is a concern, and that was a very bitter period in our nation’s life, but the normal considerations about the protection of personal papers must be followed in this case as in others.

Mr Dennis Skinner (Bolsover) (Lab): Is not the whole subject of these papers embarrassing to the Government and to the Minister? At the beginning we argued that 75 pits were to be closed, and the Thatcher Government said at the time that there were only 20. They lied continually in the House of Commons, repeating that figure, and then the Cabinet papers revealed that it was 75 after all and that the miners had been right. He is embarrassed to reveal other papers simply because that Government decided to attack the NUM and Britain’s manufacturing base, and that has been carried on by the Tories ever since.

Mr Maude: I think that the hon. Gentleman’s case would be stronger if at that time he had made the case for the National Union of Mineworkers to have a proper ballot of all its members so that they could decide whether they wanted to be brought out on strike, rather than being bullied and intimidated into it.

Ann Clwyd (Cynon Valley) (Lab): I was elected in the middle of the miners strike in 1984 and know exactly what happened: we were lied to by those in authority. They said that our pit, Tower colliery, was uneconomic. We kept it going because the miners put their own money into it for another 10 years. There are lots of things that have not yet been revealed publicly, and I think that it is high time the truth came out.

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Mr Maude: As I say, the papers have been released, subject to the normal considerations about protecting sensitive and personal documents. Again, I do not recollect—the right hon. Lady and I were elected on the same day and were Back-Bench Members of Parliament during that period—hearing her voice being raised to support a proper ballot of mineworkers on whether they wanted to go on strike at all.

Mr Jim Hood (Lanark and Hamilton East) (Lab): Why have not all the papers and memos between the Home Secretary, Leon Brittan, and the chief constables and magistrates courts been published?

Mr Maude: I can only repeat what I have said already: the papers have been released, subject to the normal considerations about protecting sensitive and personal documents, with the same considerations that are applied to all Government papers.

Big Society Network/Society Network Foundation (NAO Report)

3. Paul Blomfield (Sheffield Central) (Lab): What assessment he has made of the implications for his Department’s policies of the findings of the report from the National Audit Office entitled “Follow-up: grants to the Big Society Network and the Society Network Foundation”, HC 840. [906845]

The Minister for Civil Society (Mr Rob Wilson): I welcome the NAO report into the matter, which found that there were no issues with Cabinet Office processes and, as a result, did not make any recommendations. Therefore, I do not feel that there are any wider implications for the policies of my Department.

Paul Blomfield: The Minister clearly must have read a different version of the report. Voluntary sector organisations in my constituency tell me that they are struggling to maintain vital services for the most vulnerable as a result of this Government’s polices, yet the NAO report shows that millions of pounds of public money was wasted on failing projects as a direct result of prime ministerial interference and ministerial decisions taken despite

“concerns raised about financial sustainability and weak performance”.

Is not that truly shocking? When other charities are struggling to survive, how does the Minister justify it?

Mr Wilson: I simply disagree with the hon. Gentleman. I disagree that we should avoid funding new and innovative approaches, despite the risks that come with doing so. I note that according to the Charity Commission, the number of registered charities went up from 162,000 to 164,000 between 2010 and 2014, and the total income of all registered charities has grown from £54 billion to £64 billion in the same period.

Sir Tony Baldry (Banbury) (Con): One of the lessons for us all to learn is the transformative potential of social enterprises encouraged by the Treasury—social enterprises such as the Cinnamon Network, which does

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everything from running food banks to helping people when they are released from prison. Social enterprises have the potential to make a real change in our society.

Mr Wilson: My right hon. Friend is exactly right. Supporting social enterprises has been a huge priority for this Government, which is why in the autumn statement the Chancellor of the Exchequer increased social investment tax relief, raising the cap to £5 million. We are the party of small business, but we are also the party of social enterprises.

Lisa Nandy (Wigan) (Lab): Will the Minister explain why his Department, which is supposed to be responsible for Government transparency, has refused to release any minutes or attendance lists of meetings between his advisers, the Big Society Network and the Society Network Foundation, and why over six months he has refused to answer 76 parliamentary questions on the subject? Some £3 million were wasted, there were two damning reports from the National Audit Office, thousands of charities are in crisis, and the only beneficiary from the big society has been a Tory donor’s bank account. Is it any wonder that the Minister does not want to answer questions about it?

Mr Wilson: As the hon. Lady knows, it has long been the convention in this and previous Administrations that the minutes of ministerial meetings are not routinely released, but all the information pertinent to this issue was shared with the NAO in the course of its investigations. As for the Tory party donors that she mentioned, it is not the case that any of the trustees gained financially from the Cabinet Office funding. The matter has been investigated by the Charities Commission and the NAO twice, and which both found no evidence of what she suggests. Furthermore, the trustees of the charities have invested significant personal resources into them.

Trade Union Facility Time

4. Mr Andrew Robathan (South Leicestershire) (Con): What assessment he has made of the use of trade union facility time by civil servants; and if he will make a statement. [906846]

The Minister for the Cabinet Office and Paymaster General (Mr Francis Maude): At the time of the last general election there was no proper monitoring of trade union facility time in government. We now have controls in place that have saved taxpayers £25 million in the last rolling year to date, and have reduced the number of taxpayer-funded full-time union officials in central Government from 200 in May 2010 to fewer than 10 now.

Mr Robathan: I am sure everybody in the House believes that employees in whatever sector should be given both the right and the opportunity to be properly represented with their employers, be it by trades unions or others, but the majority of my constituents and, I suspect, the majority of people in this country would still be quite shocked and unhappy to discover that we are still funding public servants, who should be working for the public service, to support trade union activity that has nothing whatever to do with what they are paid

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for. Will my right hon. Friend bear down on the remaining members given facility time in the public service?

Mr Maude: As I say, the amount of facility time has been reduced significantly. There is a perfectly proper use of facility time for trade union duties in resolving grievances and dealing with disputes locally and effectively, and we support that, but there was also a huge amount of unmonitored and out-of-control, paid-for activity supporting trade unions, including in many cases paying for civil servants to attend seaside conferences of trade unions at the taxpayers’ expense, and that seemed to us to be wrong.

Mr David Anderson (Blaydon) (Lab): When he carried out an assessment, did the Minister consider speaking to Opposition Members who have experience of being employed under facility time arrangements, where we spent the vast majority of our time helping management to manage the service we were working in, particularly when management was faced with cuts, redundancies and redeployment forced on it by central Government?

Mr Maude: I absolutely agree with the hon. Gentleman that the proper use of a trade union presence and the use of facility time on trade union duties, as defined by law, can be very beneficial, and we support it, but what was going on went way, way beyond that. It was completely out of control, and it was quite right that we should bear down on it by first monitoring it and then reducing it. We have now reduced the amount of money spent on it to less than 0.1% of the pay bill in the civil service, and that was quite right.

National Citizen Service (Colne Valley)

5. Jason McCartney (Colne Valley) (Con): What future plans he has for the National Citizen Service in Colne Valley. [906847]

The Minister for Civil Society (Mr Rob Wilson): Next year will again see NCS programmes taking place in every local authority across England. I know that my hon. Friend has seen at first hand the transformative effect that the NCS has had on participants in and around Colne Valley, where about 500 young people took part in it last year. The NCS will continue to grow this year, and I urge all MPs to visit a programme near them.

Jason McCartney: As the Minister said, I saw at first hand the benefits of the NCS when last year I attended a tea party with Moor End academy students at Astley Grange nursing and care home that brought together many different generations and people from different ethnic backgrounds. Does he agree that the NCS has also been very effective in promoting community cohesion?

Mr Wilson: Yes. Independent evaluations of the NCS have shown that participants feel more positive about people from different backgrounds and have a greater sense of responsibility to their community. The last evaluation also demonstrated that parents believed their children had a better understanding of their local community after taking part.

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Mr Gregory Campbell (East Londonderry) (DUP): Will the Minister agree to hold discussions with relevant Ministers in Scotland, Wales and Northern Ireland to see whether there would be an appetite for extending the National Citizen Service there?

Mr Wilson: Of course we would welcome discussions. This is a devolved matter and it will be for local devolved Assemblies to make a decision on it. We are already pursuing increased numbers in Wales and having discussions there, so further discussions with other countries, including Scotland, would be welcome.

Digitising Government Services

6. Stephen Metcalfe (South Basildon and East Thurrock) (Con): What future plans he has to achieve efficiency and reform savings by digitising Government services. [906849]

The Minister for the Cabinet Office and Paymaster General (Mr Francis Maude): As part of our long-term economic plan, we are moving a first wave of 25 public services online. Our future plans are to secure further savings by digitising more public services and moving to a “Government as a platform” model, building common digital infrastructure for services that improves the user experience and saves money by building common services only once.

Stephen Metcalfe: How are the Government working with the private sector and voluntary sector in Thurrock and Basildon to ensure that my constituents have the relevant training to be able to access these services?

Mr Maude: Britain already has a high level of digital inclusion, and it is rising, but we are determined to go further and get more people online. We are working closely with almost 70 organisations from the private and voluntary sectors that are signed up to our digital inclusion charter. I have no details of exactly what is going on in my hon. Friend’s constituency, but I would happily share them with him.

Chi Onwurah (Newcastle upon Tyne Central) (Lab): Digitising public services creates vast amounts of data that can be used further to improve services and accountability, transforming the relationship between citizens and Government—a subject dear to your heart, Mr Speaker. However, each Government Department has a different approach to handling data, and there is total chaos among officials and Ministers about what is allowed, with, consequently, deep distrust among the public. In government, we will instigate a review to set out a coherent and ethical approach to data sharing. Will the Minister join us in committing to the principle that people own their own data and it is for them to say what happens to it?

Mr Maude: I am happy to welcome the hon. Lady to the movement for open data. Under the coalition, the UK Government have become the world leader in open data. There is more that can be done with sharing data, but it is very sensitive and difficult. We are determined not to make the mistake that her party made in government when it had a train wreck in trying to move data sharing too fast. We have a lot of ongoing work on this, and I would be very happy to share the thinking with her.

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Topical Questions

T1. [906798] Douglas Carswell (Clacton) (UKIP): If he will make a statement on his departmental responsibilities.

The Minister for the Cabinet Office and Paymaster General (Mr Francis Maude): My responsibilities are for efficiency and reform, civil service issues, public sector industrial relations strategy, Government transparency, civil contingencies, civil society and cyber-security.

Douglas Carswell: The Minister for the Cabinet Office stated in October 2010 that public bodies would be made more meaningfully accountable. Specifically, what new mechanisms has he put in place to make public bodies more meaningfully accountable to this House and, indeed, to the public?

Mr Maude: Our concern with public body reform has always been to ensure that accountability is improved. A number of functions have been brought within Government to make them directly accountable to this House through Ministers. A number of other activities have been discontinued completely. The number of public bodies has been reduced by about a third. When we came into office, there were no data about the actual number of public bodies. In addition to increasing accountability, we have also saved the taxpayer very considerable amounts of money.

T3. [906800] Julian Smith (Skipton and Ripon) (Con): Given the recent cyber-attacks on the United States, what strategies are the Department and the Government putting in place to protect Britain and Britain’s corporations from cyber-terrorism?

Mr Maude: This is a very real and live concern. Our cyber-security strategy—I reported to the House on its third year of operation in the last month of the year—has been backed with £860 million of new money. We take this very seriously, but much more will need to be done because the threats are moving on very quickly, as well as the need for the defences.

Lucy Powell (Manchester Central) (Lab/Co-op): In February 2010, when he was shadow Minister for the Cabinet Office, the right hon. Gentleman wrote to the Cabinet Secretary to complain that in asking Treasury officials to cost Conservative party policy, Labour had

“compromised the impartiality of the Civil Service and used the taxpayer funded service for political attacks.”

What discussions has he had with the Chancellor about special advisers using civil servants to propagate political smears and fiction this week, and has he redrafted his letter to the Cabinet Secretary?

Mr Maude: I am confident that the permanent secretary to the Treasury, who was the permanent secretary to the Treasury at that time, has followed exactly the same practice as he would have done then.

T4. [906801] Tim Loughton (East Worthing and Shoreham) (Con): Does my hon. Friend agree with Lord Winston that Labour’s mansion tax would have a devastating impact on the ability of charities to raise money from legacy giving?

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The Minister for Civil Society (Mr Rob Wilson): Yes, I do. This real concern is shared by many in the sector. Most notably, the Wellcome Trust has voiced fears of the impact it would have on legacy giving. The National Council for Voluntary Organisations reckons that 10,000 charities get legacies each year, to a value of about £2 billion. Lord Winston, who is a widely respected Labour peer, has been joined by Charles Clarke, the former Labour Home Secretary. As they have both added their voices, I hope that the shadow Chancellor will rethink this wrong-headed policy.

T2. [906799] Kelvin Hopkins (Luton North) (Lab): Earlier in this Parliament, Ministers flirted with the possibility of a politicised senior civil service. That danger seems to have receded, but will the Minister now reaffirm a Government commitment to the historic principle of political impartiality in the civil service, specifically in matters relating to the European Union?

Mr Maude: I did not catch much of what the hon. Gentleman said, but I will happily look at the transcript and come back to him with a detailed reply.

Mr Speaker: That is a commentary on the amount of noise. Let us have a bit of order for Mr Adam Holloway.

T5. [906802] Mr Adam Holloway (Gravesham) (Con): Will the Minister update us on the timing of the publication of the Chilcot report?

Mr Maude: I cannot really add to what Sir John Chilcot has said. That independent inquiry is under the control of the inquiry members. I can say that we have responded to every request for extra resources; none has been turned down. I would just add that if the previous Government had launched the inquiry at the time it was requested, it could have been finished and could have reported long ago.

T8. [906805] Kerry McCarthy (Bristol East) (Lab): In the debate on food banks just before Christmas, the Minister for Civil Society kept saying that the reasons for food bank use were complex and overlapping. He would not go beyond that. Will he join me in condemning the Tory councillor who said that the only people who use food banks are those with drug, alcohol and mental health problems, and will he acknowledge that the top two reasons for food bank use are due to the failings of this Government’s welfare system?

Mr Rob Wilson: I think the thing to say about food banks is that I and Government Members commend Britain’s very strong tradition of volunteering and community action, which sees people coming together to support those in need. Food banks are just one example that I come across on a daily basis.

Prime Minister

The Prime Minister was asked—

Engagements

Q1. [906768] Martin Horwood (Cheltenham) (LD): If he will list his official engagements for Wednesday 7 January.

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The Prime Minister (Mr David Cameron): I am sure the whole House will want to join me in condemning the barbaric attack this morning on an office of a magazine in Paris, in which it is reported that 10 or more people may have been killed. While details are still unclear, I know that this House and this country stand united with the French people in our opposition to all forms of terrorism, and we stand squarely for free speech and democracy. These people will never be able to take us off those values.

This morning I had meetings with ministerial colleagues and others, and in addition to my duties in this House I shall have further such meetings later today.

Martin Horwood: I saw the problems at Gloucestershire hospitals last week at first hand after an elderly relative phoned 111 and we ended up waiting more than four hours for her to see a doctor in Cheltenham A and E. Then she was promptly discharged. The local trust seems to be blaming patients for making bad choices, but will the Prime Minister find out why so many 111 calls end in A and E, why trusts such as ours route so many unplanned admissions through A and E and why emergency doctors cannot be provided at night in Cheltenham, all of which seems calculated to make normal winter pressures worse?

The Prime Minister: My hon. Friend makes an important point. In the last quarter, the NHS has faced some unprecedented challenges. There have been more than 5.5 million people going to accident and emergency units, which is an increase of a quarter of a million on the previous year. Gloucestershire has had £3.6 million of the £700 million of winter pressure money that we have produced, and it should use that money to make sure it provides the best possible service it can.

On the NHS 111 service, it is important to see what is actually happening. The number of people using it has almost doubled over the last year. Of those who use it, 27% say that had it not been there, they would have gone to accident and emergency, but in the event of using 111 only 7% are going. So I think it is a good service, but I am sure it can be further improved.

Recognising the pressure on the NHS, I am sure everyone in this House will want to say a thank you to our hard-working doctors and nurses and other hospital staff for all the work they do this winter.

Edward Miliband (Doncaster North) (Lab): I join the Prime Minister in expressing horror and outrage about the unfolding events in Paris. We stand in solidarity with the people of France against this evil terrorist attack by people intent on attacking our democratic way of life and freedom of speech. We are united in our determination to defeat them.

Doctors, nurses and other NHS staff are doing a valiant job, but over 90,000 people in the last quarter waited on trolleys for more than four hours, at least 10 hospitals have declared major incident status in recent days, and one had to resort to Twitter to appeal for medical staff. Does the Prime Minister agree with me that our NHS is facing a crisis?

The Prime Minister: Our NHS is facing huge pressure this winter, particularly on its A and E units, but the point that it is important to make is this: the NHS is

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facing this winter with more doctors, more nurses and more money than it has ever had in its history. What is important is that we recognise the pressures that are there and put in place plans for the short term, the medium term and the long term, and that with the massive increase in the number of people going to A and E, any health system in the world would struggle to cope with some of this pressure.

Edward Miliband: In June 2011, this was the Prime Minister’s solemn promise:

“I refuse to go back to the days when people had to wait for hours on end to be seen in A&E…So let me be absolutely clear: we won’t.”

Will he now apologise to patients across the country for having broken that promise?

The Prime Minister: I deeply regret it when any patient does not get a good service, but let us be absolutely clear about the numbers of people accessing A and E. Today, compared with four years ago, over 2,500 more patients are seen within four years—within four hours compared with four years ago. That is what is happening. We knew there was pressure on our NHS, and that is why, over the last year, we have seen 1,800 more doctors in our hospitals, 4,700 more nurses in our hospitals and 2,500 more beds in our hospitals. There is more that we need to do, but let us recognise that the health service in every part of our United Kingdom faces these challenges. We must go on giving it the money, the resources and the people so that it goes on providing a great service.

Edward Miliband: As far as I can see, the Prime Minister is not apologising to patients; he is blaming the patients. The pressures on A and E are not just happening on his watch, but are a direct result of decisions he has taken. When he decided to close almost a quarter of walk-in centres, was it not blindingly obvious that if people could not go to a walk-in centre, it would have a big impact on A and E?

The Prime Minister: We have 1,000 more doctors in A and E, and we are spending £13 billion more on the NHS, when four years ago the shadow Health Secretary said that it would be irresponsible to spend more money. What is interesting is that here we are, question No. 3 on the NHS, and the Leader of the Opposition has no solutions to put forward. That only says to me that while the Government are interested in improving the NHS, he simply wants to use it as a political football.

Edward Miliband: This is about politics—it is the Prime Minister’s politics, and they have failed. No answer on walk-in centres, so let us try him on another decision he has made that has been a cause of the crisis. When he decided to reduce the availability of social care services, so that 300,000 fewer older people are getting the help they need, was it not blindingly obvious that if people could not get the care they needed at home, it would have a big impact on A and E?

The Prime Minister: Again, absolutely no solutions—presumably, if the right hon. Gentleman had any solutions, he would have implemented them in Wales. He raises the importance of social care, and I agree. That is why from 1 April we are putting £5 billion more into social

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care via the better care fund. Up until now, the Labour party has told us not to introduce the better care fund. I assume that it now supports that important investment.

Edward Miliband: There is one very simple solution: get rid of this useless Prime Minister. No answer on care for the elderly, so let us consider the next thing he did. When he decided to ignore the pleas of doctors, nurses and patients, and plough ahead with his damaging top-down reorganisation, was it not blindingly obvious that if £3 billion is diverted out of patient care, it will have a big impact on A and E?

The Prime Minister: Our changes have cut bureaucracy and saved £4.9 billion. That is why there are 9,000 more doctors, 3,000 more nurses, and 6 million more people getting in-patient appointments—[Interruption.]

Mr Speaker: Order. There is too much noise in the Chamber from both sides of the House. The Prime Minister’s answers must be heard.

The Prime Minister: You can see this as plain as you like: the Leader of the Opposition apparently said to the political editor of the BBC, “I want to weaponise the NHS.” That is what he said, and I think that is disgraceful. The NHS is not a weapon, it is a way we care for our families, it is a way we care for the elderly, it is a way we look after the frail. Perhaps when he gets to his feet he will deny that he said he wanted to “weaponise” the NHS—a disgusting thing to say.

Edward Miliband: I will tell the Prime Minister what is disgusting—[Interruption.]

Mr Speaker: Order. I said a moment ago that the Prime Minister’s answers must be heard. The Leader of the Opposition’s questions must be heard as well. It is very simple.

Edward Miliband: I will tell him what is disgusting—a Prime Minister who said that people could put their trust in him on the NHS. He has betrayed that trust. He is in denial about the crisis in the NHS. This is a crisis on his watch as a result of his decisions. That is why people know that if they want to get rid of the crisis in the NHS, they have to get rid of this Prime Minister.

The Prime Minister: If ever we wanted proof that they want to use this issue as a political football, we have just seen it. If Labour has an answer to the NHS, can it explain why it cut the budget in Wales by 8%? That is where Labour is in charge. All parts of the United Kingdom face a health challenge, but the real risk to the NHS is the risk of unfunded spending commitments bringing chaos to our economy, which would wreck our NHS. That is the risk and that is why the choice at the election will be to stick with the people with a long-term plan, not a Labour party that would wreck our economy and wreck our NHS.

Q2. [906769] Mr Lee Scott (Ilford North) (Con): Does the Prime Minister agree with my constituent, who contacted me at the weekend asking to join us, who said that the only people fit to run our economy are the

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Prime Minister and the Chancellor? The surprise was that the gentleman was the ex-chairman of Ilford North Labour party.

The Prime Minister: I am sure that that is the first of 4 million conversations my hon. Friend will be having at the coming election. It sounds like this one is going quite well. There is an important point here: there is no strong NHS without a strong economy. With our economy, we can see the deficit cut in half, 1.75 million more people in work and the fastest growth of any major economy in the west. That is the record, and that is what will enable us to fund our NHS, to fund our schools and to provide the public services our country needs.

Q3. [906770] Mr Jamie Reed (Copeland) (Lab): With patients being told to pretend that they are camping, the symbol of the Prime Minister’s NHS is of patients being treated in tents outside accident and emergency. When he promised a bare-knuckle fight against accident and emergency service closures, did he intend to mislead the electorate?

The Prime Minister: All our health services right across the United Kingdom face a challenge. Actually, the English NHS that I am responsible for is performing better than the Welsh NHS, the Scottish NHS and the NHS in Northern Ireland, but the facts are these: compared with four years ago there are 2,500 more people every day seeing a doctor or a nurse within four hours. Why is that happening? Because we put the money in; and when we put the money in, the shadow Health Secretary said it was irresponsible. Presumably that is why Labour cut the NHS in Wales.

Mr Speaker: I call Sir David Amess.

Hon. Members: Hear, hear.

Sir David Amess (Southend West) (Con): I thank the House for that reception, which more than compensates for my having been made neither a duke nor an earl.

Later today, the second edition of the booklet, “The Party of Opportunity” will be launched. Does my right hon. Friend agree with what the former Conservative Prime Minister, Sir John Major, has written in the booklet, which is that national wealth eases poverty, pays for social care and creates jobs? That is exactly what this Conservative-led Government have been doing.

The Prime Minister: My hon. Friend is absolutely right. The first duty of a Government is to produce a stable, strong and growing economy that can fund the defence and the public services we need. On this side of the House, we understand that. On the Opposition Benches, they have learnt absolutely nothing in the past four years. They would borrow and spend and tax, and put us back exactly in the position of crisis and chaos in which we found the country in 2010.

Q4. [906771] John Robertson (Glasgow North West) (Lab): The one thing that was clear about the referendum in Scotland was the amount of young people getting involved, not just in voting but getting out there campaigning and being part of it. Is it not time that we got the rest of the country on board and got votes for 16 and 17-year-olds?

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The Prime Minister: The referendum campaign in Scotland did switch a whole lot of people on to politics and political issues, because the question being asked was so important. We have said that we should respect the views of the Scottish Parliament and the Welsh Parliament, and we will devolve powers on voting age. In this House, I am very happy for us to have a vote. Personally, I think the right age is 18, but I am very happy to listen to the debate, to listen to the arguments and to put them forward.

Michael Moore (Berwickshire, Roxburgh and Selkirk) (LD): For more than 50 years, thalidomiders have been campaigning for justice, particularly from the German manufacturers Grünenthal. Now that more than 150 MPs have signed an open letter to the German Chancellor, would the Prime Minister add this to his busy agenda today so that we might get a decent and fair settlement for all concerned?

The Prime Minister: I have raised this issue on behalf of a constituent, not only through the European Parliament but with the German authorities, and I shall certainly reflect on what the right hon. Gentleman says.

Q5. [906772] Anas Sarwar (Glasgow Central) (Lab): The price of oil has now fallen to $50 a barrel. While this is good news for motorists, it is bad news for Scotland’s oil industry and thousands of workers. It comes just weeks after Nicola Sturgeon said we were on the verge of a second oil boom and after the independence White Paper said the price would be $113 a barrel. This is a serious issue—jobs depend on it—so will the Prime Minister agree to meet my right hon. Friend the Member for East Renfrewshire (Mr Murphy), a cross-party delegation, industry leaders and workers to see what support can be provided?

The Prime Minister: I absolutely agree with the hon. Gentleman on all three grounds. First, North sea oil is a vital industry for the UK and one of the biggest investors in our country, so we should do everything we can to help it. Secondly, and for that reason, we took steps in the autumn statement to improve the taxation regime for North sea oil. Thirdly, as we said during the referendum campaign, it makes the case that North sea oil is better off with the broad shoulders of the UK standing behind it, because we never know when the oil price is going to be more than $100 a barrel or, as it is today, around $50. It makes the case for the strength of the UK and the utterly misguided nature of the SNP, which thought it could base its entire budget on such a high oil price.

Q6. [906773] Henry Smith (Crawley) (Con): The latest Office for National Statistics figures show that youth unemployment in Crawley is at its lowest level since records began, but of course we need to do a lot more. What further policies are the Government pursuing to ensure that businesses in Crawley and across the country generate even more employment as part of our long-term economic plan?

The Prime Minister: I am delighted to agree with my hon. Friend. The youth claimant count in Crawley has fallen by 42% in the last year alone, and the long-term youth claimant count—long-term young unemployed

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people—is down by 71%. He asks what more we can do. We are cutting the jobs tax on small businesses and charities by £2,000; we are abolishing national insurance contributions for those who employ under-21s; we are extending the doubling of small business rate relief; we have cut corporation tax, including for small firms; and start-up loans are being offered right around the country, including to those in Crawley, who are taking them up. This Government can claim to be the most friendly to start-ups, entrepreneurs and small businesses this country has ever seen.

Q7. [906774] Mr Virendra Sharma (Ealing, Southall) (Lab): Throughout the Christmas period, NHS staff worked tirelessly to see as many patients as they could, but increased waiting times at GP surgeries have forced more and more people to use A and E. Why does the Prime Minister not accept that Labour’s plan to employ 8,000 additional GPs is desperately needed and would make a real difference to the lives of my constituents?

The Prime Minister: From what I have read over the past 24 hours, Labour’s plan is to tax people in London and spend all the money in Scotland. I look forward to hearing how he explains that to his constituents in Ealing. There is a serious point to the hon. Gentleman’s question. The health service has changed in Ealing: Hammersmith and Central Middlesex hospitals both have GP-led urgent care centres that are open 24 hours a day and are seeing more than 400 patients a day, 99% of whom are seen within four hours; and we also have the expansion of the A and E unit at Northwick Park hospital. We need to ensure that the 111 service is helping to spread the information so that people who need care know where they can best get it.

Q8. [906775] Martin Vickers (Cleethorpes) (Con): The Government have repeatedly highlighted the importance of northern Lincolnshire and the wider Humber area to the offshore renewables sector. Does my right hon. Friend agree that the recent announcement of the establishment of a national college for wind energy, a university technical college in Scunthorpe and further expansion of existing local training facilities cement the opportunities for local people to benefit from the industry, boost the local economy and highlight the importance of northern Lincolnshire to the northern powerhouse?

The Prime Minister: My hon. Friend is a real champion for north Lincolnshire and for Humberside in general. We are determined that this recovery is going to be different from previous recoveries and that we are going to see growth in jobs and investment right across our country. That is why he and others with me have been working hard to bring investment to the Humber, including of course the vital Siemens plant, and why we have seen employment go up and unemployment come down. Because of the local growth deals agreed in July, the Humber local enterprise partnership has over £100 million for local projects, which should create up to 9,000 jobs and allow more than 5,000 homes to be built, so we are determined to see recovery embedded right across the country.

Q9. [906776] Chi Onwurah (Newcastle upon Tyne Central) (Lab): I am proud of the NHS in the north-east, but not one hospital trust is meeting the Government’s own

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scaled back targets for treatment in A and E—not one—yet the Prime Minister prefers to focus on a top-down reorganisation of the NHS, breaking it up for the benefit of his buddies and putting competition before care and profit before people. Does he really imagine we will trust him with our NHS?

The Prime Minister: Let me tell the hon. Lady what is actually happening in the NHS in Newcastle. Since 2010, there are 191 more doctors and 698 more nurses. Last week over 3,000 patients went to A and E, and all but 190 were seen within four hours. If getting rid of the bureaucracy in the NHS, which we did in England, was such a bad idea, why is the NHS in England performing better than other parts of the country that did not take those steps?

Q10. [906777] David Rutley (Macclesfield) (Con): The recent final report of the Alderley Park taskforce highlights how around 300 jobs have been brought to the site in the last 18 months, with a healthy pipeline of new businesses looking to locate there. Does my right hon. Friend agree that this helps to highlight why the Government are right to put in extra growth deal funding to help further strengthen the life sciences sector in the north-west, which is vital?

The Prime Minister: My hon. Friend has been a real champion for life sciences in general and for life sciences investment in the north-west of England, which is an absolutely crucial part of the improvement and expansion of that part of our country’s economy, and that obviously includes Alderley Park. The local growth deal announced last July is going to establish a £40 million joint life sciences fund across Greater Manchester, Cheshire and Warrington, which will support the sector right across the north-west. That will include Alderley Park. This is the first Government to have a proper life sciences strategy, because this is a vital industry for our country’s future.

Mr Elfyn Llwyd (Dwyfor Meirionnydd) (PC): Those of us who opposed the Iraq war, for very good reason, and many, many other people outside this place are very concerned about the inordinate delay in publishing the findings of the Chilcot report. May I please ask the Prime Minister: where did this bizarre notion that if it is not published before the end of February, we cannot see it until after the election come from? What about the month of March?

The Prime Minister: In many ways I share the right hon. Gentleman’s frustration: I would love the report to have come out already. Indeed, he and I voted together against the last Labour Government over and over again, saying, “Please can you get on and set up the independent inquiry that’s needed?” If they had got on and set up the independent inquiry, it would have been published, debated and dealt with by now, so I find it immensely frustrating, but it is not a matter for me. I am not able to order the publication of the report. It is independent: it is up to Sir John Chilcot when he publishes his report. He will make the decision, not me.

Q11. [906778] Julian Smith (Skipton and Ripon) (Con): Youth unemployment in Skipton is down by over 70% since 2010. City growth deal funding for the Skipton

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flood alleviation scheme will unlock a further 500 jobs. Is there anything the Prime Minister can do to make that happen?

The Prime Minister: I will look very carefully at this, because, as my hon. Friend says, not only the claimant count but the long-term youth claimant count has fallen—it has fallen by 50% in his constituency in the last year alone. I know how much his constituents want to see work on the Skipton flood defence project, which is a very high priority for York, North Yorkshire and the East Riding local enterprise proposal. We will make an announcement about this in the coming weeks.

Q12. [906779] Lisa Nandy (Wigan) (Lab): In Wigan recently, my local nurses granted a dying grandma’s fairly remarkable last wish when they wheeled her hospital bed into the car park so she could be reunited for one last time with her much loved horse, just hours before she died from cancer. Those brilliant nurses sum up everything that is great about our national health service, but in a recent poll only 4% of them said they thought the Prime Minister was doing a good job. Can he tell us why?

The Prime Minister: I am full of praise for nurses in Wigan. I think they work extremely hard to provide a good service. I particularly applaud the nurse in Wigan who chased the Health Secretary down the corridor and told him a thing or two about how to run the health service. If we are judged on our record, however, there are 9,000 more doctors and 3,300 more nurses in our NHS because we made the decision to protect the funding of the NHS, which Labour told us was irresponsible.

Q13. [906780] Mr Andrew Turner (Isle of Wight) (Con): Will my right hon. Friend join me in supporting the Perpetuus tidal energy centre, a public-private partnership that will, from the Isle of Wight, give the world its first grid-connected tidal array test facility? This will put the UK at the forefront of tidal energy technology, protect existing jobs and create several hundred new ones.

The Prime Minister: My hon. Friend makes a very good point, because the UK is now the most attractive market in the world for investment in offshore wind and marine renewables. We want to maintain that world-leading position, harness the economic and environmental benefits it brings and see local centres of expertise. From what I can see, the Perpetuus tidal energy centre sounds exactly the sort of exciting initiative we should support.

Q14. [906781] Heidi Alexander (Lewisham East) (Lab): Nearly half of all London ambulances called out to critical cases do not arrive within their target eight-minute response time. Is that what the Prime Minister had in mind when he told us that the NHS would be “safe in his hands”?

The Prime Minister: The NHS would not have been safe if we had followed Labour’s proposal to cut the NHS. We rejected that advice and put more money into it. The London ambulance service has launched a national and international recruitment campaign and has already hired 400 new members of staff. We are providing

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£15 million of extra money for the NHS ambulance service in London. That is why it met its target in 2013-14, attending over 460,000 patients with life-threatening illnesses. That is what is happening in our NHS because we made the decisions to reform the NHS, cut its bureaucracy and put the money in—decisions opposed by the Labour party.

Sir Peter Tapsell (Louth and Horncastle) (Con): Reverting to the subject of the Chilcot report, about which I have questioned the Prime Minister in the past, did my right hon. Friend note that our distinguished colleague Lord Hurd said in the House of Lords yesterday that it was an absolute disgrace that it had not been published—a view that I certainly hold? Since it is absolutely well known by the cognoscenti that the report was completed many months ago, who—if the Prime Minister is helpless on this subject—is blocking it? Is it the Cabinet Secretary or Sir John Chilcot, or is it the White House?

The Prime Minister: I say to the Father of the House that I understand that the report is largely finished, but with every report such as this there is a process: we have to write to the people who are criticised and give them an opportunity to respond. This is now the process for all these reports, irrespective of which Government they are launched under. It is known as the Salmondisation process—although I am not quite sure why, as I do not think it has anything to do with the former First Minister of Scotland. It is not within my power to grant the publication of this report. It is independent and under Sir John Chilcot, and the process has to be finished—then the report will be published.

Q15. [906782] Mr Khalid Mahmood (Birmingham, Perry Barr) (Lab): I ask the Prime Minister once again: will he apologise to all those who have suffered and continue to suffer in A and E departments across the country, due to his mismanagement of the national health service?

The Prime Minister: I could not have been clearer. I regret it when every single person who goes to hospital does not get the treatment they deserve, but our responsibility is to put in the money, which we are doing; to provide the extra staff, which is happening; to have a proper plan for joining up health and social care, which we are doing; and then to fund the Simon Stevens plan, which is the right long-term answer for our health service. People around the country will have been able to see that there is one part of this House of Commons working to improve our NHS for all its users, but that another part wants to “weaponise” the NHS—the most disgusting phrase I think I have heard in politics—and treat it like a political football. I know that they will reach the right conclusion.

Paul Burstow (Sutton and Cheam) (LD): Home care workers do a fantastic job in caring for some of the most frail people in our society, yet more than 200,000 of them are not even paid the national minimum wage. Will the Prime Minister talk to the Chancellor about ensuring that HMRC properly pursues and prosecutes the cowboy care agencies that are exploiting those people?

The Prime Minister: My right hon. Friend is absolutely right. There is far more that we can do to prosecute and chase down organisations that do not pay their staff

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properly. That is why we are bringing into the Home Office organisations that can help to make that happen. Whether the organisation concerned is the Gangmasters Licensing Authority or, indeed, the National Crime Agency, all the powers are there to enable us to go after those who do not pay the minimum wage when they should.

Alison McGovern (Wirral South) (Lab): On Monday I listened to residents of Mendell Court, an extra care facility in Bromborough in my constituency, as they told me of their serious worries about social care. For the good of all who need care and all NHS patients, will the Prime Minister go further to integrate health and social care?

The Prime Minister: Through the better care fund we are producing £5 billion, which is money that health authorities and local authorities can spend together. Up to now, the Labour party has opposed that fund and said that it should not be established; but I am afraid it is worse than that. The shadow Secretary of State for Health has been wandering around the television studios today, telling anyone who is prepared to listen that he would increase funding for social care. There is only one slight problem with that. The shadow Chancellor said on the news as recently as 5 January that

“there will be no additional funding for local government unless we can find money from somewhere else”—[Interruption.]

Ah—we are! If Labour Members had waited until the end of the quotation, they would have heard this:

“but we have not been able to do that in the case of local government.”

So there we are: total and utter chaos. One of them is going around saying that there will be extra money, another is saying that there will not be any extra money,

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and there are £20 billion of unfunded commitments that would lead to total chaos in our economy and a total breakdown in our health service.

Robert Neill (Bromley and Chislehurst) (Con): Will the Prime Minister update the House on the future arrangements for the upkeep of the Royal Air Force memorial chapel at Biggin Hill, the iconic former Battle of Britain airfield?

The Prime Minister: I can absolutely confirm to the House that that chapel will be preserved for future generations, as we have always recognised its importance and its rich heritage. I think it possible that of all the great moments in British history, the Battle of Britain 1940 stands out as one of the most important times that there have been. So we will protect the chapel, and will do all that we can to protect it for future generations.

Sir Gerald Kaufman (Manchester, Gorton) (Lab): Will the Prime Minister take action immediately to clear up the shambles at the Home Office? A constituent of mine who applied for a fast-track passport before Christmas was promised that it would be delivered to him by courier on new year’s eve, but has still not received it. As a result, he has had to cancel a trip that he was due to make yesterday, at great personal cost and great damage to his personal life. Will the Prime Minister ensure that that man is able to travel this week, and will he clear up this mess?

The Prime Minister: I shall be happy to look at the individual case that the right hon. Gentleman raises. However, I think that we have made huge strides in dealing with potential passport backlogs, and I think that the Home Secretary is doing a fantastic job.

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A and E (Major Incidents)

12.34 pm

Andy Burnham (Leigh) (Lab) (Urgent Question): To ask the Secretary of State for Health if he will make a statement on the major incidents that have been declared at a number of hospitals and on A and E performance in England.

The Secretary of State for Health (Mr Jeremy Hunt): Mr Speaker, I welcome this opportunity to come to the House and make a statement on accident and emergency services.

First, we must recognise the context. The NHS always faces significant pressures during the winter months, but, with an ageing population, we now have 350,000 more over-75s than just four years ago. As a result, we are seeing more people turning up at our A and Es, with 279,000 more attendances in quarter three of this year as compared with last, and a greater level of sickness among those who do arrive, leading to an increase in emergency admissions of nearly 6% on last year. This picture is reflected across the home nations, with A and Es in Wales, Scotland and Northern Ireland all missing key performance standards as a result.

A number of hospitals have declared major incidents over the past few days, in what is traditionally a particularly busy time in A and E. A major incident is part of the established escalation process for the NHS, and has been since 2005. This enables trusts to deal with significant demands, putting in place a command and control structure to allow them to bring in additional staff and increase capacity. It is a temporary measure taken to ensure that the most urgent and serious cases get the safe, high-quality care they need.

The decision to declare a major incident is taken locally—there is no national definition—and we must trust the managers and clinicians in our local NHS to make these decisions, and support them in doing so by making sure there is sufficient financial support available to help deal with additional pressures.

I chaired my first meeting to discuss that support on 17 March last year. On 13 June, we gave the NHS an additional £400 million for winter pressures, topped up in the autumn by £300 million to a record total of £700 million, ensuring local services had the certainty of additional money and time to plan how best to use it.

The NHS started this winter with 1,900 more doctors and 4,800 more hospital nurses than a year ago. This planning and funding has been widely welcomed by experts in the system, including NHS England, NHS Providers, the College of Emergency Medicine and the NHS Confederation. The funding the Government have put in, which is on top of the year-on-year real-terms increases in funding, is made possible by a strong economy, and will pay for the equivalent of 1,000 more doctors, 2,000 more nurses and 2,000 other NHS and care staff including physiotherapists and social workers. It will fund up to 2,500 additional beds, both in the acute and community sectors, and also provide £50 million to support ambulance services.

But the NHS also needs longer-term solutions to these pressures. We are providing £150 million through the Prime Minister’s challenge fund to make evening and weekend GP appointments available for 10 million

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people, with over 4 million already benefiting. Our better care programme integrates, for the first time ever, health and social care services in 151 local authority areas, with plans starting in April to reduce, on average, emergency admissions to hospitals by 3%. And we have funded the NHS’s own plan to deal with these pressures, the five-year forward view, with an additional £1.7 billion for the NHS in 2015-16 and £1 billion of capital over the next four years to improve primary care facilities.

Mr Speaker, let me finish by thanking hard-working NHS staff across the country for the outstanding care they continue to deliver under a great deal of operational pressure.

Andy Burnham: All over England, the NHS is stretched to the limit—and in places is at breaking point. Staff are working flat-out and we thank each and every one of them for all they are doing, but the situation is now serious and getting worse. Right now, too many vulnerable people are exposed to too much risk, waiting hours for ambulances to arrive, and held in the back of them outside A and E or on trolleys in corridors. This cannot be allowed to carry on. Patients and staff deserve better answers than they have had to date about what is being done to address this issue, and that is why, faced with this complacency, we have again had to force the Secretary of State to come here today.

Fourteen hospitals have declared major incidents. Will the right hon. Gentleman explain clearly what this means for services in those areas? What is the official advice to people living in those areas? Is he providing any central support and advice to those hospitals? If a number of major incidents are declared in the same area at the same time, what contingency plans will be put into place to protect the public? More broadly, what new measures does he have under active consideration to ease pressure at all hospitals?

The Secretary of State mentioned resources. When he allocated additional resources for winter pressure, what assessment was used to determine how much was needed? Clearly, it is not working. Does he now plan to reassess the situation and perhaps allocate more? Ministers keep blaming unprecedented demand, but the question is this: why is there such unprecedented demand? Could it have anything to do with the difficulty in getting a GP appointment, the closure of walk-in centres or the cuts to social care?

Let me turn to ambulance services. There are alarming reports of people waiting hours for ambulances to arrive. This is because ambulances are trapped in queues outside A and E departments. We are hearing that at least one service has implemented a policy of leaving patients at the door of A and E without handing them over to A and E staff. Is the Secretary of State aware of this practice, and is he satisfied that it is not putting patient safety and care at risk?

The last time we had to drag the Secretary of State here, he failed to inform the House that he had approved a proposal to relax 999 response times. So will he today tell the House what the current status of those plans is and whether they are still going ahead this winter? I have real concerns, which I have relayed to ambulance leaders, about making any such change without proper consultation and evidence. There are also reports of police and fire vehicles being used to carry people to A and E. What discussions has he had with police and

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fire service leaders about this practice? What training or advice has been given to front-line police and fire staff? Is he fully satisfied that patient safety is not being compromised?

Finally, cuts to social care are a root cause of the pressure on hospitals. A record number of elderly people are trapped in hospital beds, and any solution to this crisis must involve councils and a solution for social care. So will the Secretary of State now act on our constructive proposal to hold an urgent summit of all the public services affected—councils, police and fire services—and to develop a co-ordinated plan to ease this crisis? NHS staff deserve it. Safe patient care demands it. When will he deliver it?

Mr Hunt: First, let me thank the right hon. Gentleman for this opportunity once again to go through the plans that we have in place to support the NHS and to reiterate the gratitude of the whole House to NHS staff for what they are doing under huge pressure at the moment. Let me start by telling him where I agree with him. I agree that what happens in the social care system is closely linked to what happens in the NHS. That is why, from June last year, meetings have been happening in 140 local authority areas between the local NHS and local authorities to work out how best to plan for winter. The result of that planning process, which is funded by £700 million of Government support, is extra doctors, extra nurses, extra beds and new plans in every area. I am absolutely satisfied that that money is making a difference. Every day in our A and E departments, 2,500 more people are being seen within four hours than was the case four years ago when the right hon. Gentleman was Health Secretary. The local structures worked last year, and they are working now. Now is the time to get behind them and to support the local NHS.

In a letter that the right hon. Gentleman wrote to me yesterday, he talked about Government failure. This is not the time to play politics—[Interruption.] Perhaps Opposition Members will listen to this. The head of NHS England, Simon Stevens, a former Labour special adviser, said yesterday

“the NHS, the Department of Health and local clinicians have done everything that could reasonably be expected”

to put in place plans over the last weeks. If the right hon. Gentleman will not listen to that, perhaps he will listen to Rob Webster, who runs the NHS Confederation, a representative body of all NHS organisations. He says that we should be grateful for the huge effort NHS staff have put in over the past few weeks and that it is not the time to play political football.

The right hon. Gentleman talked about ambulances, where we are putting in £50 million of support this winter, and some changes proposed by the Association of Ambulance Chief Executives, which he was informed about three months earlier than they came to public light. This is what the AACE said:

“We have been surprised by some of the reaction today given that over the last three months the principles of what we are proposing…have been shared with Labour…and we have received no negative feedback”.

What did the right hon. Gentleman say? He said it was a panic decision to relax 999 standards. There was no

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panic, no decision, no relaxation of 999 standards; I did what any Health Secretary should do: I simply asked for clinical advice on what would be best for patients. He chose to frighten the public, to scaremonger for party political purpose. Is it not time the Labour party, for once, thought about the impact on patients of the kind of things it is saying in the press?

The right hon. Gentleman then talked, and the Leader of the Opposition has talked, about the causes of these challenges being the reforms this Government introduced in this Parliament. Let me say to him that the one part of the UK that introduced these reforms, England, happens to have the best A and E performance and the one part of the UK that has most set its face against these forms, Labour-run Wales, has one of the worst performances. If he wants to do something about A and E pressures, instead of trying to make political capital in England, he should be getting Labour to turn things round in the one place it does run the health service—Wales. He should be backing this Government’s support for the NHS in a difficult period that has meant more doctors, more nurses, more people being seen quickly, more operations, long-term support and a plan for our NHS; it should not be politics and scaremongering ahead of an election.

Dr Sarah Wollaston (Totnes) (Con): May I join the Secretary of State in warmly thanking NHS staff, who are stepping up to meet the extraordinary increase in demand for their care and expertise? Will he reassure the House that in meeting this extraordinary, complex challenge, they will not be made to chase targets, as we know that that was distorting clinical priorities in Mid Staffs, and that clinical staff should always feel absolutely confident that they have his support to place clinical priorities first and foremost?

Mr Hunt: My hon. Friend is absolutely right about that, and it is very important. Targets matter, but not targets at any cost. It is worth remembering that, over the four years we were seeing the tragedy unfold in Mid Staffs, it was meeting its A and E target the majority of the time. So it is very important that patient safety is the priority. That is why we have to support NHS trusts when they have major incidents and why we have to make it clear that, although targets matter, trusts need to be sensible and proportionate in their efforts to meet those standards.

Frank Dobson (Holborn and St Pancras) (Lab): Does the Secretary of State accept the truth of the assertions by A and E doctors and nurses that the call handlers working for the 111 service are referring far more patients to A and E than happened when NHS Direct was staffed by nurses, who exercised professional discretion?

Mr Hunt: It is always important to keep the algorithms used by call handlers—111—under review. I say to the right hon. Gentleman that 111 is part of the way we have been able to relieve pressure on A and E departments. Calls to 111 doubled this Christmas, and 27% of the people who called it said that they had been planning to go to an A and E department but did not do so following the call. That is a very important way of relieving pressure on our A and E departments.

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Mr Kenneth Clarke (Rushcliffe) (Con): Does the Secretary of State share my recollection that five years ago no political pundit of any kind predicted that the welcome ageing of the population and the ending of the 24 hours a day, seven days a week commitment of general practice would produce the quite extraordinary surge in demand that we now have to cope with? Does he therefore agree that instead of wild criticisms of local crises he needs to persist in the short term by providing resources and improving co-operation between social services and health care, and in the long term by implementing the changes necessary in response to demand, as set out by Simon Stevens in his report, which our reforms have enabled NHS England to produce?

Mr Hunt: My right hon. and learned Friend speaks with a great deal of wisdom as someone who has occupied this post and he is absolutely right. All Health Secretaries face pressures of the kind we are going through now and face difficult winters. Winter is always a difficult time for the NHS and, as the Prime Minister said, we need a short-term plan to help—that is what our plan of creating about 5,000 extra front-line clinicians this winter alone is doing—but we must also consider the long-term plan. That involves finding a better way of looking after vulnerable older people other than through A and E departments—that means better care in the community, better support from GPs and better community services—and that is exactly what we are doing.

Barbara Keeley (Worsley and Eccles South) (Lab): Bolton Royal hospital is one of the hospitals declaring a major incident. The context is as follows. The Little Hulton walk-in centre was closed, when it saw 2,000 patients a month. Salford city council had £100 million cut out of its budget, so 1,000 people this year are losing care packages. I have an elderly constituent who was admitted to Bolton Royal following poor care. It is obvious that those things are causing the problem. When will the Secretary of State take responsibility?

Mr Hunt: We take responsibility and I take responsibility for everything that happens in the NHS. Let me tell the hon. Lady what we are actually doing, because there have been some serious bed capacity issues in Bolton. Bolton has had £3 million this winter to help deal with those pressures, which has included £340,000 to spend on additional beds in the hospital supporting the A and E department and more than £100,000 to pay for additional staff in A and E. Overall, compared with in 2010, there are 114 extra doctors and 571 extra nurses. She should welcome that, rather than trying to make a political issue of it.

Jesse Norman (Hereford and South Herefordshire) (Con): May I remind the House that the private finance initiative, which expanded hospitals to 100 from zero after 1997, created at least £2 billion to £10 billion, and possibly even £20 billion, of additional costs that could now be used? In Hereford, the hospital is too small because of PFI. I have estimated that £30 million could have been spent on the hospital if contracts had been properly implemented in the first place. That is why my hospital, which declared an incident this week, has been struggling and it is quite wrong to suggest otherwise.

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Mr Hunt: My hon. Friend is absolutely right. I congratulate the doctors and nurses who are working very hard in his local hospital and point out that there are a number of historical problems. The £71 billion of PFI debt is one of those and it means that more than £1 billion every year is diverted from the front line. We have done something about the top-heavy management structures and, as a result, across the NHS we have 9,000 more doctors and 3,000 more nurses. It is very important in this debate that we focus not only on short-term pressures but on dealing with the long-term issues in the NHS. That is what we want to do in his area and in every area.

Kevin Barron (Rother Valley) (Lab): On 9 December, a member of my family was admitted to Rotherham hospital through A and E after a fall at home. She was told two days later by a doctor that there was no medical reason she should be in hospital. She spent her 93rd birthday, on 24 December, in Rotherham hospital and was discharged on Monday of this week, having at last got a care package together. Does the Secretary of State think that the cuts to Rotherham borough council’s social services have helped or hindered the situation?

Mr Hunt: We need to have much better working between the health and social care systems. If the right hon. Gentleman supports that, he should support the better care programme, which from April of this year will see co-operation between the local NHS and local authorities in 150 local authority areas for the first time. Instead, Labour is calling for that plan to be halted.

Robert Halfon (Harlow) (Con): Will my right hon. Friend thank the staff of the NHS at Harlow Princess Alexandra hospital for their passion and commitment? Although the Government have invested £5 million in our accident and emergency services, issues in nearby hospitals mean that the pressure on our A and E has been immense. Princess Alexandra hospital is one of the busiest by far for attends by bed and one in five ambulances arrives from out of the area. The PAH is now admitting four more patients a day than it was this time last year. Will my right hon. Friend meet me and the chief executive of the Princess Alexandra hospital, and will either he or the Minister responsible for hospitals visit the hospital to see what can be done to help the situation?

Mr Hunt: I am very happy to do that and I am aware of the significant pressures at the Princess Alexandra. I thank my hon. Friend for the way in which he is supporting staff in his local hospital, getting behind local plans. It is a mistake to say that there is always a new national initiative. Lots of people in the NHS have been saying over the past few days that they do not want new national initiatives. They want exactly what my hon. Friend is doing; they want people to support their local NHS and not to turn it into a political football.

Hazel Blears (Salford and Eccles) (Lab): On Monday evening, the trust of Salford Royal hospital, which, as the Secretary of State knows, is an excellent hospital, declared a major incident. I am pleased to say that the pressure has been dealt with and it has now been lifted, but it is clear to me that many of the thousands of elderly and frail people in hospital have dementia, which

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means that they stay longer and are readmitted more often. I welcome the better care fund, but it will not be enough. There needs to be a whole systems change to prevent people from being admitted in the first place, with better support and more action by GPs. We need to get on with that urgently.

Mr Hunt: I agree entirely with the right hon. Lady. The better care fund is a first step, but it is only a first step. It is happening from this April, but we have the NHS England five-year forward view, which is the long-term plan to improve community care. I agree that Salford Royal is an excellent hospital. It had £3.5 million to help it deal with winter pressures this year, but it is also a good example of how integrated care between the acute trust and local community services can make a real difference, and it is delivering some of the safest care in the country.

Paul Burstow (Sutton and Cheam) (LD): May I pay tribute to the accident and emergency staff at my local hospital, St Helier, whom I met on Monday? One thing they made clear to me is that although there is no single cause of the pressures on A and E at the moment and there is therefore no single solution, they want certainty about the long-term plans for NHS funding. Although the down payment of £2 billion announced in the autumn statement was very welcome, will the Secretary of State say whether the Government or any Government in whom he might participate in the future will deliver the additional £8 billion necessary to secure the closing of the funding gap that Simon Stevens identified?

Mr Hunt: When we did the autumn statement last year, we asked Simon Stevens and NHS England how much they needed for their plan next year and they told us it was about £2 billion, so we made that commitment. We also said that that was a down payment on delivering the entire plan, not a one-off payment. I agree about the importance of long-term certainty over funding, but the most important thing in that regard is to have a strong economy that can deliver the money that will support our NHS. It is only Government Members who have shown that they are capable of delivering that strong economy rather than the instability that would come from disastrous economic policies.

Grahame M. Morris (Easington) (Lab): The Secretary of State and Prime Minister accuse the Labour party of using the NHS as a political football and as a weapon. May I advise the Secretary of State that the NHS is a weapon—a very powerful one—for the treatment of illness and the relief of disease and suffering, and that it is being blunted by this Government and his Department under his stewardship? I met the chief executive of City Hospitals Sunderland NHS Foundation Trust about the NHS crisis and the A and E crisis, and one of the problems he identified was the lack of sufficient staff and the need to recruit locums. What is the Secretary of State doing about recruiting more staff and how many vacancies are being carried?

Mr Hunt: I agree that we need more staff, but the hon. Gentleman should welcome the fact that under this Government there are 9,000 more doctors and

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3,000 more nurses. Such an increase was made possible by a reorganisation that took money away from bureaucracy and management and put it on to the front line. What is wrong is for the Leader of the Opposition to say that he wants to weaponise the NHS—turn it into a political weapon. The NHS is not a political weapon; it is there for patients. Labour should be ashamed of trying to turn it into a political football.

Sir Alan Haselhurst (Saffron Walden) (Con): Is my right hon. Friend aware that the declaration of a major incident by Addenbrooke’s hospital has caused concern among my constituents whose non-urgent admissions have had to be postponed? Is he also aware that the hospital is currently looking after more than 300 people aged over 85, which is in itself a remarkable tribute to the NHS? However, such a figure underlines the fact that we have to give more attention to the integration of health and care issues.

Mr Hunt: I am aware of the problems at Addenbrooke’s. Indeed, the main issue, as my hon. Friend rightly says, is delayed discharges relating to care. The chief executive is running the command and control system and working with the local authority to facilitate the discharges that are necessary and to de-escalate the situation. The hospital has £2.2 million for its winter pressures support and 185 more doctors than four years ago.

Derek Twigg (Halton) (Lab): The national health service in my constituency is under immense pressure, as are the adult services. It has been known for some months now that the number of acutely ill people coming into hospital has been growing. Has the Secretary of State investigated the reasons for that significant increase, which I am hearing about from the chief executives of the hospitals? If he has, what are those reasons? Is it to do with access to primary care, or problems with adult social services? Will he tell the House now?

Mr Hunt: We have looked into that matter in huge detail. There are probably three broad factors that are behind the increase in demand. One is the ageing population. There are 350,000 more people over the age of 75 than four years ago. The point is that if someone of that age goes into A and E in the winter, there is an 80% chance they will be admitted to hospital and quite a large chance they will stay in hospital for some time. The second factor is changing consumer expectation among younger people who want faster health care—[Interruption.] That is what Professor Keith Willett, the director of emergency care at NHS England, said, and Opposition Members should listen to what our clinical leaders are saying. The third factor is a refusal by NHS trusts to do what they were pressurised to do in the past, which is to cut corners to hit targets.

Angie Bray (Ealing Central and Acton) (Con): My right hon. Friend will be aware that there have been significant changes to hospital services across north-west London. There is considerable concern from some of my constituents that the closure of A and E departments at Central Middlesex and Hammersmith hospitals has led to some of the increasing pressure elsewhere. Will he tell me whether there is any evidence of that?

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Mr Hunt: I am aware that there have been particular pressures at Northwick Park hospital, but I am also aware that a plan is in place in north-west London to have weekend opening of GP surgeries to improve out-of-hospital provision. The pressures that are faced there are like those in the rest of the country—very severe. We are doing everything we can to support the hospitals in that area with our winter pressures plans.

Ms Diane Abbott (Hackney North and Stoke Newington) (Lab): The Secretary of State spoke about the algorithms used by 111 call handlers. Does he appreciate that a frightened mother with a sick child is not really interested in algorithms? What she wants to know is that her child can get the medical help that they need promptly. He has told the House that he has been having meetings on this winter crisis since March. Is he not a little bit embarrassed that we now have people queuing to see their GPs first thing in the morning, ambulances queuing outside hospitals, people being treated in tents outside hospitals, and old people staying in hospital longer than they need to because there is a lack of funding and no proper co-ordination between health and social care?

Mr Hunt: Of course I regret any individual incidents where people do not get the care they need promptly. The hon. Lady will know that the solutions to such problems are not always things that can be done overnight. If she looks at the record of joined-up care over the past few years, she will see that this is the first Government to encourage 150 local authority areas to sit down with their local NHS and jointly plan care for the most vulnerable people in the social care system. That is a very big step forward. We are also doing nearly 1 million more operations every year across the NHS. In accident and emergency, the number of people being seen within four hours has gone up by nearly three quarters of a million since the start of this Parliament. That is real progress, but of course there are long-term issues, and we will focus on those as well.

Andrew Percy (Brigg and Goole) (Con): I congratulate Goole hospital on hitting its target 99.7% of time, and the trust as a whole on hitting its target 93% of the time. I spent my Christmas volunteering in the NHS at A and E and with the ambulance service. Staff repeatedly told me that as first responders what they see are more old and frail people needing to be admitted to hospital. That situation was not helped by 50,000 hospital beds being cut by the previous Government. One way of dealing with the problems would be to move to a community paramedicine model and to use the skills of our ambulance services more. I encourage the Secretary of State to ensure that NHS England is seriously looking at that option.

Mr Hunt: May I congratulate my hon. Friend on the shining example he gives to everyone in this House by being a first responder? I do agree that one thing that we could do in the next year is to integrate better what happens in the ambulance services, out-of-hours GP services and 111. Individually, they are all doing a good job, but they could do a much better job if what they did was integrated.

Ms Gisela Stuart (Birmingham, Edgbaston) (Lab): Facts are important in this debate. There is now good evidence to show that overcrowding in emergency

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departments increases mortality and length of stay. Will the Secretary of State ensure that the figures for hospitals are available in the House of Commons on a monthly basis, so that we can correlate spikes following emergencies with what happens to mortality rates? If mortalities increase, the problem is even more serious than we think it is.

Mr Hunt: I agree with the hon. Lady. It is critical that we look at the data carefully. I will see whether the data on mortality rates are available on a monthly basis. I will be as interested as she is to see it.

Mr Barry Sheerman (Huddersfield) (Lab/Co-op): I have just been visiting a much-loved elderly relative in hospital and I have seen what a wonderful job our nurses are doing and the pressure that they are under, but may I tell the Secretary of State that Huddersfield and Calderdale used to have an amazingly good partnership of people in the health service working together. The antagonism now between trusts and commissioning services has destroyed that partnership. All we have now is tension and stress. We no longer have a partnership delivering health care in our country.

Mr Hunt: I agree with the hon. Gentleman about the hard work of the doctors and nurses at his local trust, but the feedback I get from the front line is of closer partnership working than has ever happened before, with the local authorities and the local NHS sitting down together planning what they will do for the most vulnerable older people through the better care fund. I want to encourage that everywhere I can.

Sir Richard Ottaway (Croydon South) (Con): I join the Secretary of State in praising Croydon University hospital staff who have been working their socks off in recent days, but is he aware that CUH has a recently modernised subsidiary in Purley with a minor injuries unit, which is open only in the afternoons, and an under-used X-ray department? Will he explore with Croydon commissioning group whether those facilities can be used full time, because that would take the load off the A and E department at Croydon University hospital?

Mr Hunt: I am happy to explore that. All these suggestions need to be considered very carefully. That trust has had 40 extra doctors and nearly 300 extra nurses and £4.5 million to help with its winter pressures this year. Perhaps some of that money could be used for that purpose. I am happy to look into it.

Mr David Lammy (Tottenham) (Lab): As the Minister who introduced the precursor A and E target, may I say that the Secretary of State was right to continue with the target? Making the target work was dependent on NHS Direct, delayed discharges, the integration of social care, and targets in the rest of the hospital, particularly on cancer. He has demolished that whole system. Will he now apologise for the absence of those targets, the problems in delayed discharge and the scrapping of NHS Direct?

Mr Hunt: I am afraid that what the right hon. Gentleman says is simply not correct. We have continued with key operational targets. A number of them are under pressure,

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but when we look at each of them we see that the reason is that the NHS is treating more people than ever before but demand is outstripping supply. For example, nearly half a million more people visited A and E in the most recent quarter than in the last quarter of the previous Labour Government, and we have 1,000 more doctors in our A and E departments. That tells us that, along with short-term help with these pressures we need a long-term solution, which is what this Government are committed to.

Andrew George (St Ives) (LD): This is a serious and complex issue, and one of the factors causing it is that many seriously ill patients cannot be admitted to acute hospital wards because there are insufficient beds. In the light of that, I draw the Secretary of State’s attention to an NHS Confederation report from May 2006, “Why we need fewer hospital beds”. I cautioned at the time that it would be unwise to pursue such a policy without first front-loading primary and social care. Will he look at enhancing acute hospital beds until primary and social care have the capacity to help out the acute sector?

Mr Hunt: The hon. Gentleman makes an important point. In fact, I was talking with someone senior at the Royal Cornwall hospital on Monday about the particular pressures there. Indeed, some of the funding that we allocated to the NHS in the autumn statement for next year is designed to do precisely that—to allow hospitals to maintain bed capacity while we ramp up facilities in community and primary care. It is very important to get the timing absolutely right.

Lilian Greenwood (Nottingham South) (Lab): Yesterday the emergency department at Nottingham’s Queen’s Medical Centre faced such intense pressure that the trust was forced to enact its internal incident plan and cancel planned operations and out-patient clinics. Higher than expected admissions and delays in discharging patients who are well enough to leave hospital have been creating problems for many months. How can we resolve what is now a crisis if the Secretary of State will not even acknowledge that his Government’s deep cuts to social care are undermining the efforts of our dedicated NHS and social care staff?

Mr Hunt: We are doing an enormous amount to support social care. Some £3.9 billion of NHS funds has been given to the social care system over this Parliament, and we have strongly encouraged local authorities to ensure that any savings they have to make are done through efficiency savings, not cuts to front-line services. The hon. Lady’s local hospital has received £11 million in funding to help it through the winter. We are doing a huge amount to support the NHS through a difficult period, and she should support those efforts.

Sir Tony Baldry (Banbury) (Con): It is obviously important that those who need to be treated in A and E are treated there and that those who do not go to those parts of the NHS where they can be treated best. Does my right hon. Friend agree, therefore, that the initiatives taken by clinical commissioners in Oxfordshire where, for example, they are trying to triage patients essentially at the door of A and E so that those who need to go in

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can do so and those who need primary care get it, will help reduce pressures on A and E and ensure that people are treated in the right part of the NHS?

Mr Hunt: Those are exactly the kinds of initiatives that can make a big difference—indeed, they are recommended by the College of Emergency Medicine. Of course, the long-term solution is to ensure that people are better looked after at home so that they do not need to end up at the door of a hospital. That is why more proactive care by GPs—we plan to recruit 5,000 more GPs over the next five years—should mean that that becomes less of a pressure point.

Yasmin Qureshi (Bolton South East) (Lab): The Royal Bolton hospital in my constituency yesterday declared a major incident. As of 1 pm yesterday, there were 53 people in the A and E department, 15 waiting for a bed, some for more than 12 hours, and a number of non-urgent operations were cancelled. I thank the hospital for all its hard work, because there have been problems for the past few weeks. I would like the Secretary of State to deal with the crisis by immediately reopening walk-in centres, because their closure is the reason so many people are going to A and E, and have proper funding given to local authorities so that they can put in place a proper health and social care budget for the elderly and vulnerable.

Mr Hunt: There have indeed been pressures at the Royal Bolton hospital, particularly in relation to bed capacity and intensive care unit capacity. All patients on the wards have been reviewed and discharges have been created—the plan was to discharge between 30 and 50 patients before the end of yesterday. We are doing a lot to support the hospital. It has been given £3 million in winter money, £350,000 to create extra bed capacity and £100,000 for extra A and E staff.

Several hon. Members rose—

Mr Speaker: Order. A very large number of hon. and right hon. Members are still seeking to catch my eye. As always, I am keen to accommodate as many as possible, but I simply point out to the House that there is a statement to follow by the Secretary of State for Northern Ireland and other business. I therefore appeal to the House to help me to help individual Members. That is to say, prolonged statements prior to questions are undesirable. Pithy and succinct questions are the order of the day, in which important exercise I think we can be led by an illustrious parliamentarian, Mr Philip Hollobone.

Mr Philip Hollobone (Kettering) (Con): Kettering general hospital is experiencing its busiest winter on record. The three hon. Members for north Northamptonshire, the hon. Member for Corby (Andy Sawford), my hon. Friend the Member for Wellingborough (Mr Bone) and myself for Kettering, are working together to attract extra investment into our A and E. When we go to see the Secretary of State’s colleague, the hospitals Minister, next week, will he encourage the Minister to receive us warmly and favourably?

Mr Hunt: I think that my hon. Friend should always be able to count on being received warmly and favourably. There are particular pressures in Northamptonshire. I

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am planning to have a conversation with the chief executive of Northamptonshire county council in the next week to see whether there is anything more that can be done to facilitate discharges and relieve the pressure at Kettering.

Mark Reckless (Rochester and Strood) (UKIP): I greatly welcome the £13.4 million of investment recently signed off for Medway hospital’s A and E department. Does the Secretary of State also understand the hospital’s need for a further £20 million of capital for medical wards around the A and E department to support integrated care and improve the throughput of patients to assist in turning around Medway hospital?

Mr Hunt: I am aware of those proposals, which we will obviously look at carefully. I am also aware that there are big pressures in the A and E department at Medway, but there are also other, more profound issues to do with the leadership at the hospital. The hon. Gentleman should rest assured that we are taking every step possible to try to turn things around.

Sarah Newton (Truro and Falmouth) (Con): I recently spent a shift at the Royal Cornwall hospital’s A and E department and saw at first hand the fantastic work it is doing. Does my right hon. Friend agree with the clinical team and with Mr Virr, who leads the department so well, that people need to remember that A and Es are for life and limb emergency treatment on the day and that they should consider the excellent alternatives, such as minor injuries departments and out-of-hours GP services, before automatically going to A and E?

Mr Hunt: I commend my hon. Friend for her tremendous interest in the Royal Cornwall hospital and for her campaigning to support its efforts. I spoke with the chief executive earlier this week about the particular challenges with discharging patients. I also spoke with the deputy chief executive of the South Western Ambulance Service NHS Foundation Trust about the dramatic increase in 999 calls this winter. My hon. Friend is absolutely right that the public can help us by ensuring that they use alternatives to A and E wherever possible.

Meg Munn (Sheffield, Heeley) (Lab/Co-op): When I led an integrated health and social care team 20 years ago, we found that carers no longer being able to care was a key reason why people went into hospital and into care. Will the Secretary of State now look again at the eligibility criteria introduced under the Care Act 2014 and ensure that a much greater number of carers can get support, because at the moment the number is being reduced?

Mr Hunt: Under that Act we introduced national eligibility criteria to try to remove the postcode lottery that had existed previously. We have also introduced new rights for carers that require local authorities to take account of the pressures on them. I think that we are going in the right direction, but I accept that there is always more that can be done.

David T. C. Davies (Monmouth) (Con): Some 92.6% of patients in England are seen within four hours, as opposed to just 83.8% of patients in Wales. If Labour wants to make this a political football, why does it not

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play an away game down in Cardiff, where it is in charge and responsible for the disgracefully lower standards that we receive there?

Mr Hunt: My hon. Friend makes his point powerfully, as ever. The rhetoric that we have heard from the Labour Benches today is interesting for its absence when we have debates on Wales. It seems to the public watching this that there is one rule for England and one rule for Wales, and that Labour is satisfied with lower standards in the parts of the country that it runs.

Geraint Davies (Swansea West) (Lab/Co-op): The NHS is in financial crisis, with more money needed for A and E, yet we are spending £10 billion a year on diabetes because people are consuming twice the daily amount of sugar that they should be consuming—nine teaspoonfuls for men, which is equivalent to a can of Coke, or six for women, which is equivalent to a light yoghurt. Does the Secretary of State agree and will he support my Bill, which is published today, which requires manufacturers to express sugar content in teaspoonfuls on products to empower consumers to make rational choices in order to manage down overall obesity—

Mr Speaker: Order. [Interruption.] Order. These are extremely important matters, but their relevance to the question of A and E was not immediately obvious to me, added to which, unfortunately, the hon. Gentleman—

Geraint Davies rose—

Mr Speaker: No. I am not debating with the hon. Gentleman; I am telling him. His inquiry suffered from one little disadvantage: it was too long.

Mr Hunt: I have spoken to the hon. Member for Swansea West (Geraint Davies) about his Bill. Part of the long-term solution is to give people better information about sugar consumption. We will certainly look at what the Bill proposes.

Mrs Anne Main (St Albans) (Con): My right hon. Friend will be aware that the Minister for Policing, Criminal Justice and Victims, my right hon. Friend the Member for Hemel Hempstead (Mike Penning), and I were very unhappy that the A and E was closed and moved to Watford. Since then Watford hospital has had a turbulent time. This morning the chief executive resigned, having got part-way through a process of consultation. May I ask for the consultation to be put on hold until the new chief executive is in place and has their feet under the table? We do not need more turbulence in our hospitals in west Hertfordshire.

Mr Hunt: I am sorry to hear the news about the chief executive at Watford. I am aware of the pressures there and I agree with my hon. Friend about the need for stability in management as much as possible over the next few months.

Bill Esterson (Sefton Central) (Lab): One of my constituents wrote to me about her elderly mother who faced a wait of many hours for an ambulance to A and E. My constituent told me that at A and E she saw patients on trolleys backed up through the corridor to ambulances waiting in the car park. Meanwhile, patients were waiting

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at home, unable to get those same ambulances. She described the scene as “a war zone”. Is it not the case that A and E is unable to cope, the ambulance service is unable to cope, and patients who need to go to A and E are suffering?

Mr Hunt: I agree that there are real pressures in A and E across the system, but it is important to remind the public that even under that pressure, nine out of 10 people continue to be seen, treated and sent home within four hours. That is an extremely impressive record for the people working very hard in our A and E departments.

Chloe Smith (Norwich North) (Con): The Norfolk and Norwich hospital declared a major incident. Its medical staff say that care is safe. Will my right hon. Friend join me in supporting Norwich NHS staff and their innovative urgent care unit, will he urge Norwich GPs to apply to the access fund, and will he condemn some of Labour’s political leaflets in Norwich which carry fake NHS stories, as told to me by NHS workers?

Mr Hunt: It is important for all parties to behave responsibly when the NHS front line is under such pressure. My hon. Friend might want to remind her Labour opponents locally that in Norwich there are 97 more doctors than four years ago and 145 more nurses, all possible because of a strong economy.

Alison Seabeck (Plymouth, Moor View) (Lab): Last week 1,631 people visited Plymouth A and E. One in 10 of them waited more than four hours. Staff are showing great dedication and doing extra shifts, but that is not sustainable. Will the Secretary of State please take his head out of the sand and, if he is serious about depoliticising the issue, will he take up the shadow Secretary of State’s offer of a cross-party summit to look at all the issues behind the crisis?

Mr Hunt: I was talking to a doctor at Plymouth last night and I recognise that there are real pressures there and staff are working very hard. The long-term solution is to back the non-party political plan that the NHS itself has put together under the leadership of Simon Stevens—the “Five Year Forward View”. We made the big call in our autumn statement to find £2 billion, which is what he said the NHS needed next year, and I hope Labour will support that. Then we can have the kind of consensus that the hon. Lady asked for.

Paul Uppal (Wolverhampton South West) (Con): In 2003, a dozen years almost to the day, I accompanied my grandmother to A and E. We arrived at 8 o’clock in the morning. She was not allocated a bed until 9.30 that evening. May I impress upon my right hon. Friend that money alone is not the issue? It is important that we push ahead with the long-term plan and do not adopt a short-term opportunistic approach.

Mr Hunt: My hon. Friend is right. It is important to say that lots of people in the NHS have been asked in the past few days on the media what the issues are, and they have not been saying that it is about money. They have been saying that it is about reforming the structures.

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That is why, as well as the money that is available for this winter, we need to look at the plans that we can put in place to improve access to GPs, to improve the co-ordination between the health and the social care systems, to deal with issues that prevent people from going to hospital in the first place. That is what this Government want to do.

Seema Malhotra (Feltham and Heston) (Lab/Co-op): Many of my constituents in Feltham and Heston have raised with me their concerns about being able to access GP services, some having to wait weeks and in the mean time having to seek emergency help. Does the Secretary of State now regret the Government’s decision to axe Labour’s guarantee of a GP appointment within 48 hours?

Mr Hunt: If the hon. Lady regrets that, she might want to ask her Labour colleagues in Wales why they also axed the 48-hour target. We do need better access to GPs. That is why we are funding the training of 5,000 more GPs over the next five years. With targets, we must be careful of unintended consequences. When we had that target in place, a quarter of people who asked for an appointment in more than two days were told that that would not be possible, because we found that people played the target. That is why we do not want to go back to that system.

Justin Tomlinson (North Swindon) (Con): As set out in the College of Emergency Medicine’s 10-point plan to improve A and E, co-location of GP surgeries is key. Does my right hon. Friend agree?

Mr Hunt: I agree with pretty much all the College of Emergency Medicine’s 10-point plan. That has very much informed our approach to helping the NHS over this winter. Co-location of GP surgeries on hospital sites is very helpful, but we also need more proactive care for the most vulnerable older people before they feel the need to go to hospital. That will be at the heart of the changes that we want to see.

Mr Andy Slaughter (Hammersmith) (Lab): The reason that west London now regularly has the worst waiting times for A and E, with up to 50% of patients waiting more than four hours, is a direct result of the Secretary of State’s decision to close the Hammersmith and Central Middlesex A and E four months ago. These are sick people who need A and E, not GP services. We have GP services at those hospitals. What we need is for him to cancel or at least review the downgrading of the A and E departments at Charing Cross and Ealing hospitals to GP-led emergency centres. Will he at least do that?

Mr Hunt: I say gently to the hon. Gentleman that if we are to solve the problems in his area and others, we should listen to the doctors about the structures that will work best. The structures that we put in place are the structures that doctors advised us to set up. That is why we are supporting them.

Mr Peter Bone (Wellingborough) (Con): Mrs Bone would like to offer best wishes for the new year to the Secretary of State. The reason she can do this is the excellent health care provided by the NHS in both Kettering general hospital and Northampton general

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hospital. Locally, the commissioners and the acute hospitals are together working out a plan to deal with accident and emergency. Is not that the way forward?

Mr Hunt: Indeed. I pass on my best wishes for the new year to Mrs Bone. Like many people, she has benefited from superb NHS care. A million more people are having operations every year under this Government, and 700,000 more people are being seen within four hours at A and E under this Government.

Gavin Shuker (Luton South) (Lab/Co-op): The NHS is a system, which is why cuts to social care and other parts of the system affect A and E. With that in mind, and with 14 hospitals in a state of emergency, will the Secretary of State review the plans that are in place should a winter crisis of cold weather come along at this very vulnerable point?

Mr Hunt: It is interesting that the hon. Gentleman did not want to talk to the House about his own local hospital, which is performing extremely well for A and E. It would be good if more of those on the Opposition Benches talked about the good things that are happening in the NHS, including nine out of 10 people who go to A and E being seen within four hours.

Rehman Chishti (Gillingham and Rainham) (Con): I thank the Secretary of State for the £13.4 million given to Medway Maritime hospital’s A and E department. Will he assure me that everything that can be done is being done to turn around hospitals in special measures such as Medway, which had the seventh highest mortality rate in 2006 yet nothing was done? Will he also join me in paying tribute to all the front-line staff who do a fantastic job at Medway?

Mr Hunt: I am happy to do that. One of the things that this Government are most proud of is what we have done to turn around hospitals with entrenched low standards of care following the terrible tragedy at Mid Staffs, with 18 hospitals put into special measures and six of them turned around. Despite all the pressure on me and on this Government to hit targets, we are sending out signals to the system, loud and clear, that targets matter, but not at any cost, and that we do not want corners cut when it comes to patient safety.

Graham Jones (Hyndburn) (Lab): Last weekend at Royal Blackburn hospital’s A and E, which I have been concerned about for quite a while, 18 ambulances were waiting outside. That was revealed not by the NHS but by a whistleblower, who described the situation as “chaos”. Is it happening because there are too many patients putting too much pressure on the NHS or because of mismanagement of the NHS by the Conservatives?

Mr Hunt: It is because of unprecedented demand caused by a range of factors. If the hon. Gentleman looks at the facts, he will see an NHS that is treating more people more quickly, with more doctors, more nurses and more operations than ever before. Sometimes, though, as I said yesterday, people on the front line feel that they are running just to stand still because there is so much pressure. That is why the £700 million in our winter plan and the money we are putting in to back the five-year forward view next year are so important.

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Karen Lumley (Redditch) (Con): Does my right hon. Friend agree that we should not be playing party politics with the NHS in the way that my opponent in Redditch is by putting out leaflets saying that I am systematically voting against the NHS, but that we should be working together with our trusts and partners in ensuring that we get through this problem, as we are trying to do in Worcestershire?

Mr Hunt: I absolutely do agree. Labour Members should talk to some of the front-line NHS workers in their own constituencies, who will tell them that the last thing they want at this time is for the NHS to be a political football.

Jonathan Ashworth (Leicester South) (Lab): The Secretary of State will know that major incident status was declared at Leicester hospitals this week for the seventh time in three months. In the week before Christmas, just 67% of patients at Leicester Royal Infirmary in my constituency were seen within the four-hour target, and clinicians, who are working flat out, expect pressures to increase over the next three months. What is he now going to do to support clinicians in Leicester and get a grip of this situation?

Mr Hunt: I am aware of the situation in Leicester. The hospital has had significant space pressures in its emergency department, and a couple of nights ago it had a high in-flow during one night, but it is absolutely on the case in trying to resolve this. What are we doing? We have put in £9.2 million of winter pressures money to make sure that whatever people decide the right solution is, it is not through lack of resources that they cannot do it.

Chris Skidmore (Kingswood) (Con): Last Saturday night, while I was visiting my wife’s family in Leicestershire, my baby daughter suddenly became quite ill. Rather than going to A and E, we rang the 111 service and were quickly referred to Loughborough urgent care centre, where we had fantastic treatment; I pay tribute to the staff. Does this not go to show that we need to prioritise new models of urgent care, as set out in Simon Stevens’s review?

Mr Hunt: We absolutely do that. Telephones and the internet provide different ways to get the right advice to people quickly. The 111 service is taking a considerable amount of strain at the moment, and we have put in more money to support it. We are investing a lot more in tele-health and tele-medicine, and a lot more to help GPs who want to give people out-of-hours appointments. In the long run, that is the way we will reduce the kinds of pressures that my hon. Friend talks about.

Helen Goodman (Bishop Auckland) (Lab): Over three years ago, I raised with Ministers problems about the North East ambulance service that had been pointed out to me by the paramedics, but unfortunately they were brushed aside. My constituent, Violet Alliston, had the terrible experience of her partner ringing for an ambulance three times in the course of an hour before the ambulance came. She then died. This is obviously completely unacceptable. Why will not the Secretary of

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State look again at the resources he is taking out of the North East ambulance service, the skills base of the call handlers, and the triage system?

Mr Hunt: I am extremely sorry to hear the story that the hon. Lady talks about, and I know that the NHS will investigate it fully. We are not cutting resources to ambulances, though. We have 2,000 more paramedics than four years ago, and £50 million is being put in this winter. Of course, we need to look very carefully into the particular case that she mentions and make sure that any lessons are learned.

Several hon. Members rose—

Mr Speaker: Order. I really am keen to accommodate remaining colleagues, because I understand the interest in this subject. May I appeal to colleagues to put single, short supplementary questions without preamble? Now, who might be a master of the genre—Mr Richard Graham?

Richard Graham (Gloucester) (Con): Thank you, Mr Speaker—I will seize the moment.

Part of the long-term solution is attracting and retaining more nurses. Will my right hon. Friend encourage the National Health Executive to allow the university of Gloucestershire to run pre-registration training courses for nurses so that we can attract and retain more local nurses?

Mr Hunt: I am happy to do that, and also to welcome the 80 new nurses in my hon. Friend’s local area over the past four years.

Andy Sawford (Corby) (Lab/Co-op): The Secretary of State will be aware that there are particular issues at Kettering General hospital’s A and E unit. It has improved its performance, but it has been described, to the shock of all the MPs in the area, as the worst seen in the country. We have done an awful lot of work. On Tuesday we are bringing the local health organisations together to the Department. Will he encourage his ministerial colleagues to give the green light to our plan for our area?

Mr Hunt: We will look at that very carefully. Of course, anything that can help to relieve pressure on A and E departments is our top priority at the moment.

Fiona Bruce (Congleton) (Con): My constituent, Mr J. Hollinshead, rang Ashfields surgery, Alsager, for an appointment at 8.30 am on 2 January. He was given one for 10.30 am, when his doctor referred him for three tests to be done with the practice nurse at 11.30 am, then on to Leighton hospital for an X-ray, and he was home by 1.30 pm. His response: “How good is that?” Is not that a truer picture of the NHS under this Government than the negative messages coming out from Labour Members?

Mr Hunt: I agree that we need to recognise the successes of the NHS, and there are many of those successes. The reason we need to do that—I urge Labour Members to remember this—is that it is very important for the morale of people working in the NHS that we publicly recognise where they are being successful.

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Clive Efford (Eltham) (Lab): Is it not true that this Government set out with a plan to close nine out of 31 A and Es in London, including the one at Lewisham, as directed specifically from the Secretary of State’s office? Does he regret that? What state does he think the A and E services in south-east London would be in if he had been successful, in the face of public opposition, in closing that A and E?

Mr Hunt: First, as the hon. Gentleman knows perfectly well, there were never any plans to close that A and E, and he should desist from scaremongering about what was happening at Lewisham hospital. He should also remember that when this Government came into office—[Interruption.] The plans—

Clive Efford: You idiot—it went to court!

Mr Speaker: Order. First of all, it is unseemly to squawk, and I think it would be accurate to say that what I heard was a squawk. I am not sure if there is a verb “to squawk”, but there was a squawking sound. What is worse, it was unparliamentary language, and I believe that the hon. Gentleman used a word that he will now wish to withdraw.

Clive Efford: I withdraw it unreservedly, Mr Speaker, but the public out there will draw their own conclusions.

Mr Speaker: I am grateful to the hon. Gentleman for his withdrawal and I note what he says.

Mr Hunt: The plans were to continue to have an A and E at Lewisham but to take some of the higher-risk patients to another hospital. Those are the plans that we originally had that have now been changed. What I will say to the hon. Gentleman, though, is that there were problems with South London Healthcare Trust for years and years. This Government dealt with them and sorted them out, and that means that his constituents are getting better care than they otherwise would have done.

David Morris (Morecambe and Lunesdale) (Con): Will my right hon. Friend join me in congratulating the staff at Royal Lancaster Infirmary on meeting their A and E targets in November? Will he also share my revulsion at the Opposition putting out a leaflet saying that there are all kinds of things wrong with the A and E and that it is going to close?

Mr Hunt: That is exactly the kind of scaremongering, frankly, that is incredibly demoralising for those who are on the NHS front line right now. I urge Labour Members to think before they start doing things that make a difficult situation even worse.

Kerry McCarthy (Bristol East) (Lab): The South Western ambulance service came close to declaring a major incident on 27 December, and local hospitals warned of unprecedented demand last weekend. What is the Secretary of State doing specifically to help hospitals and the ambulance service in the Bristol and Avon area to survive the winter?

Mr Hunt: As I mentioned earlier, I have talked to the chief executive of South Western ambulance service about the particular pressures it has faced, such as the 25% increase in 999 calls. We are doing a lot of things,

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including helping to recruit more paramedics. We have 40 more paramedics starting for the London ambulance service this month, and we are doing what we can to help the South Western ambulance service as well.

Stephen Mosley (City of Chester) (Con): About a third of the patients attending A and E at the Countess of Chester hospital are from the Welsh side of the border. They choose to go there because they know they will get treated a lot quicker in England than they will in Wales. Why is that the case?

Mr Hunt: The main reason is that Labour in Wales chose to cut the NHS budget, whereas in England we chose to protect and increase it.

Mr David Crausby (Bolton North East) (Lab): Before a major incident was declared yesterday morning, 76 patients were awaiting transfer to social care in the Royal Bolton hospital—nearly four wards-full—so when is the Secretary of State going to do something effective about the crisis in social care that is causing mayhem in our accident and emergency department?

Mr Hunt: I recognise the pressures that the hon. Gentleman is talking about, but last year, for the first time, the local NHS and the local authority in Bolton sat down together to plan social care for the most vulnerable people—his constituents—who need such joined-up care and have wanted but not had it for so many years. With the better care programme from this April, we will start to see some real improvements.

Henry Smith (Crawley) (Con): In 2005, the Labour Government closed the accident and emergency department at Crawley hospital, but services are now returning to the urgent treatment centre. Does my right hon. Friend believe that such centres play an important part in relieving pressure on emergency services?

Mr Hunt: They absolutely do. One thing we must do better is signpost people to the different parts of the NHS, such as walk-in centres, urgent treatment centres, GP surgeries or A and E departments. That is why the 111 service is so important in giving that advice at the earliest possible stage.

Dr Alan Whitehead (Southampton, Test) (Lab): Does the Secretary of State now regret the cuts inflicted on Southampton social care provision—they were draconian, disproportionate and possibly motivated by political football—given that Southampton city council has been unable to support the Southampton general hospital by moving people into social care and away from accident and emergency? Will he have a word with Communities and Local Government Ministers to get that put right?

Mr Hunt: If the hon. Gentleman feels strongly about that he might want to talk to the shadow Chancellor, who this week publicly ruled out any extra funding for social care.