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House of Commons

Tuesday 5 January 2016

The House met at half-past Two o’clock


[Mr Speaker in the Chair]

Oral Answers to Questions


The Secretary of State was asked—

Out-of-hospital Care

1. John Howell (Henley) (Con): What progress his Department has made on integrating and improving care provided outside hospitals. [902858]

The Minister for Community and Social Care (Alistair Burt): Happy new year, Mr Speaker—and happy new year to the familiar faces opposite in the shadow Cabinet.

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 the integration pioneers such as Torbay and Greenwich. The Government remain fully committed to delivering integration through programmes such as the better care fund and the vanguards.

John Howell: Seventy per cent. of people would prefer to die in their own homes, yet we still allow 60% of people to die in hospital. This has to change, as it has in the Netherlands owing to the better social care provided outside hospitals. What message would the Minister give to clinical commissioning groups, such as mine, which are trying hard to bring this about and to integrate services?

Alistair Burt: I am grateful to my hon. Friend for raising this issue. We share his view: we want to see greater choice in end-of-life care so that people are able to be cared for and die in the place they choose and which is appropriate to their needs, whether that is a hospice, a hospital or their own home. The recent Choice review set out a vision of enabling greater choice at the end of life. I am working with NHS England to see how this can be best achieved and the Government expect to comment on that soon.

Debbie Abrahams (Oldham East and Saddleworth) (Lab): The Health Secretary recently received a letter from a range of social care organisations and charities panning the spending review offer, saying it

“is not sufficient to resolve the care funding crisis”

and warning of an

“increasing number of older people”

without sufficient support,

“increasing pressure on the NHS.”

Will the Health Secretary finally admit that the offer in the autumn statement is just not good enough?

Alistair Burt: That social care was an important part of the Chancellor’s spending review was noted by all. Up to £2 billion will be available through the social care precept—that will be added to council tax—and there is a further £1.5 billion available by 2020, so all in all £3.5 billion will be available by 2020. We all know resources for social care are tight; that is why we need best practice everywhere to make the best use of resources, which many leading authorities are already doing.

David Tredinnick (Bosworth) (Con): As my right hon. Friend considers integrating and improving care outside hospitals, will he discuss with the Secretary of State the medical system in the People’s Republic of China, which brings together western medicine, herbal medicine and

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acupuncture and which is bearing down on the demand for antibiotics? Before he responds to the Report on the Regulation of Herbal Medicines and Practitioners, will he look very carefully at dispensing arrangements for the small-scale assembly of herbal products, something the Government of the People’s Republic of China are very interested in?

Alistair Burt: Herbal products are slightly beyond my normal portfolio remit, but anything that assists in social care and makes people feel better and can add to their vitality and wellbeing is to be welcomed. I am sure in many local areas they are taken extremely seriously.

Jim Shannon (Strangford) (DUP): I thank the Minister for his response. Integration and improving care outside of hospitals is just one way we can revolutionise the health service. Will the Minister outline any links his Department is exploring between reducing pressure on A&Es and using care provision outside of hospitals to facilitate reducing that pressure?

Alistair Burt: Absolutely, and a number of the pilots and pioneer programmes are doing just that. Early results from the living well programme in Penwith in Cornwall show a 49% reduction in non-elective admissions to hospital and a 36% reduction in emergency admissions to hospital. So the hon. Gentleman is right: better social care and better integration may have, and should have, an impact on hospital admissions and make sure people are receiving the most appropriate care in the most appropriate place.

Kevin Foster (Torbay) (Con): I was pleased to hear the Minister’s reference to the integrated care organisation that is being created in my constituency. Given the increasing challenge of providing social care to those in the later stages of life, does he agree that this is a model that needs to be looked at, and will he give it as much support as he can?

Alistair Burt: Indeed; the ability to see how these pilot projects respond to the different demographics in different areas enables one area to learn from another. Torbay has come up frequently in this context, and I am pleased to be able to praise it again. While I am on my feet, I should also like to point out that many of those involved in adult social care were greatly affected by the recent flooding in the north of England and that they were looking after vulnerable people and working beyond the front line. That work was very important, and I am grateful to Ray James of the Association of Directors of Adult Social Services and to all those working in local authorities in the affected areas who contributed so well to looking after vulnerable people during that period.

Luciana Berger (Liverpool, Wavertree) (Lab/Co-op): The report on the appalling failures at Southern Health NHS Foundation Trust highlighted the fact that more than 1,000 unexpected deaths of mental health and learning disability patients, many of which took place outside hospital, had not been investigated. Given that the Health Secretary did not allow the House an opportunity to scrutinise those findings before Christmas, will he or the Minister respond today to the widely held concern that the experience of that NHS trust is not an isolated one? Does the Minister agree that a national public investigation is now needed?

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Alistair Burt: The hon. Lady is quite right. As my right hon. Friend the Health Secretary said in relation to that urgent question, this is a wider concern. That is why the Care Quality Commission is looking at the picture of what has happened nationally. These deaths have not been investigated appropriately in the past, and that must change. This Government are determined to change a range of things in relation to mental health and learning disabilities, and this is one area that has been forgotten for too long. It has now been brought to light, and work is being done by the Government.

GP Services

2. Scott Mann (North Cornwall) (Con): What progress his Department is making on increasing access to GP services. [902859]

The Secretary of State for Health (Mr Jeremy Hunt): Welcome back, Mr Speaker. As part of our commitment to a seven-day NHS, we want all patients to be able to make routine appointments at their GP surgeries in the evenings and at weekends, and 2,500 out of 8,000 surgeries are currently running schemes to make that possible.

Scott Mann: Many working people are asked to phone their GP surgeries very early in the morning to book appointments, but that is not always convenient when they are going about their day-to-day work. Will my right hon. Friend tell me whether priority will be given at weekends to people who are working during the week?

Mr Hunt: My hon. Friend is absolutely right. That system does not work for people who have to go to work, and we want to make it easier for people to book appointments online or using an app on their phone. We also want to make it easier for people living in rural areas such as his constituency of North Cornwall to have telehealth appointments where appropriate, so that they can see someone without actually having to go to the surgery.

Mr Ben Bradshaw (Exeter) (Lab): Given the increasing difficulty that members of the public are having in getting an appointment with their GP quickly and at a time that is convenient to them, does the Secretary of State believe that his predecessor was wrong when, as one of his first acts, he scrapped Labour’s 48-hour GP access guarantee?

Mr Hunt: No I do not, because that had perverse consequences. When that target was in place, the number of people waiting to see a GP increased rather than decreased. In the last Parliament, the number of GPs went up by around 1,600—a 5% increase in the workforce—and we have plans to increase it by 13%, which would be one of the biggest-ever increases in the GP workforce in the history of the NHS, on the back of a strong economy.

Jesse Norman (Hereford and South Herefordshire) (Con): The Secretary of State will be aware from personal experience of the excellent work being done by GPs in Herefordshire, who won one of the first seven-day-a-week

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pilots. Can he assure me that this work will continue to be funded, as it is doing an extraordinarily good job in helping my constituents?

Mr Hunt: We are very pleased with the progress that is being made in Herefordshire and in many other areas, and we are looking at how to maintain funding for those areas. Already, 16 million people are benefiting from enhanced access to GPs in the evenings and at weekends, and we would not want to see the clock being turned back on that.

Fiona Mactaggart (Slough) (Lab): Today I received a letter from the chair of Slough’s clinical commissioning group, in which he bemoaned the fact that GP practices were making 95% of patient contacts yet receiving only 8% of the NHS’s resources. He also claimed that there had been a 30% reduction in GP partners’ incomes in the past five years, and said that more and more GPs in Slough were turning to private practice. I have noticed that they are also resisting the creation of new GP practices. What is the Secretary of State doing to ensure that under-doctored areas such as mine get more GPs?

Mr Hunt: First, may I ask the right hon. Lady to congratulate, on my behalf, GPs in Slough, who have benefited from the Prime Minister’s challenge fund? Alongside a number of other schemes, it has had a significant impact on reducing emergency admissions in her area. The answer to the point she makes is that we are investing an extra £8 billion in the NHS over the course of this Parliament—it is £10 billion when we include the money going in this year. We have said that we want more of that money to go into general practice, to reverse the historical underfunding of general practice, which I completely agree needs to be reversed.

Hospital Trusts: Deficits

3. Anna Turley (Redcar) (Lab/Co-op): What proportion of hospital trusts are in deficit. [902860]

The Parliamentary Under-Secretary of State for Health (Ben Gummer): Three-quarters of trusts are reporting a deficit for the conclusion of the first half of this financial year.

Anna Turley: John Appleby, the chief economist at the independent think tank the King’s Fund, said recently that although the Government claim they will get an increase in funding in the NHS, they have

“in effect, already spent the money”

because of the scale of the hospital deficits. In my South Tees area, the deficit for 2014-15 is nearly £17 million. Will the Minister accept that the Government have totally lost control of NHS finances?

Ben Gummer: The first point to make is that this Government have provided the money for the NHS that it has asked for—this is money the Opposition refused to say they would pledge at the last election. The second point to make is that Jim Mackey, the new chief executive of NHS Improvement and one of the best chief executives in the NHS, has said that he will help to get hospital trusts in control next year, and that, with the transformation fund announced by my right hon. Friend the Secretary of State, we are confident we will be able to get hospital trusts into balance next year.

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Andrew Stephenson (Pendle) (Con): Does the Minister agree that clamping down on expensive temporary agency staff is an important step in helping to sort out the NHS and allowing it to balance the books?

Ben Gummer: My hon. Friend is entirely right, and we are already having an impact. We had to bring in the requirement for safer staffing rotas because of the catastrophe at Mid Staffs and the need to try to staff hospitals better, and that had an immediate consequence which called for agency workers. Unfortunately, some companies have taken advantage of that situation, but we have introduced measures to stop that and are already having an impact across the service.

Paul Farrelly (Newcastle-under-Lyme) (Lab): The University Hospitals of North Midlands NHS Trust faces a deficit of £19 million for 2015-16, but until the NHS’s Staffordshire review is completed it faces uncertain prospects further out, not least as it has taken over Stafford county hospital recently. The hospital wrote to the Minister before Christmas, so will he meet hospital management and local MPs as soon as possible this new year to discuss this uncertain situation and the progress on the whole Staffordshire review?

Ben Gummer: I would be happy to meet them, I will meet them and I congratulate them on eliminating 12-hour trolley waits for the first time this year. They are doing a great job in difficult circumstances, as are many hospitals across the country. I am confident that they, too, will be able to get their deficit under control next year, with the help of the transformation fund, which is available for high-performing trusts.

Rare Diseases

4. Mr David Hanson (Delyn) (Lab): How many people have diseases classified by his Department as rare. [902861]

The Parliamentary Under-Secretary of State for Health (Jane Ellison): A rare disease is a life-threatening or chronically debilitating disease that affects five people or fewer in 10,000. Research shows that one in 17 people will suffer from a rare disease at some point. In the UK, that equates to approximately 3.5 million people.

Mr Hanson: Same But Different, which is based in my constituency, is concerned about a number of the challenges faced by people with rare diseases. One key issue that it has raised with me is the level of support available at the time of diagnosis, particularly for parents of children with rare diseases. Will the Minister examine how we can signpost better help and support to those who have been diagnosed?

Jane Ellison: I am glad the right hon. Gentleman mentions that point; the House may not be aware that we recently added four new rare diseases to the newborn heel-prick test, which has helped to detect more than 1,400 children with a rare disease. I am disappointed to hear that he feels that some parents had issues with follow-up, and of course we will look into that, but I think he will find that the UK rare diseases strategy, which was published in 2013 and contains 51 commitments from government, covers that. The first report back on

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that strategy will take place this spring and it is being done by the UK Rare Disease Forum. I am happy to speak to him afterwards about whether the excellent organisation he names is part of that.

Mrs Cheryl Gillan (Chesham and Amersham) (Con): One such rare disease is Duchenne muscular dystrophy. I am sure the Minister is aware that we are awaiting what we hope will be a positive decision from NHS England on a drug called Translarna, which could help boys with the disease. We were due to have that announcement yesterday. Does she have any further and better particulars on that? Will she update us on when we can expect an announcement, which we hope will be a positive one?

Jane Ellison: I know that my colleague, the Under-Secretary of State for Life Sciences, is working very hard on that matter, and is hoping to make an announcement soon. I am sure that, at that point, he will be able to update my right hon. Friend.

Greg Mulholland (Leeds North West) (LD): With regard to ultra-rare diseases, I will be joining the family of seven-year-old Sam Brown on 23 January to celebrate the funding of Vimizim. I thank all those involved in that decision, including those in the Department. As well as an update on Translarna, can we also have an update on the possibility of funding another drug that we have been campaigning for, which is Everolimus for tuberous sclerosis?

Jane Ellison: I thank the hon. Gentleman for his words, as does my hon. Friend the Under-Secretary of State for Life Sciences. With regard to the matter that he just mentioned, I know that it is something that NHS England is reviewing and it will come forward with a view in due course.

Michael Fabricant (Lichfield) (Con): Will my hon. Friend join me in praising the work of the Institute of Translational Medicine at the University of Birmingham Medical School? It is doing outstanding, world-wide standard work in developing cures and treatments for such rare diseases, and indeed for more common diseases such as cancer.

Jane Ellison: I absolutely join my hon. Friend in that and agree with his very well-deserved words of congratulation. I know that the Under-Secretary of State for Life Sciences has visited the institute and is—as everyone is—hugely impressed with it. I also join my hon. Friend the Member for Lichfield (Michael Fabricant) and others in congratulating Charlie Craddock on his CBE in the new year honours list.

Andrew Gwynne (Denton and Reddish) (Lab): Patients living with rare cancers often have fewer treatments available to them. Often, the only option is to use off-label treatments. The cancer drugs fund has helped patients gain access to those treatments, but, despite a Conservative party manifesto commitment to continue investing in it, the fund is now under threat because of central Government cuts. What assurances will the Minister provide to people living with rare cancers that off-label drugs will still be funded? Will she apologise for the uncertainty that those cuts are causing to the thousands of people who are affected by cancer in England?

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Jane Ellison: I certainly do not recognise the shadow Minister’s characterisation of the cancer drugs fund. Some £1 billion has been committed to it and it is being reviewed. The fund was introduced by the previous Government, and we are very proud of it. It has made a big difference to the lives of more than 80,000 patients. More widely, the recent cancer taskforce published its report, “Achieving world-class cancer outcomes”, and it made many recommendations, which are particularly relevant to rarer cancers and blood cancers, many of which focus on improving access to diagnostic testing.

Mark Pritchard (The Wrekin) (Con): Of the 7% of the population that will suffer at some point in their life from a rare disease, 75% are children. Unfortunately, 30% of those will not reach their fifth birthday. What more can be done for Great Ormond Street hospital and for Birmingham children’s hospital, which do such excellent work?

Jane Ellison: My hon. Friend is quite right to highlight the number of people who will be affected by such diseases. There are between 6,000 and 8,000 rare diseases. Among the things that the Government are doing that will make a really big difference to some of the institutions that he mentioned and others, and particularly to sufferers, is the 100,000 genomes project, in which the Government have invested. The creation of a network of genetic medicine centres will underpin that further development of genetic testing services. As a very large proportion of rare diseases are genetically based, we want to make significant progress with that genomic work.

Social Care Budgets: A&E Attendance

5. Christian Matheson (City of Chester) (Lab): What assessment he has made of the effect of changes to social care budgets on A&E attendances. [902862]

The Parliamentary Under-Secretary of State for Life Sciences (George Freeman): Our health and care system is under extraordinary rising demand from an ageing society. There are a million more pensioners this year than there were at the beginning of the previous Parliament, and there will be another million by the end of this Parliament. The number of adults needing care in the next 10 years will rise from 180,000 to 264,000. That is why integration of health and care is so important, and it is why I am delighted that my right hon. Friend the Chancellor announced in the autumn statement £3.5 billion for social care by 2020 through the new adult precept and extra funding for the NHS five-year forward view.

Christian Matheson: In any given week at the Countess of Chester hospital, 70-plus elderly patients pitch up and cannot be discharged because care is not available elsewhere. We know that the Government broke their promise before the election to sort out funding for long-term care, and the King’s Fund recently said that the settlement to which the Minister refers will put

“even more pressure on … the NHS to pick up the pieces when there’s a breakdown in … care”.

Will the Minister now accept that that continuing neglect and those broken promises are the key cause of the crisis in our A&E departments?

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George Freeman: Well—happy new year! Only Labour could take a £3.5 billion commitment to fund social care as “more pressure”. We are leading the way in integration—not before time, after 14 years in which Labour did nothing. We are leading the way on integration and putting in the extra money. I am delighted to say that, through the £3.8 billion for this coming year and the £10 billion funding for the NHS Five Year Forward View for transformation, it is the Conservative party that is investing in a 21st-century NHS. Labour seems to want to take us back to “Call the Midwife”.

Andrew Bridgen (North West Leicestershire) (Con): Does my hon. Friend agree that it is an important step to devolve powers to local authorities, as they are best placed to commission care services for local populations?

George Freeman: My hon. Friend makes an excellent point. The key is, of course, more funding and more integration, but crucially more local leadership too, and we are actively making it easier through the devolution programme for local authorities and local health leaders to plan the integrated services that are appropriate for their area. Not all areas are the same.

17. [902874] Jenny Chapman (Darlington) (Lab): Having listened to what the Minister has to say, people in my constituency will be disbelieving. The number of days that patients are stuck in hospital, not because they are sick but because there is nowhere to move them, has doubled under his Government. He has to acknowledge that that is due to the neglect of local government and adult social care specifically.

George Freeman: It is true that in different areas there are different pressures. In my own area of Norfolk there are pressures. Let me remind the hon. Lady that A&E spending has gone up dramatically over the past decade, from £900 million in 2001 to £2.4 billion. The early evidence from the better care fund, which we launched only this year to tackle this very issue, is 85,000 fewer delayed transfers, 12,000 more older people at home within three months of discharge, and nearly 3,000 people supported to live independently. Through more funding, greater freedoms and local devolution, we are supporting health leaders and council leaders to bring together health and care.

David T. C. Davies (Monmouth) (Con): Despite the pressures, is it not excellent that 95% of patients who present at A&E in England are seen within the target time, unlike in Wales, where the figure is only 81%, as a result of the fact that the NHS is run by members of the Labour party?

George Freeman: My hon. Friend makes an excellent point. We hear very little from the Labour party about Wales, where it is responsible for the health service, and an awful lot of questions about England, where fortunately it is not responsible. If we want to get pressure on A&E down, we need to integrate and invest as we are doing in prevention and in keeping people out of unnecessary A&E admission.

23. [902881] Norman Lamb (North Norfolk) (LD): The Health Foundation estimates that the gap in social care funding by 2020 will be £6 billion, not taking into

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account the increase in the minimum wage, so although the spending review narrows the gap, it still leaves an enormous gap which will result in further cuts in social care. How will the Government avoid the totally unacceptable situation in which those with money will still get good care and those without money will get substandard care or no care at all?

George Freeman: I pay tribute to the right hon. Gentleman. He is a Norfolk colleague and as Minister did a lot of work in this area. He raises an important point that as a society we need to think profoundly about how we integrate health and social care. As I say, the Government have made a £3.5 billion commitment from the new precept and the better care fund is a significant commitment, but he is right—we will have to go further. Through the devolution programme and the integration programme, we will have to develop more powers so that local health leaders and care council leaders can better integrate services to reduce unnecessary pressure.

Dr Philippa Whitford (Central Ayrshire) (SNP): In Scotland, A&E performance is published weekly, but since June that in England has been published only every month and now after a six-week delay. Since that time, the performance in Scotland has risen and 96% of people were seen within four hours in Christmas week, which is a huge challenge, whereas the last data published for England were for October and show a figure below 90%. Do the Minister and the Secretary of State accept that to improve performance we need to return to more timeous and frequent analysis and publication?

George Freeman: I share the hon. Lady’s interest in data and in proper information. We need to be a little careful about Scottish figures. Over winter, England publishes three times more A&E performance measures than Scotland every week. We publish quality rankings on hospitals, care homes and GP surgeries, which Scotland does not. What we do not hear about in Scotland is A&E closures, A&E diverts, emergency admissions, general and acute beds—I could go on. It is dangerous to compare data that were not prepared on the same basis, but I share the hon. Lady’s enthusiasm, as does the Secretary of State, for information.

Dr Whitford: I am aware that the renewed strike call from junior doctors has actually been called in order to meet the new rules created by the Government’s own union laws and that negotiations are ongoing. To avoid an impact on hospital waiting times, what will the Secretary of State bring to the negotiating table to try to reassure junior doctors?

George Freeman: I am delighted to be able to announce—the hon. Lady might already have heard this—that the Secretary of State has appointed Sir David Dalton from Salford Royal to lead on that. I repeat the offer that the Secretary of State made this morning: we are very close to an agreement, so the right approach is not to strike, but to come to the table and reach it.

Barbara Keeley (Worsley and Eccles South) (Lab): Three hundred thousand fewer older people have publicly funded care packages than in 2010, and nearly half the current record level of hospital delayed discharges are

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due to waiting for a care package, and that will get worse as winter pressures mount. It is risky that the proposed increases in the better care fund are back-loaded; they do not reach £1.5 billion until 2019-20. The social care precept funding is uncertain because it will raise only £1.6 billion by 2020 if every single council decides to raise the maximum possible. Social care is in crisis now. Can the Minister explain why the Government are proposing risky, uncertain and late funding?

George Freeman: This is the most extraordinary welcome for one of the most important announcements in the autumn statement. Having come under pressure to raise more money for social care, the Chancellor and the Secretary of State announced £3.5 billion extra for social care, from the new adult social care precept and the better care fund. The Opposition say that it is not enough and that it will fail, but the data do not support that. If we look at the early data from the better care fund, which was introduced by this Government early last year, we see 85,000 fewer delayed transfers, 12,500 more older people at home within three months of discharge and 3,000 people supported to live independently. We are making real progress.

Hospital Trusts in Special Measures

6. John Stevenson (Carlisle) (Con): What progress his Department has made on improving the performance of hospital trusts in special measures. [902863]

The Secretary of State for Health (Mr Jeremy Hunt): Eleven of the 26 hospitals that have been put into special measures have exited that regime because of good clinical progress, the most recent being Morecambe Bay NHS Foundation Trust, which exited in December 2015.

John Stevenson: Given that North Cumbria University Hospitals NHS Trust has been in special measures for two and a half years, that there are now serious concerns about the wider health economy in north Cumbria, and that we have the success regime in place, will the Minister now give a commitment that the Government will ensure that the acquisition of the trust will happen?

Mr Hunt: First, I thank my hon. Friend for the campaigning he does for his local hospital. He knows that I very much support that merger and hope that it will go ahead. It is worth paying tribute to the staff at the trust, who have brought down mortality rates to within the NHS average. The Care Quality Commission says that plans to improve safety are working well. We should celebrate the fact that even the trusts in special measures have hired 700 more doctors and 1,800 more nurses and are making real progress in improving patient safety.

Rob Marris (Wolverhampton South West) (Lab): Private finance initiatives are costly and damaging; they always have been and always will be. Can the Secretary of State tell us what percentage of hospitals in special measures have had significant PFI funding?

Mr Hunt: I can write to the hon. Gentleman with the details, but I can tell him now that the Government inherited £70 billion of PFI debt, which has caused enormous pressure throughout the NHS.

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Suella Fernandes (Fareham) (Con): Although Southern Health NHS Foundation Trust is not in special measures, its performance has been criticised in an independent report, particularly in relation to poor investigation of deaths of people with learning disabilities and mental illness. I welcome the Secretary of State’s rapid action and his announcement of a CQC inquiry. Will he update the House on the progress of the inquiry and when it is expected to report?

Mr Hunt: The inquiry has only just started, but I thank my hon. Friend for her interest in it. The important conclusion that we have drawn from what happened at Southern Health is that this issue is much broader than one trust. We are not as good as we need to be at investigating unexpected mortality in the NHS. Southern Health is perhaps an extreme example, but the problem is much more widespread. A cultural change is needed, and we are determined to do something about it.

Tim Farron (Westmorland and Lonsdale) (LD): Will the Secretary of State undertake to support Morecambe Bay, the other hospital trust in Cumbria, as it moves out of special measures, by confirming the commitment made by the coalition Government to underwrite the capital costs of a radiotherapy unit at Westmorland general hospital and to support the uplift in tariff needed to sustain that unit?

Mr Hunt: I will happily look into that. I cannot give the hon. Gentleman the answer now, but we would want to do everything we can to support that trust. It has been through a very difficult time and has made huge progress. We want to help it on its way.

Prostate Cancer: Docetaxel

8. Mr Peter Bone (Wellingborough) (Con): What his policy is on making docetaxel available as a treatment for prostate cancer. [902865]

The Parliamentary Under-Secretary of State for Life Sciences (George Freeman): Docetaxel is routinely available in England for the treatment of metastatic prostate cancer, where the disease has not responded to hormone treatment. It is not at the moment licensed for use alongside hormone treatment and has not been appraised by the National Institute for Health and Care Excellence for that indication. In the absence of NICE guidance, NHS commissioners are free to make funding decisions on the best available evidence.

Mr Bone: I thank the Minister for stating the current practice. A constituent of mine has prostate cancer. His doctor, consultant and oncologist all say that he would benefit from taking docetaxel, but it is not available in Northamptonshire, although it is available in parts of the rest of the country. He has been told that if he goes down the road to the private hospital, he can have it at £2,700 a cycle. Is that not unacceptable? Should he not get the treatment on the NHS and should he not get refunded the monies paid for private treatment?

George Freeman: I congratulate my hon. Friend on being a diligent advocate for his constituent Mr Vann. I am delighted to tell him that the result of the STAMPEDE clinical trial has now been published. Today NICE is

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publishing an evidence review. NHS England will shortly be publishing its interim commissioning policy based on that evidence. That is very encouraging.

Wi-fi in Hospitals

9. Daniel Kawczynski (Shrewsbury and Atcham) (Con): What assessment his Department has made of the need for wi-fi infrastructure in hospitals to facilitate use of developing healthcare technologies. [902866]

The Parliamentary Under-Secretary of State for Life Sciences (George Freeman): Digitalisation of healthcare is absolutely essential for the 21st-century NHS—for individual care, for system performance and safety, and for research. Wi-fi is an important part of that, with benefits for doctors, nurses, hospital management and patients. That is why I am delighted that my right hon. Friend the Secretary of State secured the necessary funding in the comprehensive spending review to fund fully the NHS’s plans for digitalisation and transformation. We have announced that we are implementing Baroness Martha Lane Fox’s recommendation of free wi-fi in all NHS hospitals.

Daniel Kawczynski: I am grateful for that answer. The new chief executive of the Royal Shrewsbury hospital informed me that people can receive wi-fi in only half of the hospital area. Can the Minister give me an assurance that everything will be done to ensure that wi-fi is available throughout the Royal Shrewsbury hospital?

George Freeman: That is an important point. It is up to each hospital to implement digitalisation in its own way, but we are putting in place a series of steps to make sure that all parts of the NHS are supported and encouraged in the drive for delivery of a paperless NHS by 2020. In the new year, we are requiring the clinical commissioning group digital index, which will measure the digitalisation of all health economies, and we are launching a review of best practice. We are absolutely committed to driving digitalisation so that the 21st-century NHS is not running on paper and cardboard.

Rural Healthcare Strategy

10. Anne Marie Morris (Newton Abbot) (Con): What plans he has to publish a rural healthcare strategy. [902867]

The Parliamentary Under-Secretary of State for Health (Ben Gummer): The “Five Year Forward View” published by NHS England sets out the healthcare strategy for the whole of England, including rural areas. Rural areas have their own health needs, which should be taken into account in planning and developing healthcare systems.

Anne Marie Morris: What specific research has the Minister undertaken in order to understand, and what steps has he taken to address, the very different needs and costs of rural communities in the south-west, which has disproportionately high numbers of over 85-year-olds and population distributions that make inflexible multi-speciality community providers and primary and acute care configurations unattainable?

Ben Gummer: The “Five Year Forward View”, written by Simon Stevens, takes particular account of rural areas, but of course not all rural areas are the same. It is

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down to clinical commissioning groups to judge the needs of their local areas and make sure that they are reflecting the specific circumstances in which they find themselves.

Non-invasive Pre-natal Treatments

11. Tulip Siddiq (Hampstead and Kilburn) (Lab): What progress his Department has made on expanding access to non-invasive pre-natal treatments in hospitals. [902868]

The Parliamentary Under-Secretary of State for Health (Ben Gummer): Non-invasive pre-natal testing is not currently offered routinely for screening women in pregnancy for Down’s syndrome and other trisomy conditions within the NHS. However, it is available to detect genetic changes leading to specific skeletal abnormalities and certain forms of cystic fibrosis. The UK national screening committee has reviewed the case for implementing NIPT as part of the existing foetal anomaly screening programme and will provide its advice shortly.

NIPT is not currently offered for Down’s syndrome routinely within the NHS. Some NHS trusts have piloted the test for screening and a number of maternity units offer NIPT privately. NIPT is available through the NHS to detect genetic changes leading to specific skeletal abnormalities and also to detect certain forms of cystic fibrosis.

The UK national screening committee—UK NSC—which advises Ministers and the NHS in the UK about all aspects of screening policy, has reviewed the case for implementing NIPT as part of the existing NHS foetal anomaly screening programme and will provide its advice in the new year.

Tulip Siddiq: At my 12-week scan, I was told that I faced a risk of Down’s syndrome in my child. I was given two options. One was an invasive test available on the NHS—the amniocentesis test, which carried a risk of miscarriage. The second was a non-invasive test, which was not available on the NHS and cost £400. Does the Minister agree that the non-invasive test should be rolled out across the country so that mothers, regardless of wealth, can have equal access to screening and do not have to face the unnecessary risk of miscarriage?

Ben Gummer: I thank the hon. Lady for bringing her personal experience to the House, and I hope that all is well. She will understand that screening has to be a non-political matter. That is why we have a specific, clinically led committee to look at whether a screening programme should be implemented. It has been looking at NIPTs over the past year and will be making its decision very shortly. On the principle, though, I completely agree with her; it lies at the foundation of the NHS and we support it.

Clinical Commissioning Group Transformation Plans

12. Philip Davies (Shipley) (Con): What assessment he has made of the adequacy of clinical commissioning group transformation plans in addressing the needs of (a) all vulnerable children, (b) children in the care system, and (c) children who have been abused. [902869]

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The Minister for Community and Social Care (Alistair Burt): NHS England has assured local transformation plans that cover all clinical commissioning groups, ensuring that all the plans address the full spectrum of need for all children and young people, including looked-after children and those who have been sexually abused and/or exploited. Further thematic analysis is being carried out, and the results will be made available in March.

Mr Speaker: I think it is a case of wishing the hon. Gentleman a happy birthday.

Philip Davies: Thank you very much, Mr Speaker—much appreciated.

Children who have suffered the trauma of abuse may benefit from a range of therapeutic services, but there is a lack of consistent data about the number of abused children in need of therapeutic support and the number of services available. Can the Minister assure me that as part of plans to transform children’s mental health, the needs of abused children will be properly monitored and considered at every level?

Alistair Burt: I am grateful to my hon. Friend not only for his question but for previous questions in relation to this area and his obvious interest and concern about it. He is right. Nationally, the numbers of looked-after and abused children in the new prevalence survey—the first since 2004—would be relatively small. We have therefore asked the statisticians to look at different ways of assessing the data and the numbers so that we can address this issue. I hope to be able to report further on that later in the new year after I have had that meeting.

Nurse Training

13. Maria Caulfield (Lewes) (Con): What steps he plans to take to increase the availability of nurse training in the NHS. [902870]

The Parliamentary Under-Secretary of State for Health (Ben Gummer): I thank my hon. Friend for asking this question. I can tell her that we have made significant steps. In the past two years, there has been an 11% increase in nurse training places, and I anticipate that that increase will continue this year. We are providing over 23,000 full-time-equivalent additional nurses by 2019. We expect there to be an additional 10,000 nurse training places as a result of the announcements made by my right hon. Friend the Chancellor last year.

Maria Caulfield: Speaking as a nurse, I would struggle to undertake my nurse training given the proposed changes to the bursary scheme. I know that the Minister is working very hard on this, but will he outline what additional routes into nursing are planned to help mature students and those on a low income to gain access to nurse training?

Ben Gummer: My hon. Friend is right to point out that there are different ways into nursing. Just a few weeks ago, we announced a massive expansion in apprenticeships across the NHS, and I anticipate that a significant number will be for those going into nursing. The new post of nursing associate is a vocational route into nursing via an apprenticeship. In addition, our reforms to bursaries will ensure that there is a 25% increase in funding to recipients, bringing it into line with the

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rest of the student cohort. That cohort has seen a considerable expansion in the number of students coming from disadvantaged backgrounds as a result of the reforms that we undertook in 2011 and 2012.

Helen Jones (Warrington North) (Lab): Does the Minister accept that his Government’s decision to cut nurse training places by 3,000 a year since 2010 has led to the huge shortage of nursing staff in the NHS and an increased reliance on nurses recruited from abroad and expensive agency staff, and that that will get worse with the abolition of bursaries? Is not this a textbook example of a false economy from the Government?

Ben Gummer: The hon. Lady should look at the facts. March 2015 saw a record number of nurses in the NHS—319,595. We are increasing the number of nurse training places. We are able to increase them by considerably more than we could have done otherwise, as a result of the reforms to student finance that bring nurses into line with teachers and other public sector professionals.

Justin Madders (Ellesmere Port and Neston) (Lab): It would be good to hear the Minister concede that it was a bad idea back in 2010 to cut the number of nurse training places. Even today we are still training fewer nurses than we were in 2009. Not only have this Government failed to recruit enough nurses, they have failed to retain them too: last year there was a 12% increase in the number of nurses leaving hospitals. With staff morale already at an all-time low, why does the Minister think it is right that nurses should be burdened with a lifetime of debt to pay for his Government’s mistakes?

Ben Gummer: The hon. Gentleman raises a reasonable point about attrition rates: they have remained too high for too long. One of the things we are undertaking at the moment is to talk intensively with universities to see how we can reduce attrition rates. We have had some success in some areas, but I want to see far more. It is important that students stay on their courses as much as possible. Of course, many go into community nursing. I would be prepared to write to the hon. Gentleman about further actions we are taking on attrition rates.

Children and Young People’s Mental Health

14. Amanda Solloway (Derby North) (Con): What steps his Department is taking to involve young people in plans for improving children and young people’s mental health. [902871]

The Minister for Community and Social Care (Alistair Burt): Clinical commissioning groups have produced local transformation plans to transform their local offer for children and young people’s mental health. Those plans were decided at local level in collaboration with children, young people and those who care for them. I remember my visit to Derby very well, and I am pleased to say that the NHS in that area has collaborated extremely well with young people to produce those plans.

Amanda Solloway: Last year the Derby youth council ran a consultation on the provision of mental health services in Derby, which highlighted the disparity of services among different trusts. What steps is the Minister

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taking to ensure that NHS trusts across the UK offer the same level of support for those suffering from mental health issues?

Alistair Burt: My hon. Friend is absolutely right. I have talked more than once at this Dispatch Box about the variation in performance on different issues around the country. Two or three things will help. On funding and resources, there is a better tracking system to make sure that money that goes into children and young persons’ mental health services will be spent appropriately. More money is going into that. Equally, a children and young persons’ mental health improvement team is working across the national health service to make sure that those variations are evened out so that good practice in the best areas becomes the practice of all.

Topical Questions

T1. [902883] John Pugh (Southport) (LD): If he will make a statement on his departmental responsibilities.

The Secretary of State for Health (Mr Jeremy Hunt): Yesterday evening the British Medical Association regrettably decided to walk away from the talks on a new junior doctors’ contract and announced plans for strike action. We had made significant progress in negotiations on 15 of the 16 areas of concern, including doctors’ hours and patient safety, and will now do everything we can to make sure that patients are safe. We promised the British people we would deliver truly seven-day services and, with study after study telling us that hospitals have higher mortality rates than should be expected at weekends, no change is not an option.

John Pugh: I thank the Secretary of State for that response. He will recall the 3 million lives telehealth programme. Since then, it has all gone rather quiet on telehealth. What is the Government’s current strategy on telehealth and what pump-priming funding is there for it?

Mr Hunt: I thank the hon. Gentleman for his consistent interest in telehealth. The technology landscape has changed significantly since the 3 million lives programme was launched in 2012. We are absolutely committed to it, but we do not want to isolate a few individuals who we think would particularly benefit from it, because we think everyone could benefit from being able to talk to their GP via video conferencing or whatever. The plans we will announce for technology in the next few months will show how we can roll it out to an even wider audience.

T4. [902886] Michael Tomlinson (Mid Dorset and North Poole) (Con): Following the assisted dying debate, will the Department set out what steps it is taking to improve end-of-life care, and will Ministers join me in praising local hospices such as Forest Holme hospice in Poole, which serves my constituents?

The Parliamentary Under-Secretary of State for Health (Ben Gummer): I will certainly join my hon. Friend in praising the work of hospices. It is a unique contribution in the world of healthcare and we should be proud of their efforts. He will know that I have a commitment to end-of-life care and to improving it. I hope shortly to

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make announcements in response to last year’s NHS Choices review. I have been talking intensively to people from the sector about what might or might not be possible.

Heidi Alexander (Lewisham East) (Lab): It is a sad state of affairs when a new year starts with the prospect of industrial action in the NHS. Nobody wants strikes, not least the junior doctors, but they feel badly let down by a Health Secretary who seems to think that contract negotiations are a game of brinkmanship. When will he admit that changing the definition of unsocial hours and the associated rates of pay for junior doctors is a forerunner to changing a whole load of other NHS staffing contracts to save on the NHS pay bill? That is what all this is really about, isn’t it?

Mr Jeremy Hunt: No, it isn’t. May I start by wishing the hon. Lady every success in retaining her post in the shadow Cabinet? It would be a shame to lose her, having started to get to know her.

This is a difficult issue to solve, but at least the country knows what the Government are trying to do. The hon. Lady, on the other hand, has spent the last six months avoiding telling the country what she would do about these flawed contracts. Now is her chance. Would she change the junior doctors contract to improve seven-day services for patients—yes or no?

Heidi Alexander: Junior doctors do not need warm words from me, stood at the Opposition Dispatch Box; they need action from the Secretary of State to stop the strikes and give patients the care they deserve.

Not content with alienating one group of staff, the Health Secretary now has another target: student nurses. The disastrous decision in the first half of the last Parliament to cut nurse training places has driven the rise in the agency staff bill. We all know that we need more nurses to be trained, but why should a trainee nurse who spends half their degree caring for patients not receive a bursary? If they are on a ward at 3 o’clock in the morning, why should they be expected to pay for the privilege?

Mr Hunt: The hon. Lady cannot have it both ways. She cannot stand here and criticise cuts in nurse training but oppose the Government’s changes that mean we will be able to train 10,000 more nurses over the course of this Parliament. Let me tell her why there are 8,500 more nurses in our hospital wards since I became Health Secretary. It is because of the Francis inquiry into Mid Staffs. It is this Government that recognise the importance of good nursing in our wards. We did not sweep the problems under the carpet. She should give us credit where it is due.

T7. [902889] Matt Warman (Boston and Skegness) (Con): In Boston in my constituency, as many as one in four children are classified as obese. Will the Minister reassure me that in the forthcoming obesity strategy, the Government will acknowledge that they are allowing families and, indeed, children the opportunity to take the control of their own lifestyles that will fix this problem, rather than seeking to do it for them?

The Parliamentary Under-Secretary of State for Health (Jane Ellison): My hon. Friend is right that there is a really important role for families. More than anything,

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the Government want to make the healthy choice the easy choice for families. However, young children are not in control of the whole of the food environment around them, as I am sure he would acknowledge. The Government’s forthcoming strategy is focused on children. Obesity is a complex issue and, frankly, everyone needs to play their part—the Government, local government, health professionals, industry and families.

T2. [902884] Pat Glass (North West Durham) (Lab): The Health Secretary just tried to tell us why we have 8,500 more nurses in the NHS. Let me tell him why it is. It is because we have record recruitment from abroad. Since the Chancellor announced the scrapping of bursaries for trainee nurses and midwives, there has been a worrying reduction in the number of applications for next year’s training, compared with what we would expect to see at this time of year. That can only have a negative impact on the number of trained nurses from this country and on net migration. Was there any discussion between the Department of Health, the Home Office and the Chancellor before this idiocy was introduced?

Ben Gummer: We have record levels of nurses in training and a record number of nurses in practice because of the decision by my right hon. Friend the Health Secretary to increase nurse training by 11% over the past two years. We can expand that significantly due to our reforms to the funding of nurse training. As regards nurses from abroad, part of the reason we are undertaking this change is so that every putative nurse in this country can have the opportunity of having a nursing position. At the moment, we have to limit those positions because of the funding regime that is in place.

T8. [902890] Jake Berry (Rossendale and Darwen) (Con): Will my right hon. Friend join me in paying tribute to the first responders in Rossendale, who support the ambulance service by attending 999 calls to very serious cases, including one involving a friend of mine over Christmas? Will he in particular pay tribute to Brian Pickup, who is stepping down as team leader of the first responders after 11 years of unpaid public service?

The Minister for Community and Social Care (Alistair Burt): I am delighted to do so. First responders have been a valued addition to the frontline of allied health professionals whom we can all support, and I am delighted to pay tribute to Brian for the work that he has done. I am sure that I speak for everyone in the House in saying a warm thank you to all those who have been part of the first responder scheme for the effort they have put in.

T3. [902885] Helen Hayes (Dulwich and West Norwood) (Lab): On too many occasions, children in my constituency who need to be admitted to a psychiatric in-patient bed have to wait for more than a day in accident and emergency before a tier 4 bed is found. Too often, available beds are outside London, and sometimes as far away as Nottingham, Glasgow or Southampton. How long does the Minister believe it is acceptable for a child to wait in A&E for a tier 4 child and adolescent mental health services in-patient bed to become available? Does he consider it acceptable for very unwell children to be sent such a long way from home for the treatment and care that they need?

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Alistair Burt: In short, no. That is why there has been a drive to find more beds for children and young people who are having a serious crisis, but more support is also going into community services to prevent such crises in the first place. There will always be a need for some specialist beds to be available regionally or nationally, and not everything can be dealt with locally. Where people can be treated locally they should be, and we are working towards that.

T10. [902892] Mark Garnier (Wyre Forest) (Con): The Worcestershire Acute Hospitals NHS Trust now finds itself in special measures, and today its chairman has resigned, largely as a result of an over-extensive and highly complex review of clinical services in the county that has so far failed to reach an agreed conclusion. Given the complexity of the review process, and the apparent impossibility of it reaching an agreed conclusion, what steps can the Government take to untie the Gordian knot that created that situation and help the trust to get back on a stable footing?

Ben Gummer: My hon. Friend is right and there is a particularly complex series of circumstances in Worcestershire. I am determined to do something about that, and I want to meet him and his colleagues in the next few days to discuss possible options. I will then discuss those issues in turn with NHS England.

T5. [902887] Andy McDonald (Middlesbrough) (Lab): The management at James Cook university hospital in Middlesbrough is seeking to increase nurses’ current 30-minute meal break, which they struggle to take, to a compulsory unpaid 60-minute break that will result in nurses effectively working one shift a month unpaid. In their judgment that will do nothing to address the real issues of staff shortages and patient safety, but will merely disadvantage patients and nurses alike. Will the Secretary of State investigate the matter and write to me?

Ben Gummer: I thank the hon. Gentleman for bringing that issue to the attention of the House. All contracts should be governed by the “Agenda for Change” contract, and I would be concerned if there were deviations from that. I would welcome further detail on that so that I can respond to him.

Dr Sarah Wollaston (Totnes) (Con): Nobody wants to return to the days of exhausted junior doctors being forced to work excessive hours, and the Secretary of State will know that that is why junior doctors have expressed concern about the potential impact of removing financial penalties from trusts. Will the Secretary of State set out what has happened during the negotiations to reassure the public and doctors about patient safety?

Mr Jeremy Hunt: I hope I can reassure my hon. Friend, because we have said that we will not remove financial penalties when doctors are asked to work excessive hours. To quote from the letter that I received from the chief negotiator about our offer to the British Medical Association:

“Any fines will be paid to the Guardian at each Trust, allowing them to spend the money on supporting the working conditions or education of doctors in training in the institution.”

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T6. [902888] Paul Blomfield (Sheffield Central) (Lab): Before Christmas the Chancellor pledged to match the charitable fundraising of Great Ormond Street hospital to a maximum of £1.5 million, using money from outside the health budget. The Secretary of State will know that Great Ormond Street is one of only four specialist children’s hospital trusts in the UK, and one of the other three is in my constituency. Does he agree that the Government’s matched funding should be extended to all four trusts, and will he join me in making that case to the Chancellor?

Mr Hunt: I am happy to look charitably on the wishes of the hon. Gentleman, without, of course, making any guarantees.

Nigel Adams (Selby and Ainsty) (Con): Nicole, the daughter of a constituent of mine, is currently suffering from mental health issues. She has been held in a transparent police cell overnight after self-harming, with drunks on either side, as there are no other facilities available near York. Clearly, police stations are not appropriate places for secure care. What is the Minister doing to ensure that adequate places are available locally, and that police, should they need to become involved, know how to provide a less traumatic experience for mental health patients?

Alistair Burt: My hon. Friend is absolutely right. There has been a 54% reduction in the use of police cells for mental health cases in the past three years. This is being improved by work of the local crisis care concordat. My right hon. Friend the Home Secretary will later this year introduce legislation to prevent children and young people from being held in police cells at all, but the use of police cells has gone down dramatically because of the use of the crisis care concordat. We will continue that process.

T9. [902891] Martyn Day (Linlithgow and East Falkirk) (SNP): Yesterday, the Ministers’ offer to junior doctors had still not dealt with the important issue of weekend working and appropriate compensation. As a result, doctors in England will be forced to strike and the Minister will have damaged the patient safety he claims to value. Instead of attacking consultants and junior doctors, will he follow the example of the Scottish Government and work with the medical profession to help the NHS face the challenges of increased demands and private finance initiative-induced deficits?

Mr Speaker: Project, man, project! We wish to hear the full gist of what the hon. Gentleman has to say to the House.

Mr Jeremy Hunt: We absolutely will work with the medical profession to have proper seven-day services throughout the NHS in England. I hope that the hon. Gentleman and Scotland, which has the same issues with weekend mortality rates, will follow the lead of NHS England.

Mr Robin Walker (Worcester) (Con): May I thank the Minister for his helpful answer to my hon. Friend the Member for Wyre Forest (Mark Garnier)? Further to that question, having recently met the clinical leadership at Worcester Royal hospital, they are adamant that they

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want permanent management in place at the hospital. The Care Quality Commission report said that the number of interim directors was one reason why it was put into special measures. Can the Minister reassure me that he will be doing everything he can to put in place permanent long-term management at the Worcestershire Acute Hospitals NHS Trust as quickly as possible?

Ben Gummer: I can assure my hon. Friend of precisely that.

Paula Sherriff (Dewsbury) (Lab): Mid Yorkshire Hospitals NHS Trust is planning to implement a significant reconfiguration plan 12 months earlier than was agreed by the Secretary of State. Dewsbury hospital will be significantly downgraded before infrastructure is in place to ensure that patients still receive vital care safely. Will the Secretary of State meet me to discuss this premature move, which appears to be purely financially driven and not in the best interests of my constituents?

Ben Gummer: I thank the hon. Lady for bringing that issue to the notice of the House. The reconfiguration she mentions is the responsibility of local commissioners, but I am very happy to meet her, and anyone she wishes to bring with her, to discuss the planned changes.

Helen Whately (Faversham and Mid Kent) (Con): My local mental health trust recently reduced its psychiatric liaison cover in A&E and is now considering the level for the coming year. Will my right hon. Friend provide an update on what the Government plan to do to ensure specialist mental health care in A&E?

Alistair Burt: The mental health taskforce will shortly bring forward its recommendations. It will be looking very carefully at what is provided in A&E. It was the subject of the crisis care concordat review by CQC earlier last year. I am looking specifically at psychiatric liaison, because I saw my hon. Friend’s written question very recently.

Graham Jones (Hyndburn) (Lab): What demographic impact assessment has the Secretary of State’s Department made of the potential withdrawal from the European Union on health and social care, and the consequent result it would have on demands for its services?

Mr Jeremy Hunt: None whatever.

Ben Howlett (Bath) (Con): In the previous Parliament, many people who suffer from a rare disease were pleased with the publication of the Government’s rare diseases strategy. What progress is the Minister making on publishing the ultra-rare diseases strategy?

Jane Ellison: I am happy to look into that and get back to my hon. Friend. With regard to the 51 recommendations made in the UK rare diseases strategy, he will be pleased to know that the first report on that will be in spring. I will take up the other issue with him after questions.

Danny Kinahan (South Antrim) (UUP): Health is a devolved matter, but devolved Governments may choose not to spend when it comes to expensive rare diseases and diagnoses. What more can Westminster do to help my constituents?

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Jane Ellison: One example, which I am sure the hon. Gentleman will welcome, is the fact that the four UK Health Departments, along with Cancer Research UK, are jointly funding a network of 18 experimental cancer

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medicine centres aimed at driving the development and testing of new anti-cancer treatments to deliver benefits for patients, including those with rarer cancers. That is just one example of how we can work together.

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Speaker’s Statement

3.35 pm

Mr Speaker: I am pleased to be able to announce to the House that, following fair and open competition, Her Majesty the Queen has graciously accepted my recommendation that Mr Mohammed Amal El-Hajji—usually known as Kamal El-Hajji—be appointed to the post of Serjeant at Arms with effect from 1 February. Mr El-Hajji has been Head of Front of House and VIP Relations at the Ministry of Justice since 2010 and has also held a number of administrative and security roles in the Department for Constitutional Affairs and the MOJ since 2001. In addition to being trained in the martial arts and a recipient of the British Empire Medal, Mr El-Hajji will be the first person of a black and minority ethnic background to hold the post of Serjeant at Arms.

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EU Council

3.36 pm

The Prime Minister (Mr David Cameron): With permission, Mr Speaker, I would like to make a statement on the European Council meeting that took place before Christmas. The Council focused on three issues: migration, terrorism and the UK’s renegotiation. I will take each in turn.

First, on migration, even in winter there are still many migrants coming to Europe, with over 3,000 arriving via the eastern Mediterranean route each day. Of course, Britain is not part of the Schengen open border arrangements, and we are not going to be joining; we have our own border controls, and they apply to everyone attempting to enter the UK and every day help to keep us safe. Let me repeat: these controls apply to all, including EU citizens. We have stopped nearly 95,000 people at our borders since 2010, including almost 6,000 EU nationals. These people were not allowed to come in.

What Schengen countries are now trying to put in place is a pale imitation of what we already have. What they do, of course, is a matter for them, but it is in our interests to help our European partners secure their external borders. So we have provided more technical expertise to the European Asylum Support Office than any other European country, including practical assistance to help with the registering and fingerprinting of migrants when they arrive in countries such as Greece and Italy. We have focused on the root causes—not just the consequences—of the migration crisis. That is why we continue to play a leading role in the efforts of the international Syria support group to end the conflict in Syria through a political process and why we have backed the agreement reached recently in Morocco that should pave the way for a new united, national government in Libya. We have deployed HMS Enterprise to go after the people traffickers in the Mediterranean and have provided £1.12 billion in humanitarian assistance for the Syrian conflict—by far the largest commitment of any European country and second only to America. In addition, the donor conference I am hosting next month with Germany, Kuwait, Norway and the United Nations will help further by raising significant new funding to help refugees in the region this year.

The Council focused on implementing the previously agreed measures on refugee resettlement. In Britain, we said we would resettle 20,000 Syrian refugees during this Parliament, taking them directly from the camps, and I can tell the House that, exactly as we promised, over 1,000 Syrian refugees from camps in Turkey, Jordan and Lebanon were resettled here in time for Christmas. These people are now in homes, their children are starting this new year in our schools and they can look forward to building a new life here in Britain.

Many in the House have called for us to take more refugees or to take part in the EU relocation and resettlement schemes. The reality is that we have already done significantly more than most of our EU partners in this regard. The House might be interested to hear the figures: by the time of the December Council, only 208 refugees had been relocated within the EU out of the 160,000 agreed, and in all other member states put together, according to the most recent statistics, just

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483 refugees had been resettled from outside the EU under the EU’s voluntary resettlement scheme. The point is clear: we said what we would do, and we got on and did it.

Turning to terrorism, the latest appalling video from Daesh is a reminder of its brutality and barbarism. It is desperate stuff from an organisation that hates us not for what we do, but for what we are—a democratic multi-faith, multi-ethnic nation built on tolerance, democracy and respect for human rights. Britain will never be cowed by terror. We will stand up and defend our values and our way of life, and with patience and persistence, we will defeat these extremists and eradicate this evil organisation.

I am sure the whole House will want to join me in paying tribute to the British servicemen and women who have spent this Christmas and new year away from their families. In the last month, RAF aircraft have conducted 82 strikes in Iraq and Syria. In recent weeks, the priority of the international coalition has been supporting the Iraqi security forces’ successful recapture of Ramadi, to which our airstrikes made an important contribution. They have also helped Kurdish forces to repel major Daesh counter-attacks in northern Iraq. In Syria, there have been 11 RAF strike missions, 10 against Daesh-controlled oil infrastructure and one against Daesh terrorists near Raqqa. We continue to fly intelligence, surveillance and reconnaissance missions, providing vital support to our other coalition partners.

As for the discussion at the Council, we now have a clear agreement on rules to share passenger name records. This is a vital breakthrough, but we still need to go further, so the Council agreed to take forward urgent proposals on more systematic data sharing, on stepping up our co-operation on aviation security and on working together to do even more to starve Daesh of money and resources, choking off the oil and clamping down on firearms and explosives to stop them getting into the hands of terrorists. We also agreed to do more across Europe to counter the extremist propaganda and the poisonous ideology of Islamist extremism that is the root cause of the terrorism that we face. The threat from Daesh is a threat to us all, and we must stand together to defeat it.

Turning to the UK renegotiation. I have set out the four areas where Britain is seeking significant and far-reaching reforms: on sovereignty and subsidiarity, where Britain must not be part of an “ever-closer union” and where we want a greater role for national Parliaments; on competitiveness, where the EU must add to our competitiveness, rather than detract from it, by signing new trade deals, cutting regulation and completing the single market; on fairness for countries inside and outside the eurozone, where the EU must protect the integrity of the single market and ensure there is no disadvantage, discrimination or additional costs for a country like Britain, which is not in the euro and which in my view is never going to join the euro; and on migration, where we need to tackle abuses of the right to free movement, and deliver changes that ensure that our welfare system is not an artificial draw for people to come to Britain.

This is the first time a country has tried to renegotiate its membership of the EU from a standing start. Many doubted it was even possible, but at this Council we had

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an entire session focused on this issue, lasting several hours, and with almost every European leader contributing. I am happy to go into detail on what was an extensive discussion, but the key points were these. There was strong support for Britain to stay in the EU. European leaders began their remarks by saying not that Britain is better off in Europe, but that Europe would be better off with Britain staying in it. All wanted to reach an agreement that would address the concerns we have raised. There was extensive discussion of all four areas, and difficulties were raised with all four of them. The most difficult issues were around free movement and welfare.

There was, however, a great deal of good will. At the end of the discussion, the Council agreed—and I quote directly from the conclusions—that we would

“work closely together to find mutually satisfactory solutions in all the four areas”.

I think it significant that the conclusions talk about solutions, not compromises, and I made it clear that these solutions would require changes that were legally binding and irreversible. So while each of these areas will require hard work, I believe that there is now a pathway to an agreement.

Later this week, I am continuing my efforts to secure that agreement with further discussions in Germany and Hungary, and I hope we can reach a full agreement when the Council meets again next month. What matters is getting the substance right, not the speed of the deal. If we can see this through and secure these changes, we will succeed in fundamentally changing the UK’s relationship with the EU, finally addressing the concerns that the British people have over our membership. If we cannot do that, as I have said before, I rule nothing out.

My intention is that, at the conclusion of the renegotiation, the Government should reach a clear recommendation, and then the referendum will be held. It is the nature of a referendum that it is the people, not the politicians, who decide, and as I indicated before Christmas, there will be a clear Government position, but it will be open to individual Ministers to take a different personal position while remaining part of the Government. Ultimately, it will be for the British people to decide this country’s future by voting in or out of a reformed European Union in the referendum that only we promised and that only a Conservative majority Government were able to deliver. I commend this statement to the House.

3.45 pm

Jeremy Corbyn (Islington North) (Lab): I thank the Prime Minister for his statement, a copy of which I received a short time ago. I wish you, Mr Speaker, the Prime Minister and the House a very happy new year. I hope that the Prime Minister will not misinterpret that greeting in any way whatever and will take it in the spirit in which it is meant—[Interruption.] Thank you.

Last month, I travelled to Brussels to meet European leaders, including Prime Ministers, to discuss the issues our Prime Minister has raised today. I learnt a lot at that meeting. I learnt that the Prime Minister has botched his negotiations with European leaders. I also learnt that many of our European colleagues have an intuitive understanding of British politics—they know that the Prime Minister has asked for help so that he can win a referendum he never wanted to hold.

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Does the Prime Minister now accept that his attempts to bludgeon leaders into accepting his flawed reforms have failed and that he has come back with very little? Can he really be surprised at his failure, when he has not worked with his negotiating partners in Europe, and failed even to turn up when asked for help on the European refugee crisis? To deliver change, you need patient, effective diplomacy and you need to make friends.[Interruption.] Indeed we all value our friends. But the Prime Minister is not interested in that; he is more interested in his own party. He is playing politics, rather than putting forward the interests of the people of this country.

Can the Prime Minister now explain whether his Government will have a view on the choice facing the people of this country in the referendum, and how will that be reached and expressed? What has he had to say to Lord Heseltine, who said Britain would become

“a laughing stock across the world”

if the Prime Minister made the announcement he has today? Leaders across Europe can see that the Prime Minister’s demands are a bluff, a fig leaf for Conservative party politics. Does he accept that his bluff has now been called?

The Prime Minister said that he wanted to secure more for national parliaments in the EU. It is now clear that he has achieved nothing of any substance on that point. Does he also accept, as experts have warned, that his proposals for reforming migrant benefits are not only likely to be ineffective in reducing any inward migration, but are discriminatory and unfair and likely to be legally challenged? Can he confirm that he has now abandoned those plans altogether? Can he also confirm once and for all that he has dropped his utterly disgraceful plans to weaken what is already weak workers’ protection in this country when compared with the workers’ protection offered in other European countries?

Essentially, the Prime Minister’s proposals are a distraction. The real issue is about delivering a better, more cohesive, more democratic and progressive Europe that promotes security and protection for workers, and delivers investment and a productive economy to support jobs and sustainable growth. That is why in the upcoming referendum we will fight to ensure those things are delivered in the European Union as part of a progressive reform agenda.

I would like to ask the Prime Minister something more about the refugee crisis, and what he is doing to help in this growing humanitarian crisis. First, I want to put on record my thanks to the Royal Navy and all other service personnel working in the Mediterranean trying to save lives. They have done a great job and they have saved a very large number of people who were desperate to cross the Mediterranean and find a place of safety. What funding is Britain offering to assist in the collective effort to deal with the refugee crisis across Europe? There is a very serious crisis in many countries on the borders of Europe, and we also face the present situation in Calais.

Can the Prime Minister confirm that Britain is fully part of, and signed up to, the negotiated political peace process to try to bring about a ceasefire in the Syrian civil war, and is he in a position to update us on anything to do with that?

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Does the Prime Minister agree that we now need a pan-European humanitarian relief programme, co- ordinated by the United Nations, to assess the status of all refugees and provide proper refugee support? The Government are simply not going far enough to help those in need. Will the Prime Minister commit himself to accepting at least 20,000 refugees over the next two years, rather than the next five? Will he support calls for Britain to take in 3,000 vulnerable and unaccompanied children who are currently in a quite desperate situation?

Does the Prime Minister not recognise that by isolating Britain from Europe, he is making it more difficult for us to work as partners on all these issues, and that once again he is putting the politics of his own party above the national interest? Will he join me in seeking a more progressive union across Europe which will deliver welfare and security to our workers and our economy, rather than the agenda that he has put before us today?

The Prime Minister: Let me wish the right hon. Gentleman—along with you, Mr Speaker—a very happy new year. Let me also apologise for interrupting what is clearly the longest reshuffle in history. We could have watched the entire run of “Star Wars” movies, but we still do not know who has been seduced to the dark side. There is absolutely no sign of a rebel alliance emerging either: I can see that.

The right hon. Gentleman had the temerity to say that this was a referendum that I did not want. This is a referendum that I put to the British people in a manifesto. It is odd to hear such talk from the right hon. Gentleman, who has a shadow Foreign Secretary whom he does not want.

The right hon. Gentleman asked a number of questions. Let me now answer them. He asked whether the Government would make a clear recommendation. Yes, we will: I said that very clearly in my statement. He asked whether the national Parliament measures were still in place. Yes, they are, and they received a warm reception from a number of other European countries. He asked about welfare benefits. Our four-year proposal remains on the table. I have said that I am very happy to look at alternatives, but I will not take my proposal off the table until I see something equally effective being put forward.

I would just note that at the last election, it was Labour policy to ask people coming to this country to live and work here for several years before claiming benefits. [Interruption.] Labour Members can all call out about what a great policy it was, but it has now been abandoned by their leader. Never mind how many Eagles we end up with; I think we have all worked out that they have an albatross at the head of their party. [Laughter.]

The right hon. Gentleman asked about refugees. I think he was right to praise the Royal Navy for the work that it does. As for funding, let me make it very clear that we believe the EU can do more, but the EU has a generous budget to which we are a significant contributor. In all our conversations we asked the EU to use its existing budget, knowing that countries like Britain have made huge contributions, outside the EU budget, to the excellent United Nations programmes. If only other EU countries were as generous to those programmes as we have been, we would ease the Syrian refugee crisis by a huge amount. As I said in my statement, we have contributed £1.12 billion.

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The right hon. Gentleman asked whether we were signed up to the Syrian peace process. Yes, we are. We have been one of the leading players behind that process. There was a good meeting in New York in December, but more meetings will be needed to bring about the ceasefires and the political discussions that are necessary. I will keep the House updated on that, as will the Foreign Secretary.

The right hon. Gentleman asked whether we would take more migrants. I think that the 20,000 resettlement is the right number. I stress again that we have gone ahead and delivered what we said we would, which is in stark contrast to many other promises made by other countries. He asked about the issue of the 3,000 orphans. I said in the Syria debate that we would look seriously at that issue, but there are problems. Of course we can think about helping, but we must be careful to ensure that we are not removing people from their wider families. We need to look carefully at those who have tragically lost parents.

Finally, the right hon. Gentleman claimed that somehow we were isolated in Europe, when we are leading the debate on Syria, leading the debate on Libya and leading the debate on security, and I have to say that, after his visit to Brussels, when other Prime Ministers and Presidents were not asking about terrorism or migration or indeed the British negotiation, another question on their lips was, “What on earth has happened to the British Labour party?”

Mr Kenneth Clarke (Rushcliffe) (Con): Does the Prime Minister remain confident that he will obtain a full British opt-out from the ever-closer union commitment, which until recently—in recent years—has been the principal demand of Eurosceptics, who claim to see a threat to the future independence of this country if we stay in the EU? Now that some of our right hon. and hon. Friends are taking an unaccustomed interest in benefit rules, will he confirm that his proposal on the table for a four-year limitation is stimulating a discussion with other countries anxious to take away unnecessary draws to their countries of other EU nationals, to find a solution so that we have coming here only people who will work legally in a way that benefits the British economy?

The Prime Minister: My right hon. and learned Friend makes two very powerful points. First, the ever-closer union does matter, not purely as a symbolic issue, but because it does get used as an interpretation by the European Court and has been one of the things that people feel has driven something of a ratchet in terms of EU law, so it is vital that we are fully carved out of that. He is right as well about benefits. Of course this is a controversial issue in Europe, but other countries share our concerns. Indeed, some of the countries that people are leaving are also concerned about the potential hollowing out of their countries as so many young people in their 20s and 30s leave. My point is simple: Britain has benefited hugely from migration and we should continue to support migration and free movement, but the extra artificial draw that our in-work benefit systems can bring badly needs to be addressed.

Angus Robertson (Moray) (SNP): It is our first day back in Parliament so this is our first opportunity to say that our hearts go out to all around the country who are

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suffering from the recent and ongoing flooding. In particular we think of the families who have lost loved ones, and who have endured damage to their homes and their businesses, and we should put on record our appreciation for the response of the emergency services and of neighbours, friends and total strangers who have been making a difference.

The biggest European challenge in 2016 is not the negotiations of the Prime Minister and his position on Cabinet splits, which have been described by Swedish statesman Carl Bildt as “more than bizarre”; the biggest issue for our continent is the refugee crisis, the instability in the middle east and the threat of terrorism. Three EU member states have immigration opt-outs: the UK, the Republic of Ireland and Denmark. But both Ireland and Denmark are part of the EU refugee programme, while the UK has stood aside. Given the overwhelmingly warm welcome and positive humanitarian response in the UK to Syrians fleeing conflict, will the Prime Minister reconsider that position? At least, will he follow the advice of the Select Committee on International Development and help more refugee children, just as the UK did with Jewish children in the past through the Kindertransport?

On the instability in the middle east, how is the Prime Minister going to step up diplomatic support for the Vienna process and help secure a ceasefire in Syria? Does he understand the growing concern about the worrying confrontation involving Saudi Arabia and Iran? Is it not time, however, to do more than just condemn those who behead, crucify and shoot those they disagree with? Is it not time for concrete action by the UK Government?

On European reform, it is an open secret that three of the four demands of the Prime Minister are so limited that they are almost universally uncontentious. On EU citizens working in the UK, why do we not hear more from the Government about their positive contribution to our communities, public services and the private sector, and the massive tax bonus the UK receives from EU taxpayers living in the UK? Will the Prime Minister confirm that this positive EU bonus massively outweighs any abuses of in-work benefits?

Will the Prime Minister finally—because he has had many opportunities to do this—give a guarantee that if Scotland votes to remain within the EU, it will stay within it? [Interruption.] The public at home will hear the groans from the Conservative Benches; the people of Scotland want to know if they will be taken out of the EU against their will. Will the Prime Minister give that guarantee today—he has failed to do it thus far?

The Prime Minister: On the right hon. Gentleman’s last point, Scotland had a referendum on whether to remain part of the United Kingdom, and the former Scottish First Minister, now the right hon. Member for Gordon (Alex Salmond), and I signed the Edinburgh agreement, which said that both sides had to respect the outcome of that referendum. That is the only answer that the right hon. Member for Moray (Angus Robertson) needs.

I join the right hon. Gentleman in paying tribute to the emergency services and the Army for the incredible work they have done during the recent floods. Our hearts go out to all those who have had homes, businesses and shops flooded. Let us also pay tribute to the amazing

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spirit of the British people who have come together at Christmastime and made huge sacrifices to help to each other. It is remarkable what those communities have done.

In answer to the right hon. Gentleman’s question on the EU refugee programme, we believe that our resettlement programme is better run by ourselves. We have done it well and quickly, and we have brought more people into Britain from Syria than other countries have been able to resettle. We are also able to carry out our own safeguarding checks on those people. I have already answered the question on the 3,000 orphan children, which we are looking at again.

The point that the right hon. Gentleman made about three of the four things we are asking for being uncontentious is simply not true. I encourage him to spend more time talking to European colleagues about just how difficult these things are to achieve. On the issue of the Vienna process, we have a clear view that we condemn and do not support the death penalty wherever it takes place, Saudi Arabia included. On the Vienna process, we have to find a way of trying to get Iran and Saudi Arabia into the room at the same time to negotiate what will happen in a Syrian transition. We have to be clear that that is our greatest priority. Dealing with the Syrian crisis, which is the source of so much of the terror that we face and the source of the migration crisis that is facing Europe, has to be top of mine.

Crispin Blunt (Reigate) (Con): Does the Prime Minister agree that the focus on the success or failure of his renegotiation risks diverting attention from issues of much greater substance, including the implication for Britain’s role in the world of the decision to stay or leave, and the costs and benefits to the UK of being part of a free EU labour market, given that the introduction of the living wage will dwarf the effect of any benefit entitlements as a draw for people to come to the United Kingdom?

The Prime Minister: Once this negotiation is complete, people will have to ask the big question about whether Britain is better off inside or outside a reformed European Union. The question will also be about whether we will be safer and more prosperous. I believe that this renegotiation will make a difference on competitiveness, on sovereignty, on the euro and on the issue of migration. People will also be asking the bigger question about whole of the position of Britain in Europe, and what the Government and I are doing is making sure that the choice people face is not between the status quo and leaving altogether but between an important amendment to the status quo and leaving altogether. It is right that we get that right.

Yvette Cooper (Normanton, Pontefract and Castleford) (Lab): Before Christmas, I met 11 and 12-year-olds who were living in the “jungle” in Calais. They are of a similar age to my children and those of the Prime Minister, but they are alone and separated from their parents. They are vulnerable to exploitation and prostitution, as well as to the cold, to bronchitis and to scabies. The longer the Prime Minister looks at this proposal to help 3,000 children, the more of them will simply disappear. The proposal has cross-party support, and I urge him to agree today to work with Save the Children on a plan for Britain to help 3,000 unaccompanied children from across Europe. Just agree to the principle today!

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The Prime Minister: We are going to consider this in a very proper way, as I said during the Syria debate, because there are different views among the non-governmental organisations about whether this is the right approach to take. I have said this at the Dispatch Box before. On the question of the people at Calais, we are clear that we will do everything we can to help the French with border security and with helping to process people who are in France, but at the end of the day, people do not have the right to try to break into Britain against our rules. Those people in Calais should be properly processed and dealt with by the French.

Sir William Cash (Stone) (Con): My right hon. Friend has just stated that his package would “require changes” that are “legally binding and irreversible”. As there is no treaty change on offer, on what grounds can he legitimately and honestly contend that an international agreement registered at the UN would be legally binding and irreversible, and that voters—this is what matters—could absolutely rely on it when they cast their votes? Will this be a cast-iron guarantee?

The Prime Minister: There have been occasions when countries have voted in referendums, or indeed when we have voted in this House on treaty proposals, before they are adopted and implemented by every other country. What I have said is that we need changes that are legally binding and irreversible, and those are the changes I seek.

Mr Dennis Skinner (Bolsover) (Lab): The Prime Minister said that he ruled “nothing out”. If he loses this referendum, will he resign?

The Prime Minister: This referendum is the Government’s policy, and the country will decide whether we stay in the European Union or leave the European Union. What I am doing is giving the country the very best choice there can be—by a vital amendment to the status quo—but in the end it will be Britain’s choice.

Dr Julian Lewis (New Forest East) (Con): Did the Council discuss how free societies with free media should react to terrorist propaganda? The latest Daesh atrocity video seems to feature a well-known British extremist and a brainwashed child. Does the Prime Minister agree that although the broadcast media seem to have handled this material with appropriate restraint, some of the press, in the pictorial coverage, has been playing into the hands of the terrorist propagandists?

The Prime Minister: First, on what my right hon. Friend says about what Britain is doing in the EU to counter terrorist propaganda, we have taken the expertise that we have built up here and are sharing that with other European countries as we set up some new organisations. It is very important to win this battle of ideas—in some ways it is a battle of ideas, as we faced in the cold war. I am not sure I go all the way with him on what he said about “either television or newspapers”. As he said, television media have been responsible. I do not think it would be right to have some sort of blanket ban on showing any parts of these videos. Indeed, showing a part of these videos and just how ghastly and brutal this organisation is, for instance in the way it is using children, reminds everybody, not least those who

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might be tempted by this radical organisation, of just what a sick organisation it is. On the whole, the media have been fairly responsible about this, and I think it is much better to have that form of self-restraint than anything else.

Ms Gisela Stuart (Birmingham, Edgbaston) (Lab): The Prime Minister said in his statement that in relation to euro and non-euro countries he was looking for “no disadvantage, discrimination or additional costs”. That is a pretty low bar for ambition. Should he not be looking for equality and parity between euro countries and non-euro countries?

The Prime Minister: I think if we have non-discrimination, no disadvantage and no costs, that gives us the parity that we seek. I take people who do not think this is important back to the summer, when eurozone countries looked at using a European fund, to which we were a contributor, to help bail out Greece. To people who think this stuff does not matter, I say it absolutely does matter. It is vital, in order to protect the interests of taxpayers in euro-out countries, that we have these principles clearly written down and implemented.

John Redwood (Wokingham) (Con): What treaty and other changes does the United Kingdom need so that the Prime Minister can implement his extremely popular policy of cutting migration by more than two thirds?

The Prime Minister: What we need to do is address migration from both within the European Union and from outside it; if we look at the figures, we see that at the moment about half is coming from each. I do not want us to get out of the idea of free movement—British citizens benefit from being able to go to live, work and retire in other European countries—but we should be doing something about the artificial draw that our benefits system provides. That is now widely recognised in Europe. As for migration from outside the EU, which is more under our control, we need to take further steps and the Home Secretary has set them out.

Mr Gregory Campbell (East Londonderry) (DUP): The Prime Minister has indicated that the nation must “not be part of an ‘ever-closer union”. At some point shortly he will agree the date for the people to vote on this issue. What guarantee can he give that if they were to accept his promise that we would never, ever be part of a closer union in Europe, subsequent to that vote Europe would not undermine it and eventually agree to a closer union that he has promised we would not be part of?

The Prime Minister: That is a very good question. What I am seeking is a legally binding and irreversible change that carves Britain out of an ever-closer union. The way that I explain it to my European colleagues is that we do not all want the same destination. There are some countries in Europe that do seek an ever-closer union, but Britain is not one of them. We want to be there for trade and for co-operation. There are many areas where we do share our resources, ideas and even sometimes our sovereignty to get things done, but we do not want to be part of an ever-closer union, and that should be clearly set out, legally binding and irreversible.

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Dr Liam Fox (North Somerset) (Con): I completely agree with my right hon. Friend on that point. However, the European Court has never defined “ever-closer union” but it has made reference to it 55 times in judgments since 1999. Legally, how would Britain be exempted from the concept of ever-closer union unless we were exempted from all such judgments—either those that might be made in future or those historic in nature?

The Prime Minister: Clearly, if we have a legally binding and irreversible approach that says that Britain is not part of an ever-closer union then the courts cannot use ever-closer union to provide a ratchet against Britain in future court judgments. It is an important matter. I accept that it is a symbol, but symbols matter in politics. Our politics is full of symbols. A symbol of being outside this ever-closer union speaks to the British belief that we joined a common market and not a political union, but, as I have set out, it does also have a practical application.

Mr Ben Bradshaw (Exeter) (Lab): Given that the Daesh terrorist apparently responsible for the latest disgusting video and the cold-blooded murders in Syria jumped bail in Britain, does the Prime Minister regret his decision to scrap Labour’s control orders?

The Prime Minister: The experts say that the terrorism prevention and investigation measures as amended are every bit as powerful as the control orders that they replace. We must remember that those control orders were, increasingly, knocked down in court decision after court decision. If Members listen to the experts in the security services or the police, they will hear that they are content with the approach that we have.

Mrs Cheryl Gillan (Chesham and Amersham) (Con): Given that the Prime Minister has optimistically shared with us his hope that he can reach full agreement when the Council meets at the end of the month, will he also share with us the dates he is considering for this referendum? I think that we would all like to know that.

The Prime Minister: I would love to fill in my right hon. Friend’s diary. Indeed, I would love to fill in my own diary, so that I know when all these things are happening. I cannot guarantee that we will reach agreement in February. The Council agreed that we would try to reach agreement on all four issues in February; so that is the aim. If that is possible, I am keen to get on and hold a referendum. We should not do it precipitately. I have looked at precedents. I note that when Labour held a referendum in 1975, there was only a month between the completion of the legislation and the referendum, which was not enough time. When we had the referendum on the alternative vote in the previous Government that I led, the period was less than three months, which was also not enough. We should be looking for a period longer than that, but, believe me, by the time we get to the end of the referendum campaign, everyone will have had enough of the subject.

John Cryer (Leyton and Wanstead) (Lab): The Prime Minister made only one very brief mention of the principle of free movement in his original statement. Does that mean that he has completely abandoned any negotiations on free movement, or is the subject still on the table? If it is still on the table, what changes is he looking for?

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The Prime Minister: Let me be clear: I support the principle of free movement whereby people in the European Union can travel to different countries, live and work in those countries and retire in those countries if they can support themselves. We have problems with two areas. One is the abuse whereby people have used the free movement legislation to bring criminals to the United Kingdom and the other is where they take part in immigration practices that are against our rules. Those abuses need to be dealt with. As I have said, our welfare system has provided an unnatural draw to the UK and we need to further control immigration inside the EU by addressing that problem.

Sir Edward Leigh (Gainsborough) (Con): Before people cavil too much, let us pause for a moment to remember that it is only because this Prime Minister is in place, backed by all of us, that we got this referendum at all. When my right hon. Friend was having discussions with his colleagues, was there any recognition of the fact that if any of us turned up in Warsaw, we would not be entitled to benefits for years because Poland has a contributory system, and the EU is about free movement of workers, not benefit seekers? Has there been any discussion in Government of our moving to a contributory system in order to resolve this issue?

The Prime Minister: My hon. Friend makes a very good point. One of the reasons that the problem of the draw of our welfare system arises is that unlike many other European countries we have a system to which there is immediate access. People who go to live in some other European countries would have to pay in and contribute for many years before getting their benefits. I am open to all sorts of suggestions, including the one that my hon. Friend made. We need to achieve something that cuts the draw of migrants to Britain through the welfare changes that I have set out.

Jim Shannon (Strangford) (DUP): The Prime Minister referred to terrorism in his statement—terrorism in the middle east. It is all too easy to forget about the terrorist campaign in the United Kingdom of Great Britain and Northern Ireland. Today is the 40th anniversary of the Kingsmill massacre in which 10 Protestants were murdered because of their religion. The only survivor was shot 18 times and left for dead alongside his lifeless colleagues. What steps has the Prime Minister taken to ensure that people responsible cannot cross borders, as was the case 40 years ago, when those responsible fled across the border into the Republic of Ireland?

The Prime Minister: The hon. Gentleman is right to make the point that there are many victims of terrorism and families who have lost loved ones to terrorism in our own country. Even today there is still a terrorist campaign in part of our United Kingdom, and we should take a moment to pay tribute to the police and the security services who work round the clock to try to stop that happening. With reference to his question, it is important that whatever our borders are or wherever they are, we are able to police them effectively to stop criminals and terrorists crossing them.

Mr David Nuttall (Bury North) (Con): The Conservative party manifesto said:

“We will insist that EU migrants who want to claim tax credits and child benefit must live here and contribute to our country for a minimum of four years.”

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Although I am clear that in the referendum I will vote to leave the European Union, many of my constituents are waiting to see the outcome of the renegotiation. I would be grateful if my right hon. Friend could explain whether we are still insisting on that idea, or is it now simply a basis for negotiation?

The Prime Minister: No. I very much stand by what we put in our manifesto. The four issues that we are renegotiating were clearly set out there and we need to deliver in each of those four areas.

Kate Hoey (Vauxhall) (Lab): The Prime Minister is right to give his Ministers a free vote, as Harold Wilson did in 1975, but does he realise that underpinning everything in the referendum is trust? How will the British people trust anything that he brings back, dealing with a European Union that they do not trust and with institutions that they do not trust, if we do not have a proper and fully worked out treaty change?

The Prime Minister: I think people can see that this is a process in which they can trust. We promised a referendum; we have legislated for a referendum. We promised a renegotiation; that renegotiation is well on course. This is all from a Government who said they would cut the EU budget—nobody believed us, but we did; who said we would veto a treaty if necessary—nobody believed us, but we did; and who said we would bring back the largest number of powers since Britain joined the EU which, with the Justice and Home Affairs opt-out, we did. This is a Government who have a track record, but in the end it will be for the British people to make their decision about where our future is most secure.

Damian Green (Ashford) (Con): The Prime Minister laid great stress on the fight against terrorism and it is, sadly, clear that forces that hate our democracy are establishing themselves in a larger number of countries. Does my right hon. Friend agree that the ability of democratic countries to use the European Union to take measures that allow them to co-operate on a daily basis in the fight against terrorism is a key contribution to keeping British citizens and Britain’s streets as safe as they could be?

The Prime Minister: My right hon. Friend is right. In many of the debates about Europe that we have had in the past 10 or even 20 years, much of the focus has been on economic questions. When this debate comes, a lot of it will rightly focus on security questions. Although there are still many imperfections in the way border controls and the exchange of information work, there is no doubt that we will benefit hugely from the passenger name record legislation that is coming through: it does not just tell us which passengers are coming to our country but where they bought their ticket, which credit card they used and where they are from. This is vital information which, combined with the Schengen Information System information, will help us to stop terrorists getting into our country. Of course, arguments can be made on both sides, but I think the security argument will be crucial in determining what is the right future for Britain.

Mr Chuka Umunna (Streatham) (Lab): Many of those who argue for us to leave the European Union suggest that we could continue to be part of the single market

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without having to abide by any of the obligations that go with it. Does the Prime Minister know of any non-EU states that enjoy free trade with the single market but are not part of the free movement that goes with it?

The Prime Minister: The hon. Gentleman makes an important point. Look, my argument will in no way be that Britain could not succeed outside the European Union, because of course we could; we are a great country, the world’s fifth largest economy and a great trading power. The argument will be about whether we would be more prosperous and more secure inside or outside a reformed EU. To answer his question directly—I answered this when I went to Iceland—countries such as Iceland and Norway have to obey all the rules of the single market, including on the free movement of people, but without having any say on what those rules are. In Norway it has been described as democracy by fax, because the instructions comes through from Brussels, and they pay more per head to the EU than we do. It will be for the campaign responsible to make the arguments about what life would be like outside the EU, and this is a crucial question that it will have to answer.

Mr Peter Bone (Wellingborough) (Con): Grassroots Out, or GO, was launched yesterday. Politicians from different political parties are working together at grassroots level to campaign on coming out of the European Union. Given the Prime Minister’s announcement that Ministers will be free to campaign to leave, I assume that they are now free to join GO; and given that he is still saying that there are significant difficulties and that he might eventually decide to recommend not staying in the EU, will he consider joining GO at some time in the future?

The Prime Minister: I will look carefully at what happens when you “pass go”! I believe that we are getting closer to an agreement on Britain’s renegotiation, and at that point—not before—although the Government will have a clear recommendation, Ministers will be able to campaign in a personal capacity on a different side, as I have said. But that needs to happen after the negotiation has taken place. I think that Members on both sides of the House, and indeed members of the public and businesses and others, want to know what the renegotiation amounts to. We need to have a proper debate about what we bring back, and then people will be able to make up their minds. In the end, it will not be any of us who decides the outcome; it will be the people who put us here.

Mark Durkan (Foyle) (SDLP): It is not only Save the Children but UNICEF and others, including the International Development Committee, that are urging the Prime Minister to give a positive and decisive response on the issue of unaccompanied children. Does he recognise that the over 26,000 unaccompanied children who came to Europe last year came not just from Syria but from other places of conflict, and some of them already have relatives in the UK? Does he not think that he would be in a stronger position at the donor conference he is co-hosting next month if he had already made a clear decision?

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The Prime Minister: I think that we will be in a strong position at the donor conference because we have done more than any other country, save the United States, in terms of the funding we have given to the refugee crisis, and because, having made the 20,000 pledge, we are in the process of implementing it in very good order. I said that I would look closely at the issue of orphans. The point I have made many times is that there are different views among some NGOs about how best to handle the issue. I want to ensure that what we do is genuinely helpful for the people we are trying to assist. We know—because we can vet them and look at them—that the families we are taking out of the refugee camps are better off here, and they are the sorts of people who are most vulnerable and whom we can help the most.

Neil Carmichael (Stroud) (Con): Of course the referendum will revolve around the political advantages and economic strengths that continued membership of the European Union will bring, but, in terms of his renegotiation, does the Prime Minister agree with me that the second basket, competitiveness, will actually depend on our membership of the single market and on the European Union’s ability to create free trade opportunities across the globe?

The Prime Minister: My hon. Friend is making an important point. If we were not in the single market, we would not be able to argue for the trade deals that the single market signs or the completion of the single market in services, energy, digital and elsewhere. The calculation that people will have to make is whether we are better off in the single market, making a financial contribution towards it but having a say over its rules and its future, or whether we are better off outside, without that say but with some sort of negotiation about access. That goes to the heart of the economic pros and cons of in or out, and that is the argument that needs to take place.

Emma Reynolds (Wolverhampton North East) (Lab): The Prime Minister clearly believes that he can negotiate a good deal with our European partners and it is pretty clear that he does not want to be the British Prime Minister who takes us out of the EU. Why, therefore, has he suspended collective responsibility? Why is it not possible for him to persuade his own Ministers of his position on an issue that is so vital to our national interest?

The Prime Minister: The entire Government are signed up to having a successful renegotiation and holding a referendum. Everybody backs that plan, and the plan is being put into place, but clearly there are people who have long-standing views about the European issue. As I signalled very clearly before Christmas, it has never been my intention to strong-arm people into voting for a position they do not agree with, so I think this is the right approach. As I said, it does not effectively come into practice until a deal is done because we do not yet know what the Government’s recommendation will be or when the deal will be done. I hope it will be February, but it could take considerably longer. When you are negotiating with 27 other countries, all sorts of things can happen, but on this day of all days, to have talk from the Labour party about party unity is a bit on the rich side.

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Philip Davies (Shipley) (Con): The Prime Minister has for many years rightly berated the Labour party for giving up our rebate and getting nothing in return. If his negotiations are so meaningful, why did he not ask for our rebate to be reinstated or for a cut in our contribution to the EU budget? Is it because he does not think that we should have our rebate back any more, or because he just asked for what he knew would be agreed to so that he could claim some bogus negotiating triumph at the end of it?

The Prime Minister: I hope my hon. Friend had an enjoyable Christmas and new year; he seems to have started in a slightly churlish manner.

I would make the point that we negotiated a cut in the EU budget, not just for one year but across the seven years of what is known as the EU financial perspective—in plain language, the EU budget year on year on year. We also protected what remains of our rebate, which is still immensely powerful and saves British taxpayers a huge amount of money.

If anybody thinks that what I am asking for is somehow easy or simple, they can come and sit around that table with 27 other leaders and see that actually that is not the case. I am not claiming elder statesmanship—I think I have now been to 42 European Councils because we have had so many of these things—but I would say that what I am arguing for is at the outside edge of what we can achieve.

Mr Ivan Lewis (Bury South) (Lab): Prime Minister, on the question of European funding, hundreds of my constituents in Radcliffe have had a terrible Christmas due to the flooding that has devastated so many people’s homes and businesses in Greater Manchester and across the north of England. Bury and other councils have to pick up the infrastructure costs. The European solidarity fund exists to help in such circumstances. It would be unforgivable to put Tory party management and posturing on Europe ahead of the national interest. When are the Government going to apply for the European solidarity fund money?

The Prime Minister: First of all, I send the hon. Gentleman’s constituents my sympathy for the flooding that they suffered. Let me say that we will do everything we can, including through the Bellwin scheme, to make sure that his council is fully reimbursed for all the emergency measures that it had to take. We will also make sure that we put in place the flood prevention measures and investment that are coming down the track.

I have looked very carefully at the question of EU funding; we looked at it previously in 2013. It takes a very long time to get hold of any money and it is very uncertain whether you get it. Indeed, you end up paying for it in many ways as well. I think it is quicker and better to give people the help they need from our own resources.

Sir Edward Garnier (Harborough) (Con): Beyond the talks that my right hon. Friend is co-hosting next month, what other discussions are his Government and the other European Union Governments having with functioning Governments around the Mediterranean to inhibit terrorists who disguise themselves as refugees from Asia, the middle east and Africa?

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The Prime Minister: My right hon. and learned Friend is absolutely right to raise this issue. It is why a defence co-operation operation is being undertaken in the Mediterranean, in which Britain is playing a very leading part with HMS Enterprise, which is exactly to go after the people smugglers. In time, when there is a proper Government in Libya, we need an agreement with that country that we can stop boats, and indeed turn back boats, when we think that these people should be properly dealt with in Libya—as I say, we need to break the link between their getting in a boat and settlement in Europe. We are working with all the Governments available, but crucially we need a Government in Libya with which we can deal.

Stephen Gethins (North East Fife) (SNP): May I commend the Prime Minister for, on this day of all days, demonstrating to the Leader of the Opposition that he is not the only one leading a hopelessly divided Cabinet? Does he think that a majority of his Cabinet colleagues will be joining him in the “remain in Europe” campaign?

The Prime Minister: The entire Government are behind the strategy of holding a renegotiation and having a referendum, and we have discussed repeatedly what the issues are that need to be renegotiated. What I think is so interesting across the Opposition side of the House of Commons is that there is not one single thing they want to renegotiate. They are not asking for any welfare changes, they are not asking for ever closer union changes, they are not asking for competitiveness changes—all they want to do is come here and carp and cavil at someone who is getting the job done.

Andrew Rosindell (Romford) (Con): I welcome the Prime Minister’s commitment to end the imposition of ever closer union, if that can be achieved in a binding way for the long-term future, but my constituents want to know what is being reversed. What is happening to the ever closer union that we have been subjected to for the past 40 years, and what powers are coming back to this Parliament?

The Prime Minister: We have just achieved the biggest return of powers since Britain joined the European Union, which is the opt-out from Justice and Home Affairs, where 100 measures came back to Britain. We have seen exactly the same, and we will see more, with regard to the eurozone, where we want to make absolutely sure that we suffer no disadvantage, we cannot be involved in bail-out schemes, and the British position is protected. That is a return of power. Look at what we are trying to achieve on deregulation, where we are saying that we need deregulation targets and cuts in regulation—that is about powers coming back to Britain. If you look at what we are saying about a subsidiarity test where every year the European Council should be asking, “Are these powers and these areas of powers still necessary, and can they be returned?, you see that the whole aim of this renegotiation is to say, “Yes, we are part of a European Union that is reformed and that can achieve greater prosperity and greater security for Britain, but we are doing it as a proud nation state with institutions that serve the people who put us here.”

Kelvin Hopkins (Luton North) (Lab): The recent elections in Portugal and Spain have seen a surge in support for left-wing Eurosceptic parties and have seen

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right-wing EU-supportive parties losing their grip on power. Has the Prime Minister detected levels of concern among his fellow EU leaders about these developments?

The Prime Minister: We are all democracies, so we accept the results in each other’s elections. I am happy to say that here, a Government who took difficult decisions over the economy and the deficit actually achieved a higher share of the vote at the election than they did at the previous one; there are benefits from spelling these things out. I am committed to working with the new Portuguese Prime Minister. We will see what emerges in Spain. I work very closely with Prime Minister Rajoy, who did a very good job for his country in difficult circumstances. These election results show how we need reform in Europe. We need the competitiveness, we need the jobs, and we need the ability to compete against the rest of the world so that we can create jobs and wealth as we are doing here in Britain.

Lucy Frazer (South East Cambridgeshire) (Con): Does the Prime Minister agree that it is neither unfair nor inappropriately discriminatory to place restrictions on those who come here from other member states? This is evidenced by the fact that the original EEC treaty granted a right to residence but only to those who came to pursue an economic activity.

The Prime Minister: My hon. and learned Friend is absolutely right. One of the problems that has emerged is that the legal changes that have been made have defined free movement in a more and more generous way. It used to be the case that it was free movement to go and take a job for which you had applied, whereas today, I think I am right in saying, 60% of those who come to Britain are job applicants—they do not have a job when they come. This is another reason we need to address the welfare issue, because those people will be particularly affected by changes to in-work welfare, and we will not have that unnatural draw to Britain. Many people who come to Britain work hard and contribute and all the rest of it, but we need to make sure that our arrangements reduce the unnatural pull of migration to Britain, as my hon. and learned Friend set out.

Barry Gardiner (Brent North) (Lab): The Prime Minister has said that the EU referendum will reflect the choice of the British people, but if the choice of the British people does not reflect the choice of the Prime Minister, will he resign?

The Prime Minister: This is the choice of the British people. Our aim is to set forward a choice for the British people that they want. They can choose either to stay in a reformed European Union or to leave the European Union. Come what may, I will continue to lead the Government in the way I have.

Sir Gerald Howarth (Aldershot) (Con): May I salute my right hon. Friend’s decision to allow Ministers to exercise their freedom of choice on this very important matter? Does he accept that that is a sign not of his personal weakness, but of his personal strength, because he believes that we in this party can have a sensible debate about a fundamental issue of serious importance

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to the British people? He has just said that the negotiations may come to fruition next month. If they do, when would he envisage the referendum taking place?

The Prime Minister: I make it a policy not to answer questions beginning with “If”, even if they are put as charmingly as they are by my hon. Friend. If we can achieve a result in February, I do not think we should delay the referendum. I think we should get on and hold the referendum. As I have said, it should not be done in any unnatural haste. It needs to have a proper number of months for people to consider all the arguments, and that is exactly what will happen.

Graham Stringer (Blackley and Broughton) (Lab): The common agricultural policy puts up the price of food for people in this country and is an unnecessary burden on taxpayers. Why did the Prime Minister not try to renegotiate the CAP?

The Prime Minister: If we look at the facts of the CAP, we will see that the days of the great wine lakes and butter mountains have by and large gone, and I do not think it is possible to argue in the same way as it was in the past that it adds hugely to families’ bills. That is not what is happening. There has been quite significant reform. There has also been some fairly significant reform to the common fisheries policy. Of course, our deregulation targets and subsidiarity tests apply in all those areas.

Mr Bernard Jenkin (Harwich and North Essex) (Con): May I invite my right hon. Friend to make a list of the European laws and European Court rulings he believes depend primarily on the “ever closer union” phrase in the treaties?

The Prime Minister: I am very happy to come back to my hon. Friend. I do not have the list on me, as it were—I do not carry it around to remind me. My right hon. Friend the Member for North Somerset (Dr Fox) said that the phrase had been cited in 55 different actions. My hon. Friend the Member for Harwich and North Essex (Mr Jenkin) is one of the people who in the past said how important it was to get out of ever closer union. I say to colleagues who are considering the issue that it has been raised time and again by people like me, who are concerned about the ratchet of the European Union and who want to get this renegotiation right. If we can deliver it, let us all link arms and celebrate it.

Tom Brake (Carshalton and Wallington) (LD): The Prime Minister has heard a call from first the Labour party, then the Scottish National party, then the Social Democratic and Labour party and now the Liberal Democrats for the Government to act on the question of the 3,000 unaccompanied and vulnerable children. [Interruption.] I hope that the Prime Minister’s colleagues will listen rather than laugh. The Prime Minister has said that he is considering the matter. Would he like to tell the House at what point he is going to finish that consideration, because those children are vulnerable now?