“be available to appear before a committee of the…Assembly to address, or answer on, the report.”
The reason for that, to go back to this point, is that if we are being told that these are parallel powers—if the text of the fresh start agreement tells us that power has not been given up and that Stormont has not let any power go—then the Government at least need to exercise the power of accountability for how some of the changes may be operated.
If we subsequently have a devolved Minister with those responsibilities after the sunset clause runs out, it will also make sense for the Assembly and the relevant committee of the Assembly to be able to distinguish between decisions that were taken by devolved authorities and those taken by the Secretary of State under these powers. That is another reason for the report-laying obligation, which would allow that function to be properly discharged. It is about saying that the Secretary of State would not be taking these powers without any line of accountability to the Assembly. It is also about saying that, in the course of retaining its powers, the Assembly will actually exercise some of those powers. It is about the spirit of some of those powers, in the context of ongoing scrutiny, legislative consent and accountability for some aspects of the operation.
None of the amendments in this group would be show-stoppers for the Bill or would cripple it in any way. They would not mean, as I would like, that everything stayed with the Assembly or that the Secretary of State did not have the power in her hands to direct Tory changes to benefits, which other parties said they were absolutely going to prevent from happening. However, the amendments would avoid the confusing twilight zone between the double sets of powers, with doublespeak about what is being done and the effects of decisions on people, and would therefore ensure more joined-up accountability.
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The amendments seem to be reasonable and consistent with many of the concerns that have been expressed by other hon. Members, including DUP Members. When their reasonable concerns have been reflected in these amendments, I do not know how anybody could reasonably object to them.
Ms Ritchie: I am pleased to serve under your chairmanship, Sir Alan.
It does not seem very long ago since we were debating the Second Reading of this Bill. Like my colleagues in the SDLP, I would have preferred all stages of the Bill to be taken through the Northern Ireland Assembly, because we believe in the primacy of devolution and in, shall we say, the primacy of Parliament. The role of Parliament should not be subjugated by the Executive or the Cabinet.
The amendments, which my hon. Friend the Member for Foyle (Mark Durkan) has spoken to—the Government have muzzled us by preventing us from pushing them to a vote—are about curtailing the Secretary of State’s power, because we believe in respecting and upholding the democracy of devolution. My hon. Friend has highlighted the purpose of the amendments, which is to provide greater clarity and definition of the powers that will reside with the Assembly and those that will reside with the Secretary of State.
On such a critical issue as welfare, the various aspects of which have such an impact—whether it is the benefit cap, sanctions or the four-year benefit freeze—it is important for the Secretary of State or the Minister to clarify tonight where the power lies and where it is delineated between the Assembly and here in Westminster. As my hon. Friend has said, we want to know who will take the lead on each of these powers.
On new clause 1, we are anxious to ensure that there are full measures of transparency and accountability, and that the Secretary of State gives evidence on the detail of the claimants and gives detail on the assessments in respect of section 75 of the Northern Ireland Act 1998, which deals with equality implications. We know that in the case of Northern Ireland, perhaps because of legacy issues stemming from the conflict and the troubles, and perhaps because of levels of disability and mental illness, there is a proportionately larger number of people eligible for benefits and in receipt of them. As I say, that may follow from the trauma they have faced and the degree of mental illness they may have suffered or because of the lack of access to jobs. As my hon. Friend the Member for Belfast South (Dr McDonnell) has said, we need equal investment of resources in jobs, skills and training to ensure that we are able to develop a balanced approach to regional development. We want to know what will be the impact of all these measures on individuals in the wider community.
When it comes to accountability, therefore, it is important that the Secretary of State, in keeping with new clause 1, lays a report in the House of Commons, sends the report to the Speaker of the Northern Ireland Assembly and appears before the relevant Committee. That could be the Social Development Committee or the new communities Committee. That will depend on what happens with our amendment 4, which would limit the Secretary of State’s power to June 2016, and would involve a new mandate and a new Department as per the requirements of the Stormont House agreement.
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We are seeking clarification this evening; we are not seeking to disturb or dismantle. We are trying to make a Bill much better, much more accountable and much more effective to ensure that there is a better deal for benefit claimants.
Dr Alasdair McDonnell: It is a privilege to speak under your chairmanship, Sir Alan. I will be brief in the interest of time. For me, however, this Bill should not have come before this House in the first place, and it would not have done so if the DUP and Sinn Féin had faced up to their responsibilities instead of avoiding the hard decisions and handing control of welfare back here. However, this is the situation we face, which is why we SDLP Members have tabled a number of amendments. They have been well outlined in detail by my hon. Friends the Members for Foyle (Mark Durkan) and for South Down (Ms Ritchie), and I may refer to them generally later.
The amendments will limit the involvement of the Secretary of State in the welfare system—or the out-workings of the welfare system—of Northern Ireland, and provide flexibilities and protections that we have long advocated. The Secretary of State and the Minister are familiar with the arguments that my hon. Friends and I have made not just in the last 10 weeks of talks, but in the now annual crisis talks that we have had over the last three years. As I said on Second Reading, focusing on welfare reform in isolation and neglecting the challenge of joblessness will simply fail. Punishing and sanctioning people for a failure to get a job, without looking at the total lack of job opportunity in the wider economy, is economically dysfunctional.
I emphasise again that we must tackle the fundamental issue of low-level economic activity in Northern Ireland’s population, and that we must start by providing a wide range of regionally balanced, job-related, third-level education, training, apprenticeships and employment opportunities. In my opinion, we need an ambitious strategy to get 1 million people across Northern Ireland into employment. We believe that this cannot and will not be achieved easily through this Welfare Reform (Northern Ireland) Order. We are letting down victims and their families. I find it disappointing that the fresh start agreement makes no reference to job creation, although we have raised and discussed it on many occasions. Many people do not think that it is working for Northern Ireland. They believe that it is a cover for the DUP and Sinn Féin to get through elections.
9.45 pm
The SDLP fought hard for devolution, and we will continue to support devolution and good government. However, we are annoyed by the utter disrespect and contempt that some parties have shown for the hard work and the contribution that we made during the talks, and the number of papers that we presented. The SDLP is committed to protecting devolution and making it work. We are committed to making Northern Ireland work for all its people, regardless of politics, colour, creed or class. The very purpose of devolution is to improve the lives of our people. There can be no cherry-picking—no handing back of legislation when it does not suit us.
Let me say something about our amendments, very briefly. We ask for the sunset clause—about which my hon. Friend the Member for Foyle spoke in detail—to be brought forward to 1 June from the arbitrary date of
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31 December, to reflect the fact that there will be Assembly elections in May. We also ask for any changes approved under the order to be dealt with in the Assembly as well as here. The Secretary of State would be required to provide the text of future orders seven days in advance to avoid a repetition of what happened last Wednesday, when the Assembly was given only hours in which to scrutinise this vital piece of legislation. We also ask the Secretary of State to publish, within 12 months, a report outlining the impact that the order has had on claimants, particularly those covered by section 75 of the Northern Ireland Act 1998, and including observations from independent welfare advice service providers.
We have also tabled amendments to provide flexibilities for claimants, along the lines of the amendments that we tabled at the consideration stage of the Northern Ireland Welfare Reform Bill, which Sinn Féin and the DUP voted down. Those flexibilities would limit the Secretary of State’s power to impose a benefit cap in Northern Ireland, and, indeed, the need for that power, and would reduce the maximum period of sanction from 18 months to six. We believe that the sanctions regime on this side of the Irish sea has proved disastrous, and we would prefer to avoid that.
Ultimately, we believe that the issues involved should be decided by the Northern Ireland Assembly.
Mr Wallace: It is a pleasure to serve under your chairmanship, Sir Alan.
The first two amendments will limit the changes that can be made through an Order in Council regarding certain areas such as sanctions, the benefit cap, entitlement to child benefits, and housing benefit. Amendment 3
“requires that the Northern Ireland Assembly approves a draft of any Order in Council made under this bill before it is made, and that sufficient time is given for due consideration.”
The purpose of the new clause is to place a responsibility on the Secretary of State to report on the impact of the first 12 months of any orders made under the Bill. It would require the Secretary of State to lay the report before the House of Commons, send it to the Speaker of the Assembly, and appear before an Assembly committee.
It is important to emphasise at the outset that the Bill in its present form has received the legislative consent of the Northern Ireland Assembly, which was delivered last week by an overwhelming majority of 70 votes to 22. We intend to resist amendments on that basis. I am sure that Members will join me in not wishing to undermine the consent that the devolved Administration have given the Bill by subsequently amending it.
In relation to amendments 1 and 2, it should be borne in mind that the Welfare Reform (Northern Ireland) Order 2015, which will follow the Bill, was also explicitly included in the Assembly motion that was debated and voted on last week. The agreement that was reached last week makes it clear that the Government will legislate to enable welfare reform to be implemented along the lines of the Assembly’s 2012 Welfare Reform Bill, which failed to pass in May. For that reason, the welfare reform order is based largely on this Bill.
Furthermore, the changes proposed by these amendments go beyond what was included in the Assembly’s Welfare Reform Bill. They do not therefore have the consent of the Assembly. If we were to accept them, Westminster would be legislating, in effect, without the Assembly’s
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consent. I advise the hon. Member for Foyle (Mark Durkan) that his concerns are best taken forward in the Northern Ireland Assembly. The Assembly retains legislative competence over welfare and therefore there is a degree of flexibility in how the Northern Ireland welfare system operates. I am sure that the SDLP will continue to argue forcefully for its position in the Assembly, but given that the motion passed already referred explicitly to the Welfare Reform (Northern Ireland) Order 2015 and the fact that changes proposed by this amendment can be made by the Assembly, the amendment is simply not needed.
Turning to the third amendment, it is worth remembering that it took almost three years for the Assembly’s Welfare Reform Bill to pass through its various legislative stages in the Assembly, until it finally fell in May of this year. There is an expectation on the part of those parties that have signed up to the fresh start that welfare reform will be implemented as quickly as possible. That is why the Assembly granted its legislative consent to this approach to address welfare reform the day following the agreement. Therefore, it is unnecessary to lay this order before the Assembly for seven days. To do so would only unduly delay further the implementation of welfare reform. It would no doubt leave the majority of MLAs scratching their heads and asking, “Why are we being asked to give our approval to an order that we have already approved?”
I will consider clause 1 in more detail. Clause 1 allows the Secretary of State to make provision for social security, child maintenance and arrangements for employment in Northern Ireland by Order in Council. This clause provides the vehicle for the Government to deliver welfare reform in Northern Ireland. It allows for an Order in Council made under this power to put in place a framework that will be supplemented by detailed policy to be set out in regulations by the Secretary of State or the Northern Ireland Department for Social Development. The clause provides that an Order in Council may make provision for further delegated legislation to be made by either the Secretary of State or the relevant Northern Ireland Department, allowing for detailed implementation to be carried out either in Westminster or in Stormont.
The clause allows for considerable flexibility in the drafting of the Order in Council, as this is a power that may be used on more than one occasion for slightly differing purposes, to implement possible future welfare reforms that need to be made before December 2016, for example. Finally, the clause provides that an Order in Council made under these provisions is subject to the affirmative resolution procedure.
Turning to new clause 1, I agree that it is important that the impact of welfare reform is fully understood in Northern Ireland. That is why I am pleased to see that the Northern Ireland Department for Social Development is committed to reviewing the operation of the Welfare Reform (Northern Ireland) Order that will follow this Bill. This is surely preferable to placing a commitment on the Secretary of State to report on the operation of an Order in Council made under clause 1(2) of this Bill. The Department for Social Development is better placed to understand Northern Ireland’s unique circumstances and to assess the impact of welfare reform there.
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It is also worth remembering that we are legislating as part of the agreement reached last week. I am concerned that placing an obligation on the Secretary of State to report overlooks this fact, and gives the impression that welfare in Northern Ireland is no longer devolved. We are not taking back welfare. The Department for Social Development remains responsible for implementing the welfare reforms.
I ask the hon. Member for Foyle to withdraw the amendments, and I beg to move that clause 1 stand part of the Bill.
Mark Durkan: The Minister implied that the amendment would affect just one Order in Council—the one that is in draft at the moment—but of course it would apply to various Orders in Council. He identified the problem that, having passed a legislative consent motion, the Assembly would wonder why the matter had come back to it.
We are used in this House to dealing with different stages of legislation and dealing with different decisions. There is no reason why there should not be more scrutiny.
On the Minister’s argument about the legislative consent question—that these amendments would breach the legislative consent motion because that motion does not address amendments—I make the point that legislative consent motions can be retrospective. After all, the legislative consent motion in the Assembly last week was about retrospectively endorsing the welfare clauses of the 2015 Welfare Reform and Work Bill as originally introduced, even though one of the parties that voted for that in the Assembly had voted against those provisions in this House. So I do not believe that those arguments stand up.
Similarly, we believe that there is value in the production of a report, not just for now but to provide clarity in the future. The consequences of this legislation could otherwise end up being argued about for many years. Arguments could arise, for example, about the downstream effects of direct rule decisions and of devolved decisions. We still have an interest in the reporting implications of new clause 1, so we would like to retain the option to return to the new clause later. To facilitate that, and to allow discussion of the other clauses, I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 1 accordingly ordered to stand part of the Bill.
Section 1: supplementary provision
Question proposed, That the clause stand part of the Bill.
Mr Wallace: Clause 2 provides that Orders in Council made under the power in the Bill are to be treated as Acts of the Northern Ireland Assembly. That will help to ensure that any order forms a sustainable part of the Northern Ireland legal framework. For technical reasons, an exception is made for the purpose of section 6 of the Northern Ireland Act 1998.
Clause 2 accordingly ordered to stand part of the Bill.
23 Nov 2015 : Column 1157
Extent, commencement, sunset and short title
Mark Durkan: I beg to move amendment 4, page 2, line 35, leave out “31 December 2016” and insert “1 June 2016”.
This amendment seeks to bring forward the end date for the Secretary of State’s decision making powers to take account of the fact that there will be a new assembly and a new devolved department from May
2016
.
The Temporary Chair (Sir Alan Meale): With this it will be convenient to discuss clause 3 stand part.
Mark Durkan: Amendment 4 stands in the names of my hon. Friends the Members for South Down (Ms Ritchie) and for Belfast South (Dr McDonnell) and I. It relates to the sunset provision. The Bill provides that the power that is to come to the Secretary of State, while apparently not leaving the Assembly, will last until the end of 2016. As my hon. Friend the Member for South Down has said, the Assembly will have a new mandate from next May. There could be new Ministers and possibly new departmental structures as well, if the fresh start programme and previous decisions from Stormont House are followed.
The excuse is being made about the exigencies of the requirement to move on welfare reform to break the supposed deadlock between welfare reform, the budget and the implementation of other measures. It is said that that all has to be done now. We might be told that there will be an Order in Council to transpose the 2012 Act’s provisions into Northern Ireland legislation first, and that there will be a subsequent Order in Council to deal with the current Welfare Reform and Work Bill’s provisions. There could also be supplementary regulations after that. There is no reason, however, for the powers to stay here until the end of 2016.
The shadow Secretary of State, the hon. Member for Gedling (Vernon Coaker), asked earlier why that date had been chosen. The most that the Minister could tell him was that it was what the parties had asked for. Two of the parties might have asked for it, but the rest of us did not, because we were not privy to the selection of that date. It therefore seems sensible to allow a newly created Department with its new Minister, and the Assembly with its new mandate, to take the full flush of powers that they should have, without anyone having to look over their shoulder to see what the Secretary of State is doing. It would be very good for that new Minister to be able to say that they will be exercising full responsibility and for the new committee in the new Assembly to have its full remit in terms of full legislative competence. That is why we have tabled a proposal to bring forward the date of the sunset clause.
We also seek to give people better assurance: if Ministers are assuring us that this is not intended to create direct rule for the long term or indefinitely, and that it is a temporary measure, we should make it even more definitely temporary. We should also make the timetable of that temporary arrangement more compatible with what is being provided on the Assembly’s own electoral cycle and calendar. That is the point of our proposal.
23 Nov 2015 : Column 1158
10 pm
One other point I wish to make is that the date of the end of 2016 is being confused by some people as a date which will mean that the changes planned for 2017 as a result of the Welfare Reform and Work Bill would not stand. I expect the Minister to confirm that the Bill’s sunset clause relates only to the decision-making powers and not to the effects or the reach of those decisions themselves, which will stand after the sunset clause has lapsed; there is no need for the sunset clause for those decisions to stand. So I do not know why parties would argue against an earlier date for the sunset clause. Given that the Government are so reluctant about this matter, I do not know why they would resist an earlier date.
Ms Ritchie: I rise to support amendment 4. As my hon. Friend said, this Assembly mandate is scheduled to conclude at the end of March 2016, with elections scheduled for Thursday 5 May. For that reason, we believe it would be more prudent and more effective if the sunset clause were brought forward to 1 June 2016. That would enable a new Assembly mandate and a new Department of communities to be in place, so officials with a Minister would be equipped to deal with these issues. There could then be no ambiguity about what the responsibilities of the Secretary of State were and what those of the Minister for communities were in terms of this legislation.
Mr Wallace: Let me just respond to the points made by the hon. Member for Foyle (Mark Durkan) about the sunset clause. I can confirm that it refers to the powers being taken in the Bill, not the measures passed under the Secretary of State or via those powers. The December 2016 date was chosen because the aim is to get this welfare reform through, get the Assembly back up and running, and get Stormont back to running on full engines. The idea that we should risk that by picking a date that will not give us enough time not only to pass the legislation, but to implement it is crazy. Missing the deadline by a couple of months or weeks would put at risk all the hard work that has been done over the past few months and years. December 2016 is viewed as the best timetable for achieving the implementation of both the 2012 Act and the Welfare Reform and Work Bill, which is currently going through Parliament.
Clause 3 provides that the Act extends to England and Wales, Scotland and Northern Ireland. This is to allow for any subsequent and consequent amendments that may be required to legislation that has a UK-wide extent. The Bill has practical application only in Northern Ireland, as it is concerned only with welfare in Northern Ireland. The measure also allows the Act to come into force on the day that it is passed to ensure that the subsequent Order in Council can be quickly laid in Parliament. The most substantial element of the clause is the sunset provision, which sets out that no Order in Council can be made after 31 December 2016. I request that the hon. Gentleman withdraw his amendment and that clause 3 stands part of the Bill.
Mark Durkan:
I indicated in response to the debate on the previous set of amendments that, if we were to have any kind of sample Division in relation to these amendments, our main interest would be in putting new clause 1 to a vote. I note what the Minister has said. I do not accept his arguments, and make the point that the
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sensible time for the Assembly to take the powers is when it is a few weeks into a new mandate. I hope, with all the optimism and confidence that has been expressed, that the Assembly will be in good and sufficient order when it takes its new mandate, with its new departmental structures and with its new arrangements for bringing forward a programme for government. It would seem to be a more sensible timetable, but we will not take the time of the House now by pressing for a Division. I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 3 accordingly ordered to stand part of the Bill.
Duty to report
(1) In respect of an Order in Council under section 1(1) or any order or regulations under section 1(2) the Secretary of State will, within twelve months, publish a report of its operation which must include—
(a) comparative data and information on numbers of claimants and, where relevant, dependants and the relative value of benefits, allowances, payments or credits so as to reflect any difference in provision before and after the operation of the order or regulation;
(b) assessment of any impact in respect of section 75 of the Northern Ireland Act 1998; and
(c) reflection of observations from independent welfare advice service providers.
(2) In publishing any report under subsection (1), the Secretary of State must—
(a) lay the report before the House of Commons;
(b) send the report to the Speaker of the Northern Ireland Assembly; and
(c) be available to appear before a committee of the Northern Ireland Assembly to address, or answer on, the report.”.—(Mark Durkan.)
This amendment confers a responsibility on the Secretary of State to report on the first twelve months of operations and impacts on any orders made under this Act. It would ensure the Secretary of State had to lay the report before the House of Commons, send the report to the Speaker of the Northern Ireland Assembly and appear before a Northern Ireland Assembly committee.
Brought up, and read the First time.
Question put, That the clause be read a Second time.
The Committee divided:
Ayes 5, Noes 171.
Division No. 130]
[
10.6 pm
AYES
Durkan, Mark
Elliott, Tom
Kinahan, Danny
McDonnell, Dr Alasdair
Skinner, Mr Dennis
Tellers for the Ayes:
Ms Margaret Ritchie
and
Margaret Ferrier
NOES
Andrew, Stuart
Argar, Edward
Atkins, Victoria
Bacon, Mr Richard
Baldwin, Harriett
Barclay, Stephen
Bebb, Guto
Berry, Jake
Berry, James
Bingham, Andrew
Blackman, Bob
Boles, Nick
Borwick, Victoria
Bottomley, Sir Peter
Bradley, Karen
Brine, Steve
Bruce, Fiona
Burns, Conor
Burt, rh Alistair
Cairns, Alun
Campbell, Mr Gregory
Carmichael, Neil
Clark, rh Greg
Cleverly, James
Clifton-Brown, Geoffrey
Coffey, Dr Thérèse
Colvile, Oliver
Crabb, rh Stephen
Davies, Byron
Davies, Chris
Davies, David T. C.
Davies, Dr James
Davies, Philip
Dinenage, Caroline
Dodds, rh Mr Nigel
Donaldson, rh Mr Jeffrey M.
Doyle-Price, Jackie
Duddridge, James
Ellis, Michael
Ellison, Jane
Ellwood, Mr Tobias
Elphicke, Charlie
Eustice, George
Evans, Graham
Field, rh Mark
Foster, Kevin
Freer, Mike
Fuller, Richard
Fysh, Marcus
Gale, Sir Roger
Garnier, rh Sir Edward
Gauke, Mr David
Gillan, rh Mrs Cheryl
Glen, John
Goodwill, Mr Robert
Graham, Richard
Grayling, rh Chris
Green, Chris
Griffiths, Andrew
Gummer, Ben
Gyimah, Mr Sam
Hammond, Stephen
Hands, rh Greg
Harper, rh Mr Mark
Harrington, Richard
Harris, Rebecca
Hart, Simon
Hayes, rh Mr John
Hermon, Lady
Hinds, Damian
Hoare, Simon
Hollobone, Mr Philip
Hopkins, Kris
Huddleston, Nigel
Hunt, rh Mr Jeremy
Javid, rh Sajid
Jenrick, Robert
Johnson, Gareth
Johnson, Joseph
Jones, Andrew
Jones, Mr Marcus
Kirby, Simon
Knight, rh Sir Greg
Kwarteng, Kwasi
Lancaster, Mark
Latham, Pauline
Leadsom, Andrea
Lefroy, Jeremy
Leslie, Charlotte
Letwin, rh Mr Oliver
Lewis, Brandon
Lidington, rh Mr David
Lilley, rh Mr Peter
Lord, Jonathan
Loughton, Tim
Lumley, Karen
Mackinlay, Craig
Mak, Mr Alan
Mathias, Dr Tania
Maynard, Paul
McCartney, Karl
Menzies, Mark
Merriman, Huw
Metcalfe, Stephen
Milling, Amanda
Mills, Nigel
Milton, rh Anne
Mitchell, rh Mr Andrew
Mordaunt, Penny
Morris, Anne Marie
Morris, David
Morris, James
Murray, Mrs Sheryll
Neill, Robert
Newton, Sarah
Nuttall, Mr David
Offord, Dr Matthew
Paisley, Ian
Parish, Neil
Patel, rh Priti
Penning, rh Mike
Percy, Andrew
Philp, Chris
Pickles, rh Sir Eric
Pincher, Christopher
Pursglove, Tom
Quin, Jeremy
Quince, Will
Raab, Mr Dominic
Robinson, Gavin
Rosindell, Andrew
Rudd, rh Amber
Rutley, David
Scully, Paul
Shannon, Jim
Sharma, Alok
Shelbrooke, Alec
Simpson, David
Skidmore, Chris
Smith, Chloe
Smith, Henry
Smith, Julian
Spencer, Mark
Stewart, Bob
Stewart, Iain
Stewart, Rory
Swayne, rh Mr Desmond
Syms, Mr Robert
Throup, Maggie
Timpson, Edward
Tomlinson, Justin
Tracey, Craig
Turner, Mr Andrew
Vaizey, Mr Edward
Vara, Mr Shailesh
Vickers, Martin
Villiers, rh Mrs Theresa
Walker, Mr Robin
Wallace, Mr Ben
Warman, Matt
Wharton, James
Wheeler, Heather
White, Chris
Whittaker, Craig
Williams, Craig
Williamson, rh Gavin
Wilson, Mr Rob
Wilson, Sammy
Wood, Mike
Wragg, William
Wright, rh Jeremy
Tellers for the Noes:
Margot James
and
George Hollingbery
Question accordingly negatived.
23 Nov 2015 : Column 1160
23 Nov 2015 : Column 1161
The Deputy Speaker resumed the Chair.
Bill reported, without amendment.
10.17 pm
Mrs Villiers: I beg to move, That the Bill be now read the Third time.
I thank all right hon. and hon. Members who have taken part in the debates this evening, and all the Members of the Legislative Assembly and others who have settled the question of welfare reform in Northern Ireland.
This Bill fulfils an important commitment made following the recent political talks, which culminated in the “Fresh Start” agreement. The enabling power contained in the Bill paves the way for the introduction of a modern, reformed welfare system for Northern Ireland. The Government’s welfare reforms have at their heart the principles that it should always pay to work and that the vulnerable will always be protected. The benefits cap will ensure that no one household can claim more in benefits than the average family can bring home by going out to work. This is welfare support when people need it, not welfare support as a way of life.
The legislation will help us deliver our long-term economic plan. It will replace a system that was not working, a system that was not fair to the people trapped in dependency and poverty, and not fair to the hard-working taxpayers who paid for it. An unreformed welfare system was not sustainable in Great Britain and it is not sustainable in Northern Ireland. I believe that the reforms that this Bill will allow us to implement will help more people in Northern Ireland to get on because it will enable them to get into work, with the dignity of a job, the pride of a pay packet and the peace of mind that comes from being able to support their family. As in Great Britain, the reformed system will help people to make the journey from dependence to independence, providing more opportunity and greater security.
Before I conclude, I want to be clear that this Bill and the Order in Council that is to follow do not represent the Government taking a decision to impose something on Northern Ireland, but rather what the Northern Ireland Executive have agreed and what the Northern Ireland Assembly supported in its recent LCM vote. Together with the top-ups that the Executive will implement and fund from the block grant, Northern Ireland will have the most generous welfare system in the United Kingdom and one of the most generous in the world.
We have been having the debate on welfare reform in Northern Ireland for nearly four years. The dispute over the budget has been a drag anchor on Northern Ireland politics for too long, and it is time to get this matter settled. I firmly believe that without these questions of financial sustainability being resolved once and for all, we would be on an inexorable path to direct rule,
23 Nov 2015 : Column 1162
and that is an outcome that nobody in this House wants. The Stormont House agreement ran into trouble at the implementation stage. This is our chance to learn from experience in trying to ensure that the “Fresh Start” agreement stays on track and plays its part in delivering effective, confident and stable devolved government for Northern Ireland. I commend the Bill to the House.
10.21 pm
Vernon Coaker: I join the Secretary of State in thanking everyone who has played a role in bringing the Bill to this stage and in taking it through this House—those inside the House and those outside it.
I repeat that we have not opposed the Bill, despite our serious concerns over welfare reform, as it avoids a collapse in the devolved institutions or a return to direct rule, which would have been unthinkable and a disaster for Northern Ireland. I say again to the Government that alongside welfare reform, a jobs and growth programme is needed. Notwithstanding that, today we have helped to resolve the impasse that there was in Northern Ireland, allowing its Government to carry on with the peace and progress that they want and we all want for them.
10.22 pm
Ms Ritchie: Today we have had all the stages of this welfare reform Bill for Northern Ireland. At this third and final stage, we would say again that we must have a higher ambition and aspiration to ensure the fulfilment of a meaningful devolution process in Northern Ireland. By that, we mean that we should not have brought the Bill here, as we have said during all its stages. We would also say that we have seen the Secretary of State and the Conservative Government succumb to the unwillingness of Sinn Féin and the DUP to take such a Bill through the Northern Ireland Assembly.
From a societal point of view, this enabling Bill is about addressing the needs of families and individuals who need to access the benefits system to ensure that they can live and rear their families with a relative degree of comfort. Being in receipt of benefit or having to access the benefits system is not a lifestyle choice. People are forced into this trap because of lack of access to jobs and employment, because they have lost their job or their place in employment, or because insufficient resources have been placed where jobs were located, or not located. My hon. Friends the Members for Foyle (Mark Durkan) and for Belfast South (Dr McDonnell) and I believe that there needs to be a twin-track policy that enables investment in jobs—new jobs and the sustaining of existing jobs—and investment in skills and training to ensure and facilitate all having the necessary access to employment and therefore not having to rely on benefits.
Our proposed amendments sought to curtail the power of the Secretary of State and to clarify the twin-track approach—the parallel powers—of the Northern Ireland Assembly and the Secretary of State in relation to welfare. At this late stage, we say that the Secretary of State should report directly to this House, the Speaker of the Northern Ireland Assembly and the wider community with regard to the claimant count, the sanctions and the Bill’s requirements.
Obviously, we believe that this Bill should have been taken on the Floor of the Assembly, to fulfil the ambitions of all those people on the island of Ireland, both north
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and south, who voted for full devolution. We and, I think, other Members from Northern Ireland still believe there should be more devolution measures and that we and all the citizens we represent have an enormous opportunity. We will strive to work with the Government and the Northern Ireland Executive to achieve a more fulfilled economy and training sphere.
10.26 pm
Mr Dodds: I thank the Government for bringing forward this Bill this evening. It will settle the issue of welfare reform for Northern Ireland after many years of dispute, not because of any unwillingness by three of the parties in the Northern Ireland Assembly—ourselves, the Ulster Unionist party and the Alliance party—but because it was blocked over and over again by the SDLP and Sinn Féin. It was rich of the hon. Member for South Down (Ms Ritchie) to complain that it was not being taken in the Northern Ireland Assembly, because it was as a result of her party’s actions that it could not get through the Assembly.
Anyone who opposes or who has opposed this Bill, or who voted with those who tabled amendments to it, are, in effect, in favour of continuing the stalemate and of continuing to fine the Northern Ireland Executive £2 million a week for failing to implement welfare reform. They are against having a sustainable budget in Northern Ireland and in favour of the continuation of a welfare system that is separate from that used in the rest of the United Kingdom. The absence of top-ups would mean that the increased cost to Northern Ireland would become greater with every passing year, and new computer systems would also cost hundreds of millions of pounds a year. Those who opposed the Bill in Committee
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earlier and who will vote against it tonight will, in effect, be voting for the collapse of the Northern Ireland Assembly and a return to direct rule, which would result in the full implementation of all the things they rail against, without any top-ups or amelioration for the Northern Ireland Executive.
This has been a good day for Northern Ireland, because we have finally made progress in implementing the Stormont House agreement, putting the finances of Northern Ireland on a sound, sustainable footing, and creating a welfare system that is good, reformed and fit for purpose in meeting the needs of the people of Northern Ireland. This has been a good day for this House and a good day for Northern Ireland.
Bill accordingly read the Third time and passed.
Business without Debate
Delegated Legislation
Motion made, and Question put forthwith (Standing Order No. 118(6)),
International Development
That the draft International Fund for Agricultural Development (Tenth Replenishment) Order 2015, which was laid before this House on 24 June, be approved.
Terms and Conditions of Employment
That the draft Exclusivity Terms in Zero Hours Contracts (Redress) Regulations 2015, which were laid before this House on 19 October, be approved.—(Simon Kirby.)
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Antibiotics (Primary Care)
Motion made, and Question proposed, That this House do now adjourn.—(Simon Kirby.)
10.29 pm
Maggie Throup (Erewash) (Con): First, I would like to declare an interest. Over 20 years ago, I was responsible for trying to launch a C-reactive protein point-of-care test, along with other point-of-care tests. The timing and circumstances were not right then, but things have moved on, and I believe the time is now right to get C-reactive protein point-of-care testing established in the primary care setting.
Last Monday was world antimicrobial day and that, along with the extensive media coverage over recent days about antimicrobial resistance and the vast difference between summer and winter antibiotic prescribing, makes this is a very timely debate. Antibiotics have been widely used to treat infections for more than 60 years, and without doubt the use of antibiotics has saved many millions of lives. I doubt if there is any right hon. or hon. Member who has never taken an antibiotic at some time in their life, but such extensive use of antibiotics has now become a real issue and a ticking timebomb.
Although new infectious diseases have been discovered nearly every year during the past 30 years, very few new antibiotics have been developed in that time, meaning that existing antibiotics are used to treat more and more infections. The consequence has been an increase in the prevalence of resistance to antibiotics, which in turn puts our ability to treat routine diseases in serious jeopardy. At present, treatment-resistant bacteria are responsible for approximately 25,000 deaths across Europe each year, which is a similar number to those dying in road accidents. The national risk register of civil emergencies has estimated that a widespread outbreak of a bacterial blood infection could affect 200,000 people in the UK. If it could not be treated effectively with our existing drugs, approximately 40% of those affected might die as a result, which is 80,000 people. There is an urgent need for action to slow the spread of antimicrobial resistance.
For a number of years, there has been a clear consensus among clinicians, academics and policy makers that antimicrobial resistance represents a major current and future danger to the foundations of modern medicine. In recognition of that danger, tackling the threat of antimicrobial resistance has been identified as a key priority by the Government, Public Health England and the chief medical officer. Just two years ago, the chief medical officer described the threat of antimicrobial resistance as
“just as important and deadly as climate change and international terrorism.”
I wish to focus on antibiotics in primary care and what measures can be taken to have a real impact on the way in which they are prescribed, which is currently almost like handing out a bag of sweets at the fair. In fact, 97% of patients who ask for antibiotics are prescribed them, whether or not they should have them. Owing to the popularity of primary care in the UK, that setting represents the part of the healthcare system where antibiotics are most likely to be prescribed, with 74% of them prescribed in that setting. International comparisons show that antibiotic resistance rates are strongly related to antibiotic use in primary care.
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Despite guidance encouraging a reduction in antibiotic prescribing rates, nine out of 10 GPs say that they feel pressured into prescribing antibiotics. In the UK, we do like taking antibiotics. In 2013, data showed that 41% of residents had taken antibiotics in the previous 12 months, compared with a European average of 35%. Nationally, in 2013-14—the most recent year for which I have managed to get hold of the data—a staggering 41.6 million antibiotic prescriptions were issued, at a cost of £192 million to the NHS.
Jim Shannon (Strangford) (DUP): I congratulate the hon. Lady on securing the Adjournment debate. She has outlined the issues and the epidemic potential among those who do not respond to antibiotics. Does she agree that we need something focused not just on England and Wales, but on the whole of the United Kingdom of Great Britain and Northern Ireland because this strategy has to help us all? In her submission to the House, will she say—perhaps the Minister could respond along the same lines—whether we should have a UK-wide strategy to address the issue for the constituents of all Members of the House and further afield?
Maggie Throup: I completely agree with the hon. Gentleman. It is not just a UK-wide issue; it affects the whole world. That is one of my concerns. We need to play our part to set the trend for the whole world, because this is a global issue.
As I said, antibiotic prescriptions in 2013-14 cost the NHS £192 million. What is more worrying is that many of the 41.6 million prescriptions were unnecessary and will undoubtedly have contributed to the growing issue of antimicrobial resistance. More than half the antibiotics used in primary care are for respiratory tract infections, most of which are viral or self-limiting.
So what can be done to halt the ticking timebomb? Just last Wednesday, Public Health England called for NHS patients to become “antibiotic guardians” by thinking carefully before asking for drugs and taking more care to prevent the spread of infections by washing their hands and accepting the flu jab. I believe that we can go even further in reducing the use of antibiotics in ways that are better for the patient and that save the NHS money.
Kevin Foster (Torbay) (Con): I congratulate my hon. Friend on bringing this issue before the House. Does she agree that the big problem, which she has touched on, is that a lot of people put pressure on their doctors to give them antibiotics, falsely thinking that they will cure a cold, which is a virus, when antibiotics are only useful against bacterial infections?
Maggie Throup: My hon. Friend is right. That is what we need to make clear. People often do not understand that the causes of those illnesses are quite different.
My local clinical commissioning group, Erewash CCG, is working hard to empower patients to take responsibility for their health, very much along the lines of the antibiotic guardians idea. As part of the initiative, it wants patients to learn to recognise when it is right to visit the GP and when it is right to seek alternative advice, such as that of a pharmacist.
I want to come back to where I began: the little device that performs the C-reactive protein point-of-care test. I can tell that hon. Members are wondering what C-reactive
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point-of-care testing is. A point-of-care test is a diagnostic test that is quick and easy to perform. It can be used during a patient consultation or completed while the patient waits. It allows for immediate diagnosis and treatment choice. Such point-of-care tests are designed to be used by people who are not laboratory scientists.
A C-reactive protein point-of-care test is a blood test that measures the amount of protein called C-reactive protein in a person’s blood, using just a drop of blood from the finger. Evidence shows that the test can deliver significant benefits when used in the primary care setting. It is used in the primary care setting in several European countries and has been shown to reduce unnecessary antibiotic prescribing by empowering GPs to make informed decisions.
John Glen (Salisbury) (Con): My hon. Friend is making a powerful case for how innovation in the NHS can be the key to securing significant savings and a change in the culture of antibiotic use among the general public. Does she agree that it is about time NHS England moved quickly and decisively to empower people to change their behaviour in respect of managing their own health?
Maggie Throup: I completely agree with my hon. Friend. That is exactly why I secured this debate. We need to move quickly because this is a ticking timebomb that we must address sooner rather than later.
Point-of-care testing can reassure patients that they do not need antibiotics and will recover without them. There is evidence that C-reactive protein point-of-care testing could reduce the number of antibiotic prescriptions issued in primary care for acute respiratory tract infections by up to 42%. That represents millions of prescriptions every year. It has been calculated that using C-reactive protein point-of-care tests in primary care has the potential to save £56 million a year in prescription and dispensing costs. At the same time, C-reactive protein point-of-care testing could make a significant contribution to the UK’s antimicrobial resistance strategy.
I am sure that all hon. Members will have visited a GP with a cough and a cold and feeling pretty bad, and thinking that a short course of antibiotics is just what is needed to get rid of the bugs. They expect to leave the GP’s surgery with a prescription for antibiotics and already start to feel better. The problem with that scenario is that there is a high probability that those antibiotics will be useless, because the cold is not a bacterial infection, but a viral or self-limiting infection that antibiotics will not touch. The consequences are far reaching. First, the drugs will have been ingested unnecessarily, and it is likely that antibiotics will have increased antimicrobial resistance in the population. Secondly, a prescription will have been issued unnecessarily, which is a wasted cost to the NHS.
Let us consider an alternative. The hon. Member will still visit their GP with a cough and a cold and feeling pretty bad, but now by using just a drop of blood from their finger, a C-reactive protein point-of-care test can be carried out and will give an almost instant result. If the level of the protein is low to medium, no antibiotics are needed. The hon. Member will leave the GP’s surgery without a prescription, but knowing that they will start to feel better without one. If the level of the protein is
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high, a prescription for antibiotics can be issued. Such a simple measure is better for the patient, does not add to the ticking timebomb of antimicrobial resistance, saves the need for a prescription, and saves the NHS millions of pounds. I am sure hon. Members will be asking why it is not happening already.
Such a simple test can also be used for more complex cases than coughs and colds. With the life-limiting condition idiopathic pulmonary fibrosis, GPs find it hard to differentiate between the ongoing condition and an underlying infection. An underlying infection, which could be tested by using the C-reactive protein point-of-care test, may require hospitalisation, but the ongoing condition would not. In such instances, it is not just about whether to prescribe antibiotics; it is about whether a hospital bed and all the resources alongside it are needed. Surely a low-cost, point-of-care test is worth its weight in gold given that scenario.
Despite recent reforms, the NHS still works in silos and is inflexible when it comes to funding a test that originally would be carried out in the hospital laboratory. The majority of testing required by primary care is done by block contract through the local hospital, and additional testing is seen as a cost burden on the GP—that was the barrier I hit more than 20 years ago.
Today, C-reactive protein is included as a recommended area of best practice within the National Institute for Health and Care Excellence clinical guidelines for pneumonia, which state that
“clinicians should consider a point-of-care C-reactive protein test for patients presenting with lower respiratory tract infection in primary care”.
That recommendation was made by the NICE guideline development group and based on antibiotic prescription rates, mortality, hospital admission rates, and quality-of-life outcomes. Antibiotic prescription rates were felt by the guideline development group to be the most relevant direct outcome influencing that recommendation.
Kevin Hollinrake (Thirsk and Malton) (Con): As my hon. Friend pointed out, antimicrobial resistance is a particular problem in emerging economies—in India in 2014, 58,000 babies died because of AMR. Does she think that it would be wise to use international development budgets to tackle that severe and growing problem?
Maggie Throup: My hon. Friend makes a good point and I completely agree with him.
When one prominent GP wanted to introduce the point-of-care test, he was refused funding. He is now funding it through other sources as he feels that it provides better patient care than just issuing antibiotic prescription after prescription. Things must change for the sake of the patient, to reduce the number of prescriptions, to contribute to the battle against antimicrobial resistance, and ultimately to save the NHS millions of pounds.
The recently launched review of antimicrobial resistance, chaired by Jim O’Neill, is entitled “Rapid diagnostics: stopping unnecessary use of antibiotics” and states that
“rapid point-of-care diagnostic tests are a central part of the solution to this demand problem, which results currently in enormous unnecessary antibiotic use.”
That is why I am asking the Minister to do whatever she can to break down the silos, create the funding streams for C-reactive protein point-of-care tests in primary care, play her part in implementing our national
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antimicrobial strategy and save the NHS millions of pounds that could be redirected to disease areas that would really benefit from an injection of funds. This is a win-win-win situation and it must be addressed as quickly as possible.
10.45 pm
The Parliamentary Under-Secretary of State for Health (Jane Ellison): Let me begin by congratulating my hon. Friend the Member for Erewash (Maggie Throup) on securing this very well-attended debate on a very important issue. The hour is late, but there are a number of hon. Members in the Chamber, reflecting the importance of the debate, and they have made well-informed interventions. I will attempt to address all the issues raised, but if there is anything I do not get to I will look to write to hon. Members.
This debate is timely. Antimicrobial resistance awareness week, a news item in The Lancet and news from other countries, in particular China, have helped to underline the issue that, on occasion, can sound quite dry. If people wonder what the issue is, it has been aptly illustrated in recent weeks. The prescribing and use of antibiotics has a direct impact on antimicrobial resistance. As my hon. Friend made clear, it is one of the biggest global health challenges we face and I spend a lot of time talking about it to Health Ministers from other countries. The costs of antimicrobial resistance are very significant. The O’Neill review on antimicrobial resistance, commissioned by the Prime Minister, estimates that a continued rise in resistance by 2050 would lead to millions of additional deaths worldwide each year and an economic cost of up to $100 trillion worldwide. This is a really big issue.
My hon. Friend described exactly the problem we face in terms of the appearance and spread of bacteria that are resistant to treatment by current antibiotics, and the threat that poses to modern medicine. She provided some examples of that threat. Without effective antibiotics, medical advances such as organ transplants, and even minor surgery and routine operations, will become high-risk procedures. Procedures we assume can now be done as minor day surgery will suddenly become again a serious threat because of serious resistant infection. Antimicrobial resistance is a global problem that needs to be tackled at a national and global level to ensure antibiotics are used wisely.
As my hon. Friend and others will know, in 2013 we published the “UK Five Year Antimicrobial Resistance Strategy” to address this significant threat. It takes a “one health” approach, addressing human, animal, food and environmental aspects of antimicrobial resistance. The hon. Member for Strangford (Jim Shannon) is, as ever, in his place. On many occasions I disappoint him by saying that matters are England-only, but I am delighted to be able to confirm that this is a UK-wide strategy. We are working on it in close collaboration with Scotland, Northern Ireland and Wales. At the heart of our strategy is the need to use antibiotics more effectively. The key is how we change both public and health professional behaviour, and my hon. Friend described the challenge we face.
The English Surveillance Programme for Antimicrobial Utilisation and Resistance—just another one of those catchy little titles we come up with in the health world—is
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a very important programme. The 2015 surveillance report shows that general practice accounts for 74% of prescribed antibiotics. The number of antibiotic prescriptions in primary care has declined for the last two years and are now lower than in 2011. However, analysis of the data suggests that although there have been fewer prescriptions, higher doses or longer courses of antibiotics are being prescribed. Total use of antibiotics continues to increase in the NHS, albeit at a slower rate. We still have a significant challenge. It is a challenge for all of us and, as my hon. Friend said, behaviour change is right at the heart of how we tackle the problem, both for those who prescribe and for those who use antibiotics—both are crucial to our response.
In August, the National Institute for Health and Care Excellence produced its stewardship guidelines for the health and social care system, which covered the effective use of antimicrobials, including antibiotics. We understand the pressures, as have been well described here, that primary care prescribers face every day. We know, as my hon. Friend the Member for Torbay (Kevin Foster) illustrated, that sometimes people expect to leave their doctor with a certain prescription, even if it is not the right thing. To support GPs, therefore, we have been working with the Royal College of General Practitioners to provide them with suitable tools to reduce levels of inappropriate prescribing.
Last week, research by Antibiotic Research UK found that doctors prescribed 59% more antibiotics in December than in August, despite many of the illnesses treated by antibiotics not being seasonal. That, too, touches on the challenges. One of the key resources doctors have at their disposal is TARGET—treat, antibiotics responsibly, guidance, education, tools—which is hosted on the RCGP website and aims to increase primary care clinicians’ awareness of the importance of antimicrobial resistance and responsible use. Health Education England continues to work with Public Health England to ensure that the competence and principles of prescribing antimicrobials are embedded throughout the professional curricula.
In a recent trial, the chief medical officer, Dame Sally Davies, wrote to a sample of high-prescribing GPs in England, explaining that their prescribing rates were significantly higher than those of other similar GPs and asking them to reassess their prescribing protocols. This intervention resulted in a 4% reduction in levels of prescribing in those practices. That is encouraging and more trials are planned. I put on the record the gratitude of this Government and Governments around the world to Professor Dame Sally Davies for the work she has done in spearheading not just our national AMR campaign but the international campaign. I have watched her galvanise whole countries to action on this subject. We are extremely lucky that she is leading the charge.
NHS England’s introduction of a quality premium on antibiotic prescribing for 2015-16 is another significant step. The purpose is to act as an incentive to reduce levels of antibiotic prescribing in both primary and secondary care. We are encouraged by the early results and expect a reduction in levels of antibiotic prescribing in the next set of data covering 2015-16.
We are not overlooking the consumers of antibiotics: the public. We need to improve their understanding about their appropriate use and are active participants in European antibiotic awareness day, which has just passed and which looks to engage the wider public.
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My hon. Friend the Member for Erewash highlighted the extremely important antibiotic guardian programme. We have set a target to reach 100,000 antibiotic guardians by next March. We also urge all colleagues—this is where MPs can be extremely helpful—to bring this up with their local NHS. If they ask about it, people will realise its importance, so I ask them to do so as part of their routine contact with local NHS institutions.
Public Health England, working in conjunction with the RCGP, has developed a range of patient information materials to help them think about how they care for themselves when they have a self-limiting infection, such as a cold, and when to consult a health professional. Critically, my hon. Friend referred to diagnostic testing, particularly the C-reactive protein test. I understand her frustration—sometimes it feels like things move rather slowly—but I hope that the attention the strategy has received illustrates our desire to move faster. In fact, the driving force behind the UK-wide strategy is about gearing up the whole health system to react more quickly.
Most antibiotic prescribing is done in the absence of a test to determine the nature of the illness and whether an antibiotic prescription is likely to help. Making better use of technology is a key part of our work. Greater access to and use of rapid diagnostic tests will help us to avoid unnecessary treatment and provide more targeted treatment where infections are diagnosed, which, of course, will mean better outcomes for patients.
Jeremy Lefroy (Stafford) (Con): My hon. Friend might note that, in the case of malaria, the introduction of rapid diagnostic tests has substantially reduced the inappropriate use of important antimalarials.
Jane Ellison: That is an excellent illustration of the potential of rapid diagnostic tests, and of course we had exciting news on malaria recently.
In December last year, NICE recommended that GPs should consider carrying out C-reactive protein testing for people presenting in primary care with symptoms of lower respiratory tract infection if, after clinical assessment, a diagnosis of pneumonia has not been made and it is not clear whether antibiotics should be prescribed. I understand that the test is increasingly being used in primary care, although the evidence for its use is mixed and the role of normal clinical diagnosis remains critical.
We want the right test available in the right place, from patients’ homes and the high street to primary and secondary care. That work is being undertaken as part of the implementation of the UK antimicrobial resistance strategy. To further develop the use of diagnostics in clinical practice, we are investing £1.3 million of research funding through the National Institute for Health Research. That research is being undertaken by Cardiff University, focusing on GPs’ use of the C-reactive protein test to help to target antibiotic prescribing to patients with chronic obstructive pulmonary disease. It will be interesting to see how that research goes, and I am sure we will return to it.
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In addition to the important work to improve appropriate prescribing, we should not forget the vital role of infection prevention and control—it was good to hear my hon. Friend the Member for Erewash note that. We have made significant progress, with dramatic reductions in some infections in recent years, but there is always more to do. We can make a significant contribution to that agenda by improving our ability to prevent infections in the first place. That includes work with NICE to develop clinical guidance and best practice information.
We have strengthened the code of practice on the prevention and control of infections to clarify for providers the measures needed to ensure effective infection prevention and antimicrobial stewardship. We will also improve infection prevention and control by introducing an indicator, as part of local antimicrobial resistance implementation plans from April next year, to help CCGs. That will be another good opportunity, from the spring, to ask CCGs how their plans are going and whether they can explain what they are doing locally. It was good to hear Erewash CCG being cited. I am sure my hon. Friend will hold its feet to the flames, as will others.
Let me touch briefly on the international scene. It was good to hear my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) talk about India. I had the pleasure of talking to the Indian Health Minister about this very topic at the World Health Assembly in Geneva in May. Tonight’s debate is not about the international aspect, but I would be delighted if any Member wanted a debate focusing on that, because the UK can be proud of our record in that regard. To give one example, as part of our focus on global antimicrobial resistance, the UK has committed £195 million over five years to the Fleming fund, which will support antimicrobial and infectious disease surveillance in developing countries, where we know drug resistance has a disproportionate effect. We were delighted to see all 194 member states agree to the World Health Organisation’s global action plan at the World Health Assembly earlier this year. The Government are now working towards the UN General Assembly in 2016 and are continuing to champion this agenda there.
Let me conclude by reaffirming our commitment to delivering improvements in the way antibiotics are used in the NHS. I take the challenge that my hon. Friend the Member for Erewash has highlighted and we will make sure that the NHS hears that from tonight’s debate. The work we have undertaken, and are continuing to undertake, means that we now have significantly better data and information on how antibiotics are used in both primary and secondary care, but we have much more to do. I welcome tonight’s debate as a reminder of the task that lies ahead of us.