North East Ambulance Service

Lord Beamish Excerpts

Wednesday 4th May 2016 Westminster Hall

[Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)]

I represent a very rural seat in north Northumberland, where, in January 2015, we had the tragic case of the entirely avoidable death of a young man because an ambulance did not get there in time. The Secretary of State instituted a national review on the back of that to look at the issues that triggered that tragedy. I am grateful for that, and we have made progress.

Some issues have come out of that, and the North East Ambulance Service should be commended. In my area, ambulances go to Northumbria hospital—our new emergency-only hospital. Some colleagues have already mentioned that we have been seeing the queuing of ambulances as they arrive at the various hospitals. I am not familiar with the wider north-east hospital framework, but at Northumbria it was quickly evident that that was a problem. To its credit, the North East Ambulance Service sent a paramedic to help in the triaging process, along with a specialist nurse who was diverted from other duties, to improve the process when the ambulances arrive—the hospital knows when they are going to turn up because they phone ahead—and to do a better job in ensuring that patients were removed from said ambulance and that the kit was returned to paramedics so that they could crack on with the next case.

That has been working well. We have seen a much speedier process, so I would commend that to colleagues, who could encourage other hospitals in the region to look at doing that. That has been an investment, but without doubt the cost-benefit not directly to the hospital but to the overall health package for our constituents has been hugely improved, because ambulances are back in the system. We were also then able to ensure that Northumberland-based ambulances were coming back up into Northumberland and not being taken to 999 calls elsewhere in the region, leaving paramedics working 14 or 15-hour days to get the ambulance back to Berwick or Alnwick. I commend the ambulance service for listening on the challenging problems we had and trying to make improvements.

At Northumbria hospital, the figures for urgent and emergency attendances read like this for the past three months: January had 12,911, which was a 12% increase on 2015; February had 13,731, which was a 30% increase on 2015; and March had 15,146, which was a 24% increase on 2015. However, only 24% of those cases needed emergency hospital admission. Something is broken. We are overloading our ambulance service with calls that demand an emergency ambulance, but, once at the hospital, only 24% needed emergency care.

My concern is twofold, and I ask the Minister to look at how we can make progress on this. First, the algorithm that the 111 and 999 systems demand that staff in the call centres use is dramatically risk-averse. I do not want anyone who is having a cardiac arrest to be told they have heartburn and not be sent an ambulance; quite the opposite should happen. However, a few years ago, the North East Ambulance Service built the lower-level 111 system and tested it before it was rolled out around the country.

[Mr Kevan Jones (North Durham) (Lab)]

I hear what the hon. Lady says, but is not the real problem that 111 was rushed in and relied on technology? When it originally started, we had trained paramedics in the call centres who could categorise cases. There is clear evidence, which I will present, that, if something is not deemed life-threatening or someone is not having difficulty breathing, the case is categorised as green. The figures produced are meaningless.

[Mrs Trevelyan]

I thank the hon. Gentleman for his comment. Quite a few of my constituents were among those experienced staff. Some were retired midwives or had worked as nurses and then moved into the call centre framework. There was a big shift a few years ago to downgrade the medical qualifications required for those staff. We are starting to see a change in that, because the new chief executive is mindful that the huge increase in demand is partly down to staff’s inability to assess cases correctly. If they took another 30 seconds, they could assess properly the situation on the end of the phone.

Will the Minister work with the people who are writing the algorithm and building the system to get it right? The ambulance service personnel would then have a better tool to work with. That would also encourage ambulance services, and not just our own in the north-east, to go back to higher-value trained personnel who can ask the right questions and get the right answers, so that we do not end up with over 70% of emergency calls ending in someone getting to hospital and finding that urgent care was not needed.

The other side of this issue, which I have been campaigning on with St John Ambulance, is the need to help families to be better educated so that they can assess their own medical conditions. Other than for cardiac arrests, strokes and such evidently dramatic changes, it is often not emergency care but urgent care that is required. We need to encourage people and build their confidence in assessing for themselves whether they should go to the pharmacy or the doctor or call for an emergency service. We need to do that across the board, focus on it and drive it forward.

St John Ambulance wants to get into every single school, so that we are teaching young children the difference between what to do if they burn their finger on the kettle—put it under the tap, instead of dialling 999—and what to do in an emergency, such as if granny falls down the stairs. The next generation would then have confidence in knowing the difference between when emergency care is needed and when they can manage and find the right care over a longer period.

Our paramedics will not be able to continue meeting the demand, much of which is inappropriately placed on the ambulance service. We should make much better use of our amazing paramedics and ensure that retention is higher, because they are valuable members of our community.

[Mr Kevan Jones (North Durham) (Lab)]

I congratulate my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) on securing this debate. In the past 18 months, I have heard about 12 quite serious cases. The ambulance service is in crisis, and that is not down to the men and women who work in it; it is down to the management. Urgent action is needed if we are to avoid people dying and prevent the suffering that my constituents are going through.

I will give a flavour of that suffering. In July 2014, in Chester-le-Street, a woman’s husband has severe angina. The first responder arrives and says he needs an ambulance. Three hours later, the ambulance arrives. A gentleman falls in Chester-le-Street from a six-foot fence and bangs his head. He is told to stay and wait for an ambulance. He waits two hours for an ambulance that does not arrive, so his neighbour takes him to hospital. A lady in Sacriston, which is about 10 minutes from the local hospital, has severe abdominal pains and is passed out, unconscious, waiting two hours for an ambulance to arrive. In Tanfield Lea, an 86-year-old lady has a fall at 9.30 pm on 13 February. Her partner is told by the ambulance crew not to move her. After several calls, the ambulance arrives on Saturday morning at quarter to 1. Apparently it had been diverted to Newcastle.

Patient transport is also an issue. One constituent, who had had a stroke and severe mobility problems, was waiting for patient transport to a medical appointment but was told that the ambulance would not attend. Another constituent from Stanley was transferred from his home to the Freeman hospital for regular dialysis. He had to wait two hours for transport back home, leaving him in severe discomfort. Another constituent who lives in Chester-le-Street found a young lady passed out outside her front door. She called an ambulance, and an hour and a half later, the ambulance arrived.

In New Kyo, a constituent complained that a young woman was having a fit in the local bus station. One hour and 10 minutes later, there was no response. She called the police, and they got the ambulance to arrive. Another constituent from Chester-le-Street needed to be transferred from Bishop Auckland hospital to the university hospital of North Durham. The request was made at 5 pm. She arrived in hospital at 1 am the following morning.

In Beamish, a lady fell down a flight of stairs and called an ambulance immediately. The first responder said she should not be moved. Two and a half hours later, an ambulance arrived. In March this year, an elderly lady in Sacriston—literally a 10-minute ride from the local hospital—waited an hour and 47 minutes in the cold north-east winter, being comforted by her neighbours with blankets, having broken her shoulder.

The last case I will touch on, which I have permission to mention, was raised with me by Mrs Irwin in east Stanley. Her 69-year-old mother-in-law, Joyce Irwin, had a fall on 14 March at 7.20 pm. Her son, who lives with her, came home and rang for an ambulance at 7.25 pm. He was advised by the controller that an ambulance would be there within the hour. Nothing happened. Her eldest son arrived and rang both 999 and 111. The first responder arrived at midnight, without any pain relief, and Joyce Irwin therefore had to wait until 1.10 am—four and a half hours later, having been on the floor in excruciating pain—for an ambulance to arrive. When she was finally delivered to the university hospital of North Durham, she found she had a broken hip. It is worth reading what Mrs Irwin says. She states clearly that her mother-in-law was in excruciating pain and was promised an ambulance that she did not receive. She says that Joyce has

“worked and paid her duties all of her life”.

Is that the way to treat our constituents in the 21st century? I suggest not.

There is something severely wrong with the North East Ambulance Service. I have a particular problem with the way in which it treats elderly people. My hon. Friend the Member for Washington and Sunderland West said that the service is missing its targets for red 1s and 2s, but fall cases such as those I mentioned are not even put down as red 1s and 2s; they are put down as greens. In many cases, these are elderly people who have broken bones and are in severe pain, but they are put down at the bottom of the queue. Will the Minister interrogate the hospital trust about the way it is prioritising cases?

I have been told anecdotally by a firefighter and a policeman that if someone wants an ambulance to arrive quickly, they should ring them up and say that a person either has chest pains or is unconscious. They will then get an ambulance straight away. In this day and age, it is not acceptable that our constituents—elderly, vulnerable people like Joyce Irwin, who have done the right thing all their lives—are treated like that. They have worked hard and paid into the system, and they expect in their old age that if they need the NHS in an emergency, it will deliver. It is not only the individual who is affected. The trauma also affects their families and loved ones, who, in Joyce Irwin’s case, saw her on the floor for four and a half hours in excruciating pain. That is simply not acceptable.

May I also ask the Minister to tackle the North East ambulance trust about its response to Members of Parliament, because it is absolutely diabolical at responding to Members’ complaints? I have had many complaints from people who have called an ambulance when they have seen an incident and they ask why the ambulance took so long. When I inquire, the ambulance trust responds, “We cannot discuss that case because of patient confidentiality,” because the complainant was not affected. That is complete rubbish. Those people do not want to know what happened to the individual; they just want to know why an ambulance did not turn up. It is interesting that we have got this debate today, because I recently had a flurry of answers to my questions, but I say to the Minister that there is a serious issue about how Members of Parliament can represent their constituents who complain to them.

I have a similar problem—if the Minister wants to intervene, that would be helpful—with the North Durham clinical commissioning group, which has failed to answer any complaints at all, so I have raised the matter with NHS England. There is something seriously wrong with the North East ambulance trust, although it is not down to the hard work of the individuals who work for it. They do a tremendous job in very difficult circumstances. There is also a question about the priority system that uses algorithms, as the hon. Member for Berwick-upon-Tweed (Mrs Trevelyan) suggested.

There is a question about rurality as ambulances are diverted to more urban areas rather than rural areas. I did not think I would say this, but it might be time to break up the North East Ambulance Service and put it into special measures. It covers a large area and is completely failing. Will the Minister look into whether it is fit for purpose in the long term? I do not think it is. Urgent action is needed. People are not only suffering, but they have lost faith in the service, which is a terrible thing. What should be a flagship service—North East Ambulance Service—that people call upon only in a time of need is clearly failing.

--- Later in debate ---

[Ian Lavery]

What I am saying is not meant to be any criticism of the people in the call centre, either—because if they veer from the crib sheet they have got, they are in trouble; but it shows how bad the whole situation is.

I want to mention Mr Taylor. I must say that he is a relative of my wife, who waited 11 and a half hours for an ambulance to arrive. He was really poorly. Plenty of people came from the NHS and said, “He needs an ambulance”—and then someone says “He doesn’t” and someone says “He does,” and someone else says “He doesn’t”. When he actually got the ambulance, at 1.45 in the morning, he was in a coma. That was seven months ago, and he is still lying in a coma as we speak. If that ambulance had turned up before, he might not be.

I will not dwell on that point other than to say that that brings me on to the complaints procedure, because MPs have complained, as well, about what happens to our constituents. We get a chronological list of what happened, and why the ambulances could not come, because they were diverted to other more serious incidents. That is not good enough. It is not good enough for me to say to one of my constituents, “Your mam couldn’t get an ambulance because somebody else was more important”—when she was lying suffering. Or if someone has a terminal disease and is desperate, or someone has a chest disease—it is not good enough; and the complaints procedure is not good enough. They are not treating people like human beings.

I have got lots to say and not a lot of time to say it, but I am going to reiterate the fact that these delays are utterly unacceptable and we cannot continue on this basis with the North East Ambulance Service operating as badly as it is. Someone mentioned that the service will be fully operational in 12 months. I have heard that before. It is not good enough for the people who will trip, fall and stumble. It is not good enough for elderly people, or young people playing football.

[Mr Kevan Jones]

My hon. Friend has obviously had the same letter from the North East trust that I have had; but does he agree, also, that it is not good enough because it is a question of our constituents’ confidence in the service? It should be a first world service, but it is more reminiscent of the third world.

[Ian Lavery]

I fully concur with my hon. Friend’s sentiments, and I am pleased about that intervention, because I think I might otherwise have needed an ambulance myself. I feel as if my blood pressure it is getting exceedingly high.

More seriously, we have to look at the North East Ambulance Service now. We cannot announce a review in weeks to come. We have got to get to the bottom of why the service is operating so badly. It is not meeting its major targets in almost every single category. It has been mentioned that it may perhaps be put in special measures, or that it should be broken up. To be honest, I do not have the answers, but one thing I will say is that the Government have to look at the North East Ambulance Service and improve it in the same way as in other areas of the country. There is no reason why people in my area, in the north-east, should be tret any differently from anywhere else in the country. We need to get hold of the situation immediately.

--- Later in debate ---

[Mr Kevan Jones]

I hear this from the Minister and I hear it from the trust, but could I ask her officials or NHS England to actually delve into the figures? The hon. Member for Berwick-upon-Tweed (Mrs Anne-Marie Trevelyan) raised an interesting issue. This is actually about the ways in which ambulance calls are classified. There are clearly reds that are not reds, but the other point that I would like the Minister to address, even if she cannot answer it today, is the way older people are being treated, because they are being put down as greens, whereby they get no priority at all, and they are some of the most vulnerable people in our community.

[Jane Ellison]

Indeed. I have very much taken that point on board and I will try to respond, but if I do not do so today, I will certainly write to the hon. Gentleman, because it is a fair point. The more general point is where the ambulance service sits in terms of our response and general position on urgent and emergency care. I will respond to some of the points made by my hon. Friend the Member for Berwick-upon-Tweed (Mrs Trevelyan), because I think that this sits within a wider, systemic challenge and I want to touch on that.

Every patient should expect to receive first-class care from the ambulance service, but the nature of emergency response work means that there will always be incidents in which unfortunate timing leads to a person assessed as being in a non-life threatening situation calling 999 at the same time as several other people who are in life-threatening situations. I am sure that hon. Members are realistic about that, but clearly we do not want to hear about such problems occurring on a very regular basis. Where that does occur, obviously the life-threatening situations must be prioritised and resources focused on those calls. Very rarely—unfortunately, we have heard about such cases this afternoon—waits may be unacceptably long. I do not shy away from that, but it is important to remember that the vast majority of people receive a timely response when they dial 999.

I have already said, echoing the words of the hon. Member for Washington and Sunderland West (Mrs Hodgson), who led the debate, that although the NEAS has not met the performance targets, that does not reflect on the hard work, dedication and skills of the local staff. A number of speeches brought that out. I am advised that although ambulance delays are the main reason for patient complaints, the number of complaints received in 2015-16 fell, but we do not want any complaints; that would be the situation in an ideal world. However, the fall is indicative of the fact that the efforts of the local ambulance staff are paying dividends. Although the performance target is effective in driving improvements and maintaining response times to the most critically ill and injured patients, it does not, inevitably, paint the complete picture of how a trust is doing.

I will talk about some things that the North East Ambulance Service, has put in place to bring about improvements to service, because that is the focus of the debate and people want to hear that the direction of travel is positive. The NEAS continues to expand the number of specialist clinicians working in its clinical hub who can provide telephone assessment and advice, and who can prevent the dispatch of an emergency response if it is not deemed necessary. That goes to one of the points made earlier. The trust expects that that will have a positive effect on response times.

Last winter, the NEAS piloted an end-of-life-care transport service, which provided three dedicated ambulances that were on call to respond to transport requests from healthcare professionals to take a person to their final place to die. The scheme has meant that emergency ambulances are not tied up in transporting patients when they are needed for more serious cases, and that terminally ill patients are not waiting a long time for transport to their preferred place of death. Although we do not often like to talk about end-of-life care, the preferred place of death is an important part of reducing stress at an inevitably very difficult time for an individual and their family. Results from the pilot were overwhelmingly positive and eased pressure on vital services.

Hon. Members have raised valid concerns about handover times between ambulance crews and emergency departments in the local area, and that is an issue across the country. Patient handover needs to be as efficient as possible to achieve the best possible outcome for the patients and to free up ambulance resource, but more can be done and is being done. Measures include hospital ambulance liaison officers, which are being put in place by the NEAS. HALOs are present in hospitals across the trust territory and I am advised that the trust has sought to make use of dedicated ambulance resource assistants as well.

The urgent and emergency care vanguard programme in the north-east will include the development of a standardised handover process for all acute providers, intended to minimise delays across the patch. That goes to the shadow Minister’s point about looking at the wider system. That will be to the benefit of crews and emergency departments. I understand that, as part of the vanguard, the NEAS also hopes to secure funding for a new “flight deck” information system that will enable diverts by ambulance crews to other hospitals to be proactively managed and will prevent ambulances from stacking up outside already full A&E departments. The trust believes that those initiatives will help to distribute A&E workload evenly and will be welcomed.

Several hon. Members have rightly commented on the recruitment challenge. It is very much recognised that there is currently a shortage of paramedics nationally and the NEAS trust is no different. We recognise that front-line staff are the vital component of a safe, effective and high-performing service, and work is being done by the NEAS to rise to the recruitment challenge. The hon. Member for Washington and Sunderland West mentioned some things that are being done. Efforts include developing new advanced technician roles to support front-line services, and the trust is running a substantive recruitment of paramedics nationally and internationally.

The trust expects 77 student paramedics to graduate by February 2017, in addition to recruiting an additional 36 qualified paramedics in 2016-17. The trust has also recruited a total of 56 emergency care clinical managers, and that represents a significant investment in front-line clinical leadership. It also advises me that it expects to be up to full paramedic establishment by April 2017. I know that that commitment will be keenly watched by hon. Members.

Mental Health Taskforce

Lord Beamish Excerpts

Tuesday 23rd February 2016 Commons Chamber

[Mr Speaker]

I know that the right hon. Gentleman will take it in the right spirit when I say that it is immensely encouraging that he notices his own answers.

[Mr Kevan Jones (North Durham) (Lab)]

Parity of esteem and extra resources are important, but one of the main messages from this report is that we need to hard-wire mental health and well-being into public policy. Twice as many people take their own lives as are killed on our roads each year. Does the Minister agree that it is now time for a national campaign to address this issue?

[Alistair Burt]

Yes, I do, and I thank the hon. Gentleman for his comments and for his work and interest in this area. Included in the taskforce’s recommendations is a national ambition to reduce by 10% the number of suicides—that would be a reduction of some 400 a year. Three areas are already piloting a “zero suicide ambition strategy”, and this probably needs to be given more prominence than it has been. A national suicide prevention strategy is in place, which I am reviewing to see how it can be better implemented locally, because not all local areas have a similar strategy. It is right that that gets extra prominence, and we had a debate on it not too long ago in Westminster Hall. We recognise that it is a significant issue for men in particular, because three times as many men as women take their own lives. The recent increase in the number of women doing so, which was noted just a few weeks ago, is also significant. It is important that we talk about this more, recognise that suicide is not inevitable, and have a national ambition to challenge it and do more. I am confident that the hon. Gentleman will be able to champion that work, just as he has championed other things.

Mental Health

Lord Beamish Excerpts

Wednesday 9th December 2015 Commons Chamber

[Mr Kevan Jones (North Durham) (Lab)]

I welcome today’s debate. We are doing a very simple thing today, but it is very effective: we are again talking about mental health in this Chamber. Both the Secretary of State and my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) talked about a change in attitudes and said that things are changing. I agree totally that things are changing for the better, not just in this place, but in the media and in society. Sadly, in my own party there are some parts that still need to go a bit further in understanding mental health, but we are making great strides and they should be recognised. That is down to the great work that is being done by Rethink, Time to Change and other charities, which are not only those individuals who work for those organisations, but the thousands of volunteers behind them.

[Chloe Smith]

I hope the hon. Gentleman will welcome this intervention, because I seek only to give him the due credit that he deserves for his place in that all-too-brief history of our actually talking about mental health.

[Mr Jones]

I thank the hon. Lady for her intervention. I have a simple view on mental health, which is that we need to talk about it more, because that will change attitudes.

What do we do next? Well, we need to hardwire mental health and mental wellbeing into public policy and society. To those who ask why that is important, I say that not only is it the right thing to do, but, even in these times of austerity, it makes economic sense. It saves money as well as lives. We need a system in which every single Government policy is road-tested against mental health and mental wellbeing.

The Secretary of State accused my hon. Friend the Member for Liverpool, Wavertree of being political on this matter. Well, I am sorry, but the Government cannot escape from some of the things that they are doing in this area. It is the Opposition’s job not only to question the statements they make, but to look at the facts. The Chancellor announced an investment of £600 million in talking therapies, which I welcome, but that is set against a cut of almost 8.5% in the previous Parliament. The money will do nothing to replace the beds that have been lost in psychiatric wards. As the right hon. Member for North Norfolk (Norman Lamb) has said, there are people who have to travel ridiculous distances around the country to access those beds. What is the root cause of that? Is it a shortage of beds? Yes, it is in some areas, but another root cause, particularly in London, is the shortage of available housing. Our housing policy has a direct effect on the problem.

Another area of concern relates to the back-to-work interviews and the work capability assessments. My hon. Friends and I have raised that matter on numerous occasions, but the Department for Work and Pensions is not listening. People are still being put through that tortuous process, which is neither good for the taxpayer nor good for the individuals concerned. A 56% cut in the local government budget will have a direct effect on the delivery of mental health and support services. At the moment, a consultation exercise is out on the formula for allocation of public health funding. On that basis, County Durham will lose £20 million a year.

People might say that all those policies have nothing to do with mental health, but they do have a direct impact on the services that we deliver. We need to hardwire mental health and mental wellbeing into all those areas, whether it be schools, society, the family or the criminal justice system.

Many issues face people with mental illness. Personally, I have been to some very dark places, but the most tragic and darkest place is faced by those who commit suicide. We are talking about not just a life being cut short, and the opportunities that are missed in terms of the fulfilment that that person could give both to society and to their families, but families being left bereft and in a very emotional state. In this country, three times more people commit suicide every year than are killed on the roads. We had a great road safety campaign, which addressed the problem of people being killed on our roads. We need the same campaigning zeal to attack the suicide rates in this country.

My own region in the north-east has an unenviable suicide record. We have the highest rate of suicides in the country, with 13.8% per 100,000 individuals taking their lives. Such rates are related to the economic situation. People may try to gloss over that fact, but economic situations do affect people’s lives. We must also address the fact that 78% of that figure are men. Men are terrible at talking about mental health. So, yes, progress is being made, but we do need to have mental health and mental wellbeing running through all Government policies.

I welcome the debate today, because it provides us with another opportunity to talk about mental health on the Floor of the House, which must be a good thing. Now is the time to change those words into action.

[Several hon. Members rose—]

--- Later in debate ---

[Mr Kevan Jones]

I commend the right hon. Gentleman for his work. Does he agree that those leaders now need to translate that action into policy, both at a national and a local level?

[Norman Lamb]

I totally agree. We have to set the framework, put the funding in place and deliver services on a local basis. How can anyone in this Chamber possibly justify this: if someone has suspected cancer, they have a right to an appointment with a specialist within two weeks of referral by their GP, but a youngster with an eating disorder has no such right, yet we know that their condition can kill? That is a scandal and an outrage and it must change. There must be equality of access.

When someone does get access to treatment, too often it is a lottery. As we discussed last Friday, we have the continuing scandal—the hon. Member for North Durham (Mr Jones) referred to this earlier—of people being shunted around the country in search of a bed. That would never happen to someone suffering from a stroke or a heart condition. It is inequality of access to treatment, and it is a complete scandal.

[Mr Jones]

There is an issue with the number of beds, but does the right hon. Gentleman also accept that one of the problems is that people are in those beds for far too long? One of the crisis points in London is access to adequate housing so that people can be discharged into the community.

[Norman Lamb]

I was so pleased that the hon. Gentleman made that point in his speech, and I pay tribute to him for the work he has done. The answer is not simply to have more beds; we should also be reducing the length of stay, which often is not therapeutic for the individual. Getting them into secure housing is central to their health and wellbeing.

Cities and Local Government Devolution [Lords] Bill

Lord Beamish Excerpts

Wednesday 21st October 2015 Commons Chamber

[James Wharton]

I have had discussions with my hon. Friend the Member for Altrincham and Sale West, I recognise the comments that he makes and I will of course listen carefully to the further discussion today. I will set out the Government’s position on the issue in due course, but I wish to make it clear that the intention is to be consensual. We intend to listen to concerns that hon. Members might raise and try to find a way whereby we can agree across this House on what we want to deliver. I recognise the important point being made and I am sure we will discuss it further.

Amendment 4 is about mayors being a condition of devolution. We are seeking to remove the requirement that a mayor cannot be a precondition of transferring local authority or public authority functions to a combined authority, because it is wrong in principle, and it is at odds with our manifesto policy and manifesto commitment. In addition, if the requirement remained, it would mean that the deals we have made already with Greater Manchester and with Sheffield could be in jeopardy. The requirement is wrong in principle.

[Mr Kevan Jones (North Durham) (Lab)]

I welcome this movement, but can the Minister explain why the Secretary of State has always insisted in his discussions with the combined authority and the north-east council leaders that a prerequisite for any devolution is having a mayor?

[James Wharton]

I think the hon. Gentleman may have misunderstood the direction of travel that I am setting out, but I am happy to clarify it and I hope to go on now to address his concerns.

--- Later in debate ---

[James Wharton]

It is important to be clear about what the devolution we are talking about does. It takes powers that exist in Whitehall—powers that rest with public bodies—and transfers them to local decision makers. It does not affect the arrangements that are already in place for local government, which recognise differences and the communities within them. We will allow them, of course, to pool areas of policy if they wish to do so, but nothing in this legislation would allow us to compel them to do so.

In his Budget speech in July, the Chancellor was clear:

“The historic devolution that we have agreed with Greater Manchester in return for a directly elected Mayor is available to other cities that want to go down a similar path.”—[Official Report, 8 July 2015; Vol. 598, c. 329.]

All of that is reflected in our manifesto commitments to

“legislate to deliver the historic deal for Greater Manchester”

and to

“devolve far-reaching powers over economic development, transport and social care to large cities which choose to have elected mayors.”

[Mr Kevan Jones]

I would like the Minister to clarify something. As he knows, the north-east combined authority area is not a metro area, because it covers a large rural area. He said that the agreement is between the combined authority and the relevant Minister, but the insistence so far from the Secretary of State has been that the only way the north-east combined authority will get devolution is if it has an elected mayor. Is the Minister now saying that there is an option for devolution without an elected mayor for the north-east?

[James Wharton]

The hon. Gentleman will recognise from the quote by the Chancellor that I just read out that where areas want significant devolution on the scale that Greater Manchester has and where they have metropolitan areas at their heart, the Government will ask for that requirement to be part of that deal process. However, nothing in this Bill will allow the Government to compel any area to have a mayor or to have devolution. This is an enabling piece of legislation. The hon. Gentleman is absolutely right that in the deal that we are discussing with the leadership in the north-east area—all of it from his party—there is that expectation and requirement, and it is a deal on which great progress is being made.

--- Later in debate ---

[Mr Betts]

The right hon. Gentleman is absolutely right. Of course, the whole principle of the devolution that the Government propose, which I support, is that areas should come forward with their own ideas about what they want to see devolved. Why should they not also come forward with their own ideas about how that devolution should be exercised and about the governance arrangements for it?

[Mr Kevan Jones]

I agree with my hon. Friend, but it is obvious why the Government want mayors. In certain areas—in his area and in others—they are hoping to break up the powers of locally elected Labour local authorities in the hope that if they have an elected mayor, they will either get an independent or someone who claims to be independent but is actually a member of the Conservative party.

[Mr Betts]

I would not want to second guess the motives of the Secretary of State, so I will use my own arguments to resist what the Government are trying to do.

Apart from the inconsistency of approach, the proposals are confusing. That takes me back to the point I made in my intervention on the Minister. In the Sheffield city region the economic powers, which are important and cover skills, economic development and the infrastructure associated with it, are to be devolved to the combined authority, which will cover nine districts—four metropolitan and five non-metropolitan districts. But as I understand it from the deal, the mayor will have responsibility for just transport. So the mayor is to run transport, and the combined authority is to run economic development. The public want some consistency of approach on these matters. I do not believe that the combined authority, the district, would naturally have come forward with a proposal that broke up the responsibilities in this way.

--- Later in debate ---

[Mr Kevan Jones]

My hon. Friend talks about the principles of devolution, but one of the key factors as to whether it will work will be the proper and fair allocation of resources. This Government have a track record of devolving responsibility to local authorities while at the same time top-slicing their budgets. Is not my hon. Friend concerned that this Government, who are committed to a small state, will devolve not only responsibility without resources, but blame for cuts?

[Mr Allen]

My hon. Friend makes a very sound point, of which we should all be wary. We need to break that system so that we are able to go with the begging bowl and say, “We can prove we need a little bit more than anyone else,” and take as much control as possible of our own areas and resources. The amendments I have tabled seek to achieve that. The localities need their own tax base and powers. Those powers also need to be entrenched so that they cannot be sucked back by any Government—by that black hole of magnetic force we call Whitehall—unless they are able to demonstrate that their stance can be defended constitutionally, as explained in a couple of my amendments.

We need not be afraid. As well as the tremendous example of what has happened in Scotland, we have the example of what happens in every other western democracy. People in western Europe and north America take as given the independence of their locality, state, region or länder from the centre. They cannot be told what to do. The idea that the President of the United States could tell the states of New York and Georgia how they should spend their money is laughable, as is the idea that all the money in individual areas in Germany, Italy and Scandinavia should go to the centre and then be redistributed. They would think we were crazy if we proposed that system for them, yet that is the system we operate for ourselves. We are the oddities—we are the odd ones out.

We need to mature as a democracy. Sometimes I think our democracy is a bit frail and feeble, but actually it is underpowered: we do not have enough of what other nations in the western world have and we are unable to take steps forward. That is why I welcome the Bill in general, but I want to propose a number of other steps for the Minister to take either now or, perhaps more realistically, in the next devolution Bill.

--- Later in debate ---

[Mr Rees-Mogg]

I am very grateful for the hon. Lady’s intervention, because it brilliantly encapsulates what I want to say, which is that Bristol is a fantastic city, a noble city, a city of fine history, but it is not Somerset. What I want to do is to protect Somerset from encroachment by Bristol. I want Her Majesty’s Government to ensure that the people of Somerset are not subjected to any pressure, any force or any arm twisting to be ruled from Bristol or to subsidise Bristol. I would rather, and I know the people of Somerset would rather, see our money spent through decisions made in Whitehall than decisions made in Bristol. We see the unity of the nation and we see the history of our county; what we do not see is a random administrative area.

I hope that the Minister can give me one commitment, which is that if we do not sign up to these things and if we retain our independence and freedom of manoeuvre, the Government institutions that spend money, such as Highways England, will continue to spend money—that it will not mean any loss of money, but will merely be about who decides how it is spent. For once, I am trusting the man in Whitehall against the man in red trousers in Bristol.

[Mr Kevan Jones]

The Minister made three startling claims in his opening remarks. He said that mayors will not be imposed, that devolution settlements will not be imposed and that the Government will seek consensus on such settlements. That is just not what the Government are doing.

The hon. Member for North East Somerset (Mr Rees-Mogg) talked of an iron fist in a velvet glove. What we have here is complete doublespeak. The portrayal of the situation by the Minister and others is that these decisions will somehow be taken in local areas. At the same time, the North East combined authority is being told that it will get devolution, but that a non-negotiable condition of that is to have a mayor. When councillors meet the Secretary of State and ask him why they need a mayor, he says that it is because the Chancellor of the Exchequer requires it as a prerequisite of devolution. The Conservative party and its friends in the north-east state that when the North East combined authority’s leaders ask sensible questions about why other areas have devolution without a mayor, or legitimate questions about how the mayor will work in practice, they are somehow being difficult, and that is why amendment 51 is so important. Throughout this entire exercise we are forgetting one important group of people—those who elect us and who are served by local councils and local areas.

Last week on Second Reading the hon. Member for Bromley and Chislehurst (Robert Neill) claimed that the Secretary of State was being a Chamberlain-style reformer. No, he is not, and I agree with my hon. Friend the Member for Sheffield South East (Mr Betts) when he says that we will end up with a complete dog’s breakfast.

There has been no great commission. When the Conservative party restyled local government in the 1970s we had the Redcliffe-Maud report, and in the ’60s—I think it went over into the Heath Government—the Crowther commission considered devolution. At least we are considering the issue and have some consistency to our approach, but that is because this Bill has nothing to do with real devolution and is about the Chancellor’s political control. He is seeking to ensure that the cuts required by his ideal of a small-state Britain can be devolved to local authorities or mayors, so that when people ask, “Why do you have to make these cuts?”, he will stand back and say, “It is nothing to do with me. It is down to your local mayor, and you decide.”

[Ian Mearns (Gateshead) (Lab)]

The North East LEP does not really hang together cohesively in its geography. It extends from south of Barnard Castle that borders North Yorkshire, right up to the Scottish border at Berwick-upon-Tweed—a considerable distance. This is not some sort of city region; it is an urban heart with a considerable rural hinterland. It does not hang together well from a business perspective.

[Mr Jones]

My hon. Friend makes a good point. In 2010 the Government were completely against regions, but now they have recreated a region in the northern LEP area. What he says is right—the area is very diverse and has some difficult issues regarding population, services, and other things that are delivered.

This is slightly different from when we had mayors for local authority areas. The Minister said that we need elected mayors because this is about devolving power from Whitehall to the regions, and that is why the approach needs to be different. I am sorry but—I make no bones about this—in 2004 I remember the Labour Government’s proposals for regional government in the north-east. Was it right for local people to have a say in whether the north-east had an extra tier of regional government? Yes, I think it was, and people overwhelmingly rejected it. I am not sure whether the Minister was around then, but many Conservatives in the north-east who now support him argued vigorously for the idea that it was right for people to have a say in the future governance of their region. Indeed, I think that some of the people who funded his election campaign also funded the no campaign in the north-east.

If it was good enough then, and the Conservative party and its backers in the north-east argued vigorously for why we should allow people to have a say, why now will they not allow people to have a say over a new tier of regional government? That is inconsistent, and it is interesting that the same voices that once argued vociferously against regional government in the north-east have remained completely quiet now that a Conservative Government are preparing to impose a system on the north-east without giving local people a say.

I congratulate the hon. Member for Hazel Grove (William Wragg) on his amendment, and I hear what people are saying about Manchester. I will not get into Manchester politics, but council leaders should be careful. If we have learned one thing in the past few years, it is that people cannot be taken for granted. If we are to listen to and represent people, it is important at least to give them a say in what we do. This is a major issue, given the change to how the country will be governed, and excluding people in the north-east and not giving them a voice in their future is completely wrong. The Government need to explain why they are afraid to allow people in the north-east to have a say in the future governance of their region.

[Several hon. Members rose—]

--- Later in debate ---

[James Wharton]

My hon. Friend is of course right about the importance of sharp accountability with respect to the ability of a metro mayor to drive the change that devolution presents an opportunity to deliver. This direct approach from the elected metro mayor should help to ensure that we get the maximum benefit from a process of devolution. That has been shown the world over, when many big cities with mayors deliver real improvement and success for the areas they represent. It is a proven model, one that we want to see delivered through this devolution agenda. It is also one, importantly, that will not be imposed on any area.

[Mr Kevan Jones]

Will the Minister just be honest? He says that he is not going to impose a system, but he well knows the alternative. Unless the north-east accepts an elected mayor, no devolution will take place. That is a take-it-or-leave-it provision; it is an imposition by any other name. The Minister should admit that he wants to impose an elected mayor on the north-east irrespective of what local people or local politicians want.

[James Wharton]

I listened carefully to hon. Gentleman’s contribution, and I know that he is exercised by this issue. I do not recognise the narrative that he put forward as entirely fulsome in its representation of the processes that are under way. [Interruption.] I will explain my comments thus. The Bill does not allow the Government to impose devolution or a model of devolution on any area. It allows areas to reach agreement with the Government about devolution when they see the benefits to their areas from it.

In the north-east—an area represented by the hon. Member for North Durham (Mr Jones) and one close to my heart and interests—we have had productive discussions with local authority leaders. Those leaders are not exclusively Conservative or even Liberal Democrat, as we are talking to Labour local authority leaders, too, and they are working with us to find the right package to deliver devolution. The Bill gives no power to impose devolution on the north-east and we would not attempt to impose a model of that devolution without the two going in tandem. The opportunity is there in the legislation for areas to ask for devolution; we can enter into discussions and deals can be made in a bespoke and bottom-up way to ensure that every area gets the right deal.

We have been clear throughout this process—it was clear in the manifesto on which this party stood at the last election—that if areas with large metropolitan city centres want a devolution package similar to the one that Greater Manchester has agreed with the Government, we would expect a metro mayor to be part of the package.

--- Later in debate ---

[James Wharton]

Of course. Areas that choose not to be part of devolution—and it is their choice; devolution will not be imposed on anyone—will suffer no disadvantage as a result of that choice. I shall be happy to meet my hon. Friend and his colleagues to discuss any concerns that they may have about what may come to be proposed for the area that my hon. Friend represents, and also about the implications should an area choose not to be part of the process. This is not about imposition; it is about consensus, working together and co-operation.

[Mr Kevan Jones]

Will the Minister give way?

[James Wharton]

I will if the hon. Gentleman is very brief. I know that he is enthusiastic to have his say.

[Mr Jones]

I am, because what the Minister has just said is not true. What has been said to the seven local authority leaders in the north-east is they must either accept the mayor and the devolution settlement or not receive the extra money that has been trumpeted by the Tory party in the north-east and by the Minister’s friends. The only way to get extra resources for the north-east is to accept an elected mayor and the system to which the Minister is agreeing.

[James Wharton]

I am not sure how much more clearly I can express myself. We will not impose devolution on any area, but any area is free to come forward and negotiate with the Government to make a deal for the delivery of devolution if it wishes. Areas that do not choose to be part of devolution will not have anything taken away from them as a consequence, and when devolution is delivered, it will be about powers coming down. Local authorities will only see powers transferred up to a metro mayor when they opt for that to happen. I think I have made myself very clear on that important point.

There is one more important point that I want to make to Opposition Front Benchers, about amendment 4. It is imperative that when the conditionality amendment that was made in the other place is put forward, we are able to deliver on our manifesto commitments, and so that we can do that, the changes that the Government have proposed today need to be made.

--- Later in debate ---

[Mr Allen]

Our London colleagues have done some fantastic work on how to localise taxation that is currently held by the centre. That has to be done sensitively and carefully, but as I said earlier—I do not think my hon. Friend was present then—every other western democracy manages that difficulty without a problem. In Sweden, America, Canada, Italy, Germany and Holland, it is second nature to retain money locally from business rates, landfill taxes and land taxes such as stamp duty. They get by pretty well. In fact, because that system is institutionalised, their local government has immense power over and above what we have as vassals. In effect, we do what we are commanded to do according to the crumbs left in the begging bowl after the Chancellor has done his bit for the national economy.

It is absolutely open to us to do work similar to that done by my hon. Friend, Professor Tony Travers and consecutive London Mayors to liberate people. Nottingham gets a lot of tourists because of the Robin Hood tradition and the castle, so we could have a hotel tax or a bed tax of £1 a night. That happens in other western democratic countries and the people endorse it. There is a big caveat though: no council should do this unless the people have okayed it and bought into it. Councils should also be able to borrow on the open market on the basis of their credit rating, but they need to have the consent of the people. It is perfectly possible for us to do what my hon. Friend suggests.

[Mr Kevan Jones]

I have been listening carefully to my hon. Friend and, while I do not disagree with him, the proposal to retain 100% of business rates will be a disaster for some poorer areas. It is fine for areas of central London, such as Westminster, to argue for the ability to retain 100% of their business rates. However, business rates in poorer areas of the north-east and elsewhere are never going to generate a great deal. In fact, one large closure can devastate the local income base. There has to be a redistribution mechanism.

[Mr Allen]

My hon. Friend is absolutely right. A proper redistribution mechanism—whether it is based on the amount received from income tax, business rates or any other taxation—must be in place; otherwise the system could be distorted and deeply unfair. That is why my amendments, which my hon. Friend will have read, suggest that equalisation should be central to the process; otherwise we will end up with the disjointedness he mentions.

[Mr Allen]

No, I do not believe that is the case. That happens everywhere. Although I am very much an ardent devolver, I believe there is always a place for the federal level. President Clinton was not denied his wish to introduce Head Start to every state in the union. He did not impose it, but he offered it as a federal programme and virtually every state picked it up. Devolution would not diminish our role in this place to do good things, and it certainly should not diminish our role in insisting on the sort of equalisation that my hon. Friend the Member for North Durham (Mr Jones) has in mind.

[Mr Kevan Jones]

Does my hon. Friend agree, though, that that is not what is being offered by this Government? They are offering retention of 100% of business rates without equalisation, which will have a dramatic effect on those areas with low business rate receipts. It will also be to the advantage of some areas that perhaps do not need extra resources.

[Mr Allen]

I again agree with my hon. Friend. We are not there yet and it is not a done deal yet. We need to make the points that he very ably makes about equalisation. I will say to him, however, that if it is a choice between being instructed by Whitehall how to spend not very much money and having not very much money to spend locally, I would go for spending it locally every time, because we will maximise value and spend the money sensitively. Whatever money is available, it is better spent by those who know what they are doing, rather than by the man in Whitehall. I totally accept my hon. Friend’s points.

--- Later in debate ---

London is different from the rest of England. The scale of our economic and social challenges, our rapidly rising population and the fact that our competition is now far more about New York, Berlin and Tokyo than about other UK cities demand a much stronger devolution package for London. That does not by any means undermine the case for further devolution to other parts of England, as the Bill already suggests.

[Mr Kevan Jones]

Amendment 2, tabled by my hon. Friend the Member for Nottingham North (Mr Allen), calls for the creation of a constitutional convention, which I think is very important.

As we heard earlier from my hon. Friend the Member for Sheffield South East (Mr Betts), the Government’s proposals are likely to end up as a dog’s breakfast. The Bill does not represent a movement for devolution or an attempt to improve local government or governance; it represents a clear political agenda. It is about the Chancellor’s vision of a small state Britain that will make it easier for him to push through draconian cuts. Once he has pushed responsibilities down to local government or regional tiers, he will be able to top-slice the budgets, while the difficult decisions will have to be faced locally, by mayors and councils. Those individuals will get the blame for the tough decisions that will be taken. The Chancellor and this Government will step back and say, “I’m sorry, it’s not our fault; it’s your local decision-making process.”

This is a unique way of approaching the devolution debate in this country. There have been other approaches. There was the Crowther debate in the late 1960s and early 1970s, which stood back and looked at not only Scotland, Northern Ireland and Wales, but how to devolve power locally. The Redcliffe-Maud reorganisation of local government took time to look at future structures for local government. That was controversial at the time—some of the historical counties were abolished, for example— but at least there was an evidence base.

That is not what is on offer now, which is why amendment 2 is so important. We need a properly thought-out national debate on devolution and what the structures will be. What we have now in this so-called enabling legislation is legislation with a big stick attached to it. Local areas such as the north-east have been told they can have devolution but only if there is an elected mayor, even though the Minister keeps denying that. He said an interesting thing in response to the previous set of amendments; he said no area would be disadvantaged if it did not go down the devolution route. That is not what he has been saying in the region or what his supporters in the Conservative party have been arguing in the region. The argument there is that if these truculent local authorities do not agree to devolution, they will lose out on all this money. The Minister has changed his tune this afternoon and said that is not conditional. It will be welcome if there is still an option to get those extra resources without necessarily going down the route he wants.

This is about local decision making, but what is key in any organisation is who holds the purse-strings. The Chancellor still holds the purse-strings under what is being proposed, and when the tough decisions come down the line his fingerprints will not be on them.

My hon. Friend the Member for Harrow West (Mr Thomas) mentioned business rates. I take his point: allowing local councils and others to have the powers to regenerate areas and try to create extra revenue is welcome, but he will appreciate—as my hon. Friend the Member for Nottingham North noted earlier—that there is not a level playing field across the UK. Without any mechanism for redistribution in local business rates, areas such as the north-east—those that have already been hit disproportionately by this Government taking the need element out of grant formula, which rewards richer areas more than poorer areas—are going to lose out.

Westminster city council will benefit if it gets to retain 100% of its business rates and gains from any new development it can have. Its situation will be easy compared with that of the poor people of Redcar; Redcar council is going to find it very difficult to attract new development that plugs the hole left by the closure of the steelworks.

We need to ensure we put in place structures that not only will work and have the support of people, but are practical. If we have a Teesside mayor and a mayor for the north-east, both will have responsibility for transport in their area. Where that will leave the A19, the M1 or any of the other transport links that cross the area, no one seems to know. Will the mayor of Teesside be responsible for the section of the A19 as far as the border of the area? Will the mayor for the north-east assume responsibility for the road network beyond that point? Therein lies one of the issues.

The Government said that they were against regions, but they have now divided quite a small geographical area. Supporters of the proposals have not explained how all this will work in practice. They have been out there in the north-east vigorously putting forward their case. Many of them have been posing as business people while forgetting to tell everyone that they are actually Conservatives.

There is a similar problem with resource allocation. The Government are proposing to impose a new tier of regional government, but how will it relate to the existing local authority tiers? The Minister keeps saying that this will be different because it involves moving power down from Whitehall to the region, but I can envisage people starting to ask whether they really need the large numbers of councils that they have at the moment. That will certainly happen in Manchester, for example. I know that turkeys do not usually vote for Christmas, but some local authorities need to think about where the Government’s agenda will lead. The Conservative party has traditionally been quite passionate about local government—it has always been supportive of it—but I believe that the Bill represents a move to reduce those tiers of local representation.

We need to step back and look not only at how the new system will work in practice but at the levels of local support. The Government are refusing to allow the people of the north-east a say in whether they want an extra tier of local government. The Minister is adamant that he is not prepared to give those people a say over whether they want an elected mayor whose responsibilities would stretch from the Scottish border down to Barnard Castle. As I said earlier, when we proposed a regional assembly in 2004, we quite rightly put it to the people. The Conservatives and their supporters argued vigorously against the proposal, and I am sure that if the then Labour Government had imposed an assembly on the region without taking the proposal to the people, we would rightly have been criticised. There would have been an outcry. Those same advocates who argued against us then are keeping very quiet now, however.

I have some sympathy with the amendment tabled by the hon. Member for Carlisle (John Stevenson). He has raised various issues, and I agree that there is a problem. One question that some of the smaller district councils will face is whether they will have capacity as a result of the cuts that will be imposed in the autumn statement, on top of those that have already been imposed. The last Labour Government introduced unitary councils in the north-east, in Durham, and it was one of the best things that happened making decisions more straightforward. I hate to think what some of those smaller councils would do if they were still in existence now, given the cuts that this Government have imposed. I doubt that they would have the capacity to deliver their services.

I put it to the Minister that these larger areas will need an effective mechanism for ensuring that local people are engaged in the decision-making process. I used to work in Cumbria and I know it well. I understand some of the attitudes he has referred to. Having a veto over decisions on what is needed there could be a disadvantage for Cumbria rather than an advantage.

We need the measures that my hon. Friend the Member for Nottingham North is proposing. We should have had them in place before we embarked on this process, but the Government know exactly what they are doing. This is not about devolution. It is about the clear political agenda of the Conservatives and the Chancellor. They know what they are doing, and it has nothing at all to do with the proper devolution of decision making.

[John Mann (Bassetlaw) (Lab)]

I concur that a constitutional convention would be very sensible, as my hon. Friend the Member for Nottingham North (Mr Allen) said.

I hear the idea of a hotel tax in London—I hope it is not on my constituents coming down for a good overnight stay, but on those coming from abroad. I am not sure a hotel tax would work particularly well in Bassetlaw, although it is worth considering. I recall that until the last few years Welbeck Estates levied £3 on every tonne of coal produced for a century. If local government had been allowed to do that, Bassetlaw would be a very different place, because the infrastructure and so on would have been appropriately remunerated for the coal that we provided for the rest of the country in wartime and in peacetime, at great cost. That concept of local decision making is a very good one, so I would accord with the idea, but I hope there would be some exemptions to anything that is done in relation to the good people of Bassetlaw.

--- Later in debate ---

[John Mann]

I suppose Bassetlaw would have the option of declaring itself a unitary authority, of getting approval for that and of joining Sheffield city region. There may be routes around it, but the principle is fundamental. We need to have the ability to choose. If those two choices were put to the electorate, I suspect that I know which they would choose, and probably decisively. They may have a different view to me, but that is their prerogative—we have a word for that: democracy. What we do not want is “undemocracy”. Some people are very hostile to what the Government are doing and some are much more sympathetic. Either way, will these two options—is it the D2N2 model—lead to more councillors?

[Mr Kevan Jones]

I am very interested in what my hon. Friend is saying. He knows that I am very familiar with his constituency, having grown up there. Does he think that the fundamental weakness of this Bill is that there is nowhere for the people to have a say in what actually happens?

[John Mann]

The Minister will clarify whether, legally, people can have a say, but I am sure that there are ways in which a say can be created to ensure that there is popular consent. There are ways in which we could choose to do that. I am not talking about my own informal consultations, which are pretty huge. It would be interesting to get the Minister’s take on that. Those are key points.

Can we have some assurance that, over time, these measures will not lead to more elected representatives? If people are honest, they understand that if we have a two-tier scenario linked in with unitaries, either the districts or the counties will inevitably go at some stage, and probably sooner rather than later. That is bound to happen. Some may say that that is a good thing. As I have said, I have argued for unitaries before, but it is important that councillors understand that that is what is happening. Similarly, it must be clear that we will be able to choose, and the Derbyshire districts will be able to choose, where we will go. I am sure that the Government want that. They say that it is a brilliant idea, so they must want us to be part of it. It is really how we do that with guarantees. It would be useful to have that on the record.

--- Later in debate ---

[Alistair Burt]

I know the area well, and I know exactly what the hon. Gentleman is referring to. Yes, that is part of the consideration, but it is essentially part of the consideration of the combined authority. Not only will it have to devise the working of its services within the confines of what is commonly known as Greater Manchester, but it will have to recognise that some of the provision of those services is carried out by those with cross-border responsibilities, and work something out with the adjoining areas. Nothing in the Bill speaks to that, because it does not relate to what I am discussing—the control of standards and the like—but the hon. Gentleman is absolutely right. That is part of the process that people will be going through.

[Mr Kevan Jones]

The Minister has said that the Secretary of State will retain overall control.

[Alistair Burt]

Not overall control.

[Mr Jones]

If something goes wrong in the delivery of care, where does the buck stop? Does it stop with the Secretary of State, or at local level?

[Alistair Burt]

I have read the report of the debates in the House of Lords on exactly this topic, because there was a lot of confusion. My understanding is that it depends on precisely what the breakdown is. Let us suppose that the breakdown, or failure, is in the way in which services have been put together by the combined authority. This is purely off the top of my head, and does not refer to anything of which I have any current knowledge. Let us suppose that there was a dispute between two constituent areas of Greater Manchester, one of which claimed that there was some inequity between the service that it was receiving and the service being received by the other. It might be claimed, for instance, that the combined authority’s decision was somehow disadvantaging Ramsbottom in favour of Bramhall. In the event of such a dispute, the buck would stop with those who were making the decisions locally, and that is the combined authority. The matter would not go anywhere near the Secretary of State. What the Secretary of State retains responsibility for is the standards and whether or not there has been a breach of NHS duties in relation to anything that falls within his own overall responsibility. So the buck still stops with the constituent authority that is delivering the service. In relation to a CCG that is not performing properly, the buck will stop with the CCG, not the combined authority. If there is a lapse of standards in anything connected with the NHS, ultimately the regulators govern that and the Secretary of State would be responsible. But if it is a decision being taken by those who are responsible for the new combined authority to do with where services go and it is within their remit, it will be a matter for them—the buck will stop with them. The short answer, therefore, is that where ultimately responsibility lies depends on where the breakdown is, but it is clear in relation to each of the services and it does not mean anyone can evade their responsibilities.

Cosmetic Surgery

Lord Beamish Excerpts

Tuesday 20th October 2015 Commons Chamber

[Mr Kevan Jones (North Durham) (Lab)]

I would like to raise the case of my constituent, Mrs Dawn Knight, who lives in Kip Hill in my constituency. Mrs Knight is one of the 45,000 people in the UK who undergo cosmetic surgery each year. In 2012, she underwent a cosmetic procedure on her eyes. The operation was arranged by a company called The Hospital Group and the surgery was done by an Italian doctor called Arnaldo Paganelli. During the surgery, he removed too much skin from her lower eye lids, and as a result, the inner parts of her eyes, usually covered, are now exposed to the air. Following this botched surgery, she must now apply artificial teardrops into her eyes every two hours to minimise the pain. On the advice of specialists at the Royal Victoria infirmary in Newcastle, she must also tape her left eye closed every night when she goes to sleep to avoid further damage. While she sleeps, she must apply a thick ointment in both eyes, leaving her unable to see until it is washed out in the morning. Doctors have warned her that this serious condition might result in loss of sight altogether.

This incompetent procedure has left Mrs Knight with serious health problems and a life-changing condition, but her troubles did not cease there. A fight to get the mistake corrected and compensation for her distress have thrown up major questions about the operation of The Hospital Group and the regulation of cosmetic surgery in the UK. The Hospital Group’s website claims to run the world’s largest plastic surgery facility at its private hospital in Birmingham. It also claims to have General Medical Council-registered surgeons. Anyone looking at its adverts or website will conclude that it is running a hospital similar to a local NHS hospital, but it is not. As Mrs Knight found when she complained, she had entered into a contract not with The Hospital Group but directly with Dr Paganelli.

[Jim Shannon (Strangford) (DUP)]

Last Wednesday in Parliament, there was a public meeting at which constituents from across the UK registered their concerns about cosmetic surgery, particularly eye operations. Many people have found themselves in a similar position to Mrs Knight. Last year, 100,000 cosmetic surgery operations were performed in the UK. Is it not time for full and robust regulation to monitor and reflect the risk attached to all cosmetic surgery?

[Mr Jones]

The hon. Gentleman makes an important point. This is not just about Mrs Knight; it is about many more such cases, and I will be talking later about exactly the need for more regulation and information in this area.

Although The Hospital Group tries to give the impression it is a hospital, it is, in effect, a facilities, management and brokerage company for individuals wishing to undergo cosmetic procedures. The Hospital Group is very good at self-promotion. It even has celebrity endorsements from individuals such as Kerry Katona. I think the celebrities who appear on the website need to examine their consciences about being associated with this organisation. Clearly, their endorsements are encouraging young people to undergo these procedures, forcing people into the hands of a company that I think is, frankly, completely irresponsible. The sale of after-care packages is emphasised. In Mrs Knight’s case, hers cost £3,500, but she found that this means nothing when things go wrong. It would appear that once The Hospital Group has people’s money, it is not much interested if things go wrong.

Having tried to pursue a case against The Hospital Group, Mrs Knight then tried to pursue Dr Paganelli for redress, only to find that he is bankrupt, lives in Italy and flies into the UK to operate on behalf of The Hospital Group. What astounds me is that he is still doing this today, working in hospitals or clinics that are run by The Hospital Group, as we speak. The Hospital Group’s response is that it is nothing to do with them. Dr Paganelli was uninsured and The Hospital Group says that it is the patient’s responsibility to check whether the surgeon is General Medical Council-registered and holds insurance. If we look on the website today, however, we find the words:

“Book a free consultation today, with our GMC registered surgeons!”,

giving the impression that all the surgeons have been vetted by this organisation when that is clearly not the case. Despite this, Dr Paganelli remains licensed by the GMC, meaning that he is deemed fit and suitable to continue to operate in this country, even though he holds no insurance and if things go wrong, patients have no redress against him.

Having examined this case and the others to which the hon. Member for Strangford (Jim Shannon) referred, it would appear that a plumber who comes to fix someone’s kitchen sink is more heavily regulated than someone who is allowed to operate on your body. The current law allows any qualified doctor—not just surgeons—to perform cosmetic surgery, without having additional training or qualifications. My right hon. Friend the Member for Cynon Valley (Ann Clwyd) has raised many issues about GPs who have undertaken cosmetic surgery without any formal training. Clearly, there needs to be more robust regulation of these private companies, which stand to make a fortune out of the misery experienced by people such as my constituent Mrs Knight.

The Royal College of Surgeons believes that the GMC needs to be given new legal powers formally to recognise additional qualifications or credentials, and I fully support that call. These should be displayed publicly so that people know that the doctors are properly registered and have gone through the necessary training. Will this solve malpractice and eradicate the problem of cosmetic surgery overnight? No, it will not, but it will at least ensure that some type of regulation is in place. It would be an important and significant start, and it would allow patients and employers such as The Hospital Group to tell competent cosmetic surgeons from cowboys, or indeed from anyone who has limited or no recognised experience in cosmetic procedures.

There has not been inaction in this area. Legislation was drafted by the Law Commission at the request of the Department of Health in 2014, following Sir Bruce Keogh’s recommendations in the wake of the PIP scandal. The coalition Government failed to find the parliamentary time to take it forward in 2014. You will remember, Mr Deputy Speaker, that at that time the Order Paper was not exactly overflowing with legislation, so we need to answer the question why this was not brought forward. Both the RCS and the GMC are keen to bring in these changes. Again, the Government have failed to include such legislation in the Queen’s Speech. I ask the Minister to explain why that is the case, and when the Government intend to introduce such legislation. As I have said, it would have the support of both the Royal College of Surgeons and the General Medical Council, but it would also have cross-party support in the House.

May I also ask the Minister about the cost to the NHS? In Mrs Knight’s case, the cost of putting right the mistakes made by Dr Paganelli will have to be picked up by the NHS. As the hon. Member for Strangford said, this affects a large number of people, and the NHS is having to treat them at great expense because of the actions of organisations such as The Hospital Group and individuals such as Dr Paganelli. Is it right for the taxpayer to pick up the bill while those organisations and individuals are making absolute fortunes out of people’s misery? I do not think it is. We need to look into how the NHS can recover the cost of the treatment that Mrs Knight and others are undergoing at the taxpayer’s expense.

[Jim Shannon]

Some of the people who were at the meeting on Wednesday told horrifying stories about the ways in which in which the surgery had affected them. Some of them had partially lost their eyesight. There was the depression, there was the trauma, and there were all the other side effects of what had happened to them. Despite all that, however, some of the people who carried out those operations continue to perform this surgery. People are experiencing life-changing medical conditions. Something must be done, and perhaps the Minister needs to tell us that tonight.

[Mr Jones]

The hon. Gentleman has made a very good point. It is not just a question of the initial cost. Some people will need lifelong treatment, which will be very expensive for the taxpayer. I think that there should be a mechanism enabling the taxpayer to recover some of the cost from private companies and individuals when things go wrong.

I am also concerned about the issue of regulation. These organisations produce a great many glossy brochures, set up websites and have celebrity endorsements, but it is clear that some of the people who undergo cosmetic surgery need counselling beforehand, and there is no legal or other requirement to ensure that they receive it. Surgery that may be seen as life-changing—and, in some cases, is, for the wrong reasons—may also not be appropriate for some of those involved. They are mainly women, but, according to various reports that I have read, an increasing number of men are undergoing these procedures. They are not right for everyone, and I think that counselling and advice should be a key part of the process before anyone is convinced about going under the knife. The companies involved clearly exert a great deal of pressure to ensure that a steady flow of people enables them to make the money that they do make.

Let me finally ask the Minister about The Hospital Group itself. It gives the impression that it is a hospital group providing healthcare services, but it is clear that it is actually a facilities management company brokering details between patient and surgeon. Its material is very misleading. For instance, its website deliberately states that its surgeons are GMC-registered. It even refers to the Care Quality Commission as though that gave it the stamp of approval, and provided some type of guarantee. A misleading impression is being given.

I ask the Minister to examine the way in which The Hospital Group in particular, but other groups as well, uses terminology. I think that the average man or woman in the street may get the wrong impression from the CQC symbol or the reference to the GMC registration. The fact that when things go wrong they find that The Hospital Group wants nothing to do with it, and it is up to them to decide what to do, is another matter. That is not the impression given by the misleading publicity—deliberately so, I think—that is put out.

My constituent’s case is one of many that have highlighted the need for regulation. The legislation is there and we should press forward as a matter of urgency because if we do not more people will suffer. If there is one thing that my constituent, Mrs Knight, wants, it is that other people should avoid the awful experiences that she has gone through because of the negligence and greed for profit of both The Hospital Group and Dr Paganelli.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

I thank the hon. Member for North Durham (Mr Jones)for securing this debate on what is clearly an extremely distressing case for his constituent and an unfortunate one more generally. I want to pick up on the specific issues he raised to do with his constituent’s case before talking about the generality of the regulation of cosmetic surgery.

The hon. Gentleman pointed out the failure of his constituent’s doctor to have insurance and he will be pleased to know that, as of July 2014, new legislation required all surgeons providing cosmetic interventions to provide insurance and proper cover. A failure to do so would render them liable to undergo the fitness to practise tests conducted by the GMC. Those doctors operating outside the UK but in the EU who would have a temporary ability to operate in this country under the directive on mutual recognition of professional qualifications would still, under GMC regulations, be required to provide evidence of insurance cover. That legislation was brought into effect in August, which was clearly too late in the case of his constituent.

[Mr Kevan Jones]

Will the Minister look specifically into the case of Dr Paganelli, as I understand that he is still practising in this country?

[Ben Gummer]

I will certainly look into that case, as it does not sound right. I cannot trespass on the realms of the GMC, but I will inquire into the specific case outlined by the hon. Gentleman.

The hon. Gentleman makes a valid point about the cost to the NHS and this is not the only area in which we have considered and continue to consider cost recovery for the NHS. It can be difficult as sometimes the cost of legal action outweighs the cost of recovery and it is not something that the service is used to doing. I am keen to explore it further, but in the context of the action we are taking, which I shall come on to, I hope that the hon. Gentleman will understand the need to take this bit by bit so that we get the process right. In principle, I certainly agree that if organisations cause a cost to fall on the NHS, as in this case, there is a good argument for seeing whether that cost can be recovered.

That takes me on to another part of the hon. Gentleman’s speech that was particularly striking, about the celebrity endorsements in this case. It is not for me to make policy announcements in an Adjournment debate, nor would I want to in the case of celebrity endorsements, but I agree with the hon. Gentleman that people should think carefully about how they endorse cosmetic surgery. It is a serious intervention and if anyone seeks to glamorise something to which careful thought should be given, people and the organisations using those endorsements should treat them with extreme care.

I would point the organisation that the hon. Gentleman is dealing with and everyone else towards the code of conduct in advertising, the Committee of Advertising Practice and the Broadcast Committee of Advertising Practice, which drew up guidance in October 2013, especially on protecting children and young people. I think it would be appropriate to make sure the organisation of which he speaks is complying with the spirit as well as the letter of that guidance, and if not I will certainly help him to ask whether anything more can be done on that.

The hon. Gentleman raises the issue of counselling. Any reputable organisation should seek to ensure that people undertake procedures only when they need to do so and have been properly counselled on the consequences of their actions so that they can make an informed decision. The Government believe that that should happen in every case for cosmetic surgery. There should be an informed decision, taken with serious thought.

Finally, on the issues to do with The Hospital Group the hon. Gentleman raised, I cannot speak without further advice, but there clearly seem to be questions about trading standards, which he raised. I hope that I and my officials will be able to meet him to look carefully at this case, to make sure if The Hospital Group is misrepresenting its position apropos its surgeons and those it seeks to represent, it is not besmirching an industry which more widely does take its duties and the way it represents itself seriously.

Post Office Horizon System

Lord Beamish Excerpts

Monday 29th June 2015 Commons Chamber

[Mr Kevan Jones (North Durham) (Lab)]

I congratulate the hon. Member for North West Leicestershire (Andrew Bridgen) on securing this debate.

My constituent Tom Brown, a postmaster for 30 years, had a post office in Newcastle. In 2008, he informed the Post Office that there was a problem with his Horizon system, and it took away one of his base units to change it. He was told by the helpline—a euphemism because it has not been very helpful to many sub-postmistresses and sub-postmasters and has actually got them into more trouble—that the system would rectify itself. It did not. The next audit said that his figures were down by £85,000. He was arrested by Northumbria police, and his car and home were searched. Subsequently, the police dropped all charges as there was no evidence against him. Then, for some unknown reason, the Post Office took out a prosecution against him to take him to court for false accounting. That process took until July 2013, when he finally appeared in court for the third time. No evidence was put forward to the court, and after that the case was dropped.

This man has lost his home, his livelihood and his good reputation. He is one of the individuals who have gone through the mediation system, even though, as the hon. Gentleman outlined, the system is a sham. He was given four different dates that were all delayed. He described this to me as six hours of wasted time. The Post Office employed top lawyers from Newcastle to represent it. It again went through what it said was the evidence, and made no offer at all. The system is a sham. As the hon. Gentleman outlined, it has been a way of delaying decisions on these cases.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

Does my hon. Friend agree that the Post Office has failed to be transparent about this process? My constituent, Mrs Carter, a sub-postmistress, asked the Post Office to audit her branch to get to the bottom of the problem, but it refused to do so.

[Mr Jones]

I will go further than that. It has not only not been transparent; it has gone out of its way to delay cases and hide evidence.

My concern about the work done by Second Sight is that it suggests that if information is returned to the Post Office, evidence will go missing. That is why I totally agree with the hon. Member for North West Leicestershire that there needs to be an independent judicial inquiry into this—as he described it—national scandal. I am pleased that my hon. Friend the Member for Hartlepool (Mr Wright), the new Chair of the Business, Innovation and Skills Committee, is present for this debate. I urge him and his Committee to look at this as a matter of urgency.

The fundamental point is this: who controls the Post Office? This organisation is out of control. It has led to people’s lives being ruined and, as we have heard, in some cases to people being given prison sentences when clearly they are innocent. It is important that we get to the bottom of this. Without a judicial inquiry, I fear that this national scandal will continue and these people’s reputations will continue to be blackened.

Child and Adolescent Mental Health Services

Lord Beamish Excerpts

Tuesday 3rd March 2015 Commons Chamber

[Grahame M. Morris]

I cannot disagree with that. I come from the perspective that we need to plan interventions on the basis of evidence, but how can we do that without current and relevant data on child and adolescent mental health? We certainly need that data. On the structure of the contracts, I am a firm believer in integration. There may well be issues with block contracts. The Health Committee received evidence from the south-west indicating that there are vast areas of the country where there is very little access to certain types of in-patient mental health provision, which is clearly unacceptable. One might have thought that a large block contract would make that less likely, but apparently that is not so. However, I am not an expert in commissioning; I am simply trying to identify the policy areas.

Having spent a number of years in local government, I have no doubt that local authorities wish to tackle some of the barriers that young people face in accessing mental health services. It is a complicated area, and we need to enable local areas—the hon. and learned Member for North East Hertfordshire (Sir Oliver Heald) just referred to larger block contracts—to commission better services, and perhaps that is better done on a more local level.

[Mr Kevan Jones (North Durham) (Lab)]

Does my hon. Friend realise that one of the problems with block contracts is that, because of their size, they freeze out small voluntary organisations that could deliver services on a local basis?

[Grahame M. Morris]

That is true. Some of the organisations that submitted evidence to the Health Committee and subsequently provided briefings made that point.

Another issue of concern is the complex commissioning landscape for CAMHS, which can result in poorly co-ordinated services and a lack of clarity about roles and responsibilities, leading to gaps in provision and poor transitions from child to adolescent and from adolescent to adult. The service is certainly underfunded. We often talk in this place about parity of esteem. As other Members have reported, CAMHS nationally is receiving about £1.8 billion of the £14 billion that is spent on mental health. Local authority-provided services, which are often having to bridge the gap, are facing huge financial challenges. My local authority, which I share with my hon. Friend the Member for North Durham (Mr Jones), has had to cope with cuts of £250 million over the lifetime of this Parliament. That is forcing councils to make extremely difficult decisions about which services are funded.

I fully understand the point made by the hon. Member for Brigg and Goole, but I also fully understand the difficult decisions faced particularly by authorities in the north that seem to be suffering disproportionate cuts. Councils are embracing their new public health responsibilities—

Child and Adolescent Mental Health Services

Lord Beamish Excerpts

Monday 2nd February 2015 Commons Chamber

[Norman Lamb]

I pay tribute to the hon. Gentleman for the work he did in his campaigning on the Mental Health Act and more recently as a Children’s Minister in the Department for Education. I know his passion for the subject and I share his view that it is intolerable that children and young people should go to adult wards. It has been a long-standing issue—it is not new—but it should not happen, just as it should not be the case that children are still placed in police cells. That is why I take the view that we need to ban it in law so that it cannot happen, and there are consequences if it ever does happen.

[Mr Kevan Jones (North Durham) (Lab)]

I do not question the Minister’s commitment to mental health. He is a great champion of parity of esteem, but he is part of a Government who are cutting money for mental health services. For young people in 2015 to be put in police cells is totally unacceptable. To pick up the point made by the right hon. Member for Sutton and Cheam (Paul Burstow) about CAMHS, is it not time not only for a fundamental review but for a new system, including the abolition of the present CAMHS system?

[Norman Lamb]

I am grateful to the hon. Gentleman for his generous remarks—perhaps he ought to talk to his Front-Bench colleagues about my commitment. He is absolutely right to highlight the fact that although there is quite a mixed picture across the country, in many areas there has been disinvestment in children’s mental health services. They are local decisions, and they are not decisions that I accept. That is why I made the serious point about the absolute importance of introducing waiting time and access standards, including in children’s mental health services. We need data so that we can monitor performance against those standards, and we need a payments system that does not disadvantage mental health. I also share his view that we need to change the way services are organised and commissioned so that we focus much more on prevention.

Oral Answers to Questions

Lord Beamish Excerpts

Tuesday 13th January 2015 Commons Chamber

[Mr Hunt]

Obviously this is very important, and that is what is happening now for the first time. We are seeing the true integration of health and social care through the better care fund and record working, and in my hon. Friend’s area, despite the pressures they have been feeling this winter, they have made some good progress. They have put an urgent care centre next to the A and E. They are seeing within four hours nearly 12,000 more people every year, and they are doing about 12,000 more operations every year as well.

[Mr Kevan Jones (North Durham) (Lab)]

In the Chancellor’s announcement last year of extra funding for the NHS, my clinical commissioning group got a 0.24% increase, whereas Windsor, Ascot and Maidenhead got 3.7%. The Secretary of State blamed the NHS for this when he responded to my hon. Friend the Member for Middlesbrough South and East Cleveland (Tom Blenkinsop), but is it not because this Government have taken need out of the formula—a similar thing to what they have done in local government—which means the movement of money from the north to the south?

[Mr Hunt]

No, we have not. The NHS funds were allocated on the basis of a formula and the extra money was given to the places that were most off-target on the basis of the number of older people, the level of social deprivation and a range of other important factors. All I would say to the hon. Gentleman is that we have increased the NHS budget in real terms in his area, whereas those on his own Front Bench wanted to cut it.

NHS (Five Year Forward View)

Lord Beamish Excerpts

Monday 1st December 2014 Commons Chamber

[Mr Hunt]

I am happy to do so. We have made good progress during this Parliament, increasing by 10% the proportion of people with dementia who receive a diagnosis. This is not just about getting a diagnosis, however; it is the care and support that people get when the diagnosis is made that really matter. That is the reason for giving the diagnosis. Let me characterise the change that we want to see for people with dementia over the next few years. When someone gets a diagnosis, we want to wrap around them all the care and support that they and their family need to help them to live healthily and happily at home for as long as possible, so that they do not get admitted to hospital in an emergency or need to go into residential care until the very last moment. Of course that will cost the NHS less, but it is also far better for the individual concerned.

[Mr Kevan Jones (North Durham) (Lab)]

The Secretary of State talks about party politics, but he cannot get away from the fact that the number of mental health beds in this country has dropped by 1,500 on his watch. We have heard about the scandal in Devon last week, and my hon. Friend the Member for Hampstead and Kilburn (Glenda Jackson) has told the House how some patients have to travel up to 200 miles to access an emergency bed. What is the Secretary of State going to do to deliver those beds where the mental health patients who are in crisis actually need them, which is close to their homes?

[Mr Hunt]

I agree with the hon. Gentleman that we need to address the issue of availability of mental health beds for crisis care, but we also need to recognise that the model of care for people with mental health needs is changing. We think that it is much better to avoid long-term institutionalisation if we possibly can, and that is why there has been a process of reduction in the number of beds. That happened under the Labour Government as well. If he wants to know what I am doing, I will tell him. I am part of the Government who are delivering a strong economy, which means we can put more money into the NHS.