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House of Commons

Tuesday 17 November 2015

The House met at half-past Eleven o’clock

Prayers

[Mr Speaker in the Chair]

Oral Answers to Questions

Health

The Secretary of State was asked—

Learning Disabilities and Autism

1. Jack Lopresti (Filton and Bradley Stoke) (Con): What steps his Department is taking to improve care and support for people with learning disabilities and autism. [902107]

The Minister for Community and Social Care (Alistair Burt): We are determined to ensure that people with learning disabilities live independent lives, with better care and improved outcomes. Taken together, the Government’s recent response to the “No Voice Unheard, No Right Ignored” consultation and the newly published “Transforming care” consultation set out the steps we will take to protect rights, strengthen choice, meet physical and mental health needs and end institutional care by default.

Jack Lopresti: I thank my right hon. Friend for his answer. South Gloucestershire and Stroud college, based in my constituency, is making an application to open a free school for autistic children. How does he feel that such schools can improve the support and education for children with autism?

Alistair Burt: I thank my hon. Friend for the question. Autism is certainly a growing area of identified special educational need across the country that requires an increasing range of provision to meet the diverse needs of the population. Although it would be inappropriate for me to comment on a particular free school application, where it is needed, a special free school can add to the local continuum of provision, by providing specialist places and specialist expertise that can be shared more widely.

Bill Esterson (Sefton Central) (Lab): The all-party group on foetal alcohol spectrum disorders took evidence last week about the link between alcohol consumed by mothers during pregnancy and the growing incidence of learning disability and autism. In Canada, this has been widely known for many years, and the Canadian Government at national and federal levels have invested heavily in raising awareness. When can we expect the same in this country?

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Alistair Burt: The syndrome to which the hon. Gentleman rightly draws attention is well known here as well. I understand from the public health Minister, my hon. Friend the Member for Battersea (Jane Ellison), that a consultation in relation to this will be announced shortly, and of course there will be new guidelines in response. The all-party group is right to draw attention to this, and anything that can protect women during pregnancy and, of course, their children is of benefit to all.

Mr Nigel Evans (Ribble Valley) (Con): In one family in my constituency, three of the four youngsters have autism. Will the Minister look at the work of local authorities? In this specific case, Lancashire is clearly not working closely enough with the mother, who has one idea about how she wants her youngsters to be educated. The local authority, for cost reasons alone, is simply not working with the parents. It would prefer to see her prosecuted, rather than working with her.

Alistair Burt: I fairly regularly meet families and others who have had young people and older people in the system and where there is a difference of opinion about what might be done. Some of the stories are very distressing. Families will sometimes feel that people have not listened to them. There can be quite difficult clashes of opinion on occasion. Of course, any case that my hon. Friend wants to bring me I would be happy to see, but this is a perpetual issue. The important thing is always to listen to those who are closest to a problem. That is likely to be the best way forward. Even if there is a difference of opinion, if people feel that they have been listened to, there is a proper opportunity to explore what can be done.

Jim Shannon (Strangford) (DUP): The autism numbers in Northern Ireland are growing. I understand that it is a devolved matter, but it is clear to me that three Departments have a responsibility: Health, No. 1; Education, No. 2; and Employment, No. 3. We need to ensure that the health of autistic children is looked after and that they have an education that prepares them for employment. Does the Minister have a strategy that takes all three Departments on board, and if so, is it shared among all the regions of the United Kingdom of Great Britain and Northern Ireland?

Alistair Burt: Yes. I could not have put it better myself. We have an autism programme board, on which sit representatives of the families of those with autism, which provides an opportunity to look overall at the Government strategy. The hon. Gentleman is right to say that it contains many different elements. For example, in relation to work, we have set out a challenge to halve the disability employment gap, because more people with disabilities want to take the chance of working. That must be done in the right way; we are working closely with the Department for Work and Pensions in relation to that, but things such as the autism programme board give a chance for families to be involved right across the areas where they might expect help and assistance.

Full Hospital Services

2. Michael Tomlinson (Mid Dorset and North Poole) (Con): What steps he plans to take to ensure that full services in hospitals are available seven days a week by 2020. [902109]

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The Secretary of State for Health (Mr Jeremy Hunt): By 2020, all patients admitted to hospital in an emergency will have access to the same level of consultant assessment and diagnostic tests, whichever day of the week they are admitted.

Michael Tomlinson: With mortality rates at weekends suggesting that there is an increased risk of dying, does the Secretary of State recognise the importance for Dorset of getting right the proposal for a new emergency hospital in the Poole and Bournemouth area and ensuring that there are specialist consultants 24/7?

Mr Hunt: I thank my hon. Friend for raising that issue, which is incredibly important for his constituents and for Dorset as a whole. I know that the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), who has responsibility for hospitals, will be going there very soon. The clinical standard says that anyone admitted to hospital in an emergency should be assessed by a consultant within 14 hours. Across every day of the week and all specialties, that happens in only one in eight of our hospitals. That is why it is so important to get this right.

Rachael Maskell (York Central) (Lab/Co-op): Bootham Park mental health hospital and York’s place of safety shut with four working days’ notice, so York no longer has a seven-day service, nor even a one-day service in our hospital. That would have been totally avoidable if one NHS body had overarching responsibility for patient safety. Will the Secretary of State agree to meet me and to have an independent inquiry so that mental health patients are not put at serious risk again and we can have a full seven-day service before 2020?

Mr Hunt: Obviously, I am very concerned to hear what the hon. Lady says. I know that my right hon. Friend the Minister of State has been looking at this issue and is very willing to talk to her about it. Alternative provision has been made, but she is right to make sure that her constituents have access to urgent and emergency care seven days a week.

Dr Andrew Murrison (South West Wiltshire) (Con): Does my right hon. Friend agree that full hospital services does not mean full services in every hospital, and that if we are to achieve our ambition of driving down excess weekend deaths, we will have to look again at concentrating services in regional and sub-regional centres, and, in addition, make sure that we network properly among smaller hospitals, where they exist?

Mr Hunt: My hon. Friend speaks very wisely on this issue. Yes, this is not about making sure that every hospital is providing every service seven days a week. It is about making sure that in an urgent or emergency situation, people can access the care they need and that, for example, high dependency patients are reviewed twice a day, even at the weekends, by consultants. That happens across all specialties in one in 20 of our hospitals, which is why it is so important to get this right.

Ms Margaret Ritchie (South Down) (SDLP): What assessment has the Department made of the impact of reduced accident and emergency hours, and what effect will that have on the implementation of a seven-day work plan?

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Mr Hunt: I am not quite sure I understand what the hon. Lady is referring to. We are not reducing A and E hours; we are investing. We have nearly 2,000 more consultants in our A and E departments than five years ago and we need to support strong A and E departments as much as possible.

Andrea Jenkyns (Morley and Outwood) (Con): Over the weekend we learned of the close links between the leadership of the British Medical Association and the Labour party. It seems that the BMA is more interested in pushing its own political agenda than in securing the best deal for its members. Can my right hon. Friend assure me that he will hold his nerve and deliver the seven-day NHS that will make the NHS safer for our patients?

Mr Hunt: I can absolutely give my hon. Friend that assurance. This is essential for the constituents of all hon. Members, whichever side of the House they sit on, and this Government will always stand on the side of patients. The weekend mortality rates are not acceptable. That is why we are doing something about them.

Daniel Zeichner (Cambridge) (Lab): Given the acute pressures on the national health service, we are a long way from the vision that the Secretary of State wants to achieve. I met the Indian Workers Association this morning. Thousands and thousands of care workers of Indian origin are trained nurses and could be in our NHS, but the bar for the language test has been set so high that they are excluded. Will the Secretary of State look again at the test?

Mr Hunt: I commend the extraordinary contribution made by NHS front-line workers of Indian origin. I have met the Indian doctors association, the British Association of Physicians of Indian Origin, and have had many discussions on that front. It is very important, however, that people speak good English if they are providing care in the NHS. There are real issues for clinical safety when the standard of English is not high enough. We have a lot of fantastic support from immigrants who do a great job on the NHS frontline, but good English is an absolute pre-requisite.

Diagnostic Testing (Primary Care)

3. Maggie Throup (Erewash) (Con): What steps the Government are taking to improve diagnostic testing in primary care. [902110]

The Parliamentary Under-Secretary of State for Life Sciences (George Freeman): The Government are determined to improve and invest in diagnostic testing in primary care. Diagnostics and breakthroughs in innovative diagnostics are key to a 21st-century NHS. That is why we have set up the medical technology strategy group, which I chair, to look at accelerating diagnostics into the system; the cancer strategy taskforce; the Prime Minister’s GP access fund; the new models of care programme; and the accelerated access review, which is looking to accelerate those diagnostics with particular value to patients and the system. We have also introduced the new guidelines for the National Institute for Health and Care Excellence, and, through

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the genomics programme, we are investing in 21st-century molecular diagnostics, which will come to shape the future.

Maggie Throup: C-reactive protein point-of-care testing could reduce the number of prescriptions for antibiotics, contribute to the UK’s anti-microbial resistance strategy, and save the NHS millions of pounds each year. Ahead of my Adjournment debate on this issue next Monday, will the Minister agree to look at this type of testing as a way of saving the NHS money and providing appropriate patient treatments?

George Freeman: My hon. Friend makes an excellent point. We are completely committed to tackling anti-microbial resistance, and reducing the volume of antibiotics prescribing is vital to that. We are a world leader in this field in tackling AMR. We have an expert group looking at how to improve diagnostic services in relation to AMR, and it has already identified what diagnostics are currently in use and what new technologies are on the horizon, including C-reactive protein point-of-care testing. The group is currently formulating conclusions. The public health Minister, my hon. Friend the Member for Battersea (Jane Ellison), is looking forward to responding to my hon. Friend’s debate on Monday to set out more of the detail.

Mr John Baron (Basildon and Billericay) (Con): The Government have done a very good job in getting one-year cancer survival rates into the DNA of the NHS as a means of encouraging clinical commissioning groups to promote earlier diagnosis—cancer’s magic key. Does the Minister agree that we all need to ensure that we keep the CCGs’ feet close to the fire as regards these one-year figures so that we do not just improve diagnostic testing in primary care, but improve screening rates, GP referral rates and awareness campaigns as a means of ensuring that we save the thousands of lives that are needlessly lost through late diagnosis?

George Freeman: My hon. Friend is absolutely right. I pay tribute to his work on this through the independent cancer taskforce. The aim is to save 30,000 more lives a year by 2020. We are working with Harpal Kumar and Cancer Research UK on implementing its recommendations. NICE has set out new guidelines on clear ambitions and standards on how quickly patients should be referred for diagnostics. There is good news in that in 2014-15, compared with 2009-10, over 4.3 million more imaging and endoscopy tests were commonly used to diagnose cancers, but I agree that we have much more still to do.

Suicide Rates

4. Simon Danczuk (Rochdale) (Lab): What steps he is taking to reduce suicide rates. [902111]

The Minister for Community and Social Care (Alistair Burt): Every person lost to suicide is a tragedy. We continue to deliver the national suicide prevention strategy to reduce suicide rates by working across Government and with the NHS, community, voluntary and charitable sectors. But above all, we must challenge the inevitability of suicide, and I want us to be more ambitious about suicide prevention.

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Simon Danczuk: In Rochdale, suicides have gone up by 25% since 2010. The rate is 11.8% against an average of 8.9% in England. We have a much higher rate of male suicide. If the Government continue to get their approach to this wrong, there will be more and more needless deaths. Are they going to fund mental health services properly?

Alistair Burt: Looking at mental health services is just part of what we intend to do, and more money is going into mental health. The hon. Gentleman is absolutely right about male suicide. Men are three times more likely to commit suicide than women. It is also a particular cause for concern among young men. Overall, our national suicide rates remain relatively low in comparison with others, but they have been rising, and I am worried. I am interested in the theory of zero suicide, with more work to try to ensure that suicide is not seen as inevitable and more work in detail with particularly affected communities. The work that we are doing with people at a younger age, using child and adolescent mental health services more effectively to deal with depression and similar issues before suicide becomes a greater risk, will also be important. I am really interested in this area, and I think we are going to have a debate on it later this week.

Mr David Nuttall (Bury North) (Con): As my right hon. Friend says, we will indeed be having a debate on this matter later this week, on Thursday in Westminster Hall. It will be the first time that we have been able to mark international men’s day and consider the whole issue of male suicide in more detail, and it will give us the opportunity to look at why the proportion of male deaths to female deaths has increased steadily since 1981.

Alistair Burt: I am grateful to my hon. Friend for raising the subject and for mentioning the forthcoming debate. The subject deserves to be looked at extremely carefully. As I have said, there should be neither complacency nor a sense of inevitability about suicide, and I am very interested in what more can be done. I have met one or two of the families who have experienced these tragedies and I am deeply impressed with their commitment to doing something for those age groups particularly affected. This afternoon I will meet a gentleman who is well known for having been involved in a suicide prevention incident. We are doing work to reduce stigma and to find places for people to talk about their concerns, and the more people are prepared to talk about things that might cause suicide, the better. This is an issue that we can give a higher profile to and do more work on, because every time there is a suicide it leaves a trail of damage for families and friends that is truly distressing to behold.

Luciana Berger (Liverpool, Wavertree) (Lab/Co-op): Last week, yet another report—this one from the King’s Fund—warned of a mental health system that is under huge pressure. On this Government’s watch, just 14% of patients feel that they have received appropriate care in a crisis. The number of mental health nurses has dropped, and increasing numbers of people are having to travel hundreds of miles for a bed. What action will the Minister take to turn his rhetoric into reality?

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Alistair Burt: This is a cross-party matter and it is very important. We believe we have made strides during both the previous and this Government. We are investing more money in mental health services—it was increased to £11.7 billion last year—and this was the first Government to introduce standards for access and waiting times with regard to mental health, to try to put it on a par with other conditions. That was not how it was done before. We will now try to ensure that the money that goes in nationally is used to provide assistance locally, and that the money that is put in for local use is used locally.

There are areas to celebrate. We are world leaders with the improving access to psychological therapies service, which has treated 3 million people since 2009. We want to build on that. We know that the service has lagged behind others in the past, which is why we are determined to do much more about it. I think it is the view of the whole House that we should do more about it, and we will.

Luciana Berger: I listened very carefully to the Minister’s response, but I reinforce the point that the suicide rate in this country is going up, not down. It is a national scandal that we need to address.

The Minister mentioned prevention. The Government have confirmed that they will make an in-year £200 million cut to local public health grants. That is a political decision. It is not going to save money and, apart from the devastating human price, it is going to cost our NHS and our local authorities more as they deal with both physical and mental ill health that could have been prevented. How can the Minister justify that?

Alistair Burt: First, £1.25 billion is going into creating new services for children and young people’s mental health services during the course of this Parliament. The hon. Lady’s party did not make that commitment before the general election. More work is being done in schools to provide a better base for mental health. We have, for the first time, appointed in the Department for Education a Minister with responsibility for mental health in schools.

The pressures on public health budgets are the same as those on every other budget. Those pressures on the national health service were met by my colleagues during the general election, with a commitment to provide an extra £8 billion—the figure is now £10 billion—by the end of this Parliament. That commitment was not made by the hon. Lady or her party. She asks for more money to be spent, but we have committed to do that and we are finding it. It is very important that we take the position that we have to do as much as we can with what we have got. Mental health services are moving forward and we should take the opportunity to say that and welcome what has been done. We have provided the resources in a way that I am afraid the hon. Lady’s party did not.

Car Parking Costs

5. Jo Cox (Batley and Spen) (Lab): If he will take steps to assist hospital trusts to mitigate the cost of car parking on NHS sites for out-patients and visitors. [902112]

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The Parliamentary Under-Secretary of State for Health (Ben Gummer): It is for NHS organisations locally to set the cost of car parking, but they should be informed by the principles and guidance set by the Department of Health.

Jo Cox: My local trust of Mid Yorks has just increased parking charges at Dewsbury and district hospital and has introduced charges for drivers with disabilities. The trust is clear that that is due to the financial settlement from Government. Does the Minister think it is acceptable that people who are ill or in need of medical attention, and their loved ones, are being penalised in this way?

Ben Gummer: The financial settlement from the Government is more generous than the one promised by the hon. Lady’s party at the last election. We are committing £10 billion over the next few years. I would ask her trust to look at the savings suggested by Lord Carter, who has identified considerable savings that can be made within hospitals. If it feels that it needs to increase car parking charges, it should refer to the Department of Health guidance, which makes it clear that there should be concessions for blue badge holders.

Ben Howlett (Bath) (Con): Hospital car parking charges are clearly too high in the UK. I am sure that my hon. Friend agrees that the Minister without Portfolio, my right hon. Friend the Member for Harlow (Robert Halfon), led an amazing campaign during the previous Parliament to reduce the charges. Will my hon. Friend confirm that he is pursuing his commitment to reduce hospital car parking charges and explain how that will help patients and visitors to the Royal United hospital in my constituency?

Ben Gummer: The principles that the Department publishes are clear that charges, if they are set, should be proportionate and fair and should be set at a level that assures people of a car parking space. One of the problems of free car parking is that it often means there are no spaces for carers and for the sick when they turn up. Clearly, hospitals should exercise judgment in making sure that carers and people making frequent visits get a heavily discounted rate so that such charges do not become an impediment to free access to healthcare.

Paula Sherriff (Dewsbury) (Lab): Mid Yorkshire Hospitals NHS Trust has recent imposed charges for blue badge holders. Many constituents have told me that, as a result, they will struggle to attend their appointments. The trust admitted to me that it had not considered the impact on the DNA—did not attend—rate. Does the Minister agree that not only does this place an extra financial burden on the vulnerable, but could lead to their being denied access to the healthcare that they desperately need?

Ben Gummer: The hon. Lady raises the surprising point that the hospitals did not consider the impact on their operations, which they should have done. The principles make it quite clear that disabled drivers should get concessionary rates, although charges sometimes need to be applied so that there are spaces for disabled drivers. The hospitals should have thought that through, and should look for savings elsewhere in their operations before they look at car parking charges.

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Clinical Outcomes

6. Helen Whately (Faversham and Mid Kent) (Con): What steps his Department is taking to improve clinical outcomes for people treated by the NHS. [902113]

The Parliamentary Under-Secretary of State for Health (Ben Gummer): On a number of fronts, the Department is looking at how it can improve clinical outcomes. Indeed, that is the entire focus of the Department. With reference to hospitals, we can improve clinical outcomes across the service through introducing a seven-day NHS, by increasing transparency and by looking at the cover provided by consultants and doctors.

Helen Whately: I welcome the Government’s commitments to improving outcomes for patients admitted at weekends, but seven-day services are needed not just in hospitals but in primary care, community care, social care and mental health services. What steps are the Government taking to make sure that seven-day services are available in all settings where patients need care urgently?

Ben Gummer: My hon. Friend makes her point extremely well. A seven-day NHS will operate only if it works across all areas of care. That is why the local integration of care and health services is part of our wider vision for the NHS. I urge her to look, when it is published, at Professor Sir Bruce Keogh’s report on urgent and emergency care, which envisages precisely the sort of joined-up care that will ensure people receive the correct attention at the correct level and do not therefore go to hospital when they can be dealt with in primary care settings.

Nick Thomas-Symonds (Torfaen) (Lab): On the Friday before last, a Minister stood at the Dispatch Box and talked out my private Member’s Bill, the Off-patent Drugs Bill, which would have provided a mechanism for improved clinical outcomes by making repurposed drugs more consistently available across the country. The Minister for Community and Social Care said that the Government would consider an alternative pathway. What is that pathway and when will it be implemented?

Ben Gummer: As I am sure the hon. Gentleman knows, my hon. Friend the Under-Secretary of State for Life Sciences is fully committed to the ambition expressed in the hon. Gentleman’s Bill. My hon. Friend feels that the mechanisms do not work, but has set up a working party to ensure that that ambition can be taken forward. I know that he would welcome full engagement with the hon. Gentleman to make sure that that happens.

David Tredinnick (Bosworth) (Con): If we are to improve patients’ clinical outcomes, surely we need to look more at patient experiences. According to TheBMJ, only 11% of the 3,000 treatments looked at in clinical trials proved to be beneficial, with 50% being of unknown effectiveness. Now that the Society of Homeopaths is regulated by the Professional Standards Authority, should we not spend more than a paltry £100,000 a year on homeopathic medicine in the health service?

Ben Gummer: The Department’s position, despite repeated questioning from my hon. Friend, is consistent on this matter and remains the same.

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Mr Speaker: As I have often had cause to observe, repetition is not a novel phenomenon in the House of Commons.

Mr Philip Hollobone (Kettering) (Con): In Northamptonshire, 80% of end-of-life patients die in hospital, whereas 80% of end-of-life patients want to die at home, assisted by the hospice movement. I have discovered that GPs are ticking the end-of-life box on the quality outcomes framework form, but that that information is not being passed automatically to local hospices. What can the Department do about that?

Ben Gummer: My hon. Friend raises a terribly important matter. Clinical outcomes can be assessed in a complete sense only if they include end-of-life care for those for whom there is no clinical outcome in the commonly received understanding of the term. If that is what is happening in his clinical commissioning group area, it is unacceptable. I point him to the work that the Government are doing on a paperless NHS to ensure that the kind of bureaucratic muddle he has identified no longer occurs.

Genomics England

7. Jo Churchill (Bury St Edmunds) (Con): What progress has been made by Genomics England in making the UK the world leader in genomic medicine. [902114]

The Parliamentary Under-Secretary of State for Life Sciences (George Freeman): The Genomics England project, which was launched by my right hon. Friend the Prime Minister, has electrified the global life and health science community. We are the first nation on earth to commit to sequencing 100,000 entire genomes of NHS patients, which will be combined with patient records to unlock NHS and UK leadership in the fast-emerging field of genomic medicine, focusing initially on rare diseases and cancer. I am delighted to report that we have the genomes of 5,000 patients fully sequenced and that 11 genomic medicine centres have been set up. We have identified first diagnostics and treatments for some rare diseases; 2,500 researchers are involved in the project; the cost of sequencing a genome has fallen from £5,000 to £1,000; and, importantly, NHS England is setting the international standard on ethics and patient consent in genomic medicine.

Jo Churchill: Does the Minister agree that the world-leading Genomics England will deliver a personalised and patient-centred revolution in modern healthcare by combining the talent of global companies such as AstraZeneca with that of UK-based companies such as Congenica in my region, to the benefit of patients with cancer and other rare diseases, the vitality of our NHS and, through jobs and innovation, the strength of our economy?

George Freeman: My hon. Friend makes a great point. I pay tribute to Congenica, a small company in Cambridge that is doing extraordinary work. I recently went to open Illumina’s global research and development headquarters, which is a £160-million commitment. As well as the significant investment in technology and research in the UK, NHS England is leading genomic

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medicine across the UK, not just in the Oxford-Cambridge-London triangle, but through 11 genomic medicine centres across the country, which are bringing genomic diagnostics to the benefit of us all.

John Pugh (Southport) (LD): The Minister will know of the case of one-year-old Layla Richards, who was saved from leukaemia by genome editing at Great Ormond Street hospital. What specific help does he give for such hands-on pioneering work?

George Freeman: The hon. Gentleman makes an excellent point. Genome editing is the latest in a suite of technologies that is rapidly emerging in genomics. Through the Genomics England programme, we are actively supporting those tools and intermediate technologies, and through the accelerated access review that I have launched, we are looking to harness those breakthroughs to support new treatments and new flexibilities for the National Institute for Health and Care Excellence and NHS England on targeted treatments.

Junior Doctors (New Contract)

8. Oliver Colvile (Plymouth, Sutton and Devonport) (Con): What progress he has made on implementing a new contract for junior doctors; and if he will make a statement. [902115]

9. Caroline Lucas (Brighton, Pavilion) (Green): What plans he has to introduce a new contract for junior doctors. [902117]

The Secretary of State for Health (Mr Jeremy Hunt): Junior doctors are the backbone of the NHS. It is highly regrettable that their union has let them down by refusing to negotiate a new contract that will be fairer for doctors and safer for patients, and deliver the truly seven-day services we all want.

Oliver Colvile: I thank my right hon. Friend for that answer, but has he had an opportunity to speak to medical schools about the new contract for junior doctors, especially the Peninsula medical school in my Plymouth, Sutton and Devonport constituency?

Mr Hunt: NHS Employers has regular discussions with the Medical Schools Council, which represents the Peninsula medical school. Although the training of doctors is not the specific contractual dispute that is in the headlines, it is something on which we could make significant improvements. We want to use this opportunity to work with medical schools and the royal colleges to see whether we can bring back some of the continuity of training that used to be such an important feature of junior doctors’ training.

Caroline Lucas: The person who has let down junior doctors is none other than the Secretary of State. Does he recognise how insulting it is to those doctors to imply that they are not already working seven days? Crucially, will he listen to the professionals—junior doctors and their senior counterparts who support them—and drop his threat to impose the contract so that meaningful talks can take place?

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Mr Hunt: What exactly would the hon. Lady say to her constituents who are not receiving the standard of care that they need seven days a week, and will she stand side-by-side with them, or with a union that has misrepresented the Government’s position? We have been clear that there are no preconditions to any talks, except that if we fail to make progress on the crucial issue of seven-day reform, we of course reserve the right to implement a manifesto commitment. That must be the way forward, and I urge the British Medical Association to come and negotiate rather than grandstand, so that we get the right answer for everyone.

Dr Sarah Wollaston (Totnes) (Con): I am deeply concerned about the impact on patient care caused by the proposed three days of industrial action, including two days of a full walk-out. Will the Secretary of State say what advance preparations are taking place to ensure patient safety? Will he reassure the House that there are no preconditions that will act as barriers and to which the BMA has to agree before negotiations can take place?

Mr Hunt: I absolutely give my hon. Friend that reassurance. There are no preconditions, and this morning I wrote again to the BMA to reiterate that point. Of course, if we fail to make progress we have to implement our manifesto commitments, but we are willing to talk about absolutely everything. I agree strongly with my hon. Friend that it will be difficult to avoid harm to patients during those three days of industrial action. Delaying a cancer clinic might mean that someone gets a later diagnosis than they should get, and a hip operation might be delayed when someone is in a great deal of pain. It will be hard to avoid such things impacting on patients, and I urge the BMA to listen to the royal colleges—and many others—and call off the strike.

Dr Philippa Whitford (Central Ayrshire) (SNP): It is 40 years since the last junior doctor strike—before I even started medical school. Given the ballot tomorrow, does the Secretary of State regret the antagonistic approach that he took before the summer towards senior and junior doctors? Should he instead have worked with them and not threatened to impose a contract so as to reach a stronger emergency seven-day service?

Mr Hunt: I do not know what the hon. Lady thinks is antagonistic about holding reasonable discussions with doctors for three years to try to solve the problem of seven-day care. Those discussions ended with the BMA, after two and a half years, walking away from negotiations last October. We made a manifesto commitment to have a seven-day NHS and to do the right thing for patients, and we simply asked the BMA to sit round the table and talk to us about it. I am confident that we can find a solution.

Dr Whitford: Claiming in July that senior doctors do not work outside 9 to 5 was perhaps felt to be antagonistic. Contrary to the figures quoted by the hon. Member for Dudley North (Ian Austin) last Monday, A&E figures for NHS England are 5% below those in Scotland. With such disappointing figures before we even get into winter or face a work-to-rule, and in the presence of eye-watering deficits, how does the Secretary of State plan to support hospital trusts through the winter?

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Mr Hunt: I urge the hon. Lady to correct for the record her wholly untrue statement that I ever said that doctors do not work outside 9 to 5. That is exactly the kind of inflammatory comment that makes the current situation a whole lot worse than it needs to be. I have always recognised the work that doctors do at weekends, but I also recognise that we have three times less medical cover at weekends, which means that mortality rates are higher than they should be. On A&E performance, we are taking extensive measures to ensure that the NHS is prepared for winter. It will be a tough winter, but unnecessary and wholly avoidable industrial action by the BMA will make it worse.

17. [902129] Sir Simon Burns (Chelmsford) (Con): Does my right hon. Friend agree that the failed attempt by the BMA to get an injunction against the General Medical Council to stop it issuing guidance on how doctors should behave responsibly towards patients if there were to be a strike undermines the BMA’s claim that it is putting patient safety first? Will he assure the House that the BMA will have no veto on a seven-day NHS? That was a Conservative party manifesto commitment and it is what the vast majority of people in this country want.

Mr Hunt: My right hon. Friend championed the cause of patients when he was a Health Minister, and we must continue to do the right thing for patients, which is also the right thing for doctors. It is wholly inexplicable that the BMA should try to gag the GMC and stop it issuing guidance to doctors about their professional responsibilities. Whatever the disagreements over the contract, the most important thing is to keep patients safe.

Justin Madders (Ellesmere Port and Neston) (Lab): I am sure that both sides of the House genuinely appreciate the excellent work done by all staff in our NHS, which at a time of unprecedented strain relies more than ever on the goodwill of its employees to keep going. We have to support and value our staff, not criticise them and provoke them when there is disagreement. Calling junior doctors militant is not the way to end a dispute, and we have heard more of the same rhetoric this morning. Industrial action is always a last resort when negotiations have failed. Does the Secretary of State accept any responsibility for that failure?

Mr Hunt: I accept total responsibility for doing the right thing to save patients’ lives. I have to say that I think that any holder of this office would be doing wholly the wrong thing if they were to try to brush under the carpet six academic studies that we have had in the last five years that say we have higher mortality rates at weekends than we should expect. This Government are on the side of patients and we will do something about that.

Genetic Problems (Children)

10. Philip Davies (Shipley) (Con): If he will take steps to reduce the number of children born with genetic problems due to marriages between first cousins. [902119]

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The Parliamentary Under-Secretary of State for Health (Jane Ellison): I am aware that there is an increased risk of recessive genetic conditions in births that occur as a result of first cousin marriages. It is a complex issue, and other factors are also significant, but experienced health professionals use some well-established tools and materials. Specialist clinicians in my hon. Friend’s area are looking at this important issue.

Philip Davies: I am grateful to my hon. Friend for that reply, but given the severe medical conditions that are caused by first cousin marriages, is it not time that the Government considered the only proper solution—outlawing first cousin marriages in this country?

Jane Ellison: Such a change in the law would not be for the Department of Health. Let me respond to my hon. Friend’s specific point about the particular localised challenges. He might be interested to know that in May 2012 a major conference was held at Leeds town hall, with groups drawn from across the area he represents and from the wider West Yorkshire area to look at these issues. As he knows, I have already written to the public health director in Bradford asking what is being done locally to address this issue, and I suggest that it would be useful if my hon. Friend followed up on that. I would be happy to hear how that conversation goes.

Psychological Therapies

11. William Wragg (Hazel Grove) (Con): What steps his Department is taking to ensure that the NHS recruits, trains and retains adequate numbers of therapists, clinicians and other staff to improve access to psychological therapies. [902123]

The Minister for Community and Social Care (Alistair Burt): Health Education England, working with NHS England, is charged with ensuring that there are sufficient staff with the right skill mix to support the delivery of the improving access to psychological therapies programme, and that is monitored by an annual workforce census. For example, HEE’s plans for 2015-16 are to train 946 additional individuals—a 25% increase on last year.

William Wragg: As well as providing adequate numbers of high quality specialised staff, given the prevalence of mental health issues in our society, is it not also important that general awareness is raised of mental health issues and the available treatments among all medical professionals, especially GPs? What future steps can the Government take to improve that training?

Alistair Burt: There are two particular ways to do that. The first is to enhance GP training, and work is already going on to do that. The second is through continuing professional development, and the Royal College of General Practitioners and HEE are combining to ensure that a good range of materials is available for clinicians and others to improve their skills in that area. My hon. Friend is right to raise the issue.

Health Problems (Poverty)

12. Tommy Sheppard (Edinburgh East) (SNP): What assessment he has made of the effect of poverty on the incidence of health problems. [902124]

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16. Peter Grant (Glenrothes) (SNP): What assessment he has made of the effect of poverty on the incidence of health problems. [902128]

The Parliamentary Under-Secretary of State for Health (Jane Ellison): Across Government we are working to improve the life chances of children, and that is at the heart of our efforts to tackle the real causes of child poverty and improve the prospects for the next generation. That involves taking a broad approach to improving poor health and tackling health inequalities which the last Government embedded in the law. The wider causes of ill health, such as worklessness and unhealthy lifestyles, are all being addressed at the moment. I welcome the fact that we have record numbers of people in work and a dramatic drop in the number of children living in workless households. That goes to the heart of some of the broader drivers of ill health and poverty.

Tommy Sheppard: I am pleased that the Government accept that there is a causal link between poverty and poor health outcomes. They will also know of the widespread concern that the proposed changes to the tax credits regime will result in greater poverty, which will in itself cause poorer health outcomes and may put great pressure on the NHS. Will the Department consider putting in place mechanisms to monitor the effect of the tax credit changes on demands on the national health service?

Jane Ellison: We do far more than monitor health inequalities; we are taking action to deal with them. The heart of my portfolio is comprised entirely of tackling health inequalities in our nation. Let me give just a couple of examples: the expanded troubled families programme, on which the Department of Health is working closely with other Departments; and the family nurse partnership, where we support some of the most vulnerable young parents in the earliest years of their children’s lives. Those programmes have the greatest impact on our most disadvantaged communities. The matters that the hon. Gentleman raises are for other Departments, but I assure the House that improving the life chances of all our children is core business for the Government.

Peter Grant: Interesting answer, but unfortunately it was not the answer to the question that was asked. No doubt my hon. Friend will follow that up later. Is the Minister aware of work produced by, for example, Sir Harry Burns, the former chief medical officer of Scotland, which clearly indicates that although there is a very strong link between poverty and poor health, that link is not inevitable and should not be allowed to become inevitable? What are the Government doing to change policy, so that that link can be broken?

Jane Ellison: I have already given some examples of the work the Government are doing to tackle health inequalities in our nation. Let me give the hon. Gentleman another practical example. The burden of disease that tobacco brings falls disproportionately on poor communities. As well as the action that we have taken on standardised packaging and on smoking in cars with children, we are committed to a new tobacco strategy. I have said publicly that at the heart of the strategy there must be effective action to look at the areas in which

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the effect of tobacco falls most heavily—disadvantaged communities. We are taking practical action to close gaps in health outcomes in a range of ways.

Hepatitis C Infection (Winter Fuel Payments)

13. Drew Hendry (Inverness, Nairn, Badenoch and Strathspey) (SNP): If he will discuss with the Secretary of State for Work and Pensions provision of winter fuel payments to people infected with hepatitis C by NHS blood transfusions. [902125]

The Parliamentary Under-Secretary of State for Health (Jane Ellison): Those affected by the contaminated blood tragedy are entitled to receive Department for Work and Pensions winter fuel payments if they meet its eligibility criteria. For the benefit of the House, if not the hon. Gentleman, it is worth explaining that there are separate programmes of support. The bodies that put support in place for affected individuals also provide some winter payments. If somebody is eligible for both, receiving something from one body does not preclude them receiving a DWP winter fuel payment if they meet the criteria, but they are two different schemes.

Drew Hendry: With the UK Government dragging their feet on the £25 million transitional compensation payments for those in receipt of infected blood products, will they now make a firm commitment to supporting patients through this winter, and then get on with the business of getting a just and lasting settlement?

Jane Ellison: I have had conversations with my opposite numbers in Scotland about this issue and, as the hon. Gentleman knows, Shona Robison wrote to me about it. We are looking at her proposals in the context of wider scheme reform. I have also ensured that my officials are talking to the other devolved Administrations as we move forward to a better solution to this tragedy.

Non-hospital Care

14. Dame Angela Watkinson (Hornchurch and Upminster) (Con): What progress has been made on integrating and improving care provided outside of hospitals. [902126]

The Minister for Community and Social Care (Alistair Burt): The Government are committed to transforming out-of-hospital care for everyone, in every community, by 2020. We have seen excellent progress in areas led by integration pioneers, such as South Devon and Torbay. My hon. Friend’s own area also has in place a number of initiatives, such as the community treatment team and intensive rehabilitation service, which is rated very highly in her local community.

Dame Angela Watkinson: My right hon. Friend will be aware that elderly people deteriorate rapidly and lose their independence skills when they are admitted to hospital. What discussions have been held with local authorities to ensure that there is an adequate supply of carers to enable older people to remain in their homes whenever possible?

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Alistair Burt: I meet regularly, as does the Department, with our partners in the provision of social care. A new recruitment and retention strategy has been launched by the Department of Health and Skills for Care on how to ensure more care is provided by more skilled and more valued workers in the home environment. My hon. Friend is right to raise this issue.

Mr Speaker: Equally briefly, the last question and answer. I call Barbara Keeley.

Barbara Keeley (Worsley and Eccles South) (Lab): The ResPublica report, “The Care Collapse”, states that our residential care sector is in crisis. It says:

“Providers are being faced with an unsustainable combination of declining real terms funding, rising demand for their services, and increasing financial liabilities.”

It also states that a £1 billion funding gap in older people’s residential care would result in the loss of 37,000 care beds, which is more than in the Southern Cross collapse. No private sector provider has the capacity to take in residents and cover the lost beds, so those older people will most likely end up in hospital. What is the Minister doing to protect the care sector from catastrophic collapse?

Alistair Burt: As the House is aware, social care is a matter of great importance as we head towards the spending review round. We are aware of pressures in the system, and there is always contingency planning to identify particular problems. We are working hard with the National Care Association to improve the quality of care provided by the sector, and my right hon. Friend the Secretary of State has commissioned Paul Johnson, of the Institute for Fiscal Studies, to look at pressures in the care home sector and how to ensure that we can meet the challenges. If challenges require more money, which they always seem to do according to the hon. Lady, she needs to come up with ideas for how to provide that money, but she never does. It is the Government’s responsibility to meet those challenges within the context of the overall economic position.

Topical Questions

T1. [902172] Kate Hollern (Blackburn) (Lab): If he will make a statement on his departmental responsibilities.

The Secretary of State for Health (Mr Jeremy Hunt): On Friday, I announced an ambitious plan to halve the rates of maternal deaths, neonatal harm and injury and still births by 2030 by learning from best practice in this and other countries. Following the tragic events in Paris, I know the House would also like my reassurance that we regularly review and stress test the NHS’s preparedness for responding rapidly to terrorist attacks. I have written to Madame Marisol Touraine, my French counterpart, to offer our solidarity and support. Vive la France!

Kate Hollern: Just after the election, the Health Secretary called childhood obesity a national scandal and made tackling health inequalities one of his key priorities. How will a flat-rate cut in the public health grant across all authorities, regardless of specific health challenges, as well as a further projected cut, under the reformulation, of £3 million in my constituency, help him to achieve his mission?

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Mr Hunt: I gently say to the hon. Lady that we have to find efficiencies in every part of the NHS, and we are asking the public health world to find the same efficiencies as hospitals, GP surgeries and other parts of the NHS, but that should not be at the expense of services. I completely agree with her about childhood obesity, on which we will announce some important plans shortly.

Mr Speaker: Forgive me colleagues, but what we need at Topical Questions is short inquiries, without preamble, if we are to make progress. Let us be led in this exercise by Fiona Bruce.

T3. [902174] Fiona Bruce (Congleton) (Con): This is alcohol awareness week. In Scotland, the number of drink-driving offences dropped by 17% in the first three months after the introduction of a lower drink-driving limit. In the light of this encouraging evidence, is the Minister’s Department looking at the public health implications of reviewing the drink-driving limit in England and Wales as part of its alcohol review?

The Parliamentary Under-Secretary of State for Health (Jane Ellison): Obviously, tackling drink-driving remains a priority for the Government. We will be interested to see a robust and comprehensive evaluation of the change to the Scottish drink-driving limit, and I can confirm that Public Health England’s review of the public health impacts of alcohol will include drink-driving. Obviously, some of the issues my hon. Friend raises are for the Department for Transport, but I can confirm that we will be looking at this issue, and I will be interested to see the evidence.

Heidi Alexander (Lewisham East) (Lab): On Sunday, independent experts, the King’s Fund, the Nuffield Trust and the Health Foundation, had this to say about the coming winter:

“Expect the inevitable: more people dying on lengthening waiting lists; more older people living unwell, unsupported and in misery; and a crisis in Accident and Emergency.”

Are they all wrong?

Mr Hunt: They are right about the pressures on the NHS, which is why we are investing £5.5 billion more into it than Labour promised. Those pressures will be made a lot worse by the forthcoming strike, so will the hon. Lady clear something up once and for all: does she condemn the strike—yes or no?

Heidi Alexander: Let us be clear: if junior doctors vote for industrial action, one person will be to blame, and that person is the Health Secretary.

The Health Secretary does not want to admit that NHS funding is not keeping pace with demand and that over the last five years, his Government’s deep cuts to social care have left the NHS bleeding. Will he guarantee that every penny of the money his Department had set aside for implementing the now-postponed cap on care costs will go directly into funding social care?

Mr Hunt: That is the difference: the hon. Lady follows the unions; I lead the NHS. When Labour had a big choice whether to support vulnerable patients who desperately need better weekend care, they chose political expediency—and the whole country noticed.

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T6. [902177] Seema Kennedy (South Ribble) (Con): St Catherine’s hospice provides outstanding end-of-life care, but receives only 26% funding compared with 34% nationally. Will the Minister confirm whether he has any plans to encourage clinical commissioning groups to pay their fair share for hospice care?

The Parliamentary Under-Secretary of State for Health (Ben Gummer): I thank my hon. Friend, who is right to raise the issue of end-of-life care, which is central to our plans to provide better care across the NHS. Indeed, it was a manifesto commitment of ours at the general election. NHS England is looking at a more transparent, fairer and clearer funding advice formulae for CCGs. I encourage her CCG to look very carefully at that and to copy the example of some CCGs such as Airedale, which have put this at the centre of the work they do looking after local patients.

T2. [902173] Ruth Cadbury (Brentford and Isleworth) (Lab): I strongly associate myself and my colleagues with the remarks of the Secretary of State about the atrocities in France this weekend. What assessment has the right hon. Gentleman made of the impact of housing problems on the difficult task of recruiting and retaining clinical staff, particularly nurses in London and London’s NHS?

Mr Hunt: I do think it is a serious problem. People find it hard to live near to the hospital at which they work, particularly where housing is very expensive. This is an issue that we are looking at closely.

T8. [902179] Julian Sturdy (York Outer) (Con): Can the Secretary of State assure me that the NHS funding review that is currently under way will deliver a fairer formula for my constituents and many others across York and North Yorkshire by putting age and rurality—some of the biggest drivers of health costs—at the heart of this long overdue review?

The Minister for Community and Social Care (Alistair Burt): Clinical commissioning group formulae are based on advice provided by the Advisory Committee on Resource Allocation. I can assure my hon. Friend that an adjustment per head is made for morbidity over and above age and gender, but as to whether or not one area is fairer than another, I am afraid that that is always a matter for local decision and discretion.

T4. [902175] Margaret Greenwood (Wirral West) (Lab): Can the Health Secretary explain how cutting £200 million from public health budgets is consistent with the emphasis on prevention and public health as set out in the five-year forward view?

Mr Hunt: I have already explained that, but I hope the hon. Lady will understand that we also need the Labour party to explain why it is committed to £5.5 billion less for the NHS over this Parliament than this Conservative Government, on the back of a strong economy that her party has never been able to deliver.

T9. [902180] Mrs Flick Drummond (Portsmouth South) (Con): Some of our GP surgeries are finding it difficult to attract new GPs. What plans do the Government have to train new GPs and encourage them to work in areas where it is difficult to recruit?

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Alistair Burt: We are very conscious of the pressure on general practice and of the pressure of ensuring that enough GPs are available. The Government’s plans are for 5,000 more doctors to be working in primary care by 2020, and that is supported by our recruitment, retention and returning campaign, as well as by efforts to ensure that medical schools do everything they can to ensure that general practice is made more attractive. This work will continue right through this Parliament.

T5. [902176] Imran Hussain (Bradford East) (Lab): According to Public Health England, life expectancy in the most deprived areas of Bradford is 9.6 years lower for men and eight years lower for women, demonstrating that there are clear health inequalities in urban areas in Bradford. The Government’s attack on the poor makes this issue worse, so will the Minister tell me what they are doing to tackle these inequalities and give people in Bradford the quality of life that they deserve?

The Parliamentary Under-Secretary of State for Health (Jane Ellison): The hon. Gentleman will be aware of my earlier answers to other questions. A wide range of aspects of the public health work that this Government are taking forward attack that very issue—the inequality of outcomes for some communities. I gave examples earlier, including the family nurse partnership and the troubled families programme, which has a health aspect to it. More widely, the universal health visiting programme, which has just moved into commissioning by local government, contains significant elements that were designed exactly to support poorer families and disadvantaged communities.

Heidi Allen (South Cambridgeshire) (Con): For the avoidance of doubt, will the Secretary of State please repeat again that he will enter into completely open-minded, non-preconditional negotiations with the British Medical Association? The public need to see that we are approaching this matter with an open mind.

Mr Hunt: I am happy to confirm that we are willing to talk about absolutely anything with the BMA to avoid a dispute that would be very damaging to patients. We do, of course, reserve the right to implement our manifesto commitment to seven-day reforms if we fail to make progress in the negotiations, but at this time, in the interests of patients, the right thing to do is sit round the table and talk rather than refusing to negotiate and going ahead with the strikes.

T7. [902178] Simon Danczuk (Rochdale) (Lab): Rochdale infirmary now has fantastic dementia provision which really meets the needs of local people. Will the Secretary of State observe the good practice there, and look into how it could be shared more widely?

Mr Hunt: I shall be happy to do that. We have made great progress in tackling dementia, and there are some very good examples all over the country, but we can still do a lot better. We now need to concentrate not just on dementia diagnosis, but on the quality of the care that we give people when they have been given such a diagnosis.

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Chloe Smith (Norwich North) (Con): What support will be available to hospitals over the winter? Norfolk and Norwich University hospital declared a black alert last week.

Ben Gummer: We are preparing for the winter on an unprecedented scale, having learnt from the experience of last winter. Specific support has already been provided for Norfolk and Norwich University hospital, and support will be provided consistently throughout the winter to enable us to deal with the additional challenges that are, I am afraid, being thrown in the way of hospitals throughout the country by the junior doctors and their industrial action.

Norman Lamb (North Norfolk) (LD): Is the Secretary of State doing everything he can to ensure that we

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secure extra dedicated investment in mental health in the spending review? He will know that introducing the access rights that everyone else already enjoys requires hard cash. I am sure he will agree that we must end the outrageous discrimination against those who suffer from mental ill health.

Mr Hunt: I congratulate the right hon. Gentleman on his timing, given that the Prime Minister is now present. I assure him that we are committed to putting extra resources into the NHS, and to ensuring that we increase the proportion of those resources that go into mental health. I also congratulate the right hon. Gentleman on the mental health award that he received last week, which was extremely well deserved.

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G20 and Paris Attacks

12.32 pm

The Prime Minister (Mr David Cameron): With permission, Mr Speaker, I will make a statement on the terrorist attacks in Paris and the G20 summit that took place in Turkey over the weekend.

On Paris, the Home Secretary gave the House the chilling statistics yesterday. We now know that among the victims was a 36-year-old Briton, Nick Alexander, who was killed at the Bataclan. I know that the thoughts and prayers of the whole House will be with the families and friends of all those affected.

On Saturday, I spoke to President Hollande to express the condolences of the British people and our commitment to helping in whatever way we can. After our horror and our anger must come our resolve and our determination to rid our world of this evil, so let me set out the steps that we are taking to deal with this terrorist threat.

The more we learn about what happened in Paris, the more it justifies the full-spectrum approach that we have discussed before in the House. When we are dealing with radicalised European Muslims, linked to ISIL in Syria and inspired by a poisonous narrative of extremism, we need an approach that covers the full range: military power, counter-terrorism expertise, and defeating the poisonous narrative that is the root cause of this evil. Let me take each in turn.

First, we should be clear that this murderous violence requires a strong security response. That means continuing our efforts to degrade and destroy ISIL in Syria and Iraq, and, where necessary, working with our allies to strike against those who pose a direct threat to the safety of British people around the world. Together, coalition forces have now damaged over 13,500 targets. We have helped local forces to regain 30% of ISIL territory in Iraq and we have helped to retake Kobane and push ISIL back towards Raqqa. On Friday, Kurdish forces retook Sinjar. The United Kingdom is playing its part, training local forces, striking targets in Iraq and providing vital intelligence support. Last Thursday the United States carried out an air strike in Raqqa, Syria, targeting Mohammed Emwazi, the ISIL executioner known as Jihadi John. That was a result of months of painstaking work in which America and Britain worked hand in glove to stop this vicious murderer.

It is important for the whole House to understand the reality of the situation that we are in. There is no Government in Syria with whom we can work, particularly in that part of Syria. There are no rigorous police investigations or independent courts upholding justice in Raqqa. We have no military on the ground to detain those preparing plots against our people. In this situation, we do not protect the British people by sitting back and wishing things were different. We have to act to keep our people safe, and that is what this Government will always do.

Secondly, on counter-terrorism here in the UK, over the past year alone our outstanding police and security services have already foiled no fewer than seven terrorist plots right here in Britain. The people in our security services work incredibly hard. They are a credit to our nation and we should pay tribute to them again in our House today. But now we must do more to help them in their vital work. So in next week’s strategic defence and

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security review, we will make a major additional investment in our world-class intelligence agencies. This will include over 1,900 additional security and intelligence staff and more money to increase our network of counter-terrorism experts in the middle east, north Africa, south Asia and sub-Saharan Africa.

At the G20 summit in Turkey this weekend, we agreed additional steps to better protect ourselves from the threat of foreign fighters by sharing intelligence and stopping them travelling. We also agreed for the first time to work together to strengthen global aviation security. We need robust and consistent standards of aviation security in every airport in the world and the UK will at least double its spending in this area.

Thirdly, to defeat this terrorist threat in the long run we must also understand and address its root cause. That means confronting the poisonous ideology of Islamist extremism itself. As I have argued before, that means going after both violent and non-violent extremists—those who sow the poison but stop short of actually promoting violence; they are part of the problem. We will improve integration, not least by inspecting and shutting down any educational institutions that are teaching intolerance, and we will actively encourage reforming and moderate Muslim voices to speak up and challenge the extremists, as so many do.

It cannot be said enough that the extremist ideology is not true Islam, but it does not work to deny any connection between the religion of Islam and the extremists, not least because the extremists themselves self-identify as Muslims. There is no point denying that; what we need to do instead is take apart their arguments and demonstrate how wrong they are, and in doing so we need the continued help of Muslim communities and Muslim scholars. They are playing a powerful role and I commend them on their absolutely essential work.

We cannot stand neutral in this battle of ideas. We have to back those who share our values with practical help, funding, campaigns, protection and political representation. This is a fundamental part of how we can defeat this terrorism both at home and abroad.

Turning to the G20 summit, there were also important discussions on Syria and on dealing with other long-term threats to our security, such as climate change. Let me briefly address those.

On Syria, we discussed how we do more to help all those in desperate humanitarian need and how to find a political solution to the conflict. Britain, as has often been said, is already providing £1.1 billion in vital life-saving assistance—that makes us the second largest bilateral donor in the world—and last week we committed a further £275 million to be spent in Turkey, a country hosting over 2 million refugees. In February, the United Kingdom will seek to raise further significant new funding by co-hosting a donors conference in London together with Germany, Norway, Kuwait and the United Nations.

But none of this is a substitute for the most urgent need of all: to find a political solution that brings peace to Syria and enables millions of refugees to return home. Yesterday I held talks with President Putin. We reviewed the progress made by our Foreign Ministers in Vienna to deliver a transition in Syria. We still have disagreements—there are still big gaps between us—but there is progress.

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I also met with President Obama and European leaders at the G20, and we agreed some important concrete steps forward, including basing some British aircraft alongside other NATO allies at the airbase at Incirlik if that is the decision of the North Atlantic Council, which meets shortly. These would be in an air defence role to support Turkey at this difficult time. We also agreed on the importance of stepping up our joint effort to deal with ISIL in Iraq and Syria—indeed, wherever it manifests itself.

This raises important questions for our country. We must ask ourselves whether we are really doing all we can be doing—all we should be doing—to deal with the threat that ISIL poses to us directly, not just through the measures we are taking at home, but by dealing with ISIL on the ground in the territory that it controls. We are taking part in air strikes over Iraq and have struck over 350 targets. Significant action has been taken in recent hours. ISIL is not just present in Iraq; it also operates across the border in Syria, although that border is meaningless to it—as far as ISIL is concerned, it is all one space. It is in Syria, in Raqqa, that ISIL has its headquarters, and it is from Raqqa that some of the main threats against this country are planned and orchestrated. Raqqa is, if you like, the head of the snake.

Over Syria we are supporting our allies—the US, France, Jordan and the Gulf countries—with intelligence, surveillance and refuelling. But I believe, as I have said many times before, that we should be doing more. We face a direct and growing threat to our country, and we need to deal with it not just in Iraq but in Syria too. I have always said that there is a strong case for our doing this: our allies are asking us to do it, and the case for doing it has only grown stronger after the Paris attacks. We cannot and should not expect others to carry the burdens, and the risks, of protecting our country.

I recognise that there are concerns in this House. What difference would action by the UK really make? Could it make the situation worse? How does the recent Russian action affect the situation? Above all, how would a decision by Britain to join in strikes against ISIL in Syria fit into a comprehensive strategy for dealing with ISIL and a diplomatic strategy to bring the war in Syria to an end? I understand those concerns, and I know that they must be answered. I believe that they can be answered. Many of them were expressed in the recent report by the Foreign Affairs Committee.

My firm conviction is that we need to act against ISIL in Syria. There is a compelling case for doing so. It is for the Government, I accept, to make that case to this House and to the country. I can therefore announce that as a first important step towards doing so, I will respond personally to the report of the Foreign Affairs Committee. I will set out our comprehensive strategy for dealing with ISIL and our vision for a more stable and peaceful middle east. This strategy should, in my view, include taking the action in Syria that I have spoken about. I hope that, in setting out the arguments in this way, I can help to build support right across the House for the action that I believe it is necessary to take. That is what I am going to be putting in place over the coming days, and I hope that colleagues from across the House will engage with that and make their views clear, so that we can have a strong vote in the House of Commons and do the right thing for our country.

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Finally, the G20 also addressed other longer-term threats to global security. In just two weeks’ time, we will gather in Paris to agree a global climate change deal. This time, unlike in Kyoto, it will include the USA and China. Here at this summit, I urged leaders to keep the ambition of limiting global warming by 2050 to less than 2° above pre-industrial levels. Every country needs to put forward its programme for reducing carbon emissions. And, as G20 countries, we also need to do more to provide the financing that is needed to help poorer countries around the world to switch to greener forms of energy and adapt to the effects of climate change.

We also agreed that we should do more to wipe out the corruption that chokes off development, and to deal with antimicrobial resistance. Corruption is the cancer at the heart of so many of the problems we face in the world today, from migrants fleeing corrupt African states to corrupt Governments undermining our efforts on global poverty by preventing people from getting the revenues and services that are rightfully theirs. And if antibiotics stop working properly—the antimicrobial resistance issue—millions of people in the world will die unnecessarily. So these are both vital issues on which the United Kingdom is taking a real lead.

Let me conclude by returning to the terrorist threat. Here in the UK, the threat level is already severe, which means that an attack is highly likely, and it will remain so. That is why we continue to encourage the public to remain vigilant. We will do all we can to support our police and intelligence agencies as they work around the clock. The terrorist aim is clear: it is to divide us and to destroy our way of life. So now more than ever we must come together and stand united, carrying on with the way of life that we know and love. Tonight, England will play France at Wembley. The match is going ahead. Our people stand together as they have done so many times throughout history when faced with evil. And once again, together, we will prevail. I commend this statement to the House.

12.44 pm

Jeremy Corbyn (Islington North) (Lab): First, I thank the Prime Minister for his statement, a copy of which he kindly sent me earlier. May I also thank him for the measured and careful tone of his public statements since the dreadful events of last Friday in Paris? In the face of such tragic events, and the horror, anxiety and sorrow that have caused the British public to stand up in solidarity with the people of France, it is right that we take an approach of solidarity with them.

The Prime Minister and the Home Secretary have talked of the importance of achieving consensus in our response to the attacks and a common objective in trying to defeat ISIL. I agree with him, and the Opposition stand ready to work with him and the Government towards that end. May I also thank him for arranging for the National Security Adviser to brief my Opposition Front-Bench colleagues last weekend? Will he assure me that the Opposition and other parties will continue to be briefed about developments as they emerge?

On behalf of Labour Members, I want to express my condolences to and solidarity with the people of Paris in the wake of the horrific and unjustified attacks on the people who suffered in that city last Friday night.

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That solidarity extends to all victims of terrorism and conflict, whether they be in Paris, Beirut, Ankara or Syria itself. Absolutely nothing can justify the deliberate targeting of civilians by anyone, anywhere, ever. These contemptible attacks were an attempt to divide Muslims, Christians, Jews, Hindus and peoples of all faiths and none, as was tried in London some years ago. They will fail.

Secondly, I wish to take a moment to praise the efforts and work of emergency service workers, in Paris and elsewhere, who spring into action in these dreadful and very difficult situations, and help to save life. It is easy to forget the extraordinary heroism of those involved in simply going to work, not knowing what will happen. It is not easy to drive an ambulance not knowing what you are going to find when you arrive at the scene.

In my letter to François Hollande this weekend, I said that we stand united with his country in expressing our unequivocal condemnation of those involved in planning and carrying out these atrocities. The shocking events in Paris were a reminder to all of the ever-present threat of terrorism and indiscriminate violence. In this House, we also have a primary and particular duty to protect the people of this country and keep them safe. Yesterday, my right hon. Friend the Member for Leigh (Andy Burnham) pledged our support for the Government in their efforts to do that, and that we reiterate again. We welcome the sensible measures to make more funding available for our security services, so that they can gather intelligence and expose and prevent plots, but can the Prime Minister confirm that those will be balanced with the need to protect our civil liberties, which were so hard won in this country and are so stoutly defended by many of us? They are part of what distinguishes us from many other regimes around the world—indeed, regimes from which people are fleeing.

My right hon. Friend said yesterday that in the forthcoming spending review there should be protection of the policing budget and policing services, which clearly will be playing a vital role on the ground in ensuring that our communities are safe. Will the Prime Minister now confirm that he is willing to work with us to prevent cuts to our police force and ensure that they are able to continue with the protective work they have to do? Does he agree with the former Metropolitan Police Commissioner, Lord Blair, that it would be “a disaster” to axe police community support officers, as they bring in vital intelligence from communities to help prevent attacks? As a Member of Parliament for an inner-city community, I fully understand and appreciate the great work that safer neighbourhood teams and community policing teams do.

As for community cohesion, we in Britain are proud to live in a diverse and multi-faith society, and we stand for the unity of all communities. There are more than 2 million Muslims living in Britain, and they are as utterly appalled by the violence in Paris as anybody else. We have seen after previous atrocities such as this that there can be a backlash against the Muslim and other communities. Anti-Semitism, Islamophobia and far-right racism have no place whatsoever in our society or our thinking, and I hope there will be no increase in any of that degree of intolerance as a result of what has happened in Paris.

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Will the Prime Minister set out in more detail the steps his Government are taking to work with representative organisations of all our faith communities to ensure that we achieve and strengthen community cohesion during these very difficult times? We must also ensure that those entering our country, whether they be refugees or visitors, are appropriately screened. Will he confirm that the Home Office will provide the border staff necessary to do that?

It is also important in these circumstances to maintain our humanitarian duty towards refugees. The Syrian refugees are fleeing the daily brutality of ISIL and Assad and it is our duty—indeed it is our legal obligation—to protect them under the 1951 Geneva convention. I hope the Prime Minister will confirm that our obligation to maintain support for that convention and the rights of refugees will be undiminished by the events of the past few days.

At a time of such tragedy and outrage, it is vital that we are not drawn into responses that feed a cycle of violence and hatred. President Obama has said that ISIS grew out of our invasion of Iraq, and that it is one of its unintended consequences. Will the Prime Minister consider that as one of the very careful responses that President Obama has made recently on this matter? It is essential that any military response that might be considered has not only consent, but support of the international community and, crucially, legality from the United Nations. I welcome the Prime Minister’s comments at the G20 yesterday when he said:

“I think people want to know there is a whole plan for the future of Syria, for the future of the region. It is perfectly right to say a few extra bombs and missiles won’t transform the situation.”

I welcome the Prime Minister’s commitment to respond personally to the Foreign Affairs Committee report, which has been so carefully presented to the House and the country. Will he confirm that, before bringing any motion to the House, he will provide answers, as he has indicated that he will, to the seven questions raised by the Select Committee report? Will he also say more about the particular contribution that Britain has made to the Vienna talks on the future of Syria? The talks possibly provide a basis for some cautious optimism that there could indeed be a political future in Syria that involves a ceasefire and the ability of people eventually to be able to return home.

Finally on this matter, will the Prime Minister also say what more can be done to cut off supplies of weapons and external markets to ISIL? Weapons are being supplied to some of the most repressive regimes in the region. What is being done to ensure that they do not end up in even worse hands, including those of ISIL and some of the extremist jihadist groups in Syria? What more can be done to bring to account those Governments, organisations or banks that have funded these extremists, or turned a blind eye to them? We need to know the financial trail by which ISIL gets its funding and indeed sells its oil.

Turning quickly now to other G20 issues, did the Prime Minister have a chance to congratulate the new Canadian Prime Minister? He did not mention it, but I am sure that he has. Is he also aware that the current slowdown in the global economy is causing concern? What discussions has he had with his Chancellor about the dangers of more demand being sucked out of the economy at this time?

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In conclusion, the Prime Minister mentioned the climate change talks that will be going on in Paris over the next few weeks. They are very, very important indeed. I welcome the commitment he made in relation to the problems created by epidemics and antibiotic resistance. I ask him also to consider this: the cuts that have been made to renewable energy in this country run directly counter to everything he and his Government have said they want to achieve at the climate change talks. We must combat climate change globally, internationally, and here in Britain.

The Prime Minister: I thank the right hon. Gentleman for his remarks and for the tone that he is taking in trying to aim for greater consensus. Let me try to answer each question in turn.

Briefing on national security issues is available to all Privy Counsellors. If it is not offered, then Members should ask. The National Security Secretariat is there to help, and its role is particularly important during these times of heightened alert.

The right hon. Gentleman was right to praise the emergency services in France, as they did an amazing job. It is important to reiterate—and the Home Secretary did this yesterday—that ever since the Mumbai attacks and following the intelligence we had about the potential for marauding firearms attacks some years ago, a lot of work has been done in Britain to try to ensure that we would be ready for any such attack. I thank him for his support of the security services. He was right to mention the vital importance of our civil liberties. Indeed, they are part of what we are fighting to defend.

On policing, we protected counter-terrorism policing budgets throughout the last Parliament, and we will continue to do so throughout this Parliament, which is vital. Members will see the uplift that we are giving to our intelligence and security services. We will do what is necessary to ensure that we keep our country safe.

The right hon. Gentleman is right to condemn anti-Semitism, Islamophobia and right-wing extremism. All those issues are addressed in our counter-extremism paper. We shall be working with local communities, as he suggests, to ensure that they often lead in these debates. Some of the things that have been said by Muslim clerics and Muslim leaders have made a huge difference in recent weeks.

The right hon. Gentleman asked about borders. We do have the opportunity to carry out screening and checks at our borders, because we did not join, and we are not going to join, the Schengen no-border system. Once again, we can see the importance of having those border controls and using them to the best of our ability.

On the Syrian migrant programme, it is worth reminding the House that we are taking 20,000 Syrian refugees from the camps rather than from among those who have already arrived in Europe. That enables us to screen very carefully the people whom we take. There are two levels of screening, the first of which is carried out by the United Nations High Commissioner for Refugees, and the second by the Home Office, to ensure that we are getting people who are genuinely fleeing persecution and who would not pose a risk to our country.

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The right hon. Gentleman asked about the genesis of ISIL. The so-called Islamic State is one of the branches of this violent Islamist extremism that we have seen in our world for more than 20 years—I am talking about Boko Haram, al-Qaeda and al-Shabaab. It is worth making the point that the first manifestations of this violent Islamist extremism, not least the twin towers attack, happened before the invasion of Iraq. It is important that we do not try to seek excuses for what is a death cult, which has been killing British citizens for many, many years. He rightly asks about the process in Vienna. We are a key part of that, with our Foreign Secretary playing a very strong role. Indeed his work was commended by Secretary of State John Kerry yesterday.

The right hon. Gentleman mentioned what I said yesterday about additional bombs and missiles only being able to go so far in Syria. Yes, that is right, Britain can do more, and because of our expertise and targeting, we could cut the number of civilian casualties when that action is taken. It would make a difference, but, alongside that, we also need a process that delivers a Government in Syria who can represent all of the Syrian people. We cannot defeat ISIL purely by a campaign from the air; we need to have Governments in Iraq and in Syria who can be our partners in delivering good government to those countries and in obliterating the death cult that threatens both us and them. Those things go together.

The right hon. Gentleman asked about cutting the supply of weapons and money. We are a key part of the international committee that is working on that. A large amount of ISIL’s money comes from the oil that it sells, not least to the Syrian regime. That is another thing that we would be able to address more directly if we were taking part in the action in Syria.

Finally, the right hon. Gentleman asked me whether I had met Justin Trudeau, the new Canadian Prime Minister. I did and I congratulated him on his victory. He is coming to London very shortly to see the Queen. I hope to have a meeting with him, as the Canadians will be very good partners on lots of issues where we work together.

On the economic slowdown, the right hon. Gentleman is right that the forecasts for global growth are lower than they were. Britain and America stand out in the advanced world for having more rapid economic growth, and we encourage others to take some of the steps that we have taken to deliver that growth.

Finally, the right hon. Gentleman asked about renewables and climate change. I have to say that the summit on climate change was disappointing. There is still quite a lot of opposition from some countries on putting in place the things that are needed for a good deal in Paris. Britain has played an important role in getting a good European deal. As for renewable energy, if Members look at what has happened over the past five years, they will see that there has been nothing short of a renewable energy revolution in Britain.

Dr Liam Fox (North Somerset) (Con): The continued reach and activity of ISIS represents a monumental international security challenge. The aim was to degrade and contain ISIS, but it is not contained, so I thank my right hon. Friend for what he said yesterday about the need to cut off the financial supplies to ISIS and to deal with the narrative over values, and for what he has said

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today about the need to join our allies in taking action over Syria, as well as Iraq. He is absolutely correct when he says that no military campaign of this nature has ever been won from the air alone, so we may yet require an international coalition on the ground of the sort that we required to remove Saddam from Kuwait. May I ask my right hon. Friend simply to rule nothing out and give no comfort to ISIS, because these people hate us not because of what we do but because of who we are?

The Prime Minister: I thank my right hon. Friend for his support. Obviously, we should be in the business of working out what we can do and what would make a difference, rather than what we cannot do; but it is my contention that, in the end, the best partner we can have for defeating ISIL in Iraq is the Iraqi Government, and that the best partner we can have in Syria is a reformed Government in Syria, without Assad at their head, who could credibly represent all the Syrian people and be a partner for getting rid of this death cult, which threatens the Syrian people, as well as the rest of us.

Angus Robertson (Moray) (SNP): I thank the Prime Minister for advance sight of his statement. We would very much welcome a commitment by the Government to brief all parties in the House on major developments.

May I associate the Scottish National party with the expressions of shock and sadness for the people of France and all the families and friends of those who were killed and injured in the Paris attacks.

Will the Prime Minister confirm that all assistance, including intelligence information, is being shared with our allies in France? In the UK, we are hugely indebted to all those in our police and security services who work to keep us safe. We welcome the commitment by the Prime Minister to provide necessary funding and personnel to allow them to do this vital work.

Given the scale of the disaster in Syria, we welcome the progress made at the talks in Vienna and at the G20 in Turkey. For the first time, momentum appears to be building to secure a ceasefire, to work through the United Nations and to combat the terrorism of Daesh. Can the Prime Minister update the House on the next diplomatic steps towards a potential ceasefire and political transition in Syria?

In recent weeks and months, there have been large-scale bombing operations in Syria. There has been bombing by the United States of America, by Russia, by France and by many other countries. There have been bombs dropped by drones, bombs dropped from fast jets and missiles fired from naval vessels. President Obama has reiterated his opposition to providing boots on the ground. Given these facts, does the Prime Minister agree that the long-term solution for Syria is an end to the civil war and to provide support for forces such as the Kurds who are fighting Daesh on the ground?

Today, we have seen the arrival of refugees from Syria in Glasgow. These are people who have been fleeing terrorism at home. Does the Prime Minister agree that the welcome we give to those refugees is the true mark of humanity, decency and compassion—in short, the complete opposite of what was visited on Paris by terrorists last Friday?

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The Prime Minister: I thank the right hon. Gentleman for his remarks and questions. First, on briefings, he is now a Privy Counsellor and a member of the Intelligence and Security Committee. If he feels that he is not getting enough briefings, he should please ask my team, and I will make sure that he gets them. He asks about intelligence sharing. We have very strong intelligence sharing with the French Government and, indeed, with others in Europe. There is more we can do. I spoke to the Belgian Prime Minister yesterday to talk about increasing the extent of our intelligence sharing, which is a vital agenda for us to move on.

On Vienna, as the right hon. Gentleman says, there is momentum behind the talks. The Foreign Ministers will meet again in the coming weeks, but right now the role is falling to Staffan de Mistura, the UN special envoy, to bring the different parties together. It is a very complex piece of work. It is absolutely vital that some of the Syrian opposition groups are involved in this dialogue. We want a future Syria where Sunni, Shi’a, Kurd and Christian are all represented, so the Russians should stop bombing the Free Syrian Army and recognise that it should be part of Syria’s future.

The right hon. Gentleman makes a point about how much can be done from the air. Of course what we need is an end to the civil war, but he goes on to say that we need to support the Kurds. Yes, we do, and some of that support can be delivered from the air. They need our help to bring this conflict to an end.

On the right hon. Gentleman’s remarks about Syrian refugees, let me commend what Glasgow is doing in taking Syrian refugees. I am confident that we will have 1,000 here by Christmas, and I know that they will be well looked after.

Crispin Blunt (Reigate) (Con): I thank the Prime Minister for his commitment to a personal reply to the Foreign Affairs Committee report and for his acknowledgement that the defeat of ISIL requires a transition from the Syrian civil war. The progress made at Vienna is therefore beginning to clear the path towards an international plan that would enable the full conventional military defeat of so-called Islamic State in both Syria and Iraq. Will he continue to put our full diplomatic effort into making that plan sufficiently clear politically, militarily and legally, so that he can come to the House to seek an endorsement of a role for our armed forces that will lead to the defeat of ISIL in both Syria and Iraq sooner rather than later?

The Prime Minister: I thank my hon. Friend for his support and for what he is saying. I very much welcome what he has said today. Yes, I can confirm our full diplomatic effort is towards bringing everyone together. Sitting around the table in Vienna are Saudi Arabia, Iran, Britain, France, America, Turkey and Russia. All the key players are there. On the legal basis for any action that we might take, I believe that we can answer that question comprehensively, as we have on other issues, and I am very happy to put that in front of the House, as part of my response to the Foreign Affairs Committee.

Yvette Cooper (Normanton, Pontefract and Castleford) (Lab): The Prime Minister will know that ISIL wants to exploit the refugee crisis and to poison Europe’s attitude

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towards those who are fleeing the very same barbarism that we saw, so tragically, on the streets of Paris. He has told me before that Britain is supporting proper registration in Greece. I am concerned that that is not happening. Will he look again urgently at what more Britain and Europe can do to support proper registration and border checks, not just in Greece but at internal borders throughout Europe, so that we can ensure that we provide the security and humanitarian aid that is desperately needed, and Britain and Europe can support both our security and our solidarity with desperate refugees?

The Prime Minister: I thank the right hon. Lady for what she says. She is right that, as the external border of Europe, Greece plays an absolutely vital role and that it is vital that the registration of migrants as they arrive takes place properly. My understanding is that we have given more, I think, than any other country in Europe to the European Asylum Support Office, EASO, so we are certainly putting in the resources, even though, effectively for us, Greece is not our external border; our external border is the border controls at Calais, because we are not part of Schengen. So we are doing what we can; we will continue to see whether more can be done, but she is right that making sure that people can be properly documented as they arrive will be a vital part of our security.

Sir William Cash (Stone) (Con): The planned carnage in Paris shows the danger of allowing declared jihadists to return to their country of origin. Will my right hon. Friend be good enough to review the counter-terrorism legislation to prevent declared UK jihadists from returning to the United Kingdom, whatever human rights or the charter of fundamental rights may say? We must put the lives of the people of this country before human rights.

The Prime Minister: I thank my hon. Friend for his point, and I have a huge amount of sympathy with it, and that is why in the counter-terrorism legislation that we passed we took further steps to confiscate people’s passports. If someone is a dual national, we can strip them of their UK citizenship if we think that they no longer merit citizenship of this country. We now have the power—it was controversial but the Home Secretary and I pushed it forward—to exclude temporarily even British nationals from returning to the UK. I am all for looking at options for going further to make sure that we keep ourselves safe, but it was very contentious at the time. This situation is demonstrating that we were right to stick to our guns.

Tim Farron (Westmorland and Lonsdale) (LD): I thank the Prime Minister for advance sight of his statement. I join him and colleagues on both sides of the House here today in expressing solidarity, compassion and sympathy to the people of Paris and Beirut, especially the injured and families of those who have lost their lives, and in condemning the terrorists who seek to attack us. They detest our diversity, our freedom and our generosity of spirit, and we let them win if we compromise on any of those things. It is critical that any UK military involvement in Syria should focus on civilian protection and political transition, alongside crushing ISIL; otherwise we will repeat the mistakes of the illegal and counterproductive Iraq war. So does the

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Prime Minister agree that long-term stability in Syria must be part of the strategy against ISIL, and will he confirm that any plan brought to Parliament by the Government to use our armed forces there will specifically address that?

The Prime Minister: The hon. Gentleman is right to mention the bombing in Beirut. Some people posit this as a clash of civilisations—the Islamic world against the rest. The Beirut bomb, as with so many other bombs before it, proved that these people—in this case, ISIL—are killing Muslims in their hundreds and thousands. It is very important to demonstrate to Muslim communities in our own countries that we take this violence as seriously as violence committed in Paris or elsewhere.

The hon. Gentleman asks whether what we would do in Syria would be about civilian protection. My argument is, yes, it would be about civilian protection in the obvious way—that if we can take out the murderers of ISIL, we are helping to protect the Syrian people whom they are threatening—but, because Britain has precision munitions such as the Brimstone missile, which are in many ways more effective even than some of the things the Americans have, our intervention and our assistance would mean better targeting of the people who should be targeted and fewer civilian casualties.

Mr Andrew Mitchell (Sutton Coldfield) (Con): In his very welcome statement today, my right hon. Friend is clearly right to focus on the political track in the Syrian negotiations, building in part on the Kofi Annan proposals from some time ago, and on the significant progress that appears to have been made in Vienna last week. If those negotiations are successful, that will of itself remove a huge barrier to the widespread military coalition that all of us want to see, in which Britain, as my right hon. Friend said today, would have the ability, as well as a number of unique assets, to play a very significant part. If the negotiations in Vienna are successful, I have no doubt that the Prime Minister, coming back to this House, will get a huge majority of Members from both sides supporting Britain’s full participation in it.

The Prime Minister: My right hon. Friend, who follows these things closely, makes some very good points. Of course, as I have said, to defeat ISIL in Syria two things are required. First, we need to make sure that the international community—Arab states and others—are taking the military action to degrade and defeat ISIL. Secondly, we need a political settlement that gives us an effective ally in Syria to defeat ISIL in a way that can unite the country. Those two things go together, but if my right hon. Friend is arguing that military action should follow only after some political agreement has been nailed down, we might wait a very long time for that to happen. I caution against that approach.

I want to be clear about what I am proposing here. I am saying that the Government will bring together all our arguments about how we succeed in Iraq, how we succeed in Syria, what a political process should achieve, how we degrade and defeat ISIL, the role that Britain should play, and my argument that we should be going further in Syria as well as in Iraq. We will put all those arguments together in response to the Foreign Affairs Committee. Then it will be for Members of this House to see whether they want to assent to that idea. If that

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happens, we shall have the vote and take the action so that we play a part with others in defence of our own national security.

Several hon. Members rose—

Mr Speaker: Order. May I gently say to the House that I am conscious that there are many colleagues here who cannot be accused of underestimating their own expertise in these important matters, but nearly 60 Members still wish to contribute? If I am to have any chance of accommodating them all, they will all need to follow the rubric of brevity, now to be demonstrated to perfection by Gisela Stuart.

Ms Gisela Stuart (Birmingham, Edgbaston) (Lab): Thank you, Mr Speaker. I welcome the Prime Minister’s commitment to a wider narrative explaining how he thinks Daesh can be defeated, and his insistence that that has to be done with our allies. Press reports this morning suggest that France has invoked the mutual defence clause in the Lisbon treaty for the first time. Will the Prime Minister explain what practical implications that may have for the United Kingdom and our co-operation?

The Prime Minister: I am grateful for the fact that the hon. Lady raises this. It is not a clause that has been invoked before, as I understand it, so we are looking very carefully at exactly what it would involve. Standing back from the legalities, it is very clear: the French are our friends, our allies, our brothers and sisters and we should be with them. If there are things we can do to help them, I say we should.

Dame Angela Watkinson (Hornchurch and Upminster) (Con): In the extreme circumstances of a Paris-type attack in London, does my right hon. Friend think that depriving the police of the right to shoot to kill would make the public safer?

The Prime Minister: No, I absolutely do not. I hope the Leader of the Opposition will review his remarks. What happened in Paris was an attack. It was not a siege, hostages were not taken and demands were not set out. It was an attempt to kill as many people as possible, and when the police are confronted with that, they must be clear that if they have to take out a terrorist to save lives, they should go right ahead and do so.

Mr David Winnick (Walsall North) (Lab): Is the Prime Minister aware that those of us who are not persuaded, at least at this stage, that air strikes should be extended to Syria have no less hatred for the mass murderers who have carried out so many atrocities, the latest in Paris? We are not persuaded, not because we are pacifists or semi-pacifists—I am certainly not so and never likely to be—nor because of the internal politics of the Labour party, but because, as the Foreign Affairs Committee concluded, there does not seem to be a strong case for extending air strikes, and it will achieve little or nothing and simply make us feel good that we are doing something as a result of the atrocities.

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The Prime Minister: I do not agree with that view. I respect the fact that it is for the Government to bring forward the argument, to make the case and to seek to persuade as many Members of this House as possible that it is the right thing to do. People who oppose that have to answer the question why it is right to take out ISIL in Iraq, but wrong to take out ISIL in Syria, particularly as the headquarters of ISIL are in Syria and it is from Syria that the attacks on this country have been planned and, for all we know, continue to be planned. That is the question that colleagues will have to answer after reading my response to the Foreign Affairs Committee. If we can get to the situation where it looks like Britain can come together as one and say, “It is right for us to take this action”, I am not asking for an overwhelming majority; just a majority would be good enough.

Mr Keith Simpson (Broadland) (Con): The Prime Minister is only too well aware of the danger posed to our society by those returning from serving with ISIL in Syria. What measures are the Government taking to persuade those who can to speak out against what has happened? They are more likely to influence young Muslims than any of us.

The Prime Minister: My right hon. Friend is right. Huge numbers in Britain’s Muslim communities have made it clear that what is being done by ISIL is not in their name and that those are not representatives of Islam, but a perversion of Islam. That is incredibly powerful, and I encourage all those people who have already made such an effort to go on doing that, please. My right hon. Friend is right. Those people who have been to Syria, perhaps as part of an aid convoy, who have seen what has happened and have come back, rightly disillusioned by the butchery of those people—their hatred of people with different ways of life and the appalling way they treat women as sex slaves and throw gay people off the top of buildings—can be some of the most powerful voices saying, “Those are not people we can deal with. Those are people we have to finish.”

Mr Nigel Dodds (Belfast North) (DUP): May I, on behalf of my right hon. and hon. Friends, who have experienced over many, many years the ravages of terrorism personally and at close quarters, express our full support for the Prime Minister and his words and actions in recent days in relation to the terrible events in Paris and elsewhere, and express our profound sympathies with the people affected? In relation to counter-terrorism, does the Prime Minister agree that the security services need the resources—I very much welcome what has been said in recent days—and they need the powers? We look forward to working with the Government to introduce more powers with proper ministerial oversight, but the security services also need public support and the support of politicians. When they need to shoot to kill, they need our support. I welcome what the Prime Minister has said about the shameful trait expressed, sadly, by some even in this House, of seeking to blame the terrorists’ victims for contributing to their own murders, by saying that the foreign policy of this country is wrong. That is a shameful approach. Terrorism has no excuses. It never had any excuses and the people who express such sentiments should be ashamed of themselves.

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The Prime Minister: As has often been the case in recent days and recent weeks, the right hon. Gentleman speaks with great power and great force, and I agree with what he says.

Nusrat Ghani (Wealden) (Con): As well as action from our armed forces, security forces and police, we need to tackle the ideology that lies behind the threat that we face. Does the Prime Minister agree that as part of that we need to support those who challenge the extremists, expose Daesh as a death cult, support the communities who feel vulnerable to the spread of Wahhabism within the UK, and help to stop more people sliding into extremism?

The Prime Minister: My hon. Friend is absolutely right. For too long in some European countries, Governments have felt that the way to handle community relations is to leave people in different silos and listen to self-appointed community leaders rather than engage directly with people. When it comes to this battle against extremism, we should not be neutral. We should be very clear about the groups we will engage with because they back the values we share, and those that we do not agree with and frankly think might be part of the problem. Greater clarity on this is probably not just necessary in Britain; I expect it is going to be necessary in other parts of Europe too.

Keith Vaz (Leicester East) (Lab): Last Friday evening at Wembley stadium, when the Prime Minister shared a platform with Prime Minister Modi, he made a speech about being proud to be the leader of the most multi-cultural country in the world. Does he agree that in order to protect and preserve that, we need to be very aggressive in our counter-narrative, and that that means the internet companies doing much more than they are currently to take away the most important method of recruitment, while internationally it means working with Europol and Interpol and giving them the support they need, as this is an international issue?

The Prime Minister: I thank the right hon. Gentleman for the support that he gave to the Indian Prime Minister’s visit to our country last week. What I said standing alongside Prime Minister Modi is that while of course we still have to fight discrimination and racism in our country, I think we can lay some claim to being one of the most successful, multi-racial, multi-faith, multi-ethnic democracies in our world. India aspires to do that as well, and it should link us. The right hon. Gentleman is right about working with internet companies. Just as we have worked with them to try to take paedophilia and child pornography off the internet, so there is more we can do to get this extremism off the internet as well.

Mr John Baron (Basildon and Billericay) (Con): The Prime Minister is right to focus on the importance of a multi-faceted approach, but may I suggest to him that when it comes to military intervention in Syria, we must learn from previous errors and try to ensure that we put together a proper strategy involving regional powers and allies, including Iran and Russia, which might have to recognise that ISIL is a greater danger than President Assad, because we need to accept that air strikes alone will not defeat this evil regime?

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The Prime Minister: My hon. Friend is right that bringing together an international coalition for political change in Syria is the right thing to do, and that is exactly what we are doing. Iran, Saudi Arabia, Russia, America, Britain, France, Turkey and others are all in the room together negotiating this, and that is the way it should be. But we also have to have regard to our own national security, and every day that ISIL is active in Iraq and Syria is a day that we are in some danger in our own country.

Chris Leslie (Nottingham East) (Lab/Co-op): The Prime Minister is right that the police and the security services need our full support at this time. Should it not be immediately obvious to everyone—to everyone—that the police need the full and necessary powers, including the proportionate use of lethal force if needs be, to keep our communities safe?

The Prime Minister: The hon. Gentleman is absolutely right. I think we can have huge regard for our police in this country. The old saying that the public are the police and the police are the public rings true, because they come from our communities—they are not seen as some occupying force. It is absolutely right that when they are confronting murderers and people with weapons they have to be able, on occasion, to take lethal action. I hope that the Leader of the Opposition will think very carefully about what he has said, because it is very important that we all support the police in the work they do rather than undermine it.

Seema Kennedy (South Ribble) (Con): Will my right hon. Friend set out what plans the Government are taking forward to make airport security safer given the belief that the Russian airliner was brought down by a bomb?

The Prime Minister: This morning we have seen some reports that the Russian security services are now making it clear that they believe that it was a bomb that brought down that aircraft, tragically, after it left Sharm el-Sheikh. I discussed this issue with President Putin yesterday. We need to work with others to look at the most vulnerable locations around the world and work out how we can make them safer. There is no 100% security you can deliver, even in the most advanced airport, but there are some basic things about scanners, about the way luggage is handled, about the way passengers interact with their luggage, and about what happens at the gate—best practice that can be introduced right across the world. That is what we are going to work on.

Alex Salmond (Gordon) (SNP): If a broad international coalition is not just possible but necessary on Syria, what is the obstacle to a Security Council resolution? On the subject of financial flows, will the Prime Minister answer this question directly: what are the obstacles to disrupting and degrading the financial flows and the financial institutions without which Daesh could not function?

The Prime Minister: The obstacle so far to a Security Council resolution has been the fact that one of the permanent members, Russia, has threatened to veto meaningful Security Council resolutions that would perhaps provide the overarching permission for the

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action that we believe is necessary in Syria. I will answer the question very directly in my response to the Foreign Affairs Committee in saying that the action I believe we should take is legal under international law. I know that should be spelled out clearly, and of course I will spell it out clearly.

In terms of disrupting Daesh’s financial flows, we are part of the committee that is looking at all the action that can be taken, including against financial institutions. As I said, one of the most important things we can do is to stop its funding through the oil trade, some of which it is selling directly to Assad.

Dr Andrew Murrison (South West Wiltshire) (Con): Earlier this year the Kingdom of Morocco signed an agreement with France to train imams and preachers, including women, in the moderate mainstream tradition to which my right hon. Friend referred. Will he congratulate Morocco on the exceptional leadership it has displayed in tackling extremism and commend its further efforts, whereby perhaps the UK can learn some of the lessons that France is currently undergoing?

The Prime Minister: My hon. Friend is absolutely right. We can learn the lesson from Morocco. There is also work that the German Government have been doing with Turkish imams and work that we have been doing with training imams coming into this country. One of the remarkable things about the G20 was the conversation about fighting radicalisation and extremism. The proposals made by, for instance, the Indonesian President and the Malaysian Prime Minister—both countries pride themselves on being part of the moderate Muslim world—were particularly powerful to listen to.

Caroline Lucas (Brighton, Pavilion) (Green): While we differ on the details of how to ensure that citizens are kept safe, I certainly agree that it is the overwhelming priority of the Government to make sure that they are. In that vein, will the Prime Minister assure us that as well as giving extra money to the security services, he will make a significant investment in our diplomatic services, which are world class and are needed more than ever right now? They should not be hollowed out by cuts.

The Prime Minister: Our diplomatic posts play an absolutely vital role in Britain’s soft power. We were ranked the other day as No. 1 in the world for soft power. We have been opening embassies around the world rather than closing them. This is a good opportunity to thank all our hard-working staff from this Dispatch Box.

Richard Drax (South Dorset) (Con): To counter the appalling slaughter that was faced by all those in Paris, we will need armed police on the spot within minutes. Will my right hon. Friend reassure the House that we have sufficient armed police in all our cities to do just that?

The Prime Minister: My hon. Friend is absolutely right to raise this. Following the Mumbai attacks and the intelligence we had after that about potential attacks in this country, a lot of work was done to make sure

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that our armed response vehicles have a sufficient number of people to meet the challenge in any of our major urban areas. We keep this under review. We are studying what happened in Paris. We are looking at the numbers that we need. I do not think the idea of routinely arming all the police in our country is the right approach, but certainly increasing the number of armed police that are available is something that we are looking at very carefully and something that, if necessary, we will do. While we do not talk about the role of our special forces, they are also available to help in these circumstances. We will do everything we can to make sure that they can be brought to bear at the right moment and can help with our overall effort in dealing with what are extremely challenging problems thrown up by what happened in Paris.

Emma Reynolds (Wolverhampton North East) (Lab): Does the Prime Minister agree that full responsibility for the attacks in Paris lies solely with the terrorists and that any attempt by any organisation to somehow blame the west or France’s military intervention in Syria is not only wrong and disgraceful, but should be condemned?

Hon. Members: Hear, hear.

The Prime Minister: The response right across the House shows how right the hon. Lady is. Those who think that this is somehow all caused by Iraq should remember that France did not take part in the Iraq war. Indeed, it condemned it. The fact about these ISIL terrorists is that they hate our way of life. They want to kill and maim as many people as possible. They also do that to Muslims with whom they disagree. That is why we have to confront and defeat them, not compromise with or excuse in any way this vile organisation.

James Morris (Halesowen and Rowley Regis) (Con): I welcome the Prime Minister’s statement, particularly his commitment to come to the House with an argument for extending British military action to Syria. However, does he agree that the current threat from ISIL to our national security is such that he may have to take action as Prime Minister without coming back to this House, in order to protect our national security?

The Prime Minister: I am grateful to my hon. Friend for raising this question. I have always said very clearly at this Dispatch Box that, in the case of premeditated action—for instance, against ISIL in Syria—it is right that we have a debate and a vote, and I am happy to repeat that. However, when action in the national interest needs to be taken very quickly and rapidly, and when confidentiality is needed before taking it, I reserve the right to do so and am prepared to act. That is what I did in the case of Hussain and Khan with the UK drone strike and, obviously, in the case of Emwazi, where we worked hand in glove with the Americans. I think it was right to take that action and to explain afterwards, but I will try to stick to that clear demarcation. I think that is the right approach for our country.

Mr Douglas Carswell (Clacton) (UKIP): I welcome the Prime Minister’s statement and I am sure that sensible people on both sides of the House will support sensible measures in the days and weeks ahead. Have the Government given any consideration to the way in

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which the Government of Saudi Arabia perhaps export, fund and encourage radicalism, and is that something we should address, with a view to making sure that they do not radicalise young people in the UK?

The Prime Minister: The hon. Gentleman makes an important point. I met the King of Saudi Arabia at the G20 and we discussed the situation in Syria. It is fair to say that Saudi Arabia has quite a strong de-radicalisation programme for its own citizens who have become extremists, and that has been successful. As I have said, we need to ask more broadly how we stop people setting off down the path to extremism in the first place. That is important in terms of what is taught, and how it is taught, in schools and how we make sure that, in all our educational practices right across the world—whether we are Christians, Jews, Muslims or Hindus—we are teaching tolerance and understanding right from the very start.

Mark Field (Cities of London and Westminster) (Con): Although I suspect that many, both in this House and beyond, will find it unpalatable that we are talking to President Putin at this time, I wholeheartedly support the Prime Minister having those discussions. Picking up on the point made by the right hon. Member for Gordon (Alex Salmond), is it the case that the Government are still trying to work towards getting a UN Security Council resolution on these matters, hand in glove with the other strategy to which the Prime Minister has referred?

The Prime Minister: We keep talking with Security Council partners about potential resolutions that we could put forward on any number of issues to do with this overall problem of ISIL, Iraq and Syria. However, something to back the sort of military action we have spoken about in this House has not been possible up to now, because of the potential Russian veto. It is important for us to understand that it is possible to act within, and with the full backing of, international law without a Security Council resolution. Obviously, it is better in many ways to have a Security Council resolution as well, but we cannot outsource our national security to a Russian veto or, indeed, a veto by anybody else.

Mr Pat McFadden (Wolverhampton South East) (Lab): May I ask the Prime Minister to reject the view that sees terrorist acts as always being a response or a reaction to what we in the west do? Does he agree that such an approach risks infantilising the terrorists and treating them like children, when the truth is that they are adults who are entirely responsible for what they do? No one forces them to kill innocent people in Paris or Beirut. Unless we are clear about that, we will fail even to understand the threat we face, let alone confront it and ultimately overcome it.

The Prime Minister: It is that sort of moral and intellectual clarity that is necessary in dealing with terrorists. I know there is something deep in all of us that wants to try to find an excuse, an explanation or an understanding, but sometimes the answer is staring us in the face. With ISIL, that is absolutely the case.

Will Quince (Colchester) (Con): The people of Colchester and north Essex mourn the loss of Nick Alexander. Nick died doing the job he loved, giving pleasure to

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others through music. Will my right hon. Friend join me in paying tribute to Nick and also reaffirm our resolve that we will not allow these murderous cowards to destroy our way of life?

The Prime Minister: I certainly join my hon. Friend in paying tribute to Nick. Our thoughts are with his family and friends. ISIL was trying to destroy our way of life, our value systems and the things that people like to do in their spare time. One of the most important things we can do, alongside all the security responses, is to go on living our lives.

Ms Margaret Ritchie (South Down) (SDLP): I thank the Prime Minister for his statement. On behalf of myself and my two colleagues from the Social Democratic and Labour party, I would like to convey our sympathy to those affected and our outright opposition to terrorism. Coming from Northern Ireland, we all know what it was like for so many years. We note that the Prime Minister will come back to the House with a full, comprehensive strategy. Will he define what he means by action that would be legal under international law?

The Prime Minister: What I have said is that, as part of the strategy that I will lay out in response to the Foreign Affairs Committee report, I will set out why I think we should take action not just in Iraq, but in Syria, too. In doing so, we will set out the legal advice. It is very important that the House sees that. The action we are taking in Iraq is being taken at the request of the legitimate Iraqi Government, and the action we took against Mohammed Emwazi and against Khan and Hussain was also taken on the basis of the self-defence of the United Kingdom. I can lay out very clearly the arguments about why we should be doing it, how we should help keep ourselves safe and why it is in the interests of our national security, but I will make sure that the paper addresses the legal arguments as well.

Craig Whittaker (Calder Valley) (Con): Following a second massacre in Paris last weekend, our own citizens being murdered in Tunisia and a plethora of Daesh-led massacres over the past year, may I say that now is the time not for knee-jerk reactions, but to reflect and plan effectively? Will my right hon. Friend do everything in his power to stop and destroy the murderous regime that is Daesh, for the sake of our own national security? I support him 100% in that, as no doubt do many Members in this House.

The Prime Minister: I thank my hon. Friend for his support. I do not believe in knee-jerk reactions. When events such as those in Paris happen, though, it is worth asking every single question about our state of preparedness, how we would respond and our intelligence co-operation. That is exactly what we are doing and it is right that we do that.