1 July 2015 : Column 457WH

1 July 2015 : Column 457WH

Westminster Hall

Wednesday 1 July 2015

[Mr David Crausby in the Chair]

English Votes for English Laws and North Wales

9.30 am

Albert Owen (Ynys Môn) (Lab): I beg to move,

That this House has considered English votes for English laws and North Wales.

It is good to see so many hon. Members from across the United Kingdom who are interested in North Wales. That was the purpose of this debate. We live in interesting constitutional times and I welcome the opportunity to put the case for Wales, and North Wales in particular. In the 1880s we had the Irish question. In the latter part of the 20th century, there was devolution to Scotland, Wales and Northern Ireland and we had the West Lothian question. Today, we have the North Wales question, which is an important constitutional issue.

Although I support it, devolution is unbalanced, asymmetrical and needs adjusting, but I do not believe the Government’s proposal for English votes on English laws is the answer. The UK Parliament is creaking and the devolution settlement is messy, but we need to deal with it objectively through a UK constitutional convention. That is the basis of my argument.

I want to make it clear that I support devolution. I supported it in the 1970s, when the majority of my party did not, and I supported it in 1997-98, when it was the will of the Welsh people, and the people of Scotland and Northern Ireland. It is important to remember that part of that devolution settlement was the creation of the London Assembly and the establishment of the Mayor of London, giving powers to the largest city in England. That was important, but we should have gone further. I am not just saying that with hindsight; I was arguing for it at the time, before I was a Member of Parliament, because I could see that it was an uneven settlement. I should have liked the regions of England to have an element of devolution, too, because that would have provided balance.

I go a step further than my party: I believe in a federal United Kingdom. I think we should have an English Parliament within the UK. We should retain the UK Parliament for foreign affairs and other bigger issues that concern the whole United Kingdom. I know, because I am a realist, that this is not an issue for today, but we must look to the future for a UK convention on constitutional rights.

Mr Andrew Turner (Isle of Wight) (Con): Will the hon. Gentleman explain whether there would be a separate House of Commons in a federal organisation, compared with the English basis, or can they be combined?

Albert Owen: I appreciate that intervention from a fellow islander. I was in Jersey yesterday, watching the Island games and cheering Isle of Wight on. The hon. Gentleman makes a serious point. We need a proper convention to consider these issues, because some of

1 July 2015 : Column 458WH

the arguments have not been dealt with in great detail in this House. The knee-jerk reaction of having English laws and English votes is not the answer; it is a sticking plaster and it will cause more problems than it will create solutions.

Mr David Jones (Clwyd West) (Con): Is the hon. Gentleman acknowledging that the devolution settlement established in 1999—the creature of the Labour party, of course—is grievously flawed?

Albert Owen: The call for devolution in the ’70s was so strong that there had to be a reaction to it from the UK Parliament. I mentioned in my opening remarks that there should have been a more balanced version, with more English devolution, at the time it was introduced. I am sure that the right hon. Gentleman would have supported that, because he is now a pragmatist and in favour of the current constitutional settlement.

Mr Jones: Yes, but did not the people of the north-east reject devolution to the English regions when it was put to them?

Albert Owen: Obviously, that happened. If it had been done at the same time as the London Mayor, and perhaps at the same time as another region, perhaps others would have clamoured for it later. I accept that that was an error. However, the right hon. Gentleman’s party, which opposed devolution at that time, has now wholly embraced it, so the Labour party has done his party a favour, moving it forward in many ways. The right hon. Gentleman, a pragmatic Secretary of State who wanted more devolution for Wales and for the rest of the UK, is evidence of that. I welcome the fact that many Conservative Members of Parliament have taken this journey, but I want the direction of the journey to be clear in future.

Susan Elan Jones (Clwyd South) (Lab): This is an important subject. Does my hon. Friend agree that there are many types of devolution? He talks about English devolution. Once upon a time, I served as a borough councillor in London and I think the emphasis there would be on London-wide devolution, with virtually no interest in English devolution. Does he also agree with his predecessor, the late, great Cledwyn Hughes, who spoke of an authority for North Wales? I am not necessarily advocating that as a model, but there are different types of devolution and all have to be considered in the round.

Albert Owen: I am grateful for that intervention. I will develop my argument a little further, but my point is that devolution needs to be close to the people. In the original Welsh devolution settlement, the Assembly had regional bodies where we discussed many issues. I do not want devolution to be just a movement of powers from Westminster to Cardiff Bay: within Wales, I want it to go to Colwyn bay and Cardigan bay, and to Cemaes bay in my constituency. That is real devolution and that is what I am advocating. Devolution should not just be for one part of the UK. We need even distribution of devolution across the UK.

Antoinette Sandbach (Eddisbury) (Con): Of course, the reality is that the decisions of the Assembly have led to power being centralised in Cardiff, out of the regions of Wales. That is a product of the very devolution that

1 July 2015 : Column 459WH

the hon. Gentleman professes to support, and it happened because of decisions taken in the Welsh Assembly by elected Welsh representatives. Is he arguing against the devolution that has happened in Cardiff?

Albert Owen: The hon. Lady was a North Wales Member of the Assembly. My criticism is not just about the institution or the Government in Cardiff Bay. North Wales Assembly Members should be making a stronger case for North Wales. That is what I am doing today, as a North Wales MP. I will argue, when I have a chance to develop my argument without interventions, that there needs to be representation from North Wales MPs in this debate.

The debate has gone a bit sterile post-Scottish referendum, partly because of the Prime Minister’s reaction on the morning after the referendum result, which I very much welcomed. Instead of being statesmanlike and trying to strengthen the Union after the referendum result, he chose to talk about one part of the UK: England. The Union is not strengthened by isolating and talking about one part of it. Unionism must be about the whole UK. That is why I am arguing for North Wales MPs having a strong voice and being equal in this UK Parliament. We are all elected under the same franchise and we should be allowed to debate and vote on the same rules and regulations that are before this House, and there should be no exemption. No Parliament will succeed if it has two tiers of representative. We all have the same mandate and we are here to represent our constituents and the UK, but we will not be able to do that if we go down the avenue proposed by the Conservatives. That is the gist of my argument. I will put some detail on it in the next seven or eight minutes, after which I will sit down and allow other hon. Members to contribute.

Devolution has to be more than just a theory: it has to be practical and real because it concerns services, such as health and transport, which are often provided east-west in the UK. Most decisions on transport that affect Wales are made here in the Department for Transport. The debacle over the west coast main line affects not just my constituents, but the whole of North Wales and the whole of England. It is an interconnector and a corridor between Ireland and London, going through North Wales. It would be crazy for North Wales MPs not to have a say or not to be able to question the Secretary of State when big decisions go wrong, such as when millions of pounds of taxpayers’ money is squandered by errors in the franchise process. That affects my constituency and services to my constituents. I travel on that train every week, and I know the composition of its passengers: they are from North-West Wales, other parts of North Wales and England. We need to have a voice in this House when we debate such issues, so that we can express our views and vote on big decisions that affect our constituents.

Mr David Jones: I am extremely grateful to the hon. Gentleman, who is being very kind in giving way. While I agree with the thrust of his argument, is he not choosing a rather bad example, because railway services are not a devolved issue?

1 July 2015 : Column 460WH

Albert Owen: I am trying to make a number of points, but I am being intervened on every couple of minutes; I am trying to develop a stronger argument about transport and other public services—health, for example. The right hon. Gentleman and I sat on the Welsh Affairs Committee many years ago, and we realised that there were anomalies. People from North Wales use specialised services in English hospitals, such as the Christie, Alder Hey and the Walton Centre; those specialisms cannot be delivered in general hospitals across the UK. They are specialist UK institutions providing some of the finest services in the world, and I want my constituents to be able to access them, but I also want a say if big decisions are to be made on whether to cut those services, because that would affect my constituents. I am not making the argument from an ideological point of view; it is about real services for real people. That is the principle here.

Jessica Morden (Newport East) (Lab): My hon. Friend is making an excellent point about North Wales, but what he says is equally true of South Wales. Some 48% of the Welsh population lives within 25 miles of the border, so in constituencies such as mine, many people use the English NHS and English schools and travel to work in Bristol and elsewhere.

Albert Owen: My hon. Friend is absolutely right. This debate is about North Wales, but there are important issues in South Wales and southern Scotland and England that need to be looked at, which is why we need a proper UK constitutional convention, so that we can deal with all these points properly and in a sober manner. We need decentralisation, but in a balanced way, rather than simply devolving powers from one capital city to another.

I agree with the point that the hon. Member for Eddisbury (Antoinette Sandbach) made about over-centralisation in some smaller countries after devolution. Instead of devolving power closer to the people, there is a tendency to have political control at the centre. I make no bones about it: in the 1970s, I was arguing against decentralisation. Some of the best devolution in the British state has been the Driver and Vehicle Licensing Agency move to Liverpool, the British Council move to Manchester and various bodies’ move to Scotland. Moving institutions helps to create local economies and a more balanced United Kingdom. I am certainly not happy with everything that has happened in the devolution settlement, but I believe that the response of the Conservative Government and the previous coalition Government is a sticking plaster that will cause more problems than it will create solutions. That is the reason for this debate.

I want a UK Parliament to look at defence and other issues if we are to have an English Parliament, but I am a realist and I do not think there is the appetite for that at the moment. However, the answer is not exempting Welsh, Northern Irish and Scottish MPs from issues that Parliament is discussing. I do not think there is a Parliament anywhere that has different degrees of power within the legislature. Yes, some Parliaments have more than one Chamber to discuss things in detail, but the proposals in front of us, drawn from different reports and different exercises that the coalition Government put together, are wrong for a number of reasons.

1 July 2015 : Column 461WH

I made the point that we are all elected equally on an equal franchise. We should have Second Reading debates where everyone can take part.In Committee where detailed amendments are discussed—for example, amendments dealing with health and how an English trust is run, which may affect my constituents, so they are important—I should have some input, or a chance to be on the Committee. If I do not get on that Committee, I can debate such measures on Report on the Floor of the UK Parliament. UK parliamentarians should be involved in that process. If we go down the road the Government propose, what is next on the agenda? What procedures will be passed upstairs that will exempt English Members from talking about different parts of England? That logic can be applied to the proposals as they stand, which is worrying.

Mr James Gray (North Wiltshire) (Con): Will the hon. Gentleman give way?

Albert Owen: I will give way one more time, because I want to hear the English dimension on this issue. I know that the hon. Gentleman wants to speak for England.

Mr Gray: I speak as the person who was the shadow Secretary of State for Scotland for the shortest ever time: five days. That was a result of making untoward remarks on “Newsnight” in favour of some form of federal solution of the kind the hon. Gentleman describes. I want to pick up on the point he was making a moment ago on the importance of him having a say on health matters, because his constituents use the health service in England. That is true of course and I do not disagree with him, but my constituents may well use the national health service in Wales, and I can have no say in how the NHS in Wales is run. Why should it be one way and not the other?

Albert Owen: I understand why the hon. Gentleman makes that point, but I am talking about specialisms, not general hospitals or general practitioners. Hospitals in England used by patients from North Wales were built by North Wales people specially in those locations to serve England and Wales and the rest of the United Kingdom. Let us be honest; we cannot have specialisms in every region of England and every part of Wales, Scotland and Northern Ireland. We have some of the best hospitals in the world in certain areas of the UK, and we need to be able to discuss them in the UK Parliament. It is not right to exempt MPs from that. I understand the hon. Gentleman’s frustration at having no say on general health issues in Wales, but it is more important to look at specialisms and the reality of what our constituents face, rather than the theory to which he refers.

Mr David Hanson (Delyn) (Lab): The hon. Member for North Wiltshire (Mr Gray) makes a valid point about a frustration he faces, but he can still speak on equal terms in this Parliament to the Secretary of State for Wales or the Department of Health and raise those issues. Under the Government’s proposals, he would not be able to speak or move amendments on those issues at all.

Albert Owen: Other Members, if they catch your eye, Mr Crausby, will be able to give examples of using services closer to the border in far more detail than I

1 July 2015 : Column 462WH

will, but I am laying out the context. It is a dangerous constitutional move to exempt UK Members in a UK Parliament. We are all here as equals. I do not want to be a second-class MP. I want the same rights and responsibilities as other Members.

We should have a written constitution to underpin all this. The present situation is a mess. We celebrate 800 years of Magna Carta, but we do not have a 21st-century constitution. The world has changed in those 800 years. We did not have NATO, the UN or the EU back then. We need to look at our constitution and the bloody battles we had instead of resolving this around the institutions.

I do not think the Conservative party and the coalition looked at the issue seriously. I do not agree with the Scottish National party when it talks about independence, but I do think it has the right to have that debate. Scotland had the debate and the vote. Its Members of Parliament were elected under the same franchise as the Welsh, Northern Irish and English Members and they have the same rights in this place, which is what I am defending. However, the North Wales case is special because of our east-west relationship in transport, health and the economy. We have large employers in England and large employers in Wales, and there are cross-border issues in that regard that are dealt with by the UK Parliament. I would have spoken for longer on some of the technical issues, but this debate is about empowering people and maintaining the right of MPs to speak on their behalf.

We need to have a proper UK convention on the constitution. We cannot go on piecemeal; we need to look at this in a broad context, and it cannot be done behind closed doors or in corridors. A Conservative manifesto is being pushed through without thought to exempt a large number of MPs from debates who represent areas that have been represented here for centuries. One reason we had the Act of Union when Wales became a part of the United Kingdom was to have equal representation, and that has not changed. I understand the need to have fewer MPs from areas where there are devolved Administrations, but we should not exempt those Members from voting on laws in the UK Parliament.

Let us have a proper debate. I hope that today’s discussion will help to highlight the North Wales question in some way. The Leader of the House has said that he wants a proper debate on English votes for English laws, but I want to debate the whole issue, and I want to protect my constituents’ right to elect an MP who can speak on their behalf.

Several hon. Members rose

Mr David Crausby (in the Chair): Order. I intend to call the first of the three Front-Bench speakers at 10.30 am, which gives us about 40 minutes. Ten Members have risen to speak, so if they can keep their contributions to around four minutes, everyone will have an opportunity to speak.

9.50 am

Guto Bebb (Aberconwy) (Con): It is a pleasure to serve under your chairmanship, Mr Crausby.

1 July 2015 : Column 463WH

Four minutes is not a long time to discuss the issues raised by the hon. Member for Ynys Môn (Albert Owen), whom I congratulate on securing this debate. He is a champion for his constituency and for North Wales, and there is no doubt that he has raised some genuine concerns that are felt across the region and, indeed, recognised in the wider United Kingdom. Nevertheless, it is a shame that the main thrust of his argument was that we should establish a UK constitutional convention along the lines proposed in the Labour party manifesto for the 2015 general election. If there was ever a need for such a convention, it has long since passed.

The truth is that we have a devolution settlement that was not particularly well thought through. I agree with my right hon. Friend the Member for Clwyd West (Mr Jones), who highlighted the fact that the devolution settlement we have was created without any real thought as to how to ensure that it was fair and equitable. Nevertheless, we are where we are. We must address how we move forward equitably and reasonably.

It is interesting to note that many Members from North Wales will say that they want to retain the ability to influence the services provided by, for example, the English NHS—the hon. Member for Ynys Môn spoke about the health service. It is true that people from North Wales go to Greater Manchester or the Merseyside area for specialist services, but it is also true that people from England come to Cardiff for specialist services. My cousin is a consultant in a hospital in Cardiff, and he treats people from South Wales and people from England. The point still stands: it is clear that, as Welsh MPs, we have no ability to influence most of the health services provided by the Welsh Assembly, but English MPs have no ability to influence how their constituents are treated if they require support.

The situation in North Wales is very clear: specialist services are generally provided from England, but the same is not necessarily true in all parts of the kingdom. The issue remains: how do we reach an equitable situation so that Members from North Wales and England have the ability to influence decisions? It is important to recognise that there is a feeling of unfairness, even along the North Wales coast. Having spoken to people who have moved into North Wales from England, I know that there is a feeling that there is something inequitable in the devolution situation.

Saying that we need a constitutional convention to try to address the inequities is over-egging the cake. We have not been talking about the West Lothian question only since 1977, when Tam Dalyell started to talk about it; Gladstone talked about it back in the 19th century. We can talk about it until the cows come home, but really we need to take action. I genuinely believe that the current inequity is a bigger threat to the devolution settlement than doing nothing. I am afraid that the example from Scotland and other parts of the UK is that, often, constitutional conventions are set up when there is a desire to kick something into the long grass.

We need to ensure that laws that relate only to England can be influenced by Members from Wales, Scotland and Northern Ireland, but the main decision-making on those specific laws that are deemed English-only should be made by English MPs.

1 July 2015 : Column 464WH

Ian C. Lucas (Wrexham) (Lab): Will the hon. Gentleman give way?

Guto Bebb: I will take only one intervention, because of the time.

Ian C. Lucas: What is an English-only law?

Guto Bebb: That is a key point. We have to have some confidence in the ability of this House and Parliament as a whole to come to a conclusion and define a specific law as English, English and Welsh, or UK-wide. The hon. Gentleman has highlighted a crucial point: we are talking as if a deal has been done, but the detail of the Government’s proposals has not yet been announced—

Ian C. Lucas: Give us an example.

Guto Bebb: In my view, it is clear that many Bills will be categorised as English and Welsh. In many cases, they will be categorised as UK-wide. Nevertheless, we have to accept that there is a principle that needs to be dealt with.

Finally, my hon. Friend the Member for Eddisbury (Antoinette Sandbach), who was previously a colleague of mine in North Wales, made an important point: anyone who believes in devolution cannot be very pleased with how the Welsh Assembly has worked, because it has sucked power into Cardiff. I want to stress, however, that that is not necessarily a failure of devolution; I would argue that it is a failure of how the Labour party has dealt with devolution in Wales.

9.55 am

Justin Madders (Ellesmere Port and Neston) (Lab): I speak today as an English MP elected for the first time only a few weeks ago. I have already discovered a number of instances where decisions are made in Wales that affect my constituents, but it is difficult to influence them or make representations. Members on the other side of the border clearly face the same challenge in reverse. I want to highlight some of the inequities in the system that need to be resolved before we press ahead with further change.

The western boundary of my constituency, Ellesmere Port and Neston, forms part of the border with Wales—indeed, I can leave my home and be in that great country within 10 minutes. The western side of the constituency faces the River Dee, which forms a natural barrier, but, going inland, the border is firmly on the eastern side of the river, which lies on the cusp of English settlements, going so far into the neighbouring constituency, City of Chester, that it dissects Chester City football club’s ground.

We have physical proximity, but we also share much in common with our colleagues over the border, culturally, economically and socially. For example, a great many people work on one side of the border and live on the other. Indeed, many of my early temporary jobs were in Deeside, and my most recent employer before entering the House had offices in both England and Wales—in Chester and Wrexham. Let us not forget that England and Wales share a common legal system. I hope that any proposals take that into account.

1 July 2015 : Column 465WH

I want to highlight the work of the Mersey Dee Alliance, a partnership of Cheshire West and Chester Council, the University of Chester, Denbighshire County Council, Flintshire County Council, Glyndwr University, Wirral Borough Council, Wrexham County Borough Council, the Welsh Assembly and Merseytravel that has been around since the 1990s. The alliance put it perfectly when it said that

“the area represents a single economic sub-region with a population of close to 1 million”

that just happens to be divided by a national boundary.

Transport is another key issue on which England and Wales cannot easily be separated. A recent example is at the Posthouse roundabout at the junction of the A483 and the A55, which set a record as a single set of roadworks causing chaos in two countries. In recent years, significant central Government funds have been invested in the local sustainable transport fund, thanks to a programme run by Cheshire West and Chester Council that recognises that the economic sub-region covers Chester, Ellesmere Port, Deeside, Wrexham and areas of Merseyside. I have already expressed my concern in the House about how the proposed devolution of the Borderlands Line rail franchise, as part of the Wrexham to Bidston proposals, will affect my constituents, it being the main route from Neston into Liverpool and Wales.

My constituents are at risk of being overlooked because there is no formal mechanism for conveying their views. The situation is unacceptable, and I intend to argue on behalf of my constituents so that they have a voice. It demonstrates amply the dangers of pushing ahead with a settlement that fails to give proper thought to how those who live either side of the border are properly represented.

Recently, issues have arisen that have highlighted the frustrations of cross-border concerns. I met constituents who are cockle fishers on the River Dee. They pay a licence fee to Natural Resources Wales but have no ability to influence decisions or make representations. The old adage, “No taxation without representation,” springs to mind. I am sure there are many similar examples.

Within a few weeks of entering Parliament, I have already found two significant examples of a failure to appreciate how decisions taken in one country can affect people in another. We need clarity on what matters are reserved for the Welsh Assembly and the mechanisms available for those on both sides of the border to make representations and influence decisions. Ultimately, we need to find a way to ensure accountability. I am concerned that, if we push ahead without much thought, we will end up with a system that is crude and simplistic, lacking in democratic legitimacy and accountability. Such a system will also be a barrier to economic growth in the area.

10 am

Mr David Jones (Clwyd West) (Con): It is a huge pleasure to serve under your chairmanship, Mr Crausby. I commend the hon. Member for Ynys Môn (Albert Owen) on securing an important and timely debate. It is timely, of course, because we are considering a lot of constitutional legislation, including the Scotland Bill, which continues in Committee today, and the proposed procedural changes to the rules of the House.

1 July 2015 : Column 466WH

I agree with most of the thrust of the hon. Gentleman’s argument. That said, the issue of fairness must also be considered. It cannot be fair that a Member of Parliament for a part of the country in which powers are totally devolved should have a vote—possibly a determinative vote—on matters that do not affect either that Member or their constituents. I am pleased to follow the hon. Member for Ellesmere Port and Neston (Justin Madders), who illustrated the cross-border problems quite nicely. He neatly demonstrated the frustration of English Members that they often have no voice in any democratic assembly on issues concerning them and their constituents. That cannot be right.

The problem is that the devolution settlement imposed in 1999 is frankly not fit for purpose. It does not work; it is a lash-up and it needs to be revisited. The hon. Member for Ynys Môn talked about a constitutional convention, but the fact that he had to do so shows that he also recognises that what was put in place by the Blair Government back in 1999 is not fit for purpose and ill serves the people of both England and Wales.

Albert Owen: I will be brief, as I have already spoken at some length. As Secretary of State for Wales, the right hon. Gentleman’s answer to the problem was more devolution. He just added to the devolution settlement. We need a constitutional convention so that we can pause to consider and reflect on the matter at a UK level.

Mr Jones: I certainly believed in more devolution of taxing powers and was a firm advocate of that. The hon. Gentleman makes a different point, which I will focus on in the time remaining.

What we have in North Wales, as the hon. Gentleman rightly says, is a wholly different state of affairs from that which prevails in South Wales. The Welsh devolution settlement was put in place by South Wales politicians who did not really understand North Wales, did not understand that North Wales is part of the north-west economic region, did not understand the need of North Wales patients to access medical treatment in the north-west of England and did not understand the historical and cultural ties that bind the people of the north-west of England and North Wales.

I will support the procedural changes to the rules of the House provided that they fully reflect the interests of the people of North Wales and their representatives. I will join the hon. Member for Ynys Môn in pressing for that when the matter is considered by the House. More importantly, the Wales Bill to be introduced later in this Parliament presents an opportunity to address the whole issue of devolution and to sort out the problems that were identified by the hon. Members for Ellesmere Port and Neston and for Ynys Môn. We should take the opportunity to try to improve a devolution settlement that is unfit for purpose.

10.4 am

Kirsty Blackman (Aberdeen North) (SNP): I appreciate the opportunity to speak in this Westminster Hall debate on English votes for English laws and North Wales. The Government have managed to get themselves in a right guddle over this. Despite much conversation and much posturing, there is still a total lack of clarity about what will be classed as English only and what will be considered

1 July 2015 : Column 467WH

by the whole House. The SNP is clear that Scottish or Welsh MPs should not be given second-class status in the House of Commons. We face the prospect of MPs being barred from votes, reducing our ability to help our constituents.

The process of certification as “England only” will be highly contentious and no doubt debated as the matter goes forward. Although I have much respect for both the office of Speaker and the Speaker himself, I cannot say that I envy the task he may be presented with. If the decision is taken to give the role to the Speaker, it is clear that provision needs to be written in for devolved legislatures to be consulted in advance of the Speaker’s decision. That happens in Scottish situations when neither Government have indicated a need for a Sewel motion in draft legislation, so the procedures are there. I am sure that none of us wants such issues to be decided in the courts, but it is surely of concern that the process of change through Standing Orders, rather than legislation, would mean that a contentious certification decision could not be challenged in any way, including through the courts. That is not right if people in Scotland, Wales or Northern Ireland are disadvantaged by legislation that their democratically elected MPs have been excluded from considering.

Antoinette Sandbach: The problem with going through the courts is the endless delays. We saw that in Wales with the Supreme Court’s decision regarding the Agricultural Wages Act 1948, which fundamentally altered the Act and moved Wales on to a reserved powers model. That is undemocratic because it is judicial decision making.

Kirsty Blackman: The point is that the core process is there. We need a process of legal challenge. We need to allow people to challenge decisions that are taken here. Making the change through the Standing Orders removes that right.

The key point is this: it would be ridiculous and undemocratic for Scottish or Welsh MPs to be excluded from any decision that could have a detrimental impact on the budgets of the devolved Administrations. Forty-five per cent of the Scottish people voted for independence and 55% voted to stay in the Union. Not one of them voted to cede to others the ability to legislate. It would be utterly bizarre for such a significant constitutional change to be made by a change to the Standing Orders.

Susan Elan Jones: Will the hon. Lady give way?

Kirsty Blackman: I will not, as I have only a short time remaining.

It would also be improper and unprecedented for any changes to the Standing Orders to be made without proper scrutiny. Such significant constitutional changes require significant scrutiny and debate, not a hurried announcement less than three weeks before the summer recess and with much scrabbling around to formulate a coherent policy. I urge the Minister, as I have in many written questions already, to allow extensive scrutiny of the matter. We do not need a change in the rules to determine what we can and cannot vote for. Scottish MPs already exclude ourselves from purely England-only

1 July 2015 : Column 468WH

votes. It is pretty ironic that, on a day after English MPs vote down the will of the Scottish people on the Scotland Bill, a discussion is being held on how best to exclude Scottish MPs from English legislation. We simply cannot have this rushed through without proper consideration of the consequences.

10.7 am

James Davies (Vale of Clwyd) (Con): I congratulate the hon. Member for Ynys Môn (Albert Owen) on securing this debate. I represent a constituency that is three seats into Wales, but none the less I have many constituents who daily cross the border into England, just 30 minutes away. We do not tend to hear about constitutional matters on the doorstep.

Simon Hart (Carmarthen West and South Pembrokeshire) (Con): My hon. Friend makes a valid point about constitutional matters being a sleeping pill for most of the electorate. Does he agree that one of the greatest frustrations during the election campaign was the confusion over who is responsible for what? That great exasperation probably damages the reputation of politics in the eyes of the public. Whatever we do, we must address that point. rather than just talking about ourselves to ourselves.

James Davies: My hon. Friend is quite right: we must address those issues. I will come on to that point in a minute. On the doorstep, some people pointed out the unfairness of the current situation—with particular regard to Scottish MPs, in fact; Wales was mentioned to a lesser degree—and that unfairness is ultimately a consequence of devolution. The First Minister in Wales has said that laws that affect Wales should be made in Wales—meaning by Welsh politicians. The follow-on from that is that laws that affect England should be made in England by English politicians. People cannot have it both ways.

The proposals certainly have a good deal of pragmatism behind them. That said, Wales is in a different position from Scotland in many respects. In North Wales, many live near the border, and the political boundaries do not reflect the reality of people’s day-to-day lives—where they live and work. Yes, roads, universities, energy projects and environmental issues in England affect our constituents, but having said that, they need to travel out of North Wales for that to be the case.

Today I want to highlight the issue of health. As a doctor, I am well aware of the issues that have been brought up about hospitals in the north-west. The Countess of Chester hospital, where I have worked, was built on the basis that about a third of the patients would be from Flintshire, which is still the case in many respects. Alder Hey, Gobowen, Broadgreen, Liverpool women’s, Arrowe Park and Walton are all hospitals that rely on the throughput of North Wales patients—

Albert Owen: And the staff.

James Davies: And many of the staff live in Wales, of course. The services at those hospitals exist because of the North Wales patients. This happens the other way around, but to a lesser extent; there are not many services in North Wales to which English patients travel. That said, there are English patients registered with

1 July 2015 : Column 469WH

Welsh GPs and vice versa. North Wales is a particular case; services in north-west England are designed for and accessed by North Wales patients. That perhaps does not apply in other areas.

Unfortunately, as my hon. Friend the Member for Carmarthen West and South Pembrokeshire (Simon Hart) mentioned, many voters are unaware of the devolution settlement, or disregard such things. Some of the issues, to be honest, challenge the rationale of Welsh devolution, certainly in so far as North Wales is concerned. In summary, the key thing for me is that the decision as to what is an English-only matter will be difficult, requiring much consideration to ensure that the voices and interests of North Wales residents are not overlooked. I foresee that many issues will be both English and Welsh, and not English only.

10.12 am

Mr David Hanson (Delyn) (Lab): I entered the Chamber this morning equal to every other Member attending the debate. I have been a Member of Parliament for 23 years, during which time I have been equal to other Members. That includes the time when the right hon. Member for Wokingham (John Redwood) was Secretary of State for Wales, even though the Government of which he was part had no mandate from elected Members of Parliament in Wales, and, likewise, the time when Lord Hunt was Secretary of State for Wales. I have been an MP at times when we had Labour Secretaries of State for Wales, and when the right hon. Member for Clwyd West (Mr Jones) was Secretary of State for Wales.

Wales has a 170-mile border, and 50% of the population of Wales live within 25 miles of it. That means that my constituents access services, employment and a range of other things in England as well as Wales. It is important to recognise that, and to look at the key challenges mentioned by my hon. Friend the Member for Ynys Môn (Albert Owen). We need to examine how we develop a constitutional settlement that reflects the needs and the real challenges of people who represent seats in England, but feel that they have no say on matters in Scotland, Wales and Northern Ireland.

A number of my constituents work for the fire service in Merseyside, Cheshire or Shropshire. I have key transport links in Crewe; the Halton curve provides a key link between Liverpool and services in North Wales, but it is in England. My hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) mentioned the line to Bidston from Wrexham, which goes through north Wales and is a key issue on both sides of the border. Arriva Trains Wales is devolved, but Virgin Trains provides a service that is not devolved.

There are health services in my constituency that are serviced by providers in England. Specialist services are at Clatterbridge, the Christie and the Royal Liverpool, because of the nature of our region. A third of my constituents were born in England—many at the Countess of Chester hospital, but some, like me, were born elsewhere in England. That even includes people who have played football for England, although they resided all their lives in Wales; they qualify for England because they were born in a hospital in England.

My next-door neighbours are teachers in England. I have constituents who are police officers in Merseyside, Cheshire or Shropshire. The nearest airports to my

1 July 2015 : Column 470WH

constituency are Liverpool and Manchester. I have constituents who work at Vauxhall Ellesmere Port in the constituency of my hon. Friend the Member for Ellesmere Port and Neston, or in Chester at the banking and financial institutions there. Why is that important? When Vauxhall Ellesmere Port was under pressure and delegations went to the Secretary of State for Business, Innovation and Skills in England about support funding to keep jobs in the area, I was able to participate. Furthermore, farmers from the constituency of the hon. Member for Eddisbury (Antoinette Sandbach) come to Mold market in my constituency. They come from England to sell their produce in North Wales. What matters in England matters to my constituents in Wales.

Mr David Jones: Will the right hon. Gentleman give way?

Mr Hanson: I only have a short time and I want to ask the key question: who decides what is a Welsh issue? Under the proposals, the Speaker is supposed to decide. What openness, transparency and representations will there be? How will the Speaker determine what is an English-only matter, particularly when the Government have said that they will extend the principle of English consent to financial matters? Who decides, and what does that mean for not only votes but key questions in the House of Commons? Will I be able to table parliamentary questions in the House of Commons as an equal Member? Will I be able to speak in Westminster Hall as an equal Member? Will I be able to ask for a meeting with the Minister of an English-only Department about matters to do with the fire service, the police, health, schools or employment in my area?

Ian C. Lucas: We don’t know.

Mr Hanson: Will I be able to undertake—[Interruption.] The answer to the question, as my hon. Friend said, is that we do not know. We do not know as yet, because the proposals are not there. We need clarity.

Finally, this issue is important to the unity of the United Kingdom. I cannot believe that the Conservative and Unionist party has made such proposals. I made this point in the main Chamber the other week: Gordon Brown represented a seat in Scotland and was Prime Minister of the United Kingdom; Jim Callaghan represented a seat in Wales and was Prime Minister; and Andrew Bonar Law and Alec Douglas-Home represented seats in Scotland and were Conservative Prime Ministers. Are we saying that no such Prime Minister can ever stand at the Dispatch Box again, or that they would say, “I’m very sorry, I can’t answer that question, because it is devolved to Scotland, Wales or Northern Ireland”? If that is the position of the Conservative and Unionist party, it has come an awful long way from the Conservative party I once knew.

10.17 am

Antoinette Sandbach (Eddisbury) (Con): Thank you, Mr Crausby, for calling me to speak. I am grateful to the hon. Member for Ynys Môn (Albert Owen) for securing the debate. In reality, it is easy to answer the question of the right hon. Member for Delyn (Mr Hanson) about how to identify which votes are on English-only matters and which are not. We simply look at the Wales Act 2014, for example, and decide which powers have

1 July 2015 : Column 471WH

been devolved to Wales and which are reserved; that will identify them. It happens all the time in the National Assembly for Wales, with the process delegated to the Presiding Officer. I would, however, have a great deal more sympathy with the position of the right hon. Gentleman if he had not voted for that asymmetrical and uneven devolution settlement, described by the hon. Member for Ynys Môn. We need to remember that all the arguments were made when the Government of Wales Acts were before Parliament. All those issues were identified.

I have a great deal of sympathy with the hon. Member for Ellesmere Port and Neston (Justin Madders) on his frustrations with Natural Resources Wales, a body that is incredibly inefficient and should never have been set up; I opposed it when I was in the Assembly. However, the hon. Gentleman still has an ability to influence it, and to contact it on behalf of his constituents, although he does not have an ability to vote on setting up such a body—but that is the position that my constituents are in.

As described by the right hon. Member for Delyn, I have farmers who go over to Wales to sell their products in the market at Mold. They are subject to Welsh tuberculosis restrictions on pre-movement testing of cattle, but cannot vote on the matter. That constitutional settlement was put in place by the Labour party. All the arguments we have heard today were rehearsed then—we have been hearing them for years.

I accept all the points made by Members on both sides of the House about our strong links and ties, which have been there for generations, but we have to deal with the unfairness affecting England. That issue has been raised on the doorstep. The hon. Member for Aberdeen North (Kirsty Blackman) ought to realise that it is a great cause for concern when education or health matters, which are wholly devolved to the Scottish Government, can be voted on by Scottish MPs. In reality, she will have an opportunity to vote on financial matters that may affect her constituents, because there will be a vote on the Budget and an opportunity to debate those matters.

The unevenness of the constitutional settlement was recognised by the fact that the Conservative party secured a majority with an election manifesto commitment to deliver English votes for English laws. My hon. Friend the Member for Vale of Clwyd (James Davies) was right to say that we cannot have it both ways. If something is in the Scotland Act 1998 or the Government of Wales Act 2006, it is devolved, so what constitutes an English or Scottish matter will be very clear to the Speaker. Everyone will vote on the Budget—there is no suggestion that that will not happen—but English votes for English laws is a matter of fundamental fairness in this House, and needs to be addressed. If matters are devolved to Scotland or Wales, it should be English MPs who have the vote on those matters in England. Failing to address that fundamental unfairness undermines the integrity of this House.

Mr Andrew Turner: May I ask what the difference is between the system we are proposing and one that includes a long-term think about things, which is basically what the Labour party favours?

1 July 2015 : Column 472WH

Antoinette Sandbach: The short answer is that I do not know, but the last time there was a constitutional convention, it took years; it was kicked into the long grass. Quite frankly, this situation needs to be dealt with now.

10.22 am

Mark Tami (Alyn and Deeside) (Lab): It is a pleasure to serve under your chairmanship, Mr Crausby. I thank my hon. Friend the Member for Ynys Môn (Albert Owen) for securing this important debate.

I represent a border area, but in reality the border does not exist. As others have mentioned, many thousands of people from North Wales travel across it to go to work at Vauxhall in Ellesmere Port, and at many other employers in the north-west. Equally, many people from England travel the other way to work at Airbus, Toyota, Deeside industrial park and many other places. Our road and rail networks work east to west, but do not work particularly well north to south. The Mersey Dee Alliance has worked well to promote the region as economically important not only to North Wales but to the north-west of England.

I and many other MPs from North Wales rightfully think that we should have a view on what happens on both sides of the border, as it affects the people we represent, but clearly the Government, with their usual approach, are trying to find a short-term solution to a long-term problem and have come up with a bit of a dog’s breakfast.

Mr David Jones: The hon. Gentleman speaks of short-termism. Does he not agree that the devolution settlement was lashed up hastily by the Labour Government?

Mark Tami: I do not. The right hon. Gentleman is always blaming someone else. He and his party have been in government for some time now. Surely they should take some responsibility.

Time is short, so I will set out just one example: healthcare. People in Alyn and Deeside use healthcare on both sides of the border, as has been touched on. Our children’s hospital is the Alder Hey, our heart hospital is Broadgreen, and we use services at Gobowen, the Christie and Clatterbridge.

The hon. Member for Vale of Clwyd (James Davies) mentioned the Countess of Chester hospital. It may be in Chester, but it was built to serve the people of Chester and Deeside. The previous MP for Chester used to stand up in the Chamber and talk about thousands of people from north-east Wales flooding across the border to go to that hospital. It is their hospital; it was built to serve the people of both Chester and north-east Wales—in particular the people of Alyn and Deeside. There are representatives on its council of governors from Flintshire and Wrexham. They have their view, and rightfully so. If those Welsh patients did not use it and the hospital served only the catchment area of Chester, I question whether it would be viable. Many people in Alyn and Deeside are registered with doctors and dentists on the English side of the border and vice versa. We are a particular and very different region.

Where does this start and end? Are the Government saying that because policing and transport powers are devolved to the Mayor of London and the London

1 July 2015 : Column 473WH

Assembly, London MPs should not have a view on those issues—is that what we are saying? We are talking about giving powers to city regions—will the MPs from those areas not be allowed to have a view? The question that no one has answered, although lots of Members have asked it, is: what is an English-only law? The Government need to decide where they stand. Are they going to treat people equally, and do they actually believe in the United Kingdom?

Several hon. Members rose

Mr David Crausby (in the Chair): Order. Two Members are indicating that they still wish to speak, and there is not much time left, so I hope they will keep their remarks short.

10.27 am

Ian C. Lucas (Wrexham) (Lab): I will be brief, Mr Crausby. The definition of an English-only law is crucial to this debate. The problem is that the Government are leaving us completely in the dark. We are having this debate only because my hon. Friend the Member for Ynys Môn (Albert Owen), whom I congratulate, initiated it. I tabled a question for the Secretary of State for Wales about what consultation he had had with the people of Wales on proposals for English votes for English laws. That question was transferred to the Leader of the House. I believe that virtually no consultation has taken place.

Guto Bebb rose

Ian C. Lucas: I do not have time to give way, as the hon. Gentleman well knows.

Not only has the Secretary of State not consulted the people of Wales, but he has not consulted Members of Parliament. There has been no discussion whatever with MPs on the issue. That is a crucial point. Mr Speaker will need to have the wisdom of Solomon to determine what is an English-only law. The first thing he should do is visit North Wales and Cheshire. Our region is unique in the United Kingdom and exemplifies why this question is so difficult.

I expect nationalists to divide, separate and try to have a culture of blame between each part of our country. I do not expect those of us who believe in the United Kingdom to argue in favour of division or separateness. Whatever our political background, we should stand together to work out a proper way of doing this, with consultation. That is what we need.

I will make a proposal. There are Members from North Wales who take a sensible approach to the matter. Representatives of the Mersey Dee Alliance are here in Parliament today. We need an all-party group for the Mersey-Dee region, to put the case in Parliament for a cross-border economic and cultural environment. We have that opportunity within the context of this debate. We need the Government to start to listen. Their ignorance is palpable, and they have closed their ears.

Mr David Crausby (in the Chair): I ask for a very short contribution from Paul Flynn.

1 July 2015 : Column 474WH

10.30 am

Paul Flynn (Newport West) (Lab): Devolution as given by the English nationalist party is a grudged gift. The party has never been enthusiastic for it at all, but we see it doling out little bits of power here and there, as long as doing so can solve immediate problems. Now there is a crisis, because the terrifying experience for the English nationalist party of the Scottish referendum induced panic. It went along with a vow and then came back and introduced this false solution of EVEL—English votes for English laws. That is self-defeating for the party, because the more it feeds the beast of English nationalism, which has lain dormant for a long time, the more it will deepen the divide between England and Wales, England and Scotland, and England and Ireland.

We used to talk about a slippery slope in 1979. Some people wanted devolution because they thought that it was a dangerous slippery slope, and others supported it because they knew that it was a beneficial one, but we are on a new slope now, and we are moving towards the breakup of the United Kingdom. The best way to achieve that, which I am sure is not the intention, is English votes for English laws.

10.31 am

Pete Wishart (Perth and North Perthshire) (SNP): It is a pleasure to serve under your chairmanship Mr Crausby. I congratulate the hon. Member for Ynys Môn (Albert Owen) on securing this short but important debate. I have visited North Wales and his constituency and I canvassed there during the by-election for the Welsh Assembly—I must concede to the hon. Gentleman that it was not for his party. I was delighted with the result we saw for Plaid Cymru that evening.

We have never had a measure quite like English votes for English laws. We have heard a little about the historical context and precedents, but we have to go back to the days of Gladstone before we find anything like it being attempted in this House. In those days, there were Members of Parliament from a nation that decided that it wanted its own constitutional future, just as there are now. We can see what happened when the Government tried to impose such a law in the House then, and history’s judgment. The Government of that day realised very quickly that the plans were unworkable and withdrew them.

One might think that something of such constitutional significance and historical importance would be subject to the utmost parliamentary scrutiny—wide-ranging consultative pre-legislative scrutiny and a full debate.

Susan Elan Jones: Will the hon. Gentleman give way?

Pete Wishart: I am sorry, but I cannot give way, because I have to leave time for the Front Benchers.

Instead, the proposal has been rushed through at breakneck speed. We learned yesterday from the press that the Leader of the House of Commons intends to bring forward his proposals before recess—before anybody has had an opportunity to try to understand and assess what is going on.

My hon. Friend the Member for Aberdeen North (Kirsty Blackman) and several other Members have consistently and continually asked the Leader of the House to start to explain a little about the process and

1 July 2015 : Column 475WH

how this matter will be determined. All we hear in return is that he will bring his proposals to the House soon. I think we know that, because he has said it on several occasions, but why can he not answer basic questions about what is proposed? Is what the Government are trying to do with EVEL a state secret?

We need a debate. We have to understand what is going on, because it will impact on my rights to represent my constituents effectively in the House. It will have an impact on the ability of everyone who has contributed to the debate to represent properly the people who elected us to do our jobs here.

Mr Andrew Turner: Will the hon. Gentleman give way?

Pete Wishart: I do not have time to take interventions.

It is important that we have a proper debate and proper scrutiny. We know a little about EVEL because William Hague presented his Command Paper at the end of the last Parliament. We have a sort of EVEL hokey cokey. It looks as though Welsh and Scottish Members will be gatekeepers to Bills—we will all get an opportunity to debate and vote on Second Reading. Then we will all be sent away and there will presumably be some sort of English Grand Committee, where the English Members will work on a Bill and cross the t’s and dot the i’s. The Bill will then come back to us again and, bizarrely, after English Members have done all the work on a Bill, we will get an opportunity to vote it down if we do not like it. Have you ever heard anything so bizarre or absurd, Mr Crausby? We will leave the English Members to do all the work and then decide whether we like what they have done. No wonder so many English Members are furious about the suggestion and do not like the proposals. It is a bizarre way to go forward.

The proposed arrangement will place the Speaker in the most invidious political situation possible, as it will be up to him to determine whether Bills are English only. We see in the Command Paper that the only people he will consult are the Clerks. He has to do better than that. He has to consult the Welsh Assembly. He has to consult the Presiding Officer of the Scottish Parliament to ensure that there is no Scottish consequence or impact—these things need to be determined. And it will not be open to legal challenge—that is the real reason why the Government are not bringing forward legislation. The constitution unit told us clearly that if it was introduced through legislation, there would be the possibility and option of legal challenge—the constituents we represent would be able to challenge something decided in this House. The Government are pursuing the idea of Speaker certification to take it out of the hands of the law, so that no one will have the opportunity to raise questions about its legality. That is unfair and bizarre. It is no way to proceed with something so important. We must have a say. I pity the Speaker of the House of Commons; he will be placed in a political situation of determining whether something has an impact on or consequence for the constituents we represent. That is not fair. No wonder the Speaker is anxious and nervous about being given such powers.

1 July 2015 : Column 476WH

Mr Turner: Will the hon. Gentleman give way?

Pete Wishart: I will not give way to the hon. Gentleman.

Mr Turner: Will the hon. Gentleman give way?

Pete Wishart: Can the hon. Gentleman not hear? Is he incapable of hearing, Mr Crausby? [Interruption.]

Mr David Crausby (in the Chair): Order. The hon. Member for Perth and North Perthshire (Pete Wishart) is clearly not giving way.

Pete Wishart: I will finish with what has happened over the past few days. I am sure that Members from Wales, and certainly Members from Scotland, are carefully watching.

Albert Owen: And Northern Ireland.

Pete Wishart: The hon. Gentleman is right. In the past few days, we have had the Scotland Bill and a series of amendments that the Scottish Parliament decided were necessary. They were agreed with the Scottish Parliament. We put the amendments to the House— 56 out of the 59 democratically elected MPs from Scotland, reflecting the will of the Scottish people in those amendments. What happened? English Members voted them down. If EVEL is good enough for them, what about WVWL, Welsh votes for Welsh laws, or ScVScL, Scots votes for Scots laws? English Members are happy to turn up to Scottish and Welsh questions, as they should, but this has to work both ways. We cannot have English Members voting down the settled will of the Scottish people that comes to this House through 56 out of the 59 MPs and then demanding that we have no say over legislation that will have an impact on—a severe one in some cases—and have financial consequences for our constituents.

There is an elegant solution. It is called federalism. It is called doing things properly, which is what we again put to the House. We do everything in terms of collecting our taxes and making our own decisions, and we come together in the United Kingdom Parliament to determine foreign affairs and defence issues. We put that elegant solution to the House. As long as we have asymmetric devolution, which never seems to satisfy English Members, our Welsh friends or us, we will always be revisiting the arrangement and it will always be untidy. There will always be problems and issues, but that is what the Government want and they will have to accept the consequences. It will never be neat and tidy. We will always have issues to deal with and tidy up.

Unless we adopt the solution, which we will offer again and again throughout this Parliament, whereby this nation comes as close to federalism as possible, as was promised during the referendum, we will never resolve a situation in which one nation makes up about 80% to 85% of the population of this country. Unless we get close to federalism, we will continue to revisit this issue, we will never resolve it and we will have debates, like this one, in which no one is happy about something in the United Kingdom. We have great unhappiness in Scotland, England and Wales. For goodness’

1 July 2015 : Column 477WH

sake, let us sort it out and get it fixed. Let us have federalism and ensure that everybody knows what they are dealing with.

10.39 am

Nic Dakin (Scunthorpe) (Lab): It is a pleasure to serve under your chairmanship, Mr Crausby. I congratulate my hon. Friend the Member for Ynys Môn (Albert Owen) on obtaining the debate. The debate has been attended by 23 Members, which shows the interest in Parliament, although it is odd that no Plaid Cymru Members attended. However, the nationalist position was put well by the hon. Member for Perth and North Perthshire (Pete Wishart).

The devolution genie is well and truly out of the bottle, which is probably a good thing, as it allows people to make decisions closer to their place of impact. However, here in the United Kingdom devolution is permissive, asymmetric and uneven. There is an understandable need to devolve more powers and responsibility to the English regions, but the thorny question is how to do that in a balanced, proper way. We have separate Assemblies in Wales, Northern Ireland and London, with a Parliament in Scotland, but nothing in England between the UK Government and local authorities. The space is now being filled with a rush to devolve powers to city regions such as Greater Manchester, which raises significant questions about accountability and generates a debate about the value and purpose of the United Kingdom, what powers it is appropriate to keep at which level, and what powers should be devolved and to whom. Those are difficult questions with uncertain answers.

Into that quagmire the Prime Minister went on the morning after the Scottish people spoke so clearly and strongly in favour of remaining in the United Kingdom, when he chose to proclaim boldly on the steps of Downing Street the notion of English votes for English laws. It was neither the time nor the place for him to behave as the leader of a political party rather than as the United Kingdom’s Prime Minister. Mischief making and political posturing are not the way to determine how our nation should proceed on this difficult question. It is far too important for that. The challenge demands statesmanship, careful thought and inclusive action.

We are sometimes obsessed with borders, but the reality, as today’s debate demonstrates, is that real people do not live contained and constrained by borders. As my hon. Friend the Member for Alyn and Deeside (Mark Tami) perceptively observed, in reality the border does not exist. Real life is complicated and messy. In 2012, the McKay commission was quite properly given the task of considering how the House of Commons might deal with legislation that affected only part of the United Kingdom, following the devolution of certain legislative powers to the Scottish Parliament, the Northern Ireland Assembly and the National Assembly for Wales. In the report of March 2013, McKay concluded that the

“use of a specially-constituted public bill committee with an English or English-and-Welsh party balance is the minimum needed as an effective means of allowing the voice from England (or England-and-Wales) to be heard; it would retain the opportunity at report stage for amendments to be made to a bill to implement compromises between the committee’s amendments and the Government’s view, or even— though we would expect rarely—overriding in the House what was done in committee”.

1 July 2015 : Column 478WH

Done in the right way, that has the potential to be a sensible reform, which would strengthen English and Welsh voices without creating two classes of MP. It must now be properly and fully considered.

We must not inadvertently undermine the union of nations that is the United Kingdom by pushing forward hasty proposals drawn up in secret or pursuing partisan positions. The hon. Member for Perth and North Perthshire is right when he says that that needs the utmost scrutiny. My hon. Friend the Member for Ynys Môn is also right when he warns of the danger that English votes for English laws will be a sticking plaster that causes more problems, and when he calls for a UK convention on constitutional rights.

Albert Owen: One of the best examples of the anomalies in the proposal was transport in London. Is that an England-only or a London-only issue? It is not just a question of the three nations outside England; questions arise within England.

Nic Dakin: My hon. Friend is right, and further devolution across England raises more such questions. That is why the issue is complicated and messy, needing time to get it right, rather than a rush to something that will make things much worse.

Hon. Members have raised important questions, which should be properly considered. We need to ensure that the voices of residents of North Wales continue to be heard through their elected representatives. Wales is a small country, but it is well integrated within England, as we have heard. It has received more powers in the 16 years since the Welsh Assembly was created: it now has primary law-making powers, and it is getting financial powers in the form of control over stamp duty, landfill taxes and business rates. The Government, as the former Secretary of State, the right hon. Member for Clwyd West (Mr Jones), reminded us, will introduce a Wales Bill later this year which will devolve further powers to Wales in the areas of energy, transport and the environment. We welcome that.

It is right that we recognise the need to reflect the devolution settlement in the way that Westminster works, but we must also take into account the integrated nature of the economy and society in North Wales. Many hon. Members, including my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders), made it clear how closely interrelated the economies are.

Mr David Jones: I am glad that the hon. Gentleman has mentioned the hon. Member for Ellesmere Port and Neston, because he identified a democratic deficit where English Members are concerned. Does the hon. Gentleman agree that the Wales Bill offers a good opportunity to address those problems?

Nic Dakin: The Wales Bill represents an opportunity to explore those issues. I did not hear my hon. Friend say what the right hon. Gentleman did; I heard something quite different.

Economically the border with Wales is porous. Some 90% of the Welsh population—2.7 million people—live within 50 miles of the border on the Welsh side, and a further 13.7 million live within 50 miles of it on the English side. In aggregate, 30% of the population of

1 July 2015 : Column 479WH

Wales and England, or more than 16 million people, live within 50 miles of the border between the two countries. It is estimated that 100,000 people travel between Wales and England for work, and just over half of that criss-cross border traffic is accounted for by people commuting in and out of North Wales. The A55 trunk road, which runs across North Wales connecting Holyhead with Chester, is crucial for business and residents.

Some people argue for Wales to take powers over income tax, but the Welsh Government already have the power to hold a referendum on whether and when to take those powers and the current Welsh Government do not see that as a priority. They argue that that the more pressing issue of fair funding is the priority that must be resolved sooner rather than later. There is a danger that if income tax were to be included in EVEL and it was handled in a cack-handed way, thousands of workers who cross the border to work could find that their elected MP had a limited say over the income tax they would pay. That would be against their democratic rights.

Many people from North Wales use health services over the border in England. We have heard about the personal experience of the hon. Member for Vale of Clwyd (James Davies) in that respect. About 21,000 English patients are registered with Welsh or Welsh-registered GPs. Approximately 15,000 Welsh residents are registered with English or English-registered GPs. That means that about 6,000 patients flow into Welsh primary care from England. In addition, approximately 50,000 Welsh residents travelled to non-Welsh providers for treatment, including emergency and elective patients. That far outweighs the number of non-Welsh patients admitted to Welsh hospitals; typically it is Welsh patients using specialist services at large hospitals in England, as we have heard in the debate.

Some 138 million journeys take place each year on roads and trains across the border—an average of 2.6 million journeys each week. The UK Department for Transport specifies and funds three of the four rail franchises that provide cross-border rail services between England and Wales, with the Welsh Government largely responsible for the fourth—the Wales and borders franchise. That franchise provides cross-border rail services to Manchester, Shrewsbury, Birmingham and Crewe, in addition to all rail services wholly within Wales, and is controlled by the Welsh Government. The UK Government have stated that Wales will benefit from HS2 because of additional capacity and reduced journey times on the west coast main line. Because of that it was considered a UK-wide project and no Barnett consequential was given to Wales.

All the areas I have outlined—the economy, health and transport—are examples of how defining an English policy area is not straightforward. That means that careful thought must be given to any proposals to restrict the voting rights of Welsh MPs. In any future arrangement, North Wales MPs need a full voice on matters affecting their people. As my right hon. Friend the Member for Delyn (Mr Hanson) perceptively said, everyone needs to be an equal Member in this House. I hope that the Deputy Leader of the House will unequivocally answer the question of what an English law is.

1 July 2015 : Column 480WH

Mr David Crausby (in the Chair): I call the Minister.

10.49 am

The Deputy Leader of the House of Commons (Dr Thérèse Coffey): Diolch yn fawr, Mr Crausby. I congratulate the hon. Member for Ynys Môn (Albert Owen) on securing this debate. The title of the debate could have led to a wide range of contributions about any aspect of North Wales, although given my connections with the area, I would have felt confident addressing some of those possible queries, and that is not just because I was a candidate in Wrexham in 2005. My mother grew up there, my relatives lived there, I went to school there and, indeed, my father is buried there, so I can assure hon. Members from North Wales and from across the border that North Wales is never far from my mind or, indeed, my heart.

Updating arrangements in this House to reflect the changing nature of the devolution settlement is important. To that end, this has been a useful and interesting debate. As promised in the Queen’s Speech, the Government will bring forward changes to the Standing Orders of the House of Commons to ensure that decisions affecting England, or England and Wales, can be taken only with the consent of the majority of Members of Parliament representing constituencies in those parts of the United Kingdom. We do that in the context of further devolution to Scotland, Wales and Northern Ireland. The Government have demonstrated that they will meet their commitments to devolve further powers to those countries. It is right that that is balanced by addressing the English question. Taken as a whole, the package will deliver a fair and sustainable settlement for the whole of the Union.

Paul Flynn: Will the hon. Lady give way?

Dr Coffey: I shall address some points that have been raised in the debate. If I have time at the end, the hon. Gentleman may well be able to intervene then.

The hon. Member for Ynys Môn said that we need a proper convention and that the proposals are a sticking plaster. Not only did the House not support that point of view last month in a vote, but I suggest to him that it would be a handbrake on making progress with a Wales Bill and the Scotland Bill. We are making progress with the Silk commission and, as he knows, we intend to introduce a Wales Bill, and it is important that we do not add unnecessary delay to those things.

The hon. Gentleman and some of his hon. Friends have suggested that they are being denied a voice on many issues, but there is nothing in the proposals published by the Conservative party to that effect. Although there will be many points of detail that we will discuss and debate in due course, I genuinely assure him that many of the points raised today will, I am sure, be addressed when we publish our detailed proposals, which will happen soon, and there will be time for scrutiny.

In the meantime, I will set out some points of principle that will underpin our approach, as set out in the Conservative party’s manifesto on which we won the election, including gaining a seat in North Wales—I am glad to see my hon. Friend the Member for Vale of Clwyd (James Davies) in his place. I should point out that this idea is nothing new. It was also in our 2010 manifesto, and the hon. Member for Ynys Môn contributed to a debate on the issue in 2009, so it is not novel.

1 July 2015 : Column 481WH

In changing the way the House of Commons legislates, we have to balance the need for the Commons as a whole to express the voice of our entire United Kingdom with the need for English and Welsh MPs to express their voice on matters affecting England and Wales only. Our proposals will reflect that need and respect that balance by ensuring that all MPs continue to take part in the legislative process, but that relevant measures must also have the explicit support of a majority of MPs representing constituencies in England, for an England-only matter, or in England and Wales, as the case may be.

In that way, we will resolve the current position, which has become increasingly untenable, that English or English and Welsh laws can be made without the explicit consent of the MPs whose constituents are affected. It is particularly right to progress with these proposals so that we can rectify the situation whereby hon. Members from outwith England could have a decisive impact on legislation on English constituents, not only on subject areas for which they cannot vote for their own constituents, but contrary to the views of the majority of English MPs.

Ian C. Lucas: Will the Minister give way?

Dr Coffey: I will take interventions in a bit, including from the hon. Gentleman.

I hope that the hon. Member for Ynys Môn reflects objectively on the situation I have described. Our proposals will recognise that many laws apply to England and Wales and that the West Lothian question is as relevant in Cardiff as it is in Carlisle—I suppose it could become the Delyn or the Denbigh dilemma. That is why English and English and Welsh laws will require the explicit approval of the MPs whose constituents are affected by them.

As has been set out repeatedly by hon. Members today, and as I recognise, constituents often access services across the border, as well as councils and other trade bodies that, as we have heard, work very well together. The border is not a barrier, as the hon. Member for Alyn and Deeside (Mark Tami) recognised, and I assure hon. Members that proposals that we will introduce soon will not stop access to services for constituents nor hinder the ability of any MP to hold the Government to account or stop them voting on legislation that affects those services. This is a popular policy, and not just in England. A study in January 2015 in Scotland found that over 50% of people supported the concept of English votes for English laws.

Let me turn to some other points made today. I agree with my hon. Friend the Member for Aberconwy (Guto Bebb) and my right hon. Friend the Member for Clwyd West (Mr Jones) that this is an important point of principle. I recognise that, as the hon. Member for Ellesmere Port and Neston (Justin Madders) said, close working across the border matters. My right hon. Friend the Member for Clwyd West alluded to a potential issue, but I honestly encourage the hon. Member for Ellesmere Port and Neston to raise existing problems directly with the Welsh Assembly Government or with his Labour colleagues who are representatives in the Welsh Assembly.

1 July 2015 : Column 482WH

As for the points made by the hon. Member for Aberdeen North (Kirsty Blackman), and stretching somewhat into those made by the Member for Perth and North Perthshire (Pete Wishart), I do not agree that what is proposed will create a second-class status for MPs. The hon. Lady referred to being barred from being able to help constituents, but she should recognise that she is barred now from voting to help her constituents on devolved matters. Indeed, in the last Parliament, I think the Education Bill was an England-only Bill, and I think I am also right in saying that SNP Members decided not to vote on the Second Reading of the Education and Adoption Bill. I would have thought that given the similar approach and the consistency that the SNP has shown, hon. Members should be genuinely assured that we are not seeking to do something different in that regard.

Ian C. Lucas: Does the Minister not find it extraordinary that she is calling in aid a nationalist approach to legislation within the United Kingdom to justify the approach that she is taking? Does that not mean that she is advancing a nationalist argument in favour of her case, because this is a nationalist proposal?

Dr Coffey: I disagree with the hon. Gentleman; I do not see this as a nationalist proposal. Devolution is now supported on both sides of the House, but this addresses the imbalance that English constituents feel about what has happened on the journey of devolution. I do not know why the Labour Government chose not to address this issue. Perhaps the reason was that when Tony Blair was leader of the Labour party, it won elections with a majority of MPs in England and so perhaps felt unable to do that.

Several hon. Members rose

Dr Coffey: Let me finish addressing the issues that have been raised. I should point out that the Speaker, who is of course elected by the whole House, is already required to certify Bills, such as money Bills—I am sure that some Scottish MPs may remember the Scottish Grand Committee being convened, but I do not think it has been in over a decade. However, the situation has not proved problematic so far. There have been no legal challenges, and during a Committee on the Floor of the House, the Speaker selects the amendments on which there will be votes, so in effect he already has the power to decide who can amend laws.

Several hon. Members rose

Dr Coffey: I will take an intervention from my right hon. Friend the Member for Clwyd West.

Mr David Jones: The Minister speaks of an imbalance, and I fully understand that procedural changes are necessary at this moment. In the long term, would that imbalance not be better addressed by reviewing the Welsh devolution settlement, and would a good opportunity for that not be the Wales Bill?

Dr Coffey: My right hon. Friend will have the opportunity to make that point as and when the Wales Bill is debated. Given his former office, I am sure that he is already in discussions on that point.

1 July 2015 : Column 483WH

Mark Tami: Will the Minister give way?

Dr Coffey: I am short of time—I have less than a minute—so I will not be able to.

The right hon. Member for Delyn (Mr Hanson) said that he might lose his voice, but he clearly has not. When we were talking about devolved Administrations and devolved matters last month, he said:

“I understand the need to ensure that people in England cannot have a say on some of those issues”—[Official Report, 3 June 2015; Vol. 596, c. 661.]

However, he seems to want it the other way around.

The hon. Member for Wrexham (Ian C. Lucas) asked about the definition of an English-only law, and I have referred to the Education Act 2011, which went through in the last Parliament. This is not about having a panic or break-up of the Union, but about settling that balance.

I wish I had time to cover all the other issues, but I just remind the hon. Member for Scunthorpe (Nic Dakin), who suggested that these things have been drawn up in secret, that Labour was invited to participate in the Cabinet Committee but refused to last year. Labour had the chance but decided not to do so.

In conclusion, we will take action to answer the West Lothian question and ensure that our constitutional settlement is fair and sustainable in the light of further devolution, and I believe that that will strengthen the Union.

10.59 am

Albert Owen: I do not think the English question has been answered, and the North Wales question has certainly not been answered when it comes to devolution. One thing that has been left hanging, even though the Minister had the opportunity to deal with it, is whether, if there was a London transport issue, that would be voted on only by London Members or by those from the rest of England—it would not be England-only, but London-only. We are talking about the UK transport system having all UK MPs—from Northern Ireland, Scotland and Wales—all voting with equal status. That was the purpose of today’s debate. That is how we should be going forward.

Question put and agreed to.


That this House has considered English Votes for English Laws and North Wales.

1 July 2015 : Column 484WH


11 am

Alok Sharma (Reading West) (Con): I beg to move,

That this House has considered treatment of fibromyalgia.

It is a pleasure to serve under your chairmanship for the first time in this Parliament, Mr Crausby. I welcome my hon. Friend the Minister to his place. He did brilliant work in his two Departments in the last Parliament, and I am sure that he will continue to excel during this.

I want to use this debate to throw a spotlight on a not particularly well known or medically well researched, but incredibly debilitating condition: fibromyalgia. I shall set out the views of some of those suffering from the condition, highlight the treatment available to help sufferers and, ultimately, make a few suggestions as to what can practically be done to improve life quality for those debilitated by fibromyalgia.

The last debate that I held in Westminster Hall was on sentencing for dangerous driving. That attracted significant interest from and participation by fellow Members from across the House. As you can see, Mr Crausby, today’s debate has attracted more modest interest. That is not because fibromyalgia is not a serious medical condition, but simply because it is not particularly well known, not least within some parts of the medical community.

Nick Thomas-Symonds (Torfaen) (Lab): Does the hon. Gentleman agree that a critical issue is awareness— public awareness and the awareness of sufferers themselves of what help is available? To give just one example, local support groups can be tremendously helpful. This is a two-track issue: it is about public awareness and the awareness of sufferers themselves.

Alok Sharma: Yes, of course; the hon. Gentleman is absolutely right. I shall go on to provide more details of what is going on locally and perhaps what we ought to be doing nationally.

I first learnt about the condition almost by accident a few years ago, through a chance conversation with some constituents. Since then, through the work of the excellent Reading fibromyalgia support group, which meets regularly in my constituency, I have been able to learn more about fibromyalgia and meet many of the people locally who are trying to cope with the condition, as well as medical practitioners who are focused on helping sufferers.

Jim Shannon (Strangford) (DUP): I thank the hon. Gentleman for bringing this issue to Westminster Hall for consideration. In my constituency, many people have come to me with disability living allowance claims, which is where my interest in and knowledge of fibromyalgia comes from. What concerns me greatly as a result of the correspondence and communication that I have had with my constituents is that GPs seem not always to be aware of the symptoms of fibromyalgia. That means that the figure for diagnosis in Northern Ireland is only 3%, yet we have a significantly larger number of people who have the disease. Does he think we need greater awareness among GPs to start with and then we can address the issue?

1 July 2015 : Column 485WH

Alok Sharma: Yes, of course; the hon. Gentleman is absolutely right. A common theme is emerging among colleagues participating in the debate.

Let me describe fibromyalgia. It is a long-term condition that causes pain all over the body. As well as widespread pain, people with fibromyalgia may have increased sensitivity to pain, fatigue, muscle stiffness, difficulty sleeping, problems with mental processes, headaches and problems with their bowel and stomach.

Mr David Jones (Clwyd West) (Con): I congratulate my hon. Friend on securing this debate. He mentions the severe pain that sufferers endure. My constituent, Mrs Joanne Kirkby, suffers from this terrible condition. Is he aware that most of the pain relief treatment centres in mainland Great Britain are within England and that if a patient comes from Wales, it is necessary to go through an extremely lengthy and complicated bureaucratic process to access treatment at, for example, the Bath pain relief centre?

Alok Sharma: My right hon. Friend makes a very good point. Perhaps the Minister will comment on where treatment is available and where pain clinics are situated.

The exact cause of fibromyalgia is unknown, but it is thought to be related to abnormal levels of certain chemicals in the brain and changes in the way the central nervous system processes pain messages carried around the body. It is also suggested that some people are more likely to develop fibromyalgia because of genes inherited from their parents. In many cases, the condition appears to be triggered by a physically or emotionally stressful event, such as an injury or infection, giving birth, having an operation, the breakdown of a relationship or the death of a loved one. The key point is that anyone can develop fibromyalgia, although it affects about seven times more women than men.

The condition typically develops between the ages of 30 and 50, but can occur in people of any age, including children and the elderly. Exactly how many people are affected by fibromyalgia is not clear, although research has suggested that it could be a relatively common condition. Some estimates suggest that nearly one in 20 people in the UK may be affected by the condition to some degree. Of course, one of the main reasons it is not clear precisely how many people are affected is that fibromyalgia can be difficult to diagnose. There is no specific test for the condition, and the symptoms can be similar to those of a number of other ailments.

Living with fibromyalgia can be incredibly debilitating. Ahead of today’s debate, a number of local people emailed me about their experiences of coping with fibromyalgia. I want to read out some extracts from the heartfelt and moving words that they sent me. A father of young children writes:

“I have had Fibromyalgia for a couple of years now. My life and that of immediate family has changed significantly in adapting to and attempting to cope with my condition.

I am unable to continue working as a qualified accountant, as my ability to read, write and concentrate have all been significantly affected. I suffer with ‘Fibro-fog’, a difficulty in recalling words or train of thought where the mind goes blank...I find it impossible to switch off from the pain, as it is constantly moving as though it is being scattered around my body.

1 July 2015 : Column 486WH

I, and many of the members of the Reading Fibromyalgia group, experience the lack of understanding of others due to the ignorance relating to this condition that we suffer. As we appear whole there is often a lack of compassion from others and we can be made to feel as though we are malingerers. I have always had a strong work ethic and believe in setting a good example to my children; if I could work then I would work.

My hope now is that there will be a greater understanding of Fibromyalgia and how limiting this condition can be on the individual.”

A female sufferer writes:

“My typical day starts with trying to get my body working. My joints are so stiff with pain that I have to sit on the side of the bed and massage my shoulders, lower back, my knees, elbows and hands. It takes an hour to get showered and dressed. I do feel a failure if I have to get my husband to come and help me.

After having problems with pain, exhaustion and fatigue for several years, they then turned into depression, stress and anxiety. My G.P. finally diagnosed me with Fibromyalgia.

In 2013 I went along to our local Fibromyalgia Support Group…I went in the room and saw that there was ‘nothing different’ with these people. I was reduced to tears to find that they were all like me, young and old, male or female, and that I was ‘Not a Fraud’.”

Another submission that I received was from a male sufferer. He writes:

“Living with Fibro is often difficult and it’s like we have a volume control button that is broken at maximum setting—sometimes the pain and stiffness abate with medication, exercise where we are able to do so and so forth but it always comes back later in the day or within a day or two of doing too much activity.

Depression in people with Fibro is common”

because of

“the life we used to live but many no longer can. This adds to the stress and tension and it can become a vicious circle. Exhaustion is common as well.

The lack of understanding and sympathy from other people including importantly the medical profession makes it all the harder to bear. Yet Fibromyalgia has been recognised by the World Health Organisation since the 1970s as a chronic and long-term health condition. Thousands if not millions of people worldwide have Fibro either diagnosed or not so but they display the symptoms.

Yet people still think we’re making it up, which is very disheartening to us; some even are abusive to us because they don’t understand.”

Ahead of this debate, I spoke to many fibromyalgia sufferers, and colleagues who have contributed have clearly done the same. They will have heard the same things as I heard from constituents and in emails from people across the country, detailing their own experiences of coping with this debilitating condition. Three common themes emerge. First, fibromyalgia is not well enough understood by GPs and the medical profession, as the hon. Member for Strangford (Jim Shannon) said, and there seems to be no significant research effort to find a cure. Secondly, as a result, there is no consistency of approach or care across the country in helping sufferers to deal with the effects of fibromyalgia—exactly the point made by my right hon. Friend the Member for Clwyd West (Mr Jones). Thirdly, the condition is not well enough understood by the general public or employers, and sufferers have told me that they have faced discrimination in the workplace as well as the wider community. That is completely unacceptable.

I want to mention the good work of the Fibromyalgia Association UK, which today merges with FibroAction to speak up with a louder voice for sufferers

1 July 2015 : Column 487WH

of fibromyalgia, provide national helplines and raise awareness of the condition with GPs. Although knowledge is inconsistent within the GP and health community, there are pockets of excellence. Last October, I was invited to the one-year anniversary celebrations of the re-launched Reading fibromyalgia support group. There I met with Dr Antoni Chan, a consultant rheumatologist and physician at the Royal Berkshire hospital, who gave a presentation on the ongoing research aimed at understanding the condition and developing treatments. I also met Dr Deepak Ravindran, a consultant pain specialist at the Berkshire pain clinic. The clinic offers a comprehensive service, starting with expert diagnosis and followed up by medical treatment, which is complemented by good support from specialists in physiotherapy and psychology—a truly multi-disciplinary approach. I pay tribute to Dr Chan and Dr Ravindran for the excellent work they are doing to help fibromyalgia sufferers in Berkshire.

As a result of that meeting, I wrote to North and West Reading clinical commissioning group last November, providing a copy of the pamphlet on fibromyalgia that Dr Ravindran has produced and asking the CCG to promote understanding of the condition among the local general practitioner community. Dr Ravindran recently informed me that the need for an integrated and collaborative approach to managing fibromyalgia has been recognised locally, and a community pain service in the Reading area will start in September. That will be a collaboration between the Royal Berkshire hospital and the Berkshire healthcare NHS foundation trust, and its vision is to provide fibromyalgia-specific pain management programmes. That is good news for fibromyalgia sufferers in Reading and Berkshire, but, as other colleagues and I have remarked, the approach is inconsistent across the country.

I have three asks for the Minister and the NHS. First, education and knowledge of fibromyalgia must be improved among GPs and other healthcare professionals, and awareness of new diagnostic criteria must be increased and disseminated more widely. Secondly, strategies that provide an integrated and holistic service with patient empowerment as key must be promoted and developed, because patients need to be involved in decision making and the management of their condition. Thirdly, the aim should be to set up a network of fibromyalgia clinics across the country, so that patients who have had a flare-up of the condition have somewhere to go for treatment other than A&E or hospital.

My final point is about raising awareness of the condition more generally. Jeanne Hambleton, a freelance journalist and health writer, has informed me that last year she wrote to two well-known TV soap operas and asked whether one of the characters could be diagnosed with fibromyalgia to raise viewers’ awareness of the condition. Sadly, she did not hear back from the producers of either programme. I have no doubt that many people watch debates on Parliament TV, but it is safe to venture that many, many more watch soap operas. If the producers of “Casualty” or “Holby City” are watching the debate, they may want to get back to Ms Hambleton about her suggestion. I look forward to the Minister’s response.

1 July 2015 : Column 488WH

11.14 am

The Parliamentary Under-Secretary of State for Life Sciences (George Freeman): I congratulate my hon. Friend the Member for Reading West (Alok Sharma) on securing a debate on this important issue. In his constituency, he has shown great support for his local fibromyalgia patient group by advocating on its behalf, raising money and raising the profile of the disease, which is so debilitating for its sufferers. He has helped the group to continue its important work of improving awareness of the condition and providing advice to patients and their families. I pay tribute to the work of FMA UK, other fibromyalgia charities and the many patient support groups around the country who work tirelessly to raise the profile of the disease and support those who are affected by it. I welcome today’s merger of FMA UK and FibroAction, which will help to give a stronger patient voice to those who are affected.

Fibromyalgia is an incurable musculoskeletal condition of unknown cause that can have a debilitating impact on those who are affected. Although no exact figures are available, research suggests that fibromyalgia affects around 2.5 million patients in the UK, the majority of whom are women over the age of 40. Fibromyalgia symptoms affect the soft tissues, muscles, tendons and ligaments of the body and result in widespread and variable pain throughout the body. Poor-quality, non-refreshing sleep contributes to an ongoing cycle of chronic pain and fatigue, and, in some cases, poor concentration and short-term memory problems. Irritable bowel syndrome, restless legs, head and neck pain and sensitivity to temperature change are also associated symptoms of fibromyalgia. The symptoms and their severity differ from patient to patient.

Diagnosing the symptoms of fibromyalgia can be challenging for GPs. Some 20% of the general population consult their GP about a musculoskeletal problem each year, which amounts to more than 100,000 consultations a day. The symptoms of fibromyalgia are common to other conditions such as rheumatoid arthritis, lupus and chronic fatigue syndrome. In addition, patients with fibromyalgia can often visibly appear well, despite their symptoms. GPs face a further obstacle because there is no diagnostic test that accurately identifies the condition. A diagnosis is usually made via a process of diagnostic investigation to exclude other potential causes of the patient’s ill health. It is, therefore, important that clinicians have the training, tools and resources to help them identify fibromyalgia symptoms when a patient presents.

Musculoskeletal conditions are a key part of the generalist undergraduate MBBS medical curriculum. The General Medical Council requires that the MBBS curriculum provide enough structured clinical placements to enable students to demonstrate the outcomes for graduates across a range of clinical specialties, including musculoskeletal health. Musculoskeletal health is also a key component of GP training, and the Royal College of General Practitioners’ curriculum statement on musculoskeletal conditions sets it out that GPs should be able to diagnose and manage common regional pain syndromes such as fibromyalgia.

In addition to clinical training and experience, GPs have at their disposal a number of tools and resources. They include: the Map of Medicine, an online evidence-based guide and clinical decision support tool available

1 July 2015 : Column 489WH

to GPs and other healthcare professionals in the NHS, which has a fibromyalgia and chronic pain pathway, and helps clinicians to identify the symptoms and make the right referral; a free e-learning course on musculoskeletal care, including fibromyalgia, developed by the RCGP and Arthritis Research UK, which aims to improve skills in diagnosing and managing musculoskeletal conditions; NHS evidence services, which provide access to a vast online repository of clinical knowledge and guidance covering a wide range of conditions, including fibromyalgia; and a fibromyalgia medical guide for health professionals developed by FMA UK.

Once a patient is diagnosed with fibromyalgia, a number of treatment options are available to them. In the absence of a cure, relieving pain and restoring quality of life are the primary clinical goals. Treatment options include pain relieving medication, physiotherapy, dietary and exercise advice, counselling or cognitive behavioural therapy, and self-management programmes to give patients the skills and confidence to manage their condition. The routine assessment and management of pain is a required competency of all health professionals. Many patients can have their fibromyalgia successfully managed through routine access to locally commissioned services via GPs, and community and secondary care services. I will turn to my hon. Friend’s point about specialist clinics in a moment.

Jim Shannon: The hon. Member for Reading West (Alok Sharma) and I asked how we can raise awareness within the GP profession to ensure that GPs understand the symptoms of fibromyalgia and diagnose it earlier. As I pointed out in my intervention, only 3% of people in Northern Ireland have been diagnosed with the condition, but the number of people who suffer from it is far larger. There seems to be a gap between those who have been diagnosed and those who have not. Is that because GPs are not really aware of the condition? How can we make them more aware?

George Freeman: The hon. Gentleman makes an excellent point, and he is helping to raise awareness today. I will pass on the points made today to the team at NHS England with responsibility for this issue. The answer to the question on awareness is to support debates such as this, and to promote the work of the charity and the patient advocacy groups.

The routine assessment of pain is a required competency for all healthcare professionals. However, patients who remain in high levels of pain after conventional approaches to treatment have failed are able to access specialised pain services, which are nationally commissioned by NHS England. Patients referred to such services receive multidisciplinary team care from clinicians with expertise in pain management.

Mr David Jones: The Minister heard my earlier intervention, and he now mentions specialised pain relief centres, most of which are located in England. He also heard my points about the bureaucratic difficulties experienced by patients living in Wales when accessing such centres in England. Will he liaise with his colleagues in the Welsh Government on whether a smoother path can be achieved for patients from Wales?

1 July 2015 : Column 490WH

George Freeman: My right hon. Friend is an outspoken advocate for addressing such needs in Wales, in health as in other issues. He will know that pain centres in England are distributed evenly, but they are a devolved matter in Wales and the other devolved Administrations. I will happily write to the relevant people in Wales to highlight the importance of this condition and what we are trying to do in England, and to encourage them to adopt similar best practice. I cannot vouch for their response and, as in other areas, it is a matter for the local Assembly, but I will happily pick that up.

In addition to the specialised pain services that are available, a number of NHS trusts provide dedicated fibromyalgia clinics, such as that at the Royal National hospital for rheumatic diseases in Bath. That clinic offers expert support and advice, as well as a fibromyalgia coping skills programme to facilitate self-management. Some constituents of my hon. Friend the Member for Reading West have raised concerns about the co-ordination of their care; I reassure him and them that improving care and support for people with long-term conditions, and improving the co-ordination of that care, is a central ambition of this Government, as reflected in our mandate to the NHS.

Nick Thomas-Symonds: Is there not also a social aspect to this—the issue of sufferers being able to support each other? I am delighted to hear the Minister’s point about co-ordination, because improving co-ordination is crucial to such support being more widely and more consistently available across the UK.

George Freeman: The hon. Gentleman makes an important point. Such co-ordination is happening across different therapeutic areas. Charities have a role in providing a strong voice for patient empowerment. Patient networks, increasingly including social media, allow us to advance the voice of disease sufferers in research, treatment and patient support. I am delighted by the news of today’s amalgamation of the two charities, which can only be a good thing for developing wider understanding and a patient voice in new treatment pathways.

We want everyone with a long-term condition— around 15 million people—to be offered a personalised care plan that sets out their needs and preferences for care. Martin McShane, who is responsible at NHS England for improving outcomes for long-term conditions, and Peter Kay, the national clinical director for musculoskeletal care, are working hard to make that happen. I will ensure that the points raised today are passed on to them as part of that work.

My hon. Friend the Member for Reading West mentioned research. Nationally, the Department of Health has substantially increased overall medical research investment from £885 million a year in 2010 to the more than £1 billion allocated for 2015-16. The usual practice of the Department’s National Institute for Health Research, for which I am responsible, is not to ring-fence funds for expenditure on particular topics but to invite and assess research proposals in all areas. Although no fibromyalgia projects are currently funded by the NIHR, the European Commission is contributing nearly €6 million to a project seeking better ways of treating chronic pain, including fibromyalgia. I look forward to the results after the project ends in 2018, and I urge hon. and right hon.

1 July 2015 : Column 491WH

Members who are present, FMA UK and the patients it represents to feed their comments into that project and to welcome the results.

We are considering further ways to showcase the world-class research funded by the NIHR, and we are working in this place, and with the public and charities, to drive accountability. I am working with the NIHR to put together a parliamentary open day to allow Members such as those who have spoken today to see where the £1 billion a year is spent, and to work with charities and patient groups on making applications.

A number of colleagues on both sides of the House have talked about discrimination in the workplace, which is a serious concern for people both in my hon. Friend’s constituency and in local fibromyalgia support groups. It is completely unacceptable if patients with long-term conditions are misrepresented as malingerers at work. Historically, we have seen that happen with other conditions, and as research and understanding of the disease develop, we need to be aware that people who present with conditions that are not well understood may be suffering from diseases that have yet to be properly diagnosed. People with long-term disabling conditions are rightly protected from discrimination in the workplace under the Equality Act 2010. Where a disability, such as one arising from a long-term condition, has been established, the Act requires employers to make reasonable adjustments to ensure that the disabled are not placed at a substantial disadvantage compared with their non-disabled colleagues. Failure of an employer in that regard could amount to direct disability discrimination under the Act.

My hon. Friend and a number of others spoke about the establishment of a network of specialist fibromyalgia clinics. We are aware of a number of dedicated fibromyalgia clinics across the UK, including the UK’s leading centre at the Royal National hospital for rheumatic diseases in Bath, but I will write to Martin McShane, the head of long-term conditions at NHS England, to ask whether more formal networks can be established and whether, with the support of active patients and charities, there is more we can do to develop such groups and to help them to support research on developing new treatments and pathways.

I genuinely thank my hon. Friend for his tireless constituency work to raise this issue, and I congratulate him on securing this debate. So much medicine begins with the small voice of misunderstood patients who get together through charities to promote research, raise the profile of a disease in this place and elsewhere, build a head of steam, bid for research projects—the NIHR stands open and ready to receive bids—and build cross-party support. I have no doubt that, in the years to come, this work, this discussion and this topic will come to be seen as one of those occasions when the more we come to understand a condition, the more we drive research on cure and diagnosis and the more we improve treatment across the NHS. I warmly welcome his leadership in bringing fibromyalgia to the House’s attention today.

Question put and agreed to.

11.28 am

Sitting suspended.

1 July 2015 : Column 492WH

Operational Productivity in NHS Providers

[Mark Pritchard in the Chair]

2.30 pm

Mark Pritchard (in the Chair): Given the temperature today, colleagues may remove their jackets if they so choose.

Dr Matthew Offord (Hendon) (Con): I beg to move,

That this House has considered operational productivity in NHS providers.

It is a pleasure to serve under your chairmanship, Mr Pritchard, and I welcome the Minister to his role. I believe this may be his first Westminster Hall debate, and I am greatly pleased that I am the Member who secured the debate.

The national health service featured heavily in the recent general election campaign. I recall speaking at several hustings and telling my constituents that I recognised that this Parliament would witness an increasing demand for NHS services. On occasion I was challenged on how the additional £8 billion highlighted by the Stevens review would be found. My response, then and now, is that the greatest efficiencies can be identified within current services without undermining patient care. Such a view is shared by Simon Stevens, but most interestingly it is a view shared by others, including my constituents Philip Braham and David Green, who established a medical recruitment company called Remedium Partners. I am pleased that both gentlemen are here today in the Public Gallery.

Having met Mr Braham and Mr Green before the election, I was eager to re-establish contact with them earlier this month to discuss their ideas about NHS efficiency in employment. It is possible that more cynical Members will say that this is more evidence of the Conservative party seeking to introduce greater private sector involvement in the NHS for others to make a profit, but that would be an incorrect assertion to make. In fact, I found our discussion focusing on opportunities to save the NHS more money and prevent its resources being plundered by unscrupulous individuals.

The publication of Lord Carter of Coles’s interim report, “Review of Operational Productivity in NHS providers”—hence the title of this debate—two days before our meeting could not have been more fortuitous. The report outlined four areas where Lord Carter believes greater efficiencies could be achieved to allow additional moneys to be spent on front-line care. One objective in seeking today’s debate was to air the issues and to place them on the public record. Lord Carter’s efficiencies within the NHS include saving £1 billion from improved hospital pharmacy and medicines optimisation, £1 billion from the NHS estate, £1 billion from improvements to procurement management, and £2 billion from improvements in workflow and encompassing workforce costs.

Workforce costs is the area that I intend to focus on in this debate, as I have discussed it directly with my constituents and because just a 1% increase in workforce productivity could achieve as much as £400 million of savings. This is a significant and important area of the

1 July 2015 : Column 493WH

work of the NHS. Lord Carter believes that the £2 billion figure would be achieved without making anyone redundant and without seeking to increase the responsibilities of staff, nor would it mean decreased levels of remuneration for future employees. What it does mean is a greater command of management control on non-productive time, which are the periods when staff emphasis is not on direct patient care—days and shifts of annual leave, sickness and training. It also includes better management of rosters, improved guidance on appropriate staffing levels and skill ranges for certain types of wards.

The NHS is one of the largest employers in this country, employing more than 1.3 million staff in more than 300 different types of roles. In the last year that figures were available, the cost to the NHS budget was £45.3 billion, the largest proportion of the £118 billion budget. The cost of nurses alone totals £19 billion, and with the increased number required for safer staffing and a third increase in the number of nurses leaving the profession in the past two years, the reliance on agency nurses will see this figure rising.

Mr Jim Cunningham (Coventry South) (Lab): When the hon. Gentleman talks about increasing the productivity of staff, can he itemise which staff he is referring to and say how much would actually be saved?

Dr Offord: We are talking about all the different staff. There are 300 different employment roles in the NHS, so we are talking about everyone across the NHS, but I hope later in my speech to come to the specifics of clinicians and the use of agency staff for that sort of role.

John Stevenson (Carlisle) (Con): I congratulate my hon. Friend on securing this important debate. In my constituency in north Cumbria there is a hospital with a large number of agency staff, which has been a problem for some considerable time. I understand the need to employ agency staff, but does he agree that it would be far better to have staff employed directly by the hospital, as that would improve patient care and staff morale and also—to echo his point—improve the costs and productivity of that hospital?

Dr Offord: I certainly do agree with that point, and I hope to elaborate further on that. I also wish to touch on the use of bank nurses, or bank employees, who periodically work for parts of the NHS. I agree that for patient care it would be best to have full-time permanent staff who not only know the patients and the hospitals, but know the other employees they work with on a day-to-day basis.

Most worryingly, Lord Carter identified the fact that, in some of the 22 hospitals he surveyed, bank nurses are remunerated at a level that does not discourage them from remaining with, or moving to, agencies. I looked at the website of one of the trusts that took part in the review by Lord Carter and was surprised to see the range and number of bank employees—including, ironically, the position of the e-roster co-ordinator. I will not name that particular trust, as this debate is not a “name and shame” exercise, but I raise it to illustrate the point, because if such a role is vacant, what hope can there be to ensure that other clinical positions are staffed suitably?

1 July 2015 : Column 494WH

The e-roster co-ordinator is in the best position to monitor employment and identify irregularities in work patterns to prevent fraudulent practices. The majority of people who work for the NHS are honest, but there are a minority who seek to defraud its resources. I want to highlight the types of fraud that occur. Such fraud involves staff and professionals who claim money for services not provided or more money than they are entitled to, or who divert funds to themselves. It can also involve external organisations that provide false or misleading information, including invoices, to claim money they are not entitled to. Some of these frauds can be fairly low value, but they can often cost the NHS hundreds of thousands of pounds.

One example is Michael Botham, a hospital worker in Stoke-on-Trent who claimed nearly £20,000 for shifts he did not work. He applied for work via a recruitment agency, AMG Nursing and Care Services, in October 2007. He was then assigned as an unqualified healthcare worker to Bucknall hospital in Stoke-on-Trent, where he worked in the complex needs ward. Most worryingly, it took a ward manager to identify an overspend and to report their suspicions about Botham to the trust’s local counter-fraud specialist team. When the team analysed his timesheets, they revealed that he had submitted false claims for work from 1 January to 26 July 2009, complete with forged authorisation. In fact, he had worked only one shift during that period.

Botham also claimed payment for four shifts at Bradwell hospital, part of the same trust, in January 2009. Again, he had not worked those shifts and the authorising signatures were also false. In total, the trust overpaid £19,362 as a result of his false claims to the agency, which invoiced the trust in good faith on a weekly basis, but subsequently, to its credit, offered to pay back its fees of £3,956.50. This is a clear case of an individual deciding to defraud the NHS, but what is concerning is that the problem emerged only as a result of the scrutiny of another member of staff whose role was not to look for fraud.

Karin Smyth (Bristol South) (Lab): I worked for a clinical commissioning group in Bristol. Does the hon. Gentleman accept that one reason why that would have happened is that all members of NHS staff have to undergo mandatory and statutory training to recognise and counter fraud?

Dr Offord: I do, but I am saying that this should have been picked up by an individual with a strategic, holistic approach to staffing and staffing budgets, rather than leaving it to one individual on the ward who realised there was a problem with the budgets. There are processes in place to ensure that fraud does not happen, and I would like all hospital trusts to introduce such processes. In his report, Lord Carter highlights a case where one provider identified 20 cases of counter-fraud when they reviewed and strengthened their sickness and annual reporting leave. That prompts the question of why such abuses continue to be left unchecked.

There is another case of fraud that I want to highlight, which has been judged more harshly, although it can be argued that it is certainly not as deceptive because the individual actually undertook the work. Simon Olufemi Ajani was sentenced to 12 months’ imprisonment following a fraud investigation by NHS Protect after he had

1 July 2015 : Column 495WH

produced a false passport and certificate of entitlement to the right of abode in the UK. That enabled him to obtain work with patients at East London NHS Foundation Trust, South London and Maudsley NHS Foundation Trust, and other London trusts through NHS Professionals, the agency that supplies temporary staff to the NHS. His fraud was first uncovered through a data-matching exercise that highlighted inconsistencies between UK Border Agency records and NHS payroll records.

The difference between those two cases is that Ajani worked the hours that he was paid for, even though he was not entitled to be employed in this country, while Botham was just a crook stealing money directly from the NHS and patient care. These examples lead me to ask the Minister about the employment of those from outside the EU, an issue I have discussed recently with my constituents, as I mentioned. There is some criticism about the use of foreign doctors in the NHS, and some people consider that these jobs have been taken out of the reach of British people. However, we all know that the NHS does not have the numbers of doctors and nurses that it needs and there is not the capacity within the population of the United Kingdom to provide them. That is why some agency staff are required.

For some medical practitioners, however, remaining a locum is an alternative to having a permanent position. Some doctors are able to earn between £1,400 and £1,500 for a 12-hour shift, while the on-costs payable to agencies mean that hundreds of thousands of pounds a year are being charged to health trusts around the country for employment of temporary staff. One alternative to the costly system of locums could be the employment of a permanent doctor from overseas who could earn a salary of between £75,000 and £120,000. I need not ask the Minister whether he feels that this is better value for money than having a locum.

The NHS is an employer of those considered to have skills that are needed in this country, and a tier 2 visa allows “skilled workers” from outside the European economic area with a job offer to enter the UK. However, it has been established that the immigration health surcharge is levied against non-EU citizens. This requires every applicant and their dependents to pay not only their visa fees but a further £200 each year for up to three years. It strikes me as perverse that the very people needed to work in the NHS are being penalised by paying an additional amount that should perhaps be part of their terms and conditions of employment. Can the Minister explain in his summing up how the figure of £200 was reached and whether he feels that levying this tithe against NHS employees is counterproductive?

Lord Carter’s report goes on to identify opportunities in managing annual leave—what he terms the largest part of non-productive time. There are many ways in which NHS employers can ensure they manage staff leave. I am not going to stand here and say that the Minister should micro-manage the NHS in England, but even simple practices do not appear to be implemented in some NHS trusts. We all agree that, while the needs of patients must be considered when managing annual leave, people do need time off. Introducing a notice period of a month for leave requests of, say, more than three or four days would allow NHS managers the time

1 July 2015 : Column 496WH

to plan ahead, but that is not happening uniformly, thereby ensuring that agency staff are needed as an emergency measure.

Can the Minister therefore confirm that measures introduced by the Secretary of State to reduce agency locum spend will include a requirement for trusts to ensure that their employment practices and policies include such conditions as notice periods to book leave, that trusts consider employing e-roster co-ordinators and that trusts examine their employment policies so that they can compare themselves with their peers and undertake a skill mix review, the combination of which would reduce the need for spending on agency staff?

A fear raised with me by my constituents concerns the revalidation of full-time locum doctors. It is well known that locum doctors can experience a variety of challenges with revalidation, largely due to the peripatetic nature of their work, but annual appraisals are the backbone of revalidation and fundamental to demonstrating the fitness of medical professionals to practise. Revalidation should be carried out by the framework suppliers—the agencies that supply staff—but I have heard anecdotal reports that agencies do not revalidate, and it has been alleged that some health professionals are even practising outside their qualifications and skill range. Can the Minister tell us how the Department will ensure that the revalidation of all full-time locum medical professionals is carried out by the framework suppliers?

The final issue about the use of agency staff I want to raise is the use of master vendor contracts between health trusts and employment agencies. The use of this practice creates an opportunity for collusion within the employment industry to seek maximum financial gain through the use of exclusive contracts. While such contracts may be an easy option for the employer—in this case, the health trust—the agency can ask premium prices for a service that could be provided more cheaply if it were opened up to competition. Such a practice effectively introduces a closed shop and prevents smaller employment agencies from being able to enter the health market. Can the Minister advise us how the Department can ensure that the use of master vendors does not result in tacit collusion in the employment industry for exclusive contracts that cost the NHS more than it might pay for the services elsewhere?

In conclusion, this debate is not a negative criticism of employment agencies or the work of people in the NHS; in fact, it is the opposite. I congratulate the people who work in the NHS and I want to ensure that more people are employed in the NHS. I am framing this debate as an opportunity to assist the Government in ensuring that the resources needed by the NHS and identified by the Stevens review are made available. It is an opportunity to start the process by recognising where we can work smarter to ensure a better NHS for all and identify opportunities to achieve economies that do not undermine patient care, but in fact achieve the opposite, by ensuring the correct number of appropriately qualified staff in the NHS, working confidently, diligently and at a pace that ensures the best care for patients.

2.45 pm

Karin Smyth (Bristol South) (Lab): Thank you, Mr Pritchard, for calling me to speak.

1 July 2015 : Column 497WH

I agree with the hon. Member for Hendon (Dr Offord) that of course there are always efficiencies to be made, and ways of considering how they can be made; NHS managers and staff, including clinical staff, spend a great deal of their time doing that. My intervention about counter-fraud was meant to suggest that that work becomes part of the way that people start thinking about their work as public servants. However, this debate needs to be widened out beyond the individual savings that have been mentioned. As the King’s Fund has said, the greatest savings achieved in the NHS since 1948 were made since 2010, largely through reductions to pay and central budgets, and some restructuring. Having said that, I am slightly sceptical about the savings that can be made through restructuring.

We need to move this debate on to a discussion about quality in its widest sense, because quality is an organising principle of the NHS; ultimately, quality will deliver greater savings and contribute towards the £22 billion target. It will also involve people much more in the management of their healthcare, so that we save money that is currently spent on public health interventions. We must also ensure that when people use the health service, they understand where savings can be made. If we were able to involve patients and others much more in that debate, we would find more good examples of what we have been discussing. There are some great examples from Bristol, particularly around environmental savings. There have been some fantastic projects to reduce consumption of energy, both at Universities Hospital Bristol NHS Foundation Trust, and at North Bristol NHS Trust. There is also the reskilling that takes place within the community services organisations, to make better use of the highly skilled community nurses and to help people with the flow in and out of hospital.

However, all these measures require the system to be stable and require some transitional support to allow the transformation to happen. At the moment, I am not sure that the NHS feels it has the support to make that happen, as individual examples that will not yield overall results are being picked out. I welcome this debate about productivity, but I hope that we can have a degree of political honesty about the scale of the challenge of the £22 billion cuts.

Mr Jim Cunningham: The hon. Member for Hendon (Dr Offord) talked about efficiency, which is one thing; productivity is something totally different. Productivity is what the individual produces, whereas efficiency is really about how the individual works. Does my hon. Frind agree?

Karin Smyth: I agree with my hon. Friend. It is the environment in which an individual works and is supported into work that helps to boost productivity. I think we would all agree that generally people want to be as productive in the service as they can be, and they are very cognisant of their role as public servants. As I say, I would like to see political honesty and discussion about the scale of the £22 billion cuts. It is hard to see where they will come from, regardless of pay restraint, cuts to services and major reconfigurations. Those changes may need to happen, but there needs to be honesty across all parties in the House to support their introduction.