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Mr Ellwood: I pay tribute to the hon. Gentleman’s interest and expertise in Defence matters, which he has studied for many, many years. Indeed, Labour is to be congratulated on the introduction of that very important Act. As I said to the right hon. Member for Cynon Valley (Ann Clwyd), who also has expertise in this region, the Committees are critical. They are missing from the Chamber. All sides need to work together to get the Committees on Arms Export Controls up and running as soon as possible.

Nusrat Ghani (Wealden) (Con): Will my hon. Friend detail the contribution the United Kingdom is making to alleviate suffering in Yemen?

Mr Ellwood: The short answer is to take a look at the report of yesterday’s International Development Committee hearing, where the Minister of State, Department for International Development, my right hon. Friend the Member for New Forest West (Mr Swayne) and I spelled out in detail our commitment. We have provided almost £100 million and I hope that figure will increase. The difficulty is in getting the aid into the country itself. We are providing funds to support the UN envoy, so he can push forward the political process, too.

Mark Durkan (Foyle) (SDLP): The Minister has told us he has the report but has not received it. He has told us that he is going to take it seriously, and will read it and judge on the evidence. He has also told us, however, that he will sit down with the Saudis and go through it with a fine-tooth comb. Does he not understand that he sounds as though he is readier to offer observations on international public relations than he is to ensure there is full observation of international humanitarian law?

Mr Ellwood: As I said, I will sit down and invite the Saudi Arabians. We have two opportunities in the immediate future to go through this with a fine-tooth comb. Concerns have certainly been raised here, but we need to look at the evidence, compare it with what is going on and make sure proper processes are then followed.

Wendy Morton (Aldridge-Brownhills) (Con): The conflict in Yemen has been described as the forgotten war. Will my hon. Friend confirm whether the unrest in north Yemen is confined only to Yemen, or whether it is spilling over into Saudi territory?

Mr Ellwood: My hon. Friend raises a very important point. On the first point that this is seen as the forgotten war, this came up in the International Development Committee hearing yesterday. That almost does seem to be the case. It is perhaps a very sad reflection of the challenges we face, not just in the middle east but in Ukraine too. It is important that the international community does not turn its back on what is going on there. The scale of the humanitarian catastrophe that could be unveiled would be much bigger than what we see in Syria, Iraq or anywhere else. We need to focus on that.

On the second part of my hon. Friend’s question, she is absolutely right that the war is not contained in the country itself. Every single day, there are missile attacks from the Houthi-operated northern area of Yemen into southern Saudi Arabia. Over 300 Saudi Arabians have been killed because of what is going on there. That should not be ignored.

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Tom Brake (Carshalton and Wallington) (LD): The Minister will recall that I wrote to him on 18 November on this matter. In his reply, he said:

“We regularly raise our concerns with the Coalition through Ministerial, diplomatic and military channels”.

He went on:

“The Saudi Arabian authorities have given us assurances that they are complying with IHL”.

On the subject of cluster munitions, the Government apparently

“encouraged Saudi Arabia as a non-party to the Convention”—

the convention against cluster munitions—to accede to it. Does the Minister understand why some Members are concerned that the Government are not adopting a particularly challenging attitude towards the Saudis, when combined with the Minister’s statement about being “disappointed” at the execution of 47 people in Saudi Arabia? Will the Minister do something concrete and ask the Ministry of Defence, which is responsible for investigating IHL breaches, to look at this and, if necessary, go over the ground of previous claims about IHL breaches?

Mr Ellwood: The right hon. Gentleman is absolutely right to say that Saudi Arabia is not a signatory to the convention. We are encouraging that to happen. As I said in my opening remarks, on the exempt licences we have provided and the allegations we put forward, we matched them up with the information we have. We requested more information and where we are unsatisfied we have further discussions. Those are ongoing. We are calling for Saudi Arabia to make sure that, just as it launched an investigation into the attack on Médecins sans Frontières in Taiz, further investigations are opened as soon as possible.

Chris Green (Bolton West) (Con): Does my hon. Friend agree that the problems caused by international terrorist organisations simply build upon the incredibly complicated tribal structures within Yemen, and that this is not just about the conflict between President Hadi and the Houthis?

Mr Ellwood: My hon. Friend is absolutely right. Yemen is a relatively new country by any stretch of the imagination. In Ottoman times, we controlled one part of it as a protectorate. The glue that holds it together is not strong. It is very tribal based—there are about four or five major tribes—and underneath these super tribes there are sub-communities of loyalties. Each is not necessarily committed to one side or another, but is waiting to see which way the wind blows.

George Kerevan (East Lothian) (SNP): If the evidence in the UN report is upheld in due course—evidence that the Saudis have been using cluster weapons dropped by British aircraft on civilian populations, which can only exacerbate the political crisis in Yemen—will the Minister undertake to ban weapons sales to Saudi Arabia, or will he just give it a limp slap on the wrist?

Mr Ellwood: As I am sure the hon. Gentleman can imagine, I will not go into hypotheticals. I have committed to taking the report and speaking with the Saudi Arabians to see what we can do to move forward and to confirm what the recommendations in the report actually say.

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Bob Blackman (Harrow East) (Con): Will my hon. Friend outline the extent of humanitarian aid Saudi Arabia gives to Yemen? I believe it is extensive. If so, is that the action of an irresponsible country?

Mr Ellwood: The full coalition is doing a wide variety of things, in addition to the military campaign, which we read so much about in the papers. It is not just Saudi Arabia; it is Jordan, the United Arab Emirates, and so forth. As areas are liberated, so the coalition follows on with stabilisation capability to provide security and support and to allow a transition from war to peace. All the Arab countries are very much involved in that.

Andy Slaughter (Hammersmith) (Lab): Is this not a bit “Yes Minister”? The Minister has the report, but he has not received it, so he cannot do anything about it. Is that not a recipe for inaction? During the last invasion of Gaza, he said he would consider suspending arms sales to Israel, but by the time he had considered it, the damage had been done and several thousand civilians had been killed. Is that not what will happen here? Will he suspend arms sales? There is evidence of a breach of international humanitarian law. Will he do that now, look at the evidence and then make a decision?

Mr Ellwood: I am being asked to comment on a leaked report. It is important that I have time to digest the full report, but I have said, even at this stage, before having had an opportunity to do that, that from what I understand of the report it is seriousness enough to deserve detailed scrutiny, not just here by us, but with the Saudi Arabians. I have already made that commitment to the House.

Kevin Foster (Torbay) (Con): As the Minister will know, since the opening of the Suez canal in the 19th century, the waters around Yemen have been among the most key international trade routes, and therefore their security is of direct concern to us. Given that maintaining stability in Yemen is important to keeping those routes safe, what assessment has he made of the strength and ability of the Yemini armed forces to do that?

Mr Ellwood: I can give a twofold answer. First, the Yemeni armed forces are receiving training, and the Yemini army is improving and able to hold ground, as well, not least around the port of Aden, which, as my hon. Friend says, is critical for safe passage in the area. Secondly, there is also the UN maritime capability. UN convoys need to be able to enter, but at the moment they are being denied by the Houthis.

Margaret Ferrier (Rutherglen and Hamilton West) (SNP): The Under-Secretary of State responsible for the middle east is reportedly lobbying Saudi Arabia to promote its so-called human rights successes. Will the Minister please clarify whether that is the case and respond to criticism that it is little more than a PR exercise from a Government determined to maintain a multibillion pound arms trade with the Saudi regime?

Mr Ellwood: I am sorry about the last comments. The hon. Lady and I have discussed these issues in the House, in Westminster Hall and, indeed, privately. I hope she will recognise that the words that have been written—I think by The Independent, which used a Google translator

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system to take some Arabic words and turn them into English—were not what I said at all. Let me make it very clear: we have now issued a press release confirming exactly what I said—an overview of what I raised at some of the meetings. I can assure her that at every single meeting I had, at every level, I raised human rights issues across a spectrum of matters that this House debates on a regular basis.

Jim Shannon (Strangford) (DUP): The unrelenting blanket bombing of Yemen, the murder of innocents and the destruction of property cause great concern. What also causes great concern is the abuse of human rights, as the Minister knows—I know he is responsive to that—but also the orchestrated persecution of Christians, who are arrested in their homes, put in prison and deported. Christians are second-class citizens in Saudi Arabia. I believe that underlines the need to make all arms sales to Saudi Arabia conditional on improving human rights and stopping the persecution of Christians. What discussions has the Minister had with Saudi Arabia about that?

Mr Ellwood: May I first pay tribute to the work that the hon. Gentleman does in this area? He raises these important issues of human rights—not least for Christians, but for others as well—on a regular basis. He is absolutely right to say that Christians are not receiving the same level of support or, indeed, rights in parts of the middle east. These are things we raise on a regular basis. If I may, I will speak to the hon. Gentleman offline to talk in more detail about this, because that would be more appropriate.

Dr Philippa Whitford (Central Ayrshire) (SNP): Both in Prime Minister’s questions and when we had the statement on the executions, I raised the issue of the Médecins sans Frontières hospital in Saada in Yemen that was hit by missiles. We are providing those very weapons, so can the Minister confirm that that specific incident has been investigated?

Mr Ellwood: May I pay tribute to the work the hon. Lady does? I know she comes to this House with a huge amount of experience from the medical side, and I think the House is all the wiser for it. She raises an important issue. I think I gave confirmation earlier that that investigation is already going ahead.

Kirsten Oswald (East Renfrewshire) (SNP): The UK Government have licensed billions of pounds of weapons to Saudi Arabia. It is now recorded that UK forces have been present at Saudi weapons control centres during operations in Yemen. The UN report says that Saudi air strikes have been systematically targeting civilians, and the Minister today has acknowledged concerns and a need for improvement, so what exactly will it take for him to acknowledge, knowing all this, that we have a clear responsibility to stop selling arms to Saudi Arabia?

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Mr Ellwood: I do ask, with huge respect, that this narrative that somehow British soldiers are involved in the targeting cell is stopped. The Prime Minister made that absolutely clear yesterday—indeed, I think in response to the Scottish nationalists—saying that we are not part of the coalition. We are not in the targeting cell, and therefore we are not privy to that information. What we are calling for is absolutely the robust process that must be followed if an incident is reported.

Stewart Malcolm McDonald (Glasgow South) (SNP): The United Kingdom has practically built the modern Saudi state. It was UK workers who extracted the oil and built the roads and UK doctors and nurses who provided modern medicine—plenty evidence of the British carrot. However, I think the Minister is in a stronger position than he perhaps appreciates, so when will we see a bit of the British stick, beyond the usual platitudes that we hear from the Dispatch Box?

Mr Ellwood: Again, I have spoken to the hon. Gentleman offline. He is aware of what we try to do overtly, but also quietly, to advance change in Saudi Arabia. It is difficult: it is a very new state. We should also reflect on the fact that the royal family—the leadership there—is on the liberal wing of a very conservative country. There is a pace of change that works, and if the hon. Gentleman wants to see it move any faster, he should bear in mind that a possible consequence could be to see Daesh spreading—it has made it clear that it wants to take over custodianship of the two holy cities, and that is exactly what we could get. Therefore, I absolutely stand with him on wanting to effect change, but it needs to happen at a pace that is workable.

Alan Brown (Kilmarnock and Loudoun) (SNP): A transparent Government would welcome the setting up of the Committees on Arms Export controls. Instead of saying that it is not within the gift of the Government, will the Minister advise us what the Government are doing to facilitate the setting up of the Committee and, if there are any problems, what those problems are?

Mr Ellwood: I am calling for it; I want it; I think it is very important. It is not, however, in my gift. I understand that it is the responsibility of the three Committee Chairmen, one of whom is smiling, whose brief is internationally facing. It is for them. [Interruption.] I stand corrected; the Leader of the House is in his place. It is vital that the Committee is up and running as soon as possible. If there is one positive outcome from today, it is, I hope, that this Committee will emerge as soon as possible.

royal assent

Mr Speaker: I have to notify the House, in accordance with the Royal Assent Act 1967, that Her Majesty has signified her Royal Assent to the following Acts:

Cities and Local Government Devolution Act 2016

Psychoactive Substances Act 2016.

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Business of the House

11.45 am

Chris Bryant (Rhondda) (Lab): Will the Leader of the House give us the future business?

The Leader of the House of Commons (Chris Grayling): The business for next week is as follows:

Monday 1 February—Second Reading of the Bank of England and Financial Services Bill [Lords], followed by debate on a motion on the future of the Financial Conduct Authority. The subject for this debate was determined by the Backbench Business Committee.

Tuesday 2 February—Second Reading of the Enterprise Bill [Lords], followed by motion relating to the House of Commons Commission.

Wednesday 3 February—Opposition day (18th allotted day). There will be a debate on tax avoidance and multinational companies, followed by a debate on public finances in Scotland. Both debates will arise on an Opposition motion.

Thursday 4 February—Statement on the publication of the fourth report from the Public Administration and Constitutional Affairs Committee, The collapse of Kids Company: lessons for charity trustees, professional firms, the Charity Commission, and Whitehall, HC 433, followed by debate on a motion on parliamentary sovereignty and EU renegotiations, followed by general debate on the conflict in Yemen. The statement and subjects for debate were determined by the Backbench Business Committee.

Friday 5 February—Private Members Bills.

The provisional business for the week commencing 8 February will include:

Monday 8 February—Motions relating to the Social Security Benefits Up-rating Order 2016 and the State Pension (Amendment) Regulations 2016, followed by business to be nominated by the Backbench Business Committee.

I should also like to inform the House that the business in Westminster Hall for Thursday 4 February and Thursday 11 February will be:

Thursday 4 February—Debate on the role of men in preventing violence against women.

Thursday 11 February—Debate on a motion on Equitable Life.

Chris Bryant: I know you have already referred to this, Mr Speaker, but I would like to pay enormous thanks to Robin Fell, the Principal Doorkeeper, who is leaving tomorrow. He first arrived here in October 1969 and I believe he has been the Principal Doorkeeper since 2011. He and his mutton chops were the stars of the television programme last year. Far more importantly, Robin not only provides the snuff for hon. Members, but does so out of his own pocket—he does not keep it in his pocket, but pays for it himself. I gather he has a large supply, which might be handed over to his successor. We wish him and his wife Deidre well in his retirement.

Let me start by apologising. A couple of colleagues have said that I have been a little too cruel to the Leader of the House over the last few weeks so I thought I would try something completely different this week, and merely ask him some very straightforward questions. I warn him, however, that I want answers to them and

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not some little lecture about something completely and utterly irrelevant that he dreamt up last week or was written by his special adviser. I want straightforward answers to straightforward questions. To help him, we have produced a little aide-memoire in case he forgets any of the questions.

Here is question No. 1. There are claims that the IRA operative who planned the 1993 Shankill Road bombing was an informant who passed on details that could have allowed the security forces to prevent the atrocity in which 10 people were killed and more than 50 wounded. Will the Leader of the House ensure that the Secretary of State for Northern Ireland gives a statement on Monday on the investigation by the Police Ombudsman for Northern Ireland?

Number two concerns the Government saying they want to stop councils making ethical pensions and procurement decisions. They want to amend the Local Government Pension Scheme (Management and Investment of Funds Regulations) 2009 and publish a revised Cabinet Office procurement policy note. I believe that this constitutes a major curtailment of local authorities’ power to act. Can the Leader of the House guarantee that the changes will be subjected to proper scrutiny? That means a debate and vote on the Floor of the House on any changes in the pensions regulations, and a separate debate and vote on the procurement policy note.

Number three: more floods are predicted for the weekend, and the time limit for applying to the European Union Solidarity Fund for vital additional resources for communities that were hit by the recent floods is running out. Will the Leader of the House ensure that the Secretary of State for Environment, Food and Rural Affairs makes a statement before the deadline is reached—that is, before next Wednesday?

Number four: for two years the European Scrutiny Committee has been calling for debates on the Floor of the House about European Union Document No. 16930/13 on free movement, and about the port authorities regulations, which the Government pulled from the Committee a couple of weeks ago. How can the Leader of the House possibly complain about legislation being foisted on us by Europe when he will not allow debates on EU regulation? Will he give us a date for debates on both those subjects?

Number five: why did the Chancellor announce the sweetheart deal with Google on Twitter rather than in the House? If he was so proud of it, why did he not come to the House to defend it on Monday? Even Rupert Murdoch—of whom I am no fan—has said that

“posh boys in Downing Street”

have been too easily awed. Will the Public Accounts Committee, which is to publish a report on the matter, be sent the full details of how Google’s tax bill was arrived at, or has the Chancellor already thrown away the fag packet?

Number six: the Government have said that they want to change the Human Rights Act by the summer. We oppose that, but when will the Government publish the draft Bill of Rights? Will it be subject to pre-legislative scrutiny, and will it be published before, during or after the EU referendum campaign? Will the Leader of the House guarantee that it will not be published when the Welsh and Northern Ireland Assemblies and the Scottish Parliament are dissolved for elections?

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My final question relates to yesterday’s session of Prime Minister’s Question Time. The first building on this site was built by King Cnut, a Danish migrant. Westminster Hall was built by William Rufus, son of William the Conqueror: the clue is in the name. The Royal Family has blood from Aragon, Holland, Hanover and Greece. The Rhondda was built with the sweat of Irish and Italian migrants. Our Speaker is descended from Romanian Jews, and the Lord Speaker’s family hails from Portugal. The families of the Business Secretary and my right hon. Friend the Member for Tooting (Sadiq Khan) are from Pakistan. The father of the hon. Member for Richmond Park (Zac Goldsmith) represented France in the European Parliament. The Corbyns were Norman French, the Graylings were probably French Huguenots, and God knows where the Bryants came from. So will the Leader of the House confirm that we are all a bunch of migrants?

Chris Grayling: Let me begin by echoing your words, Mr Speaker, and those of the shadow Leader of the House about Robin Fell, who has served the House with great distinction for many years. For those of us who have been here for a few years, it will be very strange not having him around any more, but it is a tribute to the way in which he has served the House that his retirement is being greeted with such dismay and such warmth simultaneously. I am sure that we all send him our best wishes for the years ahead, and we hope that he will come back and visit us sometimes.

Let me also touch briefly on the issue of Members’ security. Most Members will by now have received the details of the security package from the Independent Parliamentary Standards Authority. Obviously we cannot discuss it in detail, but I think it is a good package, and I hope that Members feel reassured by it. May I ask any Members who still have concerns to talk to me, to the shadow Leader or to you, Mr Speaker, so that we can address them?

There have been a number of items in the news this week about the restoration and renewal Committee. Members may have seen the press coverage. It is inevitable that there will be some chat about it at a time when we are discussing with Members of both Houses the point that we have reached and the options that may be available to us, but I emphasise that no decisions have been made, and that the Joint Committee will not report until the spring.

The shadow Leader asked me a number of questions. It is noticeable whenever he asks me questions that he never uses the Opposition days that I provide to debate the subjects that he has raised. I therefore hope that he will forgive me if I do not take his approach entirely seriously. I have announced another Opposition day for next week, but, again, the Opposition have not chosen to debate the matters that the hon. Gentleman has raised today. However, the Northern Ireland Secretary will respond when she is ready to do so; on the local government changes, the Secretary of State will be here on Monday week; the Secretary of State for Environment, Food and Rural Affairs will be here next week; the announcement by HMRC, which is an independent body when it comes to these matters, was certainly made free of Government involvement; and the Human Rights Act details will be published when the Government are ready.

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The truth is that what we have not heard this week, yet again, is the things that the Labour party is doing: no request for a debate on the fact that this week the party called for shared sovereignty over the Falkland Islands, and no request for a debate on Labour’s plans to turn our border controls into a floodgate. What we have now is the reasonable people in the hon. Gentleman’s party being threatened with deselection, and Neil Kinnock says his leader—the man he works for—is not up to the job and is unelectable. The man in front of us, the shadow Leader of the House, is the man who knifed Tony Blair. He will not even now risk his Front-Bench position to stand up for what he believes in. He asked me about the word “bunch”. I am very happy to use that word today: he and his colleagues are a bunch of spineless individuals who have not even got the courage to stand up for what they believe in.

Mr Andrew Turner (Isle of Wight) (Con): One and a half million Armenians were murdered in 1915. Will the Leader of the House ensure that the holocaust memorial covers the Armenians?

Chris Grayling: As my hon. Friend knows, there has been a long debate about the terminology attaching to the tragedy that took place a century ago. What I think we should say today is that, while we are commemorating with great sadness and a determination always to remember what happened in the terrible years of the Nazi regime in Germany, we should also remember on Holocaust Memorial Day that many other tragedies on an epic scale have taken place in other parts of the world, and we should not forget the people who suffered in those and lost their lives in them.

Pete Wishart (Perth and North Perthshire) (SNP): I thank the Leader of the House for announcing the business for next week, and may I also add tributes from the Scottish National party to Robin Fell, who has been such a distinguished senior Doorkeeper? I think this is what we should do in commemoration of Robin Fell, even though he is still very much with us: the new chief Doorkeeper should inherit the whiskers, which are the finest whiskers in—[Interruption.] On seeing them standing beside each other, I think we might review that: perhaps you should not consider that request, Mr Speaker. But all the best to Robin Fell.

May I start by cautioning the Leader of the House in his role as the putative leader of the Out campaign, because he is going to be up against some powerful and remarkable forces? In this referendum it is not going to be just “project fear” he will be up agin; it is also going to be “project fud”. To reassure my hon. Friends, may I say that “fud” means “fear, uncertainty and doubt”, and thankfully not the common vernacular Scottish meaning that probably more of them are familiar with? I say to the Leader of the House that we will not be taking part in this fear campaign. We have gone through and experienced that in the Scottish referendum campaign. We will have a positive campaign. The SNP campaign to stay in Europe will be fud-free.

I am surprised there was no statement on the Government’s intention on refugee children given that there has been some sort of announcement this morning. We need to secure a real debate about this so that we can ascertain from the Government a figure for how many children they intend to accept and ask why, once again, it seems that the Government are turning their

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back on children who are in Europe. This is not the “bunch of migrants” or the swarms, or whatever the Prime Minister’s term will be next week; this is children in need of help, so let us have a full debate to see what we can do to assist them.

The row about Google’s tax arrangements just is not going away and maybe a debate about that might help to clear some matters up. I am sure the Leader of the House will welcome the European Commission’s words this morning, following an approach from the SNP, that it is now prepared to investigate Google’s tax settlement to see whether it meets European standards. Hopefully we might get some transparency on this issue.

We will soon be coming to the time in the parliamentary calendar when we debate the estimates process. I want a reassurance from the Leader of the House that it will not be done in the usual haphazard and casual way, as in previous years. You will know, Mr Speaker, that you are invited to ignore the minor consequential issues when certifying Bills as English only, and the Leader of the House repeatedly told us during the votes on English votes for English laws that all issues to do with Barnett consequentials are to be considered in the consolidated departmental spending in the estimates process. The Procedure Committee has already announced that it will be conducting an inquiry into the estimates process following the introduction of EVEL. Can the Leader of the House assure us that there will be no debates on the estimates until that inquiry has been concluded and we have had an opportunity to examine all the departmental spending of the spending Departments?

Lastly, I am not going to ask for a debate, and I do not want a further statement—I just want this Government to do the right thing on the appeal on the bedroom tax. I want them to accept the High Court’s decision and to do the right thing by vulnerable families, disabled children and women who are in need of shelter. I want them to accept the ruling from the High Court this week.

Chris Grayling: First, the hon. Gentleman raised the issue of Europe, and I suspect that there will be many lively debates in which the SNP will be involved over the coming months. I think the biggest difference between us is that the SNP appears to believe that our relationship with the European Union can remain unchanged. I have been clear in my view that I think it would be absolutely wrong for this country to have an unchanged relationship with the European Union. That is why the renegotiation process is so important and why the referendum is so important. I think it betrays the people of this United Kingdom when people argue for no change to that relationship. That is the position of Scottish National party Members, and I profoundly disagree with them.

On the issue of refugee children, we have said that we will work with United Nations agencies to identify the nature of the problem and look to take children who find themselves in a position of being unaccompanied in refugee camps. We have also made it very clear that our support is going to those in the refugee camps. We believe that that is the right thing to do, and it is actually bringing more people to this country than are being relocated through the European scheme. We think it is better to help the very large numbers of people who are stranded in those camps, because they are the most vulnerable, and not the ones who have had the money and the ability to get to continental Europe.

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The hon. Gentleman raised the issue of Google taxes. I can understand his frustration, but he is pointing in the wrong direction. The reason that we have an issue is that the Labour party was in power for 13 years and it did nothing to collect taxes from multinational companies. We are seeking to pick up the pieces of its failure. On that, I have no doubt that the hon. Gentleman and I would agree.

The hon. Gentleman also asked about the estimates process. This is being looked at by the Procedure Committee. To date, under this Government, the coalition Government and previous Governments, we have followed all the processes that are customary. If he believes that the process should change, the Procedure Committee is producing a report and he will undoubtedly have an input into that and will be able to bring his ideas to the House. Of course, time is also made available for his party if it chooses to table debates on this matter.

On the question of the court case, the Department for Work and Pensions will certainly talk to the House more about its intentions in due course.

Pauline Latham (Mid Derbyshire) (Con): May we have a statement from the Department for Transport on the possibility of establishing a register of taxi drivers? Currently, when they go before the committee of a council and are asked whether they have had previous convictions or been refused a licence, they can say yes or no but there is no method for the council to check up on their answers. May we have a statement on this, please?

Chris Grayling: I am grateful to my hon. Friend for giving me a bit of warning about this question. She has identified a very real problem. When somebody wishes to deceive, it is perhaps wishful thinking to ask them to give a truthful answer. However, I will ensure that my right hon. Friend the Secretary of State for Transport is properly briefed about the concerns she has raised before he appears before the House again on Monday week. I also ask her to raise this serious matter with him again at that time.

Ian Mearns (Gateshead) (Lab): I thank the Leader of the House for the business statement and for giving me advance notice of the Back-Bench business debates. However, it is not beyond the realms of possibility that the conclusion of business on a Monday might be later than anticipated by the Government. May I ask him once again that, when we schedule a debate that we anticipate will last for three hours, it will be given protected time just in case the Government business takes longer than anticipated? Will he also confirm that it we will be allocated some time on 11 February, the last day before the February recess?

Chris Grayling: I have listened carefully to the hon. Gentleman’s request on Back-Bench business, and I am looking into the matter. The situation can vary according to Government business and also according to what decisions you take, Mr Speaker, about urgent questions. I do not want to take an instant decision on this, but I will look at what happens over a period of time. I will look at the question of overrunning debates being curtailed, and we will see whether any change needs to be considered. The hon. Gentleman will forgive me if I do not give him an instant response on that one, but I am listening carefully to what he has said. However, I do have to answer quickly his question about the last day before

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the February recess. It will obviously depend on the availability of Government business, but I hope that he does not feel short-changed for time. I am also aware of the pressure from Members around the House for a traditional Adjournment-style debate just before recesses. I hope to inform him shortly on that.

Mr David Nuttall (Bury North) (Con): May we have a statement on what the Government plan to do to change the system that allows a convicted double murderer to walk free with a new identity? Families of the victims must be left wondering what on earth is happening to our system of justice. It cannot be right that my constituents may face the prospect of a double killer moving in next door without their knowledge.

Chris Grayling: My hon. Friend makes a serious point, and I will make sure that my right hon. Friend the Justice Secretary is aware of his concerns. My view has always been that victims and their families must come first.

On a different note, I congratulate my hon. Friend on taking an unexpected lead in the battle of the black puddings, rather, I suspect, to the distress of the hon. Member for Na h-Eileanan an Iar (Mr MacNeil). Bury black puddings were featured last night on “Bake-Off” in a scallop and black pudding manapé. I suspect that in the race for the best black pudding, Bury has a slight nose ahead.

Mr Angus Brendan MacNeil (Na h-Eileanan an Iar) (SNP): The new and excellent gifted SNP Members often talk about the great help and kindness that the staff of the House have shown since their election, Mr Speaker. Tonight, you are holding a reception for the retirement of Robin Fell, who has served the House for 46 years and knew a predecessor of mine, Donald Stewart of Stornoway. I am sure that we all wish Mr Fell a happy retirement, but we also want it to be a healthy retirement. With that in mind, and given that Mr Fell has holidayed in Stornoway with his wife, where I shared a glass of lemonade with him, I wonder whether the Leader of the House agrees that an appropriate gift for his retirement would be a Stornoway black pudding, the health details of which are listed in early-day motion 936, in my name.

[That this House welcomes the recognition of black pudding, Marag Dhubh in Gaelic, as a superfood; notes that its calcium, iron, magnesium, potassium and protein-rich nature make the black pudding an excellent addition to a healthy, balanced diet; expresses pleasure at the economic benefits to Stornoway butchers of its EU Protected Geographical Indication, one of the many great benefits of EU membership; and encourages everyone to discover the great taste of Scottish food.]

Chris Grayling: I can see this battle running and running, Mr Speaker, but on this occasion when we are marking the retirement of a distinguished servant of the House, putting him in the invidious position of having to judge between Bury and Stornoway black puddings would be an unfair way of sending him on his way to what we believe will be a happy retirement.

Byron Davies (Gower) (Con): This week the Welsh Assembly Public Accounts Committee issued a damning report on the extreme loss of revenue as a result of a land sale by the Welsh Labour Government on a property

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once owned by the Welsh Development Agency. This follows an equally damning report by the Wales Audit Office last year of the Welsh Labour Government. Will the Leader of the House agree to a debate on the sale of public assets by public authorities in the UK?

Chris Grayling: This has been a shocking chain of events. I know just how strongly my hon. Friend and others feel about the criticism that has rightly been levelled at the Welsh Government. The First Minister has had to apologise for what has happened. This situation should never have arisen, and lessons need to be learned. My hon. Friend makes his point well and he might well consider bringing it to the Floor of the House through the different channels available so that he can make his well-made points to Ministers.

Kelvin Hopkins (Luton North) (Lab): Bedfordshire police have just 169 police officers per 100,000 population, well below West Midlands, which has 256 officers per 100,000 and a similar level of burglary, and even further below Manchester, which has 274 officers and a similar level of knife crime. The police funding formula is broken and needs urgent revision, but the Home Office appears to be getting cold feet about introducing a new formula. May we have an urgent debate on this serious matter so that the people of Bedfordshire can look forward to relief from the desperate underfunding of their police force?

Chris Grayling: As an MP representing an area with a smaller force, I understand the hon. Gentleman’s point. The big city forces face some enormous challenges so it is not surprising that they have more resources than the smaller forces to deal with issues such as terrorist threats. I take his point, and I will make sure that the Home Secretary is aware of his concerns. It may be an issue that he will find is shared by other hon. Members, and he may want to use the slots that we have made available to Back Benchers to bring these matters to Ministers.

Chris Davies (Brecon and Radnorshire) (Con): My constituency faces many bank closures, with the HSBC branches in Builth Wells and Rhayader, the Barclays in Llanwrtyd Wells and the NatWest in Crickhowell all vanishing from our high streets. We now have market towns with no banking facilities whatsoever. May we have a debate on what more we can do to save our high street banks so that businesses and local people have provision for their banking needs long into the future?

Chris Grayling: Several colleagues have raised their concerns about this problem as the banks’ commitment to retain at least one branch in individual areas seems to be running a little ragged. MPs should promote and talk up the work of post offices to provide an alternative to banking services in rural areas, but my hon. Friend makes an important point that we should continue to raise in the House. As several hon. Members have raised the matter, the Backbench Business Committee might want to add it to its list for debate.

Mr Barry Sheerman (Huddersfield) (Lab/Co-op): I made a point of order about business questions earlier in the week, as you will remember, Mr Speaker. I was not suggesting that there is anything wrong with the tone and humour of proceedings; I was really talking about the amount of time taken by Front Benchers.

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I put that on the record, as well as the fact that anyone who is interested in public health believes that black pudding and any processed meat is really bad for people’s health.

May we have a debate about the hidden treasure that is locked in Icelandic bank accounts? Hundreds of millions of pounds of British taxpayers’ money is still held there, being leeched into the coffers of Grant Thornton, the liquidator. May we have a debate on the scandal of what has happened to taxpayers’ money?

Chris Grayling: I congratulate the hon. Gentleman on making his point so succinctly. That sounds like an ideal topic for an Adjournment debate.

Bob Blackman (Harrow East) (Con): Tuesday marked Indian Republic Day, and not a week goes by without a Government Minister visiting India, or an Indian Minister visiting the UK. May we have a debate in Government time about Britain’s relationship with India and the tremendous contribution that the Indian diaspora makes to this country?

Chris Grayling: We were proud to host the Indian Prime Minister in the House a few months ago as part of the successful visit to the United Kingdom by him and other members of the Indian Government. My hon. Friend makes an important point about the need to preserve the relationship, and the Government are committed to deepening our historical ties and friendship with India.

Wes Streeting (Ilford North) (Lab): Last autumn, in a consensus resolution, the United Nations Human Rights Council set out the importance of involving judges, defence lawyers, and authorised prosecutors and investigators from Commonwealth and other foreign countries in the necessary process of prosecuting human rights abuses in Sri Lanka. President Sirisena has since ruled out international involvement, yet such involvement would be an important confidence-building measure for all Sri Lankans, including the Tamil community. Given that, as well as the recent Foreign Office delegation to Sri Lanka, will the Leader of the House ask a Foreign Office Minister to make a statement in the Chamber so that we can hear what action our Government propose to take to ensure that the Sri Lankan Government fulfil their obligations under the UNHRC resolution?

Chris Grayling: We all want a long-term solution to the dreadful events that have taken place in Sri Lanka. It is enormously important that there is a settlement that provides a stable and lasting solution for both communities. I will ensure that Foreign Office Ministers are aware of the points that the hon. Gentleman raises and ask them to update the House at an appropriate early opportunity.

Steve Double (St Austell and Newquay) (Con): From tomorrow, for 10 days, Network Rail will close the A390 in the village of St Blazey, which I am proud to say is the place where I was born, so that it can carry out scheduled maintenance on a level crossing. Local businesses will face significant disruption and a loss of revenue, and local traffic will have to take a 23-mile detour. The community received notice of the closure only on 18 December, so businesses have had insufficient time to make arrangements to mitigate its impact. Network

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Rail’s behaviour has been unacceptable. Will a Transport Minister make a statement to confirm Network Rail’s responsibilities to consult local communities before closing roads, during which we could consider whether compensation should be paid for the loss of business?

Chris Grayling: My hon. Friend has been pushing hard on this issue and I understand his concern. It is clearly not acceptable for Network Rail to provide inadequate notice of, and not to make adequate arrangements for, such a closure. However, I know from my constituency experience that if level crossings become antiquated and fail, the disruption can be equally bad. My hon. Friend makes his point succinctly, and while the work clearly needs to done, it should be managed properly, and Network Rail should give due notice when it does the right thing by local people.

Barbara Keeley (Worsley and Eccles South) (Lab): Will the Leader of the House arrange to help the Prime Minister and Ministers with responsibility for pensions with a briefing on EU directives and the equalisation of the state pension age? The Prime Minister and the Under-Secretary of State for Justice, the hon. Member for North West Cambridgeshire (Mr Vara), who covers pensions, have insisted that their policy of equalising the state pension age was necessary to meet the UK’s obligations under EU law, but that is not true. A 1997 directive laid down only the principle of equal treatment; the determination of state pension age is the sovereign right of member states. Some EU states maintain a difference, while others are not equalising until 2044, and long transitional arrangements are allowed. Will the Leader of the House convey that information to his colleagues, who do not seem to understand the situation?

Chris Grayling: My colleagues have simply pointed out the obligation to pursue a strategy of equality. It is absolutely logical to have the same retirement age for men and women in a nation that believes in equality.

Richard Graham (Gloucester) (Con): When he held his previous role, the Leader of the House was supportive of my project to regenerate unused Ministry of Justice land beside Gloucester railway station. The project was approved in principle 10 months ago, with all the details subsequently agreed, except for the acceptance by the main board of the Courts and Tribunals Service of an independent valuation of the site. Will my right hon. Friend urge Justice Ministers to remind the board that the site has been empty and unused for more than eight years and that the Government’s policy is to use such assets for regeneration projects as soon as possible?

Chris Grayling: My hon. Friend and I have discussed his concern about this matter extensively. I will ensure that I give the Ministry of Justice a nudge on the project, which I know he feels is crucial to the development of Gloucester.

Christian Matheson (City of Chester) (Lab): May I add my voice to that of other hon. Members who have called for a debate on the UK’s membership of the European Union? Of course, such a debate would give the Leader of the House an opportunity to explain why he clearly has no confidence whatsoever in the ability of his boss, the Prime Minister, to negotiate a better deal for the UK.

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Chris Grayling: I have no doubt that we will be debating our relationship with the European Union extensively. I look forward to holding that debate with a group of people who believe that there should be no change in that relationship, which, to my mind, would let this country down in the worst possible way.

Paul Flynn (Newport West) (Lab): May we debate early-day motion 1019 about the new delay involving Hinkley Point C?

[That this House believes that the new delay on the plan for Hinkley Point C proves that the unaffordable, technologically-failed project is doomed; recognises that immediate cancellation would avoid the massive waste of multi-billions in cost over-runs and years of delays suffered by all other EPR projects; and urges new investments in the proven green technologies of renewable power sources.]

Such a debate would allow us to discuss why the Chancellor of the Exchequer cancelled at short notice a meeting that had been arranged in London last week with the head of Tata Steel to discuss redundancies and the future of the industry. Why is it that the Chancellor can go off to Beijing to gift the Chinese our nuclear power station jobs in perpetuity, yet show indifference to the fate of British steel jobs?

Chris Grayling: None of us is indifferent to the fate of British steel jobs. Ministers have spent a huge amount of time in recent months trying to find ways to ease the pressures on that industry, which faces a global crisis. This is an enormous challenge for all of us, but we will do everything that we can, within the powers that we have available, to ease those pressures.

Mrs Emma Lewell-Buck (South Shields) (Lab): Answers to written questions show that in almost every Government Department, disabled members of staff are twice as likely as others to report bullying and harassment, and are consistently likely to believe that they are not fairly treated. Will the Leader of the House ask the Minister for the Cabinet Office to make a statement explaining why the Government have allowed disability discrimination to take hold in the civil service, and what they are going to do about it?

Chris Grayling: Let us be clear that disability discrimination, in whatever form, is not acceptable—I agree with the hon. Lady on that point. I will ensure that the Minister for the Cabinet Office reads her comments and the parliamentary questions. I would not condone in any way, shape or form discrimination against, or the bullying of, disabled people.

Liz McInnes (Heywood and Middleton) (Lab): I reiterate the request from the shadow Leader of the House for an urgent statement on the UK’s application to the EU solidarity fund following the catastrophic flooding in the north of England and in Scotland in December 2015. Given that we are rapidly approaching the deadline from the date of the first damage caused by the disaster, are we in danger of running out of time?

Chris Grayling: We took the view early on that the best thing to do was to provide financial support as quickly as possible to those areas affected, and we have done that. The hon. Lady will be able to question the

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Secretary of State for Environment, Food and Rural Affairs next week, but the priority for us has been to get money and support into the areas affected and we have been doing that for weeks.

Justin Madders (Ellesmere Port and Neston) (Lab): I was hugely impressed to hear about the work of the Ambitious College in London, which caters for young people with autism between the ages of 16 and 25. In my constituency, Hinderton School has had four outstanding reports from Ofsted on its educational provision up to the age of 11, but it is a sad fact that three out of four young people with autism do not access any kind of education after school age. May we have a debate, please, on widening opportunities in education for young people with autism?

Chris Grayling: That is a good point and some very good work is being done. I am not aware of the college that the hon. Gentleman refers to, but it clearly plays an important role. We want to see people, when they leave school, have the opportunity to move into work or move into apprenticeships—that should be a priority for us as well. The Minister for Skills will be here on Tuesday and I will make sure that he is aware of the concerns that have been raised.

Chris Law (Dundee West) (SNP): Last week, in reply to my question regarding post-study work visas, the Leader of the House stated:

“This is an area that was not in the Smith commission report.”—[Official Report, 21 January 2016; Vol. 604, c. 1566.]

The right hon. Gentleman is entirely wrong. Page 20 of the report, which I have here, states that,

“the Scottish and UK governments should work together to explore the possibility of introducing formal schemes to allow international higher education students graduating from Scottish further and higher education institutions to remain in Scotland and contribute to economic activity for a . . . period of time.”

Will the Leader of the House apologise for his misleading reply and offer to correct the record by offering a commitment that the UK Government will now seriously consider the issue of post-study work visas, as recommended by the cross-party Smith commission?

Chris Grayling: The only person who should resign is someone who works for the current leader of the Labour party and does not agree with him. Let us be clear. The hon. Gentleman has clearly misunderstood the point that I was making last week. There is not a recommendation in the Smith commission report that this should happen. We have implemented the recommendations of the Smith commission report about what should happen. The two Administrations should carry on talking about this area and a whole variety of areas, and we do and we will, but the Smith commission did not recommend that we implement a change on this and we have not done so.

Andrew Gwynne (Denton and Reddish) (Lab): Public health and the air we breathe was greatly improved as a result of the Clean Air Act 1956, but much of the progress since then has gone backwards. In large parts of England, including in my own constituency, air quality falls dramatically below European safe standards, so may we have a statement from the Environment Secretary about the need for a new clean air Act fit for the 21st century?

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Chris Grayling: That matter is attracting increased concern both in the House and in Government. The Secretary of State will be here next Thursday. I know she takes the issue very seriously and I encourage the hon. Gentleman to ask her at that point what she is doing about it.

Roger Mullin (Kirkcaldy and Cowdenbeath) (SNP): May we have an urgent statement from the Home Office regarding tier 4 student visa holders who have applied for leave to remain? As an example, one such student, Paul Hamilton, was arrested on 17 January without notice to him or his lawyer and held until yesterday. This sends shivers down the spine of all those seeking to attract foreign students to study in the UK.

Chris Grayling: Such students are only ever going to be arrested if they are in the United Kingdom without a visa. We have rules. We may agree or disagree about them, but there is no excuse for anybody to break them.

Paula Sherriff (Dewsbury) (Lab): The Government have announced planned cuts to pharmacy funding, which could result in up to a quarter of community pharmacies in England closing. Pharmacy teams currently provide minor ailments advice to patients—who would otherwise visit over-burdened GPs or A&E departments—alongside many other essential services, including methadone dispensing. May we have a debate in Government time to establish how that would affect our vulnerable patients?

Chris Grayling: By curious coincidence, the hon. Lady has been able to make her point directly not just to the Leader of the House, but to the Minister responsible, my right hon. Friend the Minister for Community and Social Care, who is sitting next to me on the Bench. The Government’s negotiations on that have just started. There is plenty of time for representations. We need to get the process right and the Minister has heard the point she made.

Andy Slaughter (Hammersmith) (Lab): At business questions last week and at Justice questions on Tuesday I asked, without success, for confirmation of the much flagged U-turn on criminal legal aid contracts. That is vital not only to hundreds of individuals and small solicitors’ firms, which risk losing their livelihoods, but to arrested persons getting competent and timely legal advice. I now see that a written ministerial statement on criminal justice is to be published later this afternoon, presumably to spare the Government embarrassment. This is very important. Can the Leader of the House make the Justice Secretary come and give an oral statement on this subject tomorrow or Monday?

Chris Grayling: If the Justice Secretary wants to make an oral statement or has a written statement to make, he will do so in good time. I am afraid the hon. Gentleman will just have to wait and see what the Justice Department has to say.

Margaret Ferrier (Rutherglen and Hamilton West) (SNP): Yesterday at Prime Minister’s questions I raised the matter of the Chancellor failing to close the monumental financial black hole in his books. It is clear that Government austerity policy is not delivering the results it is supposed to deliver. Will the Leader of the House arrange a debate, mindful that the Conservatives do not have a

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mandate from the people of Scotland for the Government to consider reasoned and sensible alternatives to the current austerity agenda from the SNP Benches?

Chris Grayling: I do admire the chutzpah of the SNP. If it had won its referendum, if Scotland were going to become independent in six weeks’ time, it would be going through the most monumental financial crisis, the most monumental financial black hole, as oil revenues collapse—the revenues on which the SNP was going to depend for its plans for Scotland. So I will not take any lessons about black holes or lack of financial planning, because the SNP stood for and argued for something that would have been disastrous for Scotland.

Diana Johnson (Kingston upon Hull North) (Lab): May we please have a debate on the Government’s support for British business? For example, whereas the Chancellor clobbered Hull’s home-grown caravan industry by introducing the caravan tax in the omnishambles Budget in 2012 without speaking to the industry, he manages to have multiple meetings with Google, a multinational company, and allows it to set its own tax rate.

Chris Grayling: All of us in Government have meetings with business, charities, external representative groups, trade unions and other groups across our society, so that we can try to do the best for this country in Government. That is what all Governments do and it is certainly what this one does.

Jim Shannon (Strangford) (DUP): May I associate myself and my party with the very kind comments on the long service of Robin Fell and wish him all the best for the future, good health and long life? In the aftermath of the Paris atrocities, what can only be described as hostile proposals are coming from Europe on the EU weapons directive that could impact on legal and legitimate firearms certificate holders across the whole United Kingdom of Great Britain and Northern Ireland. The Leader of the House—I know the matter is close to his heart—will know that the most law-abiding section of the community are those who hold firearms, so will he agree to a statement or a debate in this House?

Chris Grayling: Although this country has experienced the dreadful consequences of terrorism, and the hon. Gentleman knows and understands the dreadful consequences of terrorism, we have in this country firearms laws that maintain the right balance and are appropriate for the needs of a modern society. The best way that the rest of Europe could deal with the matter would be to adopt the same approach as the United Kingdom has taken.

Louise Haigh (Sheffield, Heeley) (Lab): You will have noted, Mr Speaker, if you can remember back to the beginning of this Session, that the Leader of the House spectacularly failed to answer even one of the questions asked by my hon. Friend the Member for Rhondda (Chris Bryant), but particularly on council procurement policy. The question was not when the Department for Communities and Local Government would be coming back to the House to answer questions, but whether he will give time for us to debate and vote on whether this Government will strip local authorities of the ability to procure ethically.

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Chris Grayling: I indicated that the Secretary of State will be back here in a few days for the Opposition to put that question. They have an Opposition day on Tuesday. If they feel strongly about the issue, they can make that time available to debate it.

Greg Mulholland (Leeds North West) (LD): May we have a debate on the ongoing injustice in the system of pensions for widows and widowers of serving personnel? In 1971 Private James Lee was killed in service in Northern Ireland by a terrorist bomb. That was before his first daughter was born, yet when Mrs Susan Rimmer, as she now is, married another soldier in 1979 she lost her pension. She has been told now that the only way to get it back is to get divorced. That is absurd and needs to be changed.

Chris Grayling: We have made changes in that area, but I take on board the hon. Gentleman’s comments and will speak with the Secretary of State for Defence about the matter.

Mike Kane (Wythenshawe and Sale East) (Lab): Last Thursday I visited the camp at Calais as part of a cross-party delegation of UK parliamentarians and deputies from the Assemblée Nationale. It was the first such joint delegation to discuss the problems. Will the Leader of the House set out concrete proposals on how we can best improve the channels of communication between our Parliaments on this issue?

Chris Grayling: The French and UK Governments are in regular contact on this issue. I am absolutely in favour of continued dialogue, which we ought to encourage, because we will have to work very closely with the French on this problem. It is a very distressing and difficult problem, but I remain of the view that our focus should be on providing support to the very vulnerable who cannot find their way to mainland Europe, and who certainly do not have the ability to travel across mainland Europe in search of a place in the United Kingdom. We cannot accept everybody who wants to come here, so we need to focus our efforts on the most vulnerable in the camps in and around Syria.

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Kirsten Oswald (East Renfrewshire) (SNP): Twenty-five years after the beginning of the first Gulf war, as many as 33,000 Gulf war veterans could be living with illnesses connected to their service. Does the Leader of the House agree that those veterans deserve our support, in terms of research, rehabilitation and quality of life, and does he agree that we should have a debate in Government time on our obligations to those veterans under the armed forces covenant?

Chris Grayling: I do not think that anybody in this House would disagree that we need to look after our veterans. The Government have a good record in doing so, but we should also look at areas such as this one when problems become apparent. The Secretary of State is already considering these matters, but I will ensure that the hon. Lady’s concerns are passed on to him today.

Alan Brown (Kilmarnock and Loudoun) (SNP): Yesterday I used an online search engine to look up “sweetheart tax deals”. I was reminded that Vodafone once paid £1.25 billion in tax, rather than the £6 billion that it should have paid, and it still does not pay corporation tax. Goldman Sachs was let off with £20 million on interest payments, which is against Her Majesty’s Revenue and Customs rules. Following the deal with Google, a French MEP has said that the UK is preparing to become a tax haven. Therefore, may we have a debate about tax collection and transparency on this Government’s watch?

Chris Grayling: I simply say to the hon. Gentleman that we are making more changes than any previous Government. We are increasing the taxes paid by multinational companies and we are involved in international discussions and negotiations to change international rules to make that easier. I understand his frustration, but he should bear in mind that we inherited a situation in which many things had been allowed to accumulate over 13 years and we are still picking up the pieces.

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Backbench Business

NHS and Social Care Commission

12.32 pm

Norman Lamb (North Norfolk) (LD): I beg to move,

That this House calls for the establishment of an independent, non-partisan Commission on the future of the NHS and social care which would engage with the public, the NHS and care workforces, experts and civic society, sitting for a defined period with the aim of establishing a long-term settlement for the NHS and social care.

May I take this opportunity to thank the Backbench Business Committee for granting this debate and Members on both sides of the House for expressing interest in, and support for, the motion? I tabled the motion alongside the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), who sadly cannot be here because of a family illness, and the hon. Member for Leicester West (Liz Kendall). I want to be clear that I am making this case on a cross-party basis, because I believe that it absolutely transcends narrow party politics. I sought the support of, and have been working alongside, Steven Dorrell, the respected former Conservative Health Secretary, and Alan Milburn, the former Labour Health Secretary.

I have felt for a long time now that the NHS and the care system face a very real existential threat, and we have been drifting in that direction for many years. We have to get to grips with this before seriously unattractive things start happening to some of the most vulnerable people in our country. The motion obviously addresses the situation in England, but the position in Scotland, Wales and Northern Ireland is essentially the same; we are all facing the same demographic challenges and the same need to ensure that our health and care systems meet the needs of our communities today, rather than those of 1948.

There is an enormous belief in the NHS in this country, and it is a belief that I share very strongly. It engenders a sense of solidarity and the sense of the decency of this country that we all commit together to ensuring that people can access care when they need it, regardless of their ability to pay. That is a founding principle that has stood the test of time and should be sustained. That is what this debate is all about.

It was a great Liberal, William Beveridge, who put forward the proposition that there should be a national health service, and it was a great socialist, Nye Bevan, who then implemented it as Minister of State for Health. It is also fair to say that Conservative Governments since have sustained the NHS. We have always had our battles about funding levels, reorganisations, structural reforms and so forth, but the NHS has been sustained, with cross-party support, and it is very important that that continues.

As I have said, that principle has stood the test of time. The Commonwealth Fund concluded back in 2014 that, among the major economies it looked at, the NHS was essentially the best system globally, although it is worth noting that it did not score so well on outcomes or on premature mortality—those are, after all, quite important measures that we should not be complacent about. I have made the case that there is an existential challenge to the system, and I believe that it is time for what I call a new Beveridge report for the 21st century.

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Mr Andrew Mitchell (Sutton Coldfield) (Con): Is not the key point that the right hon. Gentleman has made, and that the House should consider today, that all parties support the NHS and that, therefore, it simply will not work to have one party chart the future? It would be much better, therefore—this is why I support his motion—to have a cross-party commission, although not a royal commission that would kick it into touch for three years, to try to bring everyone together to face what he rightly describes as an existential challenge to health in this country for the future?

Norman Lamb: I am grateful to the right hon. Gentleman for that intervention; he absolutely makes the case. Incidentally, I think that it is massively in the Government’s interests to respond positively, because any solution has to carry public support and support across the political spectrum.

Consider these points. Does it still make sense to maintain the divide that was originally put in place in 1948 between the NHS and the social care system? Is that serving patients effectively, particularly given that the big challenge of this century will be people living with long-term, chronic conditions, often multiple conditions, and often a mix of mental and physical health conditions? For those people, a divide between different organisations with different pools of money and different commissioning arrangements does not seem to make much sense. I think that that needs to be looked at.

Too often, the system gives the impression of being rather dysfunctional. For example, last October there were 160,000 bed days resulting from people whose discharges were delayed. These are predominantly older people, often with dementia, who remain stuck in hospital long after they are ready to go home or somewhere closer to home. This is not good care. We are letting people down by keeping them in hospital for longer than they need to be, which also makes it harder for them to become independent again. The figure went down a little in November, but it is still the second highest since the data on delayed discharges started to be recorded.

Helen Whately (Faversham and Mid Kent) (Con): The right hon. Gentleman mentions the relationship between the NHS and social care and the problem with their being separate. Does he acknowledge that the “Five Year Forward View” contains several approaches to bringing them together, and that parts of the country are already working on further integrating them? Is it not important to press on with those approaches so that we can see how they work and move as quickly as possible on this?

Norman Lamb: I totally agree with the hon. Lady. I have always been a strong supporter of the forward view. Simon Stevens is a good leader of the NHS. He has a vision, and he recognises that the solutions to this challenge often lie beyond the NHS. Some of the models that are being trialled across the country are very interesting. I do not want what I am saying to be seen in any way as undermining the very good work that is under way in the so-called vanguards around the country.

Geraint Davies (Swansea West) (Lab/Co-op): On bed blocking, when I was leader of Croydon Council it cost £300 a night to keep someone in Mayday hospital and £100 a night for us to provide a bed as a local authority.

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We had no money, so I asked the health authority to pay for our beds and save £200, and it did. However, that was an ad hoc strategy, and surely we want a holistic, integrated approach, as the right hon. Gentleman is so eloquently explaining.

Norman Lamb: I totally agree with the hon. Gentleman’s last point, but also his substantive point. The problem is that these are all ad hoc arrangements that are about good leaders doing something despite the system, not because of it. We have to mainstream this and align the incentives throughout the healthcare system so that everyone is focused on preventing ill health, preventing deterioration of health, and getting people better as quickly as possible.

Let me give an example of the pressure that the system is facing. It is fair to say, as a gentle challenge to the Government, that this year we are not seeing the data on accident and emergency pressures over the winter period, so the situation is slightly hidden from view. However, I heard that on Tuesday this week all the hospitals in Hertfordshire, north London, Bedfordshire, Northamptonshire and Leicestershire were on black alert, which occurs, in essence, when hospitals are completely full and under enormous pressure. One of the key system leaders in that area said that he had not seen anything like it for 20 years. This is happening at a time when there is no flu epidemic, and certainly no severe weather. This is one of the mildest winters on record, and yet we are seeing hospitals placed under impossible pressure.

Chris Davies (Brecon and Radnorshire) (Con): I commend you for trying to bring the parties together to have a commission to look into the matter of the NHS, but we are now living in a devolved Great Britain. It is great to get the parties together in England, but how do you propose to get Wales, Scotland and Northern Ireland together? I will give an example. My wife works for the NHS. She worked for the NHS for 18 years in Wales. She gets treated by the NHS in Wales because we live in Wales, but she works for NHS England. Given that there are so many cross-border issues, especially in Brecon and Radnorshire, how do you propose to get the whole of Great Britain to work with this plan?

Norman Lamb: I said at the start that I am primarily focused on England because health is a devolved responsibility, but I also said that the same pressures apply everywhere, and so the case for a process of this sort in Wales, in Scotland and in Northern Ireland is just as strong as it is England. I would encourage this debate to take place in Wales as well. We must overcome the clashes between the parties to recognise that something bigger is going on and we need to work together.

Dr Philippa Whitford (Central Ayrshire) (SNP): I want to return to the right hon. Gentleman’s point about the data. Last June, we had a debate about moving from weekly to monthly data, and we were told that the NHS would still know what was going on. We now have a six-week delay in the publication of those monthly data, which results in a total of 10 weeks. Having asked about this at the most recent Health questions, I understand that people within the NHS can access the data, so why are they not being shared with this place? The last data we had was in November.

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Norman Lamb: I thank the hon. Lady—that is a very good point. I fundamentally believe in openness. It is much better if everyone understands what is going on, and then there can be a much more informed debate.

One of my big concerns is that despite some of the very good policy positions that have been taken nationally, too often, across the country, crisis management prevails. Because areas are so focused on propping up acute hospitals that are under the intense pressure I described, more and more money ends up being pumped into those hospitals while the preventive parts of the system are losing out and being cut further. It becomes a vicious circle, because the more we cut back on preventive care within NHS community services, general practice and social care, the more pressure we end up putting on hospitals. We cannot escape from this, and that is why we need the long-term solution that I have talked about.

In health and social care, demand keeps rising. This is unusual in public service terms when compared with, say, police and schools. Demand has risen at 4% a year throughout the post-war period. We all know the causes: we are living longer, new medicines and new technologies come on stream, we face challenges like obesity, and so forth. The cost pressures just keep going up. It is a well-established position that by 2020 there will be a £30 billion gap in NHS funding. The Health Foundation has said that in social care the gap will £6 billion. Those are enormous figures, and they take no account of the £1 billion additional cost from increasing the minimum wage. In responding, the Government have identified an extra £10 billion for the NHS, but that leaves a £20 billion shortfall. This is based on scenarios set out in the forward view. However, the scenario of a £20 billion shortfall involves efficiency savings that are completely unheard of in the whole history of the NHS. Virtually everyone one speaks to—not just people who refuse to accept the need for efficiencies—says that achieving efficiency savings of 2%, rising to 3%, is unachievable between now and 2020.

Mr Mitchell: Is it not the case—I think this is a cross-party point—that although the NHS is under very great financial pressure, and we are trying, in effect, to get a quart out of a pint pot and have been doing so for many years, the people who work in the service are also under very great pressure? Whatever one thinks about the junior doctors’ situation, the information that has come out from across the service, and from across the junior doctors, is testament to the fact that they work under enormous pressure. This is not just a financial issue; it is also about the fact that the staff in the NHS are under unprecedented pressure that is not set to get any easier.

Norman Lamb: The right hon. Gentleman makes a very powerful point. Indeed, the staff are working under impossible pressure.

Incidentally, the assumptions about the funding gap by 2020 do not take into account the work that the right hon. Gentleman and I have done together to make the case for equality of access for people who suffer from mental ill health. This is about a historical injustice that has to be dealt with. Paul Farmer, who has led a taskforce for NHS England, has concluded that mental health will require an extra £1.2 billion a year by 2020 in

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order to ensure equal rights of access with everyone else. It is very hard to deny the justice of that cause and the right of people to get access to social care in the same way as everyone else.

Geraint Davies rose

Norman Lamb: I am conscious that Madam Deputy Speaker may start to get slightly irritated with me—

Madam Deputy Speaker (Mrs Eleanor Laing): On a point of clarification, the right hon. Gentleman is doing just fine on timing. I appreciate that he has taken a lot of interventions, and people who intervene know that, later in the debate, their speeches will be shorter as a result of their interventions. He is doing nothing wrong, and he may proceed.

Norman Lamb: I am relieved. I sensed that I might be getting into trouble. I will give way to the hon. Gentleman.

Geraint Davies: Very briefly, in terms of aggregating the expenditure of health and social care, which, incidentally, is higher in Wales where there is an attempt to have a more integrated approach, the cutting of social care will increase the total amount, as undue pressure will be put on the NHS, which then cannot release beds, and it costs more per night to keep someone in a hospital.

Norman Lamb: The hon. Gentleman is absolutely right. Simon Stevens has made the point that if we cut social care, the £30 billion gap widens. There is no escaping from that. The brutal truth is that the whole system is under very substantial pressure. Analysis by the Office for Budget Responsibility, which is independent of Government, shows that between now and 2020, we are planning to spend a reducing percentage of our GDP on health. At a time when demand is increasing so dramatically, does that decision make any sense at all? Back in 2013, the OECD did an analysis of all OECD countries in the European Union. Only five were spending a lower proportion of their GDP on health than we do. The NHS is very good value for money, but it is under extraordinary pressure.

Anne Marie Morris (Newton Abbot) (Con): The right hon. Gentleman is being very generous with his time. The picture that he is painting is one of a very reactive approach to the growing problems. I entirely support his call for this review. As a responsible society, we need to have a holistic, forward-looking, proactive approach, particularly with regard to social care. The Barker commission made a number of good proposals, some of which I agreed with and some I did not. To what extent does he agree with me on that point?

Norman Lamb: I totally agree with the hon. Lady. In fact, I think that I have agreed with every intervention so far. We will probably all just agree with each other. She is absolutely right and it goes to my point about crisis management. We are at risk of lurching from crisis to crisis, as we prop up a system that is under unsustainable pressure. Of course we always end up spending money at the repair end of the spectrum, rather than on preventing ill health.

There are some great initiatives in the west country, where volunteers, working with GPs, try to address the problems of loneliness, and that is helping to keep people out of hospital. That sort of thinking needs to be much more widespread.

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Tom Brake (Carshalton and Wallington) (LD): My right hon. Friend may be coming on to this point, but what I want to understand is how the commission, and the output of that commission, can help with some of the very difficult hospital reorganisations that we all face in our constituencies—mine being St Helier hospital—and how we can ensure that we strike the right balance between acute services and care in the community. How will the commission help with that?

Norman Lamb: My right hon. Friend comes to the central point. As someone once said, the NHS has the status of a national religion. In this partisan atmosphere in which we all work, there is a danger that anyone who proposes a change to the NHS will get condemned from on high, because of the political points that can be scored in so doing. If we are to think about what we need from a modern health and care system that focuses on prevention, and to make changes in a rational way, we must give Government the space to think afresh about how we can sustain the system and guarantee care for those who need it. We have a choice now: we continue to drift until, ultimately, the system crashes, or we grasp the nettle and come up with a long-term solution.

All parties should commit to the proposal. If we want a good example, we should look at the commission of Adair Turner, which was established by the Labour Government to look at the long-term sustainability of pensions in this country. He managed to secure cross-party buy-in. He came up with proposals that led to change and reform. It was a process that gave people the space to look at a very difficult challenge and to come up with solutions. That is one model we could follow. It should be strictly time-limited. Somebody made the point that we are talking about not a royal commission, which goes into the long grass for three or four years, but a time-limited commission of up to one year with the aim of coming up with solutions that are then implemented. It should engage with the public, with patient groups and, critically, with staff, who, as the right hon. Member for Sutton Coldfield (Mr Mitchell) said, often feel that they are under intense pressure and that they are not listened to by Governments of all political persuasions. They, together with unions and civic society, should be centrally engaged with this commission. At the end of the process, we should seek to come up with recommendations that can then be implemented and can give everyone in this country the assurance that there is a long-term settlement for the NHS and for care.

Finally, let me raise one or two things that the commission needs to consider. It needs to look at the divide between the NHS and social care and at the adequacy of funding. How much as a society are we prepared to pay to ensure that we have a good, well-functioning health and care system? At the moment, funding for our health and care system comes through three different channels: the NHS, local authorities and the benefit system. Does that make sense? Should we look again at that system?

We also need to look at how we, as a country, are spending money on our older people. Are we spending it effectively enough? Are we targeting it at those older people who most need Government help? We need to look at inter-generational fairness and at where the money comes from—a point very well made in a recent book by the respected former Cabinet Minister, David Willetts. We also need to consider how we can give power to

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people to help them to self-care. David Wanless, when he reported for the Labour Government, made the point that his projections about how much extra money the system would need was based on people being engaged in their health—I am talking about self-caring more effectively. That has not happened in the way that he proposed.

We also need to consider the case for a dedicated health and care tax, which can be varied locally. Even protecting NHS spending results in disproportionate cuts in other areas of Government spending, distorting sensible, rational decisions. As this is an area on which spending inexorably rises, there is a case for carving out such a tax.

Helen Whately rose

Norman Lamb: I am sorry, but I want to conclude my remarks now to give other Members a chance to speak.

This proposal has had very significant support. NHS Survival, which now encompasses 8,000 members—junior doctors, patient groups and so on—has strongly argued for such a tax. Forty chief executives of care organisations wrote to the Prime Minister to support the case. The chief executive of the King’s Fund, Chris Ham, has written a very helpful blog, making the case. Royal colleges of surgeons, pathologists and anaesthetists have all supported the call. I urge the Government to respond positively. They should stop and think for a moment before rejecting our proposal, because it might be an enormous help to the Government in resolving an intractable problem. This is the time for a 21st-century Beveridge report to come up with a long-term settlement for the NHS and for social care.

12.59 pm

Dr Sarah Wollaston (Totnes) (Con): I thank the right hon. Member for North Norfolk (Norman Lamb) and pay tribute to him, particularly for his work as a Minister in the coalition Government and for his personal commitment to mental health services. I welcome his call for real focus and cross-party agreement on this long-standing problem. We need that if we are to solve the problem and create a health and social care service that is fit for purpose for the next century.

I would sound one note of caution. I am very relieved that the right hon. Gentleman is not calling for a royal commission, as there is no shortage of commissions in this place. We are just a year from the Barker commission, the highly respected independent commission set up by the King’s Fund, which very clearly laid out the problems we face and suggested a number of options. Hard choices will have to be made if we are to raise the share of our GDP that we spend on health and social care to 11%, which I know many Members would support.

We know the options. The difficulty is a political one. I question whether we need a commission, and would ask whether we do not in fact need a commitment from the leaders of all political parties in England to come together to look at the proposals seriously, and get away from the endless bickering in this place about the choices before us and the pretence that this is somehow not going to happen. Unless we make such changes, we will have to start thinking rapidly about plan B as an alternative.

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What will be the consequences for all our constituents if we fail to reach a political agreement about the challenges we face?

John Pugh (Southport) (LD): If I understand the hon. Lady correctly, she supports a commitment, but not a commission, but would a commission not be a sign of such a commitment?

Dr Wollaston: In this place, we sometimes push issues into commissions, which debate them endlessly and come to no agreement. I would say the urgency of this issue demands that the leaders of all political parties sit down together and agree.

Norman Lamb: I am very grateful to the hon. Lady for giving way, and I promise not to keep intervening. I feel that there needs to be a process to which everybody is committed. If there is just a desire for the party leaders to co-operate, the temptation to score political points when a crisis comes along will be too great and it just will not happen. We need to bind people into such a process, and they must be prepared to commit to it.

Dr Wollaston: I thank the right hon. Gentleman for his clarification. I agree that we are looking for a process to which everyone can commit. We are not looking for a commission that will go away and examine the problems. We know the issues, which have been set out in very stark terms. The King’s Fund’s excellent independent Barker commission set out the whole range of options. What we have always lacked is the political buy-in and determination to move forward. I would join in making a request for any process that will make that happen, but not for something that pushes it away for three years, because, as we all know, the closer we get to a general election, the more challenging it will be to have a genuine political agreement. It therefore needs to happen as rapidly as possible.

Mr Mitchell: I am not sure that there is that big a difference between my hon. Friend and the right hon. Member for North Norfolk (Norman Lamb). My point is that as well as getting all the political parties to focus on this issue now, we need an extremely long-term approach. The House of Commons used to accept that we had to have a long-term, all-party approach to pensions, because of the length of time involved in such important decisions. We also need that in relation to this issue: as well as getting everyone to focus on it, we need to get them to focus on the importance of reaching agreement because this is such a long-term issue.

Dr Wollaston: I agree with my right hon. Friend. However, in parallel with the process of looking at long-term funding arrangements and settlements, we must get on—here and now—with changes that are needed in the short term. I want to touch on a few such areas.

The first area is prevention. I absolutely agree with the right hon. Member for North Norfolk that it is bad practice to cut money from public health, simply because of the challenges we face. If we look at the NHS budget, we can see that 70% of it goes on helping those living with long-term conditions. We know that many future problems are brewing here and now.

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Let us just take childhood obesity, which we discussed at length last week. A quarter of the most disadvantaged children now leave primary school not just overweight, but actually obese. Given the problems that that is saving up, in the personal cost to those children and the wider costs to the NHS—nearly 10% of the entire NHS budget already goes towards treating type 2 diabetes—how can we not be grasping that nettle as a matter of urgent prevention to save money for the whole system?

Geraint Davies: Does the hon. Lady agree that there is an inter-relationship between child poverty and obesity, and indeed between child poverty and other health problems that generate costs, and is not part of the solution to the dilemma of how to meet the costs of health and social care to look again at such demographic drivers?

Dr Wollaston: Indeed. The data from Public Heath England are absolutely stark: from looking at the index of multiple deprivation and the incidence of childhood obesity, we can see that not only is there a large gap, but that that gap is widening. As part of the strategy, the Government must aim not only to lower overall levels of childhood obesity, but to narrow that gap, particularly by looking at measures that will help to do so. I thank the hon. Gentleman for making that point.

The right hon. Member for North Norfolk referred to the need for self-care, and we know that we need a much greater focus on how we can support people to improve their own health. If we are going to raise money for the whole health and care system, there are mechanisms to do so that will also help to prevent ill health in the future. One example is a sugary drinks tax, which could lever money into a very straitened public health budget to put in place measures that we know will help. We need the NHS to get on with prevention, and in my view we need more of the funding that is available to go into saving money for the future.

Chris Davies: May I say what respect around the House we have for you as Chair of the Health Committee? I would therefore be very interested to hear your view of the “Five Year Forward View”—

Madam Deputy Speaker (Mrs Eleanor Laing): Order. I let the hon. Gentleman get away with it earlier, because I appreciate that he has not been in the House for very long, but when he uses the word “you”, he is addressing not the hon. Lady, but the Chair. I know he means his compliments not for the Chair, but for the hon. Lady, so he must refer to her as such.

Chris Davies: I apologise profusely, Madam Deputy Speaker. We of course have great respect for you, too.

The “Five Year Forward View” plan is already under way, led by the former Labour adviser Simon Stevens. It is looking at reforming heath and care services, and is backed by the funding that the NHS has already said it requires. Does my hon. Friend feel that setting up yet another body would benefit the NHS, or would it be a hindrance?

Dr Wollaston: I thank my hon. Friend for mentioning the “Five Year Forward View”, but I would respond by saying that Simon Stevens has referred to prevention

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and social care as “unfinished business” from the spending review. If we are to deliver the plan, we need to listen to his views and be mindful of the fact that spending on social care actually saves the NHS money. We cannot separate social care from the NHS, and we should not ignore his wise words on the importance of prevention in delivering the “Five Year Forward View”.

Dr Philippa Whitford: Is it not the case that when Simon Stevens was before the Health Committee, he said that a quarter of the £22 billion of savings that were hoped for would have to come from prevention and public health, yet that is being cut?

Dr Wollaston: Indeed; I remember that too. I agree that unless we up our game and redouble our efforts on prevention, we will not achieve the savings that are required to close the gap in the “Five Year Forward View”. That is why I wanted to touch on prevention first.

There is another area that we need to do much more on here and now. We need to have a relentless focus on variation across the NHS. We hear examples of local systems that are making things work, but the NHS has a long history of failing to roll out best practice. The “Growing old together” report, which was published today by a commission set up by the NHS Confederation, gives examples of good practice across the NHS and social care in which integrated practice is not only delivering better care for individuals, but saving money. The only depressing aspect of that is that one has to ask why it is not happening everywhere. Rather than endlessly focusing on the negatives in the NHS, let us focus more on the positives and on facilitating their roll-out.

Helen Whately: My hon. Friend is talking about work that is being done on the problems in the health service and about approaches that can improve it. Does she share my concern that although there are big challenges, there is a risk that a commission such as the one proposed could prove a distraction from getting on with the many things that we know need to happen and the very good proposals in the “Five Year Forward View”? It could therefore be unhelpful, rather than helpful, despite its objective.

Dr Wollaston: If that were the case, it would be a problem. I think that the two things could happen in parallel. We could work towards a consensus about future funding at the same time as focusing relentlessly on what needs to be done in the here and now. However, I agree that if it were a distraction, it would be a problem.

As well as continuing to have a relentless focus on tackling variation, we need to follow the evidence in healthcare. When money is stretched, we must be sure not only that we spend it in a way that follows the evidence, but that we do not waste money in the system. I caution the Minister on the issue of seven-day services, which we have discussed at the Health Committee. If there is evidence that GP surgeries are empty on a Sunday afternoon because there is no demand, and in parallel with that we are being told that out-of-hours services are in danger of collapse because, in a financially stretched system, there are not the resources or manpower to offer both, we must be led by the evidence and be prepared to change what we are doing.

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When money is tight, we owe it to our patients to focus on the things that really will improve their care. There must be no delay in making changes when we know that something that has been put in place with the best possible intentions may be having unintended consequences. We must be clear that we will follow the evidence on best practice and value for money, so that patients get the best outcomes in a financially stretched system.

Geraint Davies: The Government have decided to make Saturday a working day in a regime where a couple who are both doctors can be sent, without a choice, to different parts of the country to practise in hospitals and only have family time together at weekends. Now that Saturday will be a working day, their situation will be virtually impossible. Does the hon. Lady agree that that needs to be considered in case it causes a further leakage of doctors and, therefore, less efficiency in the system?

Dr Wollaston: I have to declare a personal interest here, because one reason why my daughter, who is a junior doctor, has spent a year in Australia is that there are sometimes difficulties with married couples—or, indeed, people in any relationship—being able to work in the same part of the country. There is far more that could be done to help junior doctors, in addition to the contract negotiation about money. However, as I have a personal interest, it is probably best if I do not comment further on that.

I want to draw attention to the role of the voluntary sector, which the right hon. Member for North Norfolk referred to. I pay tribute to the voluntary sector partners in my constituency—bodies such as Dartmouth Caring and Brixham Does Care. Across the constituency, a number of organisations are making a real difference to people’s lives, yet very many voluntary sector organisations are coming under extreme pressure. I could give examples of voluntary sector partners that have had to close, sometimes for the want of very small amounts of money, even though they have delivered enormous value. These are locally-facing organisations.

It was welcome that Simon Stevens gave a commitment to look at making the arrangements for commissioning voluntary sector partners easier. Even though those commissioning arrangements may have been made easier, often the resources are not there to fund such organisations. We need to look again at how we can deliver best value for patients by supporting voluntary sector partners across all our constituencies.

Those are the areas that I want the Minister to focus on in the here and now, but I agree that in the long term, we must look at funding. One challenge in this country—and I think it is a wonderful thing—is that almost all the funding for the health service comes directly from taxation or national insurance. We are almost unique in that. Only two other countries exceed us in that regard. Government funding for the NHS accounts for 7.3% of GDP and only an additional 1.5% is levered in from the private sector.

The choice before us is whether to expand the amount that we raise through charging and top-ups. Personally, I do not support that. The Barker commission did not support it either. Top-ups and charging do not raise as

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much as people imagine by the time the bureaucracy involved in collecting the money and the unintended consequences that are often found, such as widening health inequalities, are accounted for. I hope that we do not choose to go down that route. The most equitable funding mechanism is taxation.

There is an issue of intergenerational fairness here, as the right hon. Member for North Norfolk said, and we need to consider it. These are hard political choices, which can no longer be ducked. Given the demographic challenge and the challenge of complexity that we face, the alternatives are appalling. The alternatives are to abandon our older people. The pressures that our hospitals face from those who cannot be discharged into the community and those in the community who cannot get into hospital are mounting. We can ignore them no longer.

I call on the Government to consider very carefully working with our Opposition partners at scale and at pace to bring forward an agreement on how we will bring more money into the system as a whole, and in the meantime, to make sure that the money we do spend is spent in the best interests of patients.

1.19 pm

Liz Kendall (Leicester West) (Lab): It is a privilege to follow the hon. Member for Totnes (Dr Wollaston), who is always open to discussion and debate, and who speaks with great experience. I am sure I speak for many hon. Members in saying that we are all the better for it.

I support today’s motion not because I think we can somehow take the politics out of the NHS and social care. Services that are used by millions of people, employ more than 3 million staff and cost more than £130 billion of taxpayers’ money every single year will always be the subject of political debate and, in my view, rightly so. I support the motion because the NHS and social care face huge challenges—they are bigger now than they were at any point in our history. We must no longer ignore or downplay those challenges and expect services, staff and the families who need care to try to struggle through.

I agree with the right hon. Member for North Norfolk (Norman Lamb) that we need a new settlement for health and social care in England, and an independent commission involving the public, staff and experts could play an important role in helping us to achieve that goal. Cross-party support for such a commission is vital. As the former shadow Minister for care and older people, I know that it is extremely difficult for Front-Bench politicians, whether in opposition or in government, to be open about what it will take to ensure that our care services are fit for the future, how much that will cost, where the money will come from and, as importantly, what changes are needed to ensure that our care services are truly fit for the future. Front Benchers’ comments are likely to be leapt upon, twisted and exaggerated and end up as screaming headlines, but in the end it is not the politicians who suffer, but the patients, users, families and staff.

Many important reviews and commissions, and Green and White Papers, from both the Opposition and the Government, have addressed the issue in recent years. In particular, I give credit to the commission on the future of health and social care in England, set up by the King’s Fund and chaired by Dame Kate Barker, from which many of my comments today are drawn.

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However, all those initiatives have failed to achieve genuine cross-party involvement and agreement. The commission proposed in today’s motion could help to create the political space and buy-in that we desperately need to agree a long-term settlement for the NHS and social care, whichever party or parties are in power.

The need for such a commission is urgent. As the Barker commission said, given the budget settlement that the NHS has had since 2010, staff have performed remarkably, but the NHS is now struggling to meet many of its waiting time targets: the target for diagnostic services has not been met for 18 months; the 62-day cancer waiting time target has not been met for more than a year; and A&E waits are back to the levels of the early 2000s. NHS finances are also under acute pressure, with a projected year-end deficit already of more than £2 billion.

The situation in social care is even worse. Some 400,000 fewer people are receiving publicly funded social care than received it in 2010, even though our population is ageing. Many of those who still get care are getting less support than they were. More than 1 million people who have difficulties in the very basics of daily living, such as getting up, washed and dressed and going to the toilet, now receive no formal or informal help at all. Last year, the Care Quality Commission found that one in five nursing homes do not have enough staff on duty to ensure good-quality care. The latest survey from LaingBuisson shows that, for the first time since it started collecting figures, more older people’s care beds closed than opened. Five of the largest care home providers predict significant provider failure within the next 12 to 24 months. Three of the larger home care providers have already withdrawn, or signalled their intention to withdraw, from providing publicly funded care.

Those problems are not going away. The NHS “Five Year Forward View” sets out how the NHS hopes to close a gap in health spending that is estimated to reach £30 billion a year by 2020. That will require efficiency savings of £22 billion, and at least an additional £8 billion a year of real additional funding, which the Government have committed to provide, but no health service in the world has achieved efficiency savings of 5% in one year, let alone for five years in a row. As Simon Stevens, the chief executive of the NHS, has repeatedly stressed, the very broad calculations in the forward view depend on social care receiving a decent level of funding, given that cuts to social care inevitably increase pressure on the NHS.

I do not believe that there is a decent funding settlement for social care. The Dilnot reforms, which have been postponed to the end of the Parliament, were not intended to address current underfunding, but to cap the costs of care to individuals. The better care fund, which is welcome, and the new 2% precept on council tax for social care, will not fill the gap either. Indeed, even with the precept, it will be harder for areas with the greatest need for publicly funded social care to cover their costs, because they raise the lowest amount from council tax.

Our population is ageing and demand for care will increase, so the question we face is not whether the money will be spent, but where the costs will fall. Will they fall on collective provision through public expenditure, or on those individuals and families who are unlucky enough to need care and support?

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There is no shortage of proposed solutions to that problem. The Barker commission has called for changes to the national insurance system to help increase funding, including removing the complete exemption from employee national insurance contributions for those past state pension age, and raising to 3% the additional rate for those above the upper earnings limit. The commission also proposes restricting winter fuel payments to the least affluent pensioners, so that at least some of the extra costs of care are met by those above state pension age who have the means to contribute. In his recent interview in The Guardian, Simon Stevens called on the Government to consider the housing assets, benefits and other support received by older people to achieve

“more flexibility between current disconnected funding streams for older people, so that at times of need everyone is guaranteed high quality social care”.

I believe we must face up to the vital question of intergenerational fairness. The vast majority of older people have worked hard all their lives in paid employment and bringing up their families. They need and deserve support, and they do not want to end up having to sell the family home to pay for care if they need it, but I know from my own family as well as from my constituency that older people also worry about their children and grandchildren, and how on earth they will be able to afford to pay the bills or go to college or university, let alone have the chance to own their own homes. In my view, we simply cannot ask the working age population to shoulder all the extra costs required to properly fund the NHS and social care in future. I believe many older people would agree.

An independent commission with proper cross-party support that genuinely involves and engages with the public—after all, they are the ones who ultimately fund the NHS and social care—could finally help us to make progress on finding lasting solutions to these inevitably difficult and controversial questions. As the Barker commission says, the challenges we face are clear: more people in need are receiving no support at all; fewer people are receiving publicly funded social care; care home providers are closing in the face of rising demand; companies that provide care in people’s own homes are leaving the publicly funded market; individuals and families who are unlucky enough to need high levels of care continue to face enormous bills; and staff shortages are leading to a rise in neglect as good people are unable to deliver good care, piling further pressure on the NHS, which in turn is likely to lead to declining standards of patient care. That is not a future that anyone would wish for their parents, themselves or their children, but it is the future that is upon us. It is time for politicians on both sides of the House to act.

1.29 pm

Dr Phillip Lee (Bracknell) (Con): It is a pleasure to follow the hon. Member for Leicester West (Liz Kendall) and other colleagues who have spoken. I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing the debate.

I broadly support the call for some cross-party engagement to try to secure the future for the national health service, although I will come on to clarify that in my speech. The right hon. Gentleman may encounter some difficulties in seeking cross-party support for financing the NHS, not least because of some of the contributions

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so far. There are some profound challenges to financing health and social care, primarily because of the challenges that we, and all western societies, face with an ageing population. I remember the Intergenerational Foundation launch here in Parliament a few years ago. Only the former Member for Dulwich and I turned up. At the time, the subject was not much discussed, but I note that it is now increasingly being discussed. We are beginning to do the maths and realise that we cannot afford the current settlement for financing health and social care and that we will have to discuss it at some length. The problem is that one ends up talking about broadly different political philosophies and approaches. Some people, I suspect more on the Conservative Benches, will want to emphasise the need for personal responsibility; others, I suspect more on the Opposition Benches, will want to emphasise collectivisation and the like. That is why I suggest that discussing the financial settlement is possibly a road to nowhere.

I think there is scope, however, for discussion on the structural organisation of the health service: where our hospitals are located and what each individual hospital does. In a week when we have had yet another dreadful failure of the system with the 111 line and out-of-hours services, it is beholden on us to start to discuss what is offered in the out-of-hours arena: how the services are structured and where patients should go to seek the appropriate care for themselves or their children.

The context has been set out by other colleagues. We know that we have a problem of increasing demand, which is driven mainly by ageing, obesity and the welcome advances in surgical practice, technology and drugs. There is also a problem with the health-seeking behaviour of different generations. In my own clinical practice, I am seeing the passing of the stoic wartime generation. Their attitude towards health, and to symptoms of pain and suffering, is noticeably different from that of their children and that will bring increasing demand on healthcare services. If we consider that together with the large cohort who were born between 1945 and 1955, we have an equation that results in a significant deficit.

On the subject of deficits, since I have been here I have seen many faceless NHS bureaucrats come up with numbers relating to likely demand and shortfall. They are always wrong; the figures are usually underestimated. I said at the time that the £20 billion challenge in the previous Parliament was an underestimate of likely demand and here we are talking about £30 billion. What is next: £40 billion? I am glad that a shadow Minister for mental health has been appointed and that people are waking up to the importance of mental health because demands for mental health services in particular will increase the £30 billion figure.

On hospital structure, essentially we have 19th and 20th century buildings trying to deliver 21st century care. Medical and management staff are trying to do their best within this infrastructure, but to be blunt it is not possible to deliver the very best care in all hospitals and in all locations.

Dr Philippa Whitford: Is it not also, to some extent, a failure to engage with the public so that they understand how much 21st century medicine has changed? People who have a heart attack are not going to their local

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casualty department. They are being taken to a heart unit where they will have an angio and an angioplasty. People do not understand that the big boxy paramedic ambulance has everything that an old A&E used to have.

Dr Lee: The hon. Lady is right. Tomorrow I will be working as a doctor. I am very proud to be working as a doctor. I have been very public and open about it throughout my time here and I will continue to practise medicine for the foreseeable future. I encourage her to face down her internal critics, as well as those rather ill-informed external critics in the Scottish Daily Mail. I actually stood for election calling for the closure of my local hospital. I did not want my constituents going to an ill-equipped hospital, or thinking that it provided care that it did not. I have sought to educate my local electorate about the need for a 24-hour angio suite and for a 24-hour stroke unit.

We have made some progress on reconfiguration, particularly on stroke care. In London and in Greater Manchester, stroke services have been consolidated. That is why people are now surviving and survival rates for strokes are improving. Patients are taken to appropriate units and appropriately cared for. The appropriate intervention can be applied within the appropriate time. Sadly, that is not possible across the country. It is available only in areas where difficult decisions about reconfiguration have been taken. On oncology, there is a widespread belief that cancer outcomes are all to do with late diagnosis in primary care. Forgive me, but that is not necessarily the whole story. It is the quality of cancer care when patients reach the hospital—any delay in receiving radiotherapy and so on—that is having a profound impact on cancer outcomes. If we consolidated oncology services into fewer sites, we would get better clinical outcomes.

On out-of-hours care, when I turned up here I said that I would scrap out of hours care as it is currently constituted. Most people looked at me and thought, “Are you slightly nuts?” The answer is no. Having done many, many, many sessions in the primary care out-of-hours arena, I realised that there was the potential to delay the care of the acutely unwell in a way that could have an adverse impact and, in extremis, lead to someone’s death. I suspect, without knowing the details, that the case we heard about in the urgent question on Tuesday was such an example. I do not believe it is clinically possible to properly assess a sick child via a telephone. We can go some way towards doing it with an adult, because—guess what?—an adult can express themselves more accurately. With a child, we have to see them and touch them, and, in particular, we have to see the mother’s response towards the child, to assess how acutely unwell they are.

The problem, with all best intentions, is that with a telephone service these types of incidents are always going to happen. It was no different with NHS Direct; the medical profession used to get very frustrated with that, and 111 is the same. The symptoms of sepsis can be the symptoms of many things, so if we tighten the protocols we end up flooding the service with more and more people worried that their child has sepsis when, actually, it is not that common.

I would revisit the whole out-of-hours settlement. We could get away with having fewer doctors during antisocial hours primarily looking after the housebound and those

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who are terminally ill. The list of patients who could be visited by said doctor would be compiled by GP practices in that region. Patients would not get a visit unless the GP practice has said they are entitled to a visit because of a diagnosis of being either terminally ill or housebound. In future, I would put the resources into urgent care centres. For now, I would put one in each casualty to sift through. I would make sure it was a doctor. Forgive me, but doctors are taught to triage and to diagnose. No other healthcare professionals are taught in the same way. The best thing to do is to put one’s most experienced and qualified person at the front end, because then proper triage can take place.

Dr Tania Mathias (Twickenham) (Con): In my constituency, the borough has a brilliant GP-led out-of-hours system that I would invite the Secretary of State to considering rolling out. I appreciate the idea of a commission, but we already have the vanguards and out-of-hours services, such as the one being led from Teddington memorial hospital, which I believe set the right standards. What can a commission do that we cannot do without one?

Dr Lee: I thank my hon. Friend for her intervention because it allows me to elaborate. A couple of years ago, I had a meeting with the right hon. Member for Leigh (Andy Burnham)—all the polls were saying that the Opposition would win the election, so I thought I would have a meeting with him in advance. I said, “Look, Andy, you’re going to have a problem. We’ve got all these hospitals. We know some of them are not fit for purpose. We know we’ve probably got too many because of how healthcare has changed. Some 80% of care delivered in the NHS is for chronic conditions. Why don’t you have a cross-party commission so that all the parties can share the political pain of deciding which hospitals should be retained as acute hospitals, delivering the 24-hour stroke and angiography suites, the surgical interventions and the like, and then have more community hospitals, with urgent care centres attached”—the hub-and-spoke model. At the time, he looked at me and said, “Well, maybe”, and made no commitment.

My point was that it was extremely difficult for colleagues in marginal seats to come out and say what I said in my constituency, which was that the current local hospital settlement was not in the best interests of my constituents. It is very hard to do that in a marginal seat, be it Labour, Conservative or whatever, so, with a cross-party commission, we could all share the pain.

All the royal colleges, particularly the paediatricians and obstetricians, know that staffing in some district general hospitals is not ideal. It is extremely difficult to provide the level of care we know we can deliver. How do we get to that point? A couple of years ago, I thought that having all the parties and independent experts in a room would be one way of going from approximately 200 to 100 such hospitals in England and Wales. That is the sort of scale change I am talking about. I hope that that answers the question from my hon. Friend the Member for Twickenham (Dr Mathias).

Dr Philippa Whitford: In my constituency, we have hospitals that have grown organically and are not far apart, but we have also seen an increase in the number of modern community hospitals—what people would

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have called cottage hospitals. The hon. Gentleman says that many of our patients require the management of chronic diseases. We need to take that closer to the public. It is the highly specialised things that should be centralised. The public would accept that, provided they do not get the sense of their hospital disappearing and provided they are aware that other services are coming closer to them.

Dr Lee: Again, I agree with the hon. Lady—we are making a habit of this. I held a series of public meetings at which people were initially against my position, but when they understood that I was trying to provide more services closer to home, but that this might mean their having to travel a bit further for acute care, they accepted it and became broadly supportive.

I am under no illusions about the difficulty of all this, but if there is one goal we should all seek in the NHS, it is better clinical outcomes. At the moment, clinical outcomes are not as good as they should be. The much-trumpeted Commonwealth Fund report made that clear. Part of the problem—perhaps a significant part—is where the care is currently being delivered. The junior doctors strikes, which have just been paused; the consultant contracts; the nursing contracts to come—all these would be made easier with a structure in place that is more easily staffed. It would be easier to avoid husband-and-wife doctor teams being split if we had bigger hospitals with bigger staff pools to provide the cover.

We need to concentrate first on the structure of healthcare, and social care—I am conscious I have not spoken about social care, but of course it should be integrated; it is so obvious. But let us concentrate on the structure of healthcare first, as part of a cross-party approach, and then perhaps we can have a debate about finance. I suggest to the right hon. Member for North Norfolk, however, that finance might be a harder nut to crack than the hospitals, on which I think there is a broad consensus that we are all in it for the same outcomes: people recovering from their illnesses; people being treated appropriately when they have operations; and ultimately everybody, irrespective of means, leading long, health lives.

1.45 pm

Jim Shannon (Strangford) (DUP): It is a pleasure to participate in this debate, which I thank the right hon. Member for North Norfolk (Norman Lamb) for securing. We know he has a passion for this subject—in our many debates, we always take great account of what he says—so it was good to have him leading the debate. I think that other Members who have spoken—the hon. Members for Totnes (Dr Wollaston), for Leicester West (Liz Kendall) and for Bracknell (Dr Lee)—sat on a social care Bill Committee I sat on in the last Parliament, so we have some knowledge of the subject. I also thank the right hon. Member for Sheffield, Hallam (Mr Clegg) for kindly letting me go before him. I have a plane to catch, and sometimes these debates can go on.

Those who have spoken have brought a wealth of knowledge and experience to this debate, as will those who have not yet spoken, and I want to add a wee bit of that in relation to Northern Ireland, while commenting on the mainland as well. This year marks the 10th anniversary of the Wanless review of social care

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for older people. Since the review, there have been attempts, first by the coalition Government and now by the Conservative majority Government, to shift the policy direction and introduce new legislation to optimise healthcare provision and make the system versatile enough to cope with the increasing demand associated with an increasingly elderly population—my constituency has one of the fastest-growing elderly populations. I am going that way myself, but that is by the by.

Despite the welcome efforts by the Government, problems remain. The challenges, not least the financial challenges, are making it more difficult to provide services for the elderly, and these challenges will be around for a while. We will need to learn how to address them as the demographics of the country make service provision for the elderly more challenging. We can foresee these challenges, however, and it is encouraging that the Government recognise that. It is good to see the Minister in his place, and I look forward to reading his contribution. I apologise to him and the shadow spokesperson for being unable to stay for their speeches, as I have already said, but we are always encouraged to see the Minister on his feet, given his interest in this subject.

The importance of an integrated health and social care system is widely accepted. We have seen exciting innovative developments in Northern Ireland, where the former Health Minister, my party colleague Edwin Poots MLA, launched the “Transforming Your Care” programme, which was continued by the next Health Minister, Jim Wells, and now by the present Health Minister, Simon Hamilton. The initiative seeks to move care for elderly people from hospital into their homes wherever possible. That is the focus and goal of the strategy. Not only does this provide care closer to home and a nicer experience all round for the patient, but it has the potential to save the NHS and the social care system a lot of money in the long run. The Minister might like to note that programme as an example of what is possible. If it was replicated nationwide, it could save a lot of money in the long run and make for a more personal social care experience that would benefit the elderly.

With the financial challenges of austerity in our public services, we need to come up with innovative ideas to modernise our health and social care system and offer a first-class service in a financially difficult environment. Whether we like it or not, finance is part of the system we have to work within. The importance of integrated health and social care is widely recognised by health professionals and charities. We now need to turn this into a reality. Adult social care needs to be on a sustainable financial path if we are to maintain a world-class health and social care system, during a time of changing demographics, and we need to make sure that the pressures on the system are properly understood.

The integration of health and social care is crucial to provide a patient-centred service that makes the best use of resources. With care and caution, and with movement in the right direction, it is possible to do more with less. Innovative approaches such as the “Transforming Your Care” initiative are examples of how we can modernise the public sector to deliver real results with a tighter budget. Health and social care need to be seen as equal partners and provided with the necessary resources to

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deliver high quality services that actually serve the people. “Resources” does not necessarily mean increased funding. We know that we are living in tough times financially, and while funding is always desirable, success should be judged on results rather than the bill for the investment.

Social care is important in its own right. The Local Government Association claims there is a continuing lack of proportionality between additional funding for the NHS and adult social care. While much of the funding for the NHS is front-loaded, additional resources from the better care fund will not be available until 2017. Can the Minister say whether it is possible to consider implementing the better care fund on a shorter timescale? We will not be facing problems down the road in 2017; we are facing them right now, as Members have said and will continue to say. The Government need to make a greater effort to address the issue and ensure that the social care sector is adequately funded and resourced as we seek to make the appropriate reforms to make it a versatile and modern service that delivers for the people that it needs to.

1.51 pm

Dr Andrew Murrison (South West Wiltshire) (Con): I rise to support the motion, and I hope in my contribution I will be able to explain why. I should first declare my interest as a licensed medical practitioner, albeit one who is in awe of my colleagues in the Chamber who regularly see patients, which is something I thoroughly commend. I think most of the people out there—apart from those who write for some of the more scurrilous parts of our national press—appreciate the fact that there are people in this place who are still engaged in medical practice of all sorts. It makes us relevant, it makes us current and it gives us some authority, as we have heard already today, when we talk about areas of expertise.

There are some omissions in the motion, however. I suspect that its magisterial generality is probably by design; nevertheless, it fails to mention public health directly, which is an important part of the piece. If we are to consider the entirety of health and social care in this country, we need to talk about public health, which I think, if I am honest, has been neglected by consecutive Governments, largely because nobody fully understands what public health is. There is not really an accepted definition of “public health”. It means many things to many people. Some of us still believe, I suppose, that it is a rather old-fashioned thing, to do with the pre-1974 vision of medical officers of health, who dealt exclusively with infectious diseases. It is much bigger than that. Public health pervades all elements of the public service and needs to be addressed head on if we are to deal with some of the pressures we face in the acute sector, as well as ensuring that we meet some of the imperatives that apply to health in this country, which, as my hon. Friend the Member for Bracknell (Dr Lee) has pointed out, should mean being focused pretty much exclusively on healthcare outcomes.