Four Seasons Group

Lord Lansley Excerpts

Monday 11th January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the idea of having a commission has been discussed a number of times in this House, and there will be a long debate on this matter on Thursday. In the spending review the Government are enabling local authorities to increase their precept by 2% and they are increasing the contribution to the better care fund by £1.5 billion, which will see a real increase in the resources available for adult social care.

[Lord Lansley (Con)]

My Lords, does my noble friend agree that in circumstances of provider failure one of the most important things is for residents to be maintained in their existing homes? In fact, that was achieved in the overwhelming majority of cases following the Southern Cross collapse. It is often possible to separate the going-concern basis of individual homes from the commercial situation of the provider as a whole.

[Lord Prior of Brampton]

I fully agree. Our interest is in the residents in the homes. The CQC’s oversight regime is not intended to prop up a provider—that is an entirely different matter. My noble friend is absolutely right that when Southern Cross went into insolvency, very few homes—in fact, I do not think that any homes—closed as a direct result at the time; most of them carried on as going concerns.

Residential Care: Cost Cap

Lord Lansley Excerpts

Thursday 10th December 2015 Lords Chamber

[Lord Lansley (Con)]

My Lords, I am grateful to have the opportunity to contribute to this debate and to thank the noble Baroness, Lady Wheeler, for initiating it. It is my privilege, not having been here for long, to hear your Lordships on this important subject.

It is important that we are discussing this two weeks after the Autumn Statement and the spending review. I am sorry that the noble Baroness, Lady Wheeler, characterised the spending review, albeit perhaps quoting others, as she did at the end of her remarks. I think that the spending review offered considerable additional resources over the course of this Parliament. I am frank and realistic enough to recognise, not least from conversations with directors of adult social care over the past couple of weeks, that they are sufficient at best to maintain the level of local authority-funded care in circumstances where the demand continues to rise and therefore the gap between availability and demand will grow. At worst, we will be in the situation, as we have been recently, where the availability of local authority-funded care has been falling at a point where demand is rising.

The noble Baroness’s point that there is a need for strategic vision is well taken. It is not simply a matter of resources, even though they are an integral part of the issue. Some of that strategy is being implemented and more is available to us. I pay tribute to my friend Paul Burstow who was a Minister with me in the Department of Health. In the coalition Government, we led together on the preparation of what subsequently became the Care Act. It contains a very important set of measures, including the availability of assessments, additional carers’ rights, more consistent eligibility for care and the availability of universal deferred payments.

We need to go further. Social care and healthcare need to be integrated. Everybody supports that in terms of the integration of service design and commissioning, but, vital as that is, we can and must go further. Integration will only be real if and when care users are increasingly able to exercise control and choice through personal health and social care budgets. To make that real we have increasingly to aggregate the availability of personal health and social care budgets to those care users so that the service providers have an aggregated level of demand to be able collectively to respond and create a market for this.

We must also recognise that this will mean integrated providers with the NHS working with private sector social care providers and housing providers. There is enormous potential for housing providers and other services, particularly personal care services, to redesign the nature of the service they provide. For example, extra care housing providers together with social care providers are able to put together packages that work really well for people who are able to choose between different kinds of accommodation and service.

Time permits me to say one more thing which I think is really important. Much of what we already have in place is the product of the implementation of the Dilnot commission’s view. I hesitate because I may be stealing the thunder of the noble Lord, Lord Warner, and others in the Chamber who may have participated in equivalent work on prior commissions. I asked Andrew Dilnot and others to undertake that work and I think the result was important and right. We have included some of it in the Care Act. The Government have not implemented the cap on care costs and, to be frank, the cap that was intended was in my view insufficient. I continue to subscribe to the view that we should aim to implement a cap on care costs broadly in the way that the Dilnot commission recommended, at around £50,000 with a structure of assessment that means that probably no more than 40% of somebody’s assets would be depleted in the process of means-testing.

The combination of these two things would make it attractive to individuals to insure against this risk in so far as they have to meet that cost, and by taking away a much more substantial part of the risk of high-cost care over a longer period of time make it a more insurable risk for private sector insurers. Additionally, since the Dilnot commission reported we have more options in relation to pension flexibilities, and we always have housing asset flexibilities to enable these insurance products to become available if it is necessary for us to have those resources come into the system.

The original intention for the implementation of Dilnot before the election was that it would be funded out of inheritance tax and changes to opting out of national insurance. That moment has gone, but in internal discussions in 2012 from my point of view we were very clear about how this ought to be paid for, but it was not acceptable inside government. There was not agreement to do it because within the system we have discrimination against residential care in favour of domiciliary care. That creates an artificial distinction that we have to escape from, which is the exemption of the main or only home for the means test on charging for domiciliary care. At any given moment, about 120,000 people benefit from that, and £1.3 billion a year is available to them by virtue of that exemption. That is broadly speaking the amount that is necessary to construct a different proposition for people who are facing the insecurity of potentially very high long-term care costs. We need to go beyond simply enabling people not to have to sell their home to pay for care and give them the security of being able to find, as you do in so many other walks of life, the opportunity to insure against the often arbitrary effects of having to receive long-term care in old age.

Alcohol

Lord Lansley Excerpts

Wednesday 9th December 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, I can only repeat that we will have an independent review of the responsibility deal, at which point we will have objective evidence on which to assess it. I agree entirely with the noble Baroness that the health world, including the BMA and many of the royal colleges, takes a very strong view about alcohol. Many doctors see the appalling impact that it has on individual lives day in and day out, so we take their views extremely seriously.

[Lord Lansley (Con)]

My Lords, can I tell my noble friend the Minister—

[Noble Lords]

Ask.

[Lord Lansley]

Can I ask my noble friend the Minister if he agrees that the report from the Institute of Alcohol Studies is purely polemical in character and not a research report at all? Actually, its argument is based on a flawed proposition, which is that the pursuit of voluntary agreements through the responsibility deal prevented the pursuit by government of minimum unit pricing. Does my noble friend agree that from the very outset of the responsibility deal, it was made clear to the industry that its pricing of alcohol and indeed the Government’s attitude in terms of tax and pricing were no part of the responsibility deal, and that within government no discussion of minimum unit pricing was affected by the fact of the responsibility deal?

[Lord Prior of Brampton]

I am happy to be told that by my noble friend and I can only agree with him.

Junior Doctors Contract

Lord Lansley Excerpts

Monday 30th November 2015 Lords Chamber

[Lord Prior of Brampton]

There is a recognition that the weekend effect is caused by many factors. It is certainly not just the ability of trusts to roster junior doctors at weekends but the absence of senior cover and the fact that much diagnostic capacity is not available at weekends. Of course, you also have to be able to discharge patients at weekends, which means that social care has to be working as well. To have a truly seven-day NHS requires a lot more people and resources to be available than just junior doctors.

[Lord Lansley (Con)]

My Lords, my noble friend the Minister’s repetition of the Statement and what he was able to say additionally in response to noble Lords was very welcome. Does he agree that going back more than 20 years, to when the new deal for junior doctors was first brought in and we supported them on their concerns about Modernising Medical Careers, we on these Benches have never been lacking in support for junior doctors? We understand that when one is on the ward in a hospital at the weekend, very often the doctor who you see is a junior doctor. The point is that it is in the best interests of junior doctors and patients for seven-day working to be introduced, with proper rostering, rather than discriminating between Monday to Friday and the weekend as if they were different parts of what is in truth the same service. If we get it right, as my noble friend says, it should be possible to achieve such an agreement without bringing any detriment to junior doctors as a consequence, but rather by supporting them in the work that they have to do.

[Lord Prior of Brampton]

I thank my noble friend for those comments. One of the issues often raised by junior doctors is that they do not always feel properly supported at weekends. I think that having more seniors available at weekends—and late at night, for that matter—will be welcomed by junior doctors. There is also sometimes a misunderstanding in the public mind, as junior doctors can actually be quite senior doctors. A medical registrar is, by most standards, a senior doctor so junior doctors are not just people who have recently finished their training.

Health and Care Professions Council (Registration and Fees) (Amendment) (No. 2) Rules Order of Council 2015

Lord Lansley Excerpts

Tuesday 24th November 2015 Grand Committee

[Lord Hunt of Kings Heath (Lab)]

My Lords, this order concerns the Health and Care Professions Council and its fee raise, which is in relation to 330,000 health and social care professionals. They include paramedics, occupational therapists, biomedical scientists, chiropodists, dieticians, physiotherapists, radiographers, prosthetists, orthotists, speech therapists and social workers. That list brings home the importance of this group of professionals. Parliament, through various pieces of legislation, has seen fit to ensure that they are subject to mandatory regulation in the interests of public protection. Parliament also has a role, therefore, in overseeing the performance of the regulatory bodies.

On 1 August, the annual registration fee for members of the professions covered by the HCPC went up by 12.5% overnight as a result of the order that we debate today. The order was passed in the face of cross-party concern, including 100 Members who signed up to an Early Day Motion and indeed the tabling of a Motion to annul in committee at Holyrood. The 12.5% increase in fees followed on the heels of a 5% rise the previous year and in the face of assurances given by the HCPC in 2014 that it would not look to raise fees again until 2016. This is not being done in isolation. I know that we are not discussing other regulatory bodies, but I would mention to the Minister the NMC, which raised fees for nurses in 2013 from £76 to £100 and in 2015 from £100 to £120. The points that I want to raise in principle relate to a number of these regulatory bodies.

The contrast that I want to make is between the regulator’s demand for an increase in fees alongside what is essentially the sixth year of pay freeze and pay restraint and the Government’s policy on austerity generally. It is a puzzle as to how, when the public sector in general is under tight financial control, the one area that seems to be able to raise its fees willy-nilly is that of the professional regulatory bodies and the Care Quality Commission. The Minister will know that the CQC proposes to raise fees hugely, at some financial risk, particularly in the care sector. That is not for debate today, but there is an issue of principle here: in contrast to the issue of pay restraint and restraint generally on the public sector, a group of regulators seems to be able to put forward proposals, which the Government accept, for large fee increases.

I read the consultation paper issued by the HCPC, which said that the unexpected fee rise was prompted by the levy that it now has to pay to fund the Professional Standards Authority for Health and Social Care, the regulators’ regulator. I understand that and it was fully discussed in a debate in the other place in March. However, it subsequently emerged that the levy that it said had to be paid because of the Professional Standards Authority actually accounted for only 30% of the fee rise, and the remaining 70% was so that the HCPC could buy new accommodation for hearings, IT and quality assurance systems. In the consultation document, as far as I can see, that was not made clear. There was no breakdown or detailed justification of the fee increase.

That is particularly striking in light of the judicial review proceedings brought by the British Dental Association against the increase proposed by the General Dental Council whereas I understand that the High Court said that a regulator’s consultation on fee increase must set out a clear and detailed breakdown of the financial case for proposed increases. My point to the Minister is that that did not happen in relation to the HCPC consultation. There are three areas that I want to touch on. The first is that the consultation itself was extremely short. It covered the Easter holidays, May Day bank holiday and the purdah period. It closed on 6 May, the day before the general election. It totalled just 26 working days, leading many to suspect that it was designed to be buried away from scrutiny.

My second point is about accountability. Of those who did respond to the consultation, 86% of individual respondents objected to the increase, as did three-quarters of organisations. Their objections made not one iota of difference.

I come now to the role of the PSA, the regulators’ regulator. One of the problems is that while in a sense it can ask for a levy in order to fund itself, it does not seem to have a role to intervene on how regulators set fees or consult on them. In the light of experience with the HCPC, it would be good for the PSA to take a more proactive role. We know from submissions that I have received from staff organisations—I particularly refer the Minister to a survey by UNISON of nearly 5,000 registrants across the professions—that the fee rise was commonly referred to as a stealth tax. If you have no choice but to pay to practise your profession then it feels like a form of taxation. Yet registrants have little representation in the decision-making process that sets that fee.

Will the Minister also comment on the issue of the HCPC? Does it represent value for money? I know that the HCPC has done very good work, and I do not deny that it has absorbed a number of professions over the years successfully. However, these large fee increases bring concerns about whether the overall operation of the HCPC—and the other regulated bodies—is as efficient as it could be.

I want to raise with the Minister an issue that has been presented to me: although the fee might not be considered large in absolute terms, it is, none the less, a consideration for part-time staff in their choice of profession. The Minister may be aware that, as I understand it, the HCPC has declined to introduce a pro-rata structure, or differentiated fee structure, for part-time workers. That is a pity, given the need for us to attract staff and the fact that part-time staff have a lot to offer.

I understand that nine trade unions and professional associations representing registrants in HCPC fitness-to-practise processes have written to advise the HCPC that more could be done to control its costs, improve its efficiency and reduce the number of unnecessary hearings. They also made detailed recommendations on how the investigating process could be improved in order to root out unnecessary investigations, reduce the number of lengthy hearings and facilitate consensual resolutions. Seeing the noble Lord, Lord Lansley, here of course brings great joy to us all, but I cannot help commenting on the draft Bill drawn up by the Law Commission, which he would have received some time ago. Well, he may have commissioned it, I do not know whether he received it.

[Lord Lansley (Con)]

If I remember correctly, it was commissioned in 2011 and received by my successors in April 2014.

[Lord Hunt of Kings Heath]

My Lords, if he had still been in place I have no doubt that he would have acted on it. The point is, however, that a lot of the problems with the current fitness-to-practise procedures among health regulators generally derive from the fact that we have not implemented the Law Commission’s Bill, which would have allowed for a much more streamlined process.

The HCPC has, as I say, earned a great deal of credit for the way in which it has absorbed new professions over the years. I hope, however, that in this short debate the Minister will agree to look at some of the general principles raised. Does he agree that in any future proposal for a fee increase there needs to be a full breakdown and detailed justification for it? Does he also agree that it is not a good thing for Ministers to entertain fee rises that are higher than the percentage fee rises that are going to be given to NHS staff? There is an issue about pay restraint on the one hand and what seems to be the regulator’s ability to raise fees well above that rate on the other. Will he consider discussing with the PSA whether it will take a more proactive role in monitoring and evaluating any proposed increases by the regulator it oversees? Will he also look at whether the HCPC should be required to introduce a pro rata, or differentiated, fee structure for part-time workers?

Lastly, and I am sure the noble Lord will say yes to this, will he say that the Government will make it a priority to bring in primary legislation as soon as possible to implement the Law Commission proposals? The alternative is that the Minister will have to go through a succession of Section 60 orders when as a general principle he would find widespread support for the Law Commission proposals—there are one or two issues that we will debate—for a streamlined process that would apply consistency across all the regulated bodies. I am sure that it would reduce the cost of the regulators and, if the Government are not able to bring this in as a full Bill, at the very least it lends itself to pre-legislative scrutiny. However, there is enough consensus around the proposal to allow the Government to introduce a Bill. This short debate is a good opportunity to raise the issue of transparency of the regulators, and I hope that the Government are prepared to give this further consideration when a proposal comes up in the future. I beg to move.

National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) (No. 2) Regulations 2015

Lord Lansley Excerpts

Tuesday 24th November 2015 Grand Committee

[Lord Lansley (Con)]

My Lords, this is the first time I have had the opportunity to say something in Grand Committee, so I hope that I will be forgiven if I trespass on any of the procedures. I was tempted to speak, not least by the noble Lord’s reference in his Motion to the potential perverse incentives surrounding the referral to treatment time targets.

We do not need to speculate on where there might be perverse incentives in the system of targets and the impact they can have on how the NHS manages such targets, as we can see them. We saw them under the previous Labour Government. They had two referral to treatment time targets relating to admitted and non-admitted patients for complete pathways. The net result, of course, was a perverse incentive not to treat patients once they had passed beyond the 18-week point. It was precisely for that reason, after the 2010 election, that my colleagues and I in the Department of Health thought it was necessary to have a third target. For example, we were presented with 18,000-plus patients who at the time of the May 2010 election had waited for their treatment beyond 52 weeks.

There was a perverse incentive. It was very straightforward: if they were brought in in any significant numbers, and they and others like them had gone well beyond the 18 weeks into treatment, they would not be counted for the then 90% or 95% target—particularly the admitted patients on the 90% target. They were simply ignored. That was not acceptable. It was not what the targets were intended to do and it was not for the benefit of patients. So we introduced the incomplete pathway which had a salutary effect. It brought the numbers waiting beyond 52 weeks from more than 18,000 down to the low hundreds. It is still only about 800 patients who have waited. We introduced zero tolerance subsequently, once we had brought the numbers down for beyond a 52-week wait. We do not need to speculate about perverse incentives; they were there.

I can understand where Sir Bruce Keogh has seen that the combination of these targets can create a degree of confusion. The success of having introduced the incomplete pathway standard is something that we can build on. That is what Sir Bruce and NHS England are aiming to do—a simple standard that no less than 92% should be treated within 18 weeks. That reinforces the 18-week standard and it is very clear in the minds of patients.

Of course, there is scope for perverse incentives; there always is. In this instance, we know that by failing to distinguish, as the previous targets have done, between admitted and non-admitted patients—non-admitted patients having been less costly and complex to treat—there is a perverse incentive to concentrate on the non-admitted patients relative to the admitted patients. It is fair to say that if we see that emerging, we would have to respond in terms of the structure of the targets. To introduce something that dealt with the transparent detriment to patients of waiting beyond 18 weeks and then simply being dropped from the system and ignored was the right thing to do. When the noble Lord talks about perverse incentives, we have dealt with what was the principal perverse incentive. It is perfectly reasonable for NHS England and for the Government now to focus on one standard to make life more straightforward for those who have the responsibility of managing an increasing workload in hospitals.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, once again I thank the noble Lord, Lord Hunt of Kings Heath, for bringing this to the Committee. My noble friend Lord Lansley has pretty much done my job for me, but I think I had better go through with this to put it on the record. I thank my noble friend for that articulate and eloquent exposition of why we now have one incomplete standard and not the three that we had before.

We all accept that waiting times are critical. I should pay tribute to the Government of which the noble Lord was once a member. Bringing down waiting times was a huge success and there is no doubt that targets were one of the instruments used to do so. However, the noble Lord accepts that they are a blunt instrument and can lead to distorting clinical priorities. They can lead to gaming and extra cost, so they are not the whole answer. In particular, they can lead to perverse consequences. That is why the Secretary of State for Health and Simon Stevens accepted the recommendations made by Bruce Keogh earlier in the year. I will place a copy of his letter to the Secretary of State and Simon Stevens in the Library. The noble Lord may already have seen the letter but I will place it there.

Sir Bruce’s clinical advice on the standards used to measure the 18 weeks NHS constitution right was to remove the two standards that looked at how long people who have started treatment waited and to focus on the incomplete pathway standard—that is, the people who are still waiting. Perhaps I can explain that by using the analogy of a bus. The two earlier standards measured the people on the bus and the incomplete standard is designed to measure those who are left behind at the bus stop. As all three standards were written into the standing rules regulations, this statutory instrument, which took effect from 1 October, was required to make that change.

The change affects the metrics by which we measure the NHS’s performance on waiting times. It does not change the patient’s right. It is important that that is on the record. Patients can still expect to start treatment within a maximum of 18 weeks if they want to and it is clinically appropriate. If this is not possible, patients have the right to ask to be referred to an alternative provider that can see them more quickly, and the NHS must take all reasonable steps to meet patients’ requests. Sir Bruce Keogh recommended this change because having a set of three standards could be confusing and give rise to perverse incentives.

My noble friend described those perverse incentives. The perverse incentive was such that you could treat only one patient who had waited for more than 18 weeks as opposed to nine who had waited for less. There is no doubt that hospitals were managing their waiting lists on that basis. As a consequence, there were people waiting beyond 18 weeks for far too long. That was the wrong that the incomplete standard tried to address. As Sir Bruce said in June, while hospitals may be the ones penalised directly when they breached waiting time standards, the true penalty was laid on the patient who was waiting for much longer than he should have done. I wholly agree that that was not right.

In 2012—I think my noble friend was Secretary of State at the time—the Government introduced the incomplete pathway standard that a minimum of 92% of patients yet to start their treatment should have been waiting less than 18 weeks, to give NHS organisations a reason to prioritise patients who had been waiting a long time. The removal of the two completed pathway standards further minimises the potential for management of the waiting list to cut across clinical decision-making. Clinical priority should always be the main determinant of when patients should be treated. This clinical priority should not have been distorted because it should have been possible to meet all the clinical priorities and meet the waiting time standard, but in practice that was not always the case. Clinicians should make decisions about patients’ treatment and patients should not experience undue delay at any stage of their referral, diagnosis or treatment.

These changes will mean that there is a simplified, clearer focus on only one standard, covering all patients on the waiting list, and ensuring that those who have been waiting a long time are not left languishing. The noble Lord raised the issue, which was addressed by my noble friend, of whether having just the one standard will result in new and different perverse incentives. My noble friend made the important point that it could lead to priorities being skewed in favour of non-admitted, simpler, cases rather than admitted, more complex, cases. That is something we need to keep a very close eye on. NHS England will continue to measure trusts’ performance against all the standards except that there will be only the one measure in the contract.

I stress that changing the standards is not moving the goalposts in response to poor performance. This change has been made on the basis of clinical advice and in the best interests of patients, and has received widespread support, for example from the Nuffield Trust and the Patients Association. More than a million NHS patients start treatment with a consultant each month and the overwhelming majority are seen and treated within 18 weeks. However, the NHS is busier than ever, which is why we are investing the extra £8 billion that NHS leaders have asked for to support the five-year forward view. I hope that the noble Lord will accept that this was done in good faith and in the interests of patients and that it was a decision informed by clinicians, not by politicians. I have not addressed the concerns he raised about the eligibility criteria for nursing, because they are not strictly relevant to these regulations, but perhaps I could write to him on that matter.

Branded Medicines (NHS)

Lord Lansley Excerpts

Thursday 4th December 2014 Commons Chamber

[Mr Andrew Lansley (South Cambridgeshire) (Con)]

I beg to move,

That this House has considered availability and pricing of branded medicines on the NHS.

I am most grateful to the Backbench Business Committee for providing this opportunity to raise an issue of continuing importance to Members and their constituents. The debate will be short, but I am sure that we will be able to put it on the record that there are areas of concern. The two Front-Bench teams will, I am sure, be keen not only to respond now but to take some of these matters forward in the future as the Minister and his colleagues have sought to do over the past couple of years.

Colleagues from the previous debate must not feel that they have trespassed too much on to our debate. Listening to the contributions, it was amply clear that it was important for Members to be able to represent their constituencies. I know that all colleagues are very happy that they had the chance to do that.

Let me set the scene. Over the many years that I have been engaged with health matters, one of the most persistent sources of frustration has occurred when our constituents have not been able to access the medicines that they need through the national health service. That can happen because of a lack of data, and the National Institute for Health and Care Excellence will not appraise such a drug at that point because it determines that it is not cost-effective and is not therefore approved for NHS use, or because local commissioning decisions are incorporated in a local formulary.

Since its inception, NICE has created a more consistent national basis for decisions on access to medicines, but the application of what is essentially an arbitrary cost-effectiveness threshold still means that patients can be denied access to some new drugs. That has been exacerbated by the chronic slowness of uptake of some new medicines across the NHS, because of a clinical conservatism—new drug treatments are viewed as an extra cost rather than an opportunity to improve outcomes—or a general bureaucratic lack of responsiveness to patients.

That is deeply ironic as the UK is among the leading countries for drug discovery. We may represent only 3% of the international pharmaceuticals market, but we have been responsible in this country for 10% of new drug development, including such major innovations as monoclonal antibodies, which were first invented in my own constituency at the Laboratory of Molecular Biology.

As a coalition Government, we commit resources to world-leading research. Ministers have rightly sought both early access to new medicines and continuing support for research and innovation, but we continue to face institutional and cultural resistance. One of my objectives over recent years was to tackle that issue. I wanted to assure patients that, through the NHS, they could access the best and latest medicines and treatments. We wanted the NHS to adopt new innovation and technologies and to move away from a system in which the drug companies set a price that NICE and the NHS appraise and reject, leaving patients unable to access the medicines that their clinicians believe are best for them.

Instead, we should have a system that puts the patient at the heart of the service. If a clinician believes that a medicine is the right one for their patient, they should be able to prescribe it and the NHS and the pharmaceutical company should settle on a fair price, reflecting the value of that drug and a fair return to the costs involved in drug development.

[Bill Wiggin (North Herefordshire) (Con)]

One of the things my right hon. Friend will know probably better than anyone from his role as Secretary of State for Health and something that is not well understood by my constituents is that the NHS is one of the most exciting clients for anybody selling drugs and has the most efficient buy-in capability. Why does that not seem to come across to our patients and constituents, and what about medicines that used to work but now are not available? Will he cover that in his speech?

[Mr Lansley]

On the latter point, no, but drugs that move beyond patent become generically available to the NHS. On the former point, my hon. Friend is absolutely right. I often found this issue frustrating. The best way for drug companies to get their new medicines adopted internationally is to introduce them successfully into the NHS. As we move to a more systematic patient record system, the introduction of new treatments and medicines through the NHS will provide the strongest possible database of outcomes anywhere in the world, because of the character and scale of the NHS. So he makes a really important point.

The principle behind securing patient access to new medicines lay behind the proposal for a value-based structure of drug pricing. It was my intention that come the introduction of the new pharmaceutical price regulation scheme, which was to be negotiated for January 2014, a transition to a new price-setting mechanism would also be in place. As the House will recall, in the interim, we introduced the cancer drugs fund because patients in the UK had significantly worse access to new cancer medicines than patients in other countries. That contributed to our poor relative cancer survival rates, and we were determined that it should stop and that the lack of access to new cancer medicines should be tackled while a longer-term solution was developed.

In 2010, therefore, we introduced the CDF to meet that specific need over a defined period and within a defined budget. The achievement of the CDF has been vital. More than 60,000 patients have accessed the cancer drugs they need through the CDF over the past four years. I am immensely proud of that fact. However, the fund is not, and was never intended to be, a permanent solution. Over time, more cancer drugs will be introduced, and if we carry on like this, an increasing number will not be available other than through the fund. Some drugs, such as cetuximab, Avastin and abiraterone, have already been substantially provided through the CDF. If this continues, while other drugs are added, it will greatly increase the cost.

I welcome the Government’s commitment to the CDF through to 2016—it is needed while the pricing of drugs to the NHS is tackled—but that extension cannot continue indefinitely. I therefore call on the Government to reinvigorate the drive to a value-based assessment of new drug pricing and to incorporate that into the PPRS, so that while the Government and the NHS have control of the budget, the NHS can make all licensed new medicines available through the NHS. In addition, it would incentivise innovation in the pharmaceutical industry and result in a fair return to industry on the cost of drug discovery.

The CDF has been necessary and successful, but it was intended only as a bridge to a better scheme across the whole NHS. It cannot bear the weight that will fall on it if we do not reform the system for the pricing of medicines more generally. If we can see our way to that reform, the prospect of de-listing new or existing medicines to the CDF can be deferred. However, reform of drug pricing has not been progressed as it should have been, or as we hoped it would be.

The new PPRS did not incorporate a value-based assessment of the pricing of medicines payable by the NHS. It gave the Treasury a good deal, securing a real-terms reduction in the drugs budget, but a reduction via a rebate is not transparent to the NHS. Drug companies setting their own price for new medicines will continue to set prices that conflict with NICE cost-effectiveness thresholds.

Members might have noted that, yesterday, Roche won an appeal against NICE’s final appraisal of Kadcyla, a drug used to treat HER2-positive breast cancer. Roche won on the basis that NICE should have taken account of the PPRS but did not do so. It argued that as a budget control mechanism, the PPRS, through its rebate, could be argued to offset the relatively high cost of a medicine on introduction. Roche won the appeal, but I have to say that the NICE appraisal might none the less remain unchanged.

The rebate is not predictable; nor is it attributable to any particular drug. It goes to the Treasury, not to the NHS. So, in practice, any NHS purchaser of a high-cost medicine must fully absorb the cost, and the opportunity cost, that paying a high price implies. This case highlights the theoretical link between a NICE appraisal and the PPRS, and it demonstrates how the PPRS does not in practical terms serve to resolve the dilemma of how to introduce high-cost medicines in the NHS.

The PPRS deal showed how much the pharmaceutical industry in this country was willing to offer for a guaranteed rate of return and the ability to set prices at introduction here in the UK, which can then act as a reference price for a quarter of the drugs market across the globe. The current PPRS of course benefits the shareholders and the boards of the big pharmaceutical companies, which are able to maintain high prices throughout a quarter of the world on the back of high prices in the UK, even for those drugs that offer limited clinical benefit. The other beneficiaries are those in the Government who are able to plan spending on drugs a little bit better than they were before. The losers, unquestionably, are patients, who continue to be denied access to the drugs that their doctors think they need.

This is not the kind of price regulation we should have in future. Price should reflect the value of new medicines. A new drug that offers little or no benefit relative to the best available alternative for treatment should secure only a small price differential. New drugs that tackle unmet need or substantially reduce the burden of disease should enjoy a correspondingly substantial price premium. By such a means, we would incentivise innovation and drug development, particularly in relation to major unmet targets. We could also build a premium into pricing in areas in which drug development was most needed, such as early-stage dementia, new antibiotics or the treatment for some cancers, such as pancreatic and ovarian cancer.

The benefits of a value-based pricing system were set out in an OECD study six years ago. But the study recognised—as, subsequently, did we—that the principle had yet to be given practical effect. A year ago, the Minister responsible, Earl Howe, said that value-based assessment would be taken forward and that it would be brought in late this year. That is not happening. NICE was given the task of developing value-based assessment last year, but in September this year, it appeared to have put that on the back burner. That is just not good enough.

Without value-based assessment, NICE will continue to apply an arbitrary threshold to a measurement of the benefits of drugs which takes into account only the quality-adjusted life year gain—the QALY—and end-of-life addition, not the broader societal benefits or the need to promote drugs targeted at key areas of therapeutic need and to promote innovation.

We must look to the value beyond the QALY. We must ask NICE to design a clearer methodology for value, but not just through add-ons to its existing methodology. It should recognise the burden of disease in extending life and the importance of greater clinical and patient engagement. In developing realistic pricing, it could draw on the real-world mature outcomes data for drug use that the cancer drugs fund has given us. It must also draw on the work done by charities and by Sanofi to examine ways in which patient engagement with NICE could be supported. Qualitative judgment of innovation and patient benefits must form a part of this broader assessment, as well as the quantitative data relating to the QALY.

I congratulate Ministers for pushing the NHS to promote innovation. We had our report in December 2011 and more recently Ministers have launched the early access to medicine scheme. The Under-Secretary of State for Health, my hon. Friend the Member for Mid Norfolk (George Freeman), has been right not only to support that and the Medical Innovation Bill but to launch a review of how innovation processes can be enhanced in the NHS.

How perverse would it be if, at the same time, licensed and effective medicines were not approved or available through the NHS? In recent months, a number of drugs have not been approved by NICE, such as Kadcyla, Alimta for lung cancer and abiraterone for prostate cancer prior to chemotherapy. Several of those cases demonstrate the problem of paying for new personalised medicines, but we cannot see the difficult process of introducing new drugs being made even worse by the de-listing of drugs by the cancer drugs fund.

I hope that in response to the debate Ministers will tell NICE to reinvigorate and make progress on the work on value-based assessment, while developing a new methodology in the way that I have described. The Government should work with industry to develop the pharmaceutical price regulation scheme, so that pharmaceutical companies can, within the overall framework, continue to set the price of their medicines at introduction but accept that the NHS should receive a rebate if, and to the extent that, a value-based assessment shows a lower price. That would lead to drug-specific rebates that could then be incorporated within the overall rebate for budget control purposes. In my view, such a system must be in place by 2016, so that the cancer drugs fund can be maintained between now and then and can be the bridge that it was intended to be, while having a realistic time-limited remit.

Only by pushing forward with such measures can we expect in future to offer doctors in the NHS the assurance that they can access the medicines and treatments they think best for their patients and give patients the confidence that the NHS, as a comprehensive free service, is able and willing to provide whatever treatment is in their best interests. I am grateful for the time and attention of the House.

Ebola

Lord Lansley Excerpts

Monday 13th October 2014 Commons Chamber

[Mr Hunt]

The Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), has been in touch with Jim Wells in the Northern Ireland Assembly and she will take up that issue. The broader point that the hon. Member for North Antrim (Ian Paisley) makes is that there are many points of entry into the UK, and it is important for us to recognise that our screening and monitoring process will not catch absolutely everyone who comes from the affected regions. That is why we need to have other plans in place, such as the 111 service, and to have encouragement at every border entry point for people to self-present so that we can protect them better, should they develop symptoms.

[Mr Andrew Lansley (South Cambridgeshire) (Con)]

I welcome the Secretary of State’s statement to the House, and I am also grateful to the shadow Secretary of State for what he said. All Members share the Secretary of State’s admiration for the staff of the NHS and Public Health England who are assisting in the front-line treatment and care of those in west Africa. In that context, he is right to try to tackle the virus in west Africa, but this is not just about the availability of much better treatment facilities; it is also about working in the community in short order to try to stem the continuing transmission of the disease. Work has clearly been done on that; will he tell us how we might scale it up?

[Mr Hunt]

My right hon. Friend makes an important point. I discussed this with United States Secretary Burwell today. The US is piloting a programme in Liberia, and we are doing the same thing in Sierra Leone. We are both providing the same response, which is to tackle the disease at source. We know that, if we can get 70% of the people who develop Ebola symptoms into treatment and care, we will contain the disease. At the moment, the disease is replicating at a rate of 1.7, which means that every 10 people infected are going on to infect another 17 people. That is why the virus is spreading so fast, and we can halt it only if we get people into treatment very rapidly. Community treatment centres are therefore an important part of the Department for International Development’s strategy to help to contain the virus, and that is why we are supporting the development of 700 beds in Sierra Leone.

Regulatory Reform

Lord Lansley Excerpts

Tuesday 9th September 2014 Commons Chamber

[Mr Andrew Lansley (South Cambridgeshire) (Con)]

I did not intend to say much about the regulatory reform order but I am prompted to do so to ask some questions and to respond to one or two points. I will not rise to the bait of the shadow Minister, the hon. Member for Leicester West (Liz Kendall), other than to say that I thought it deeply ironic that, in railing against the Health and Social Care Act 2012, she instanced for most of her speech the views of Healthwatch England, a body representing patients that was created under that Act. It remedies one of the greatest failings of the last Labour Government, who demolished successive efforts to give patients a genuine voice.

I was grateful to my hon. Friend the Member for Stafford (Jeremy Lefroy) for instancing the Act’s requirements on CCGs in relation to patient involvement. “No decision about me without me” is at the heart of the principles of reform. They are set out in the primary legislation. This reform order does not in any way reduce the statutory requirements on CCGs, which must ensure that any joint arrangements they enter into match up to the requirements under the Act.

Under the Act, the essence of CCGs, compared with primary care trusts, is that they are independent statutory bodies. I will not follow the hon. Member for Blackley and Broughton (Graham Stringer) and discuss the process of the regulatory reform order, but he is right: it is not theoretical; it is practical. There is a practical reason why we are in a better place, with CCGs enjoying statutory authority compared with PCTs. Although they were statutory bodies, they did not have the authority that exists presently under statute to deliver and commission services in the interests of the population they serve, without interference or instruction by others. Therefore, as the Minister rightly says, if they wish to enter into these commissioning arrangements, they do so on a voluntary basis. My view is that in the relatively short intervening period under the Act, they have probably underestimated their capacity as statutory bodies to enter into arrangements voluntarily, exercising their statutory authorities as long as they do not improperly delegate their responsibility.

That takes us back to the practical issue. I remember that in 2006, also in Manchester, as it happens—some Members will recall this very well—there was the reorganisation of maternity and children’s services across the city. I suspect that what is being complained of in relation to Healthier Together is exactly the same kind of complaint as was made against that consultation, which had its deficiencies, of which I complained.

Leaving aside whether the consultation was good, bad or indifferent, the point is it did arrive at a position. I can remember talking to the chief executive of the primary care trust in Salford and also, separately, to the chief executive of Salford Royal, and they were told that, as a consequence of the configuration, although the primary care trust wished to commission maternity services and paediatric intensive care services from Salford Royal and the hospital wished to provide them, they were not allowed to do so because the Joint Committee of Primary Care Trusts was preventing them from doing so. In fact, as they were, in effect, in a hierarchy under the strategic health authority, under past legislation they could have been required—forced—to go down that route, and were forced to do so.

That, in my view, is not the position now, and it still will not be the position under these proposals because they are voluntary. If a CCG takes the view that it is in the best interests of its population to deliver some service, it must take a decision consistent with that view. If that means it enters into a voluntary arrangement to deliver that, that is to be supported. If it takes the view that it has to depart from any such arrangement in order to secure the best interests of its population, it must go down that path as well. It would be wrong, under this order or otherwise, for it not to do what is in the best interests of the population it serves.

Finally I have a question, which in this respect is an important one following on from what the shadow Minister asked. In commissioning—quite often when commissioning, for example, out-of-hospital and community services—it is right that one may well need to co-ordinate across CCG services and NHS England’s responsibility for the commissioning of primary care services or, indeed, other services such as dental care and pharmacy services. That being the case, however, it is also important to commission across social care services and some public health aspects of local authorities’ responsibilities. With local authorities having their own statutory authority, and CCGs likewise, it is perfectly possible for them to enter into joint commissioning arrangements, and they do so. I hope the Minister will be able to reassure me that not only are local authorities and the geography of health and wellbeing boards and scrutiny to be respected in terms of the way in which CCGs enter into these kinds of voluntary arrangements, but also that where they enter into joint commissioning arrangements they are able to do so in ways that can mesh together NHS England, CCGs, as necessary, and local authorities.

I urge that at the heart of this is a recognition that CCGs now have statutory authority. That is what is different. They are accountable to their local community, and must set out a commissioning plan and agree it with their health and wellbeing boards. If they try to enter into an arrangement which is contrary to the best interests of their population, as set out in that commissioning plan or by agreement with the health and wellbeing boards, clearly it would be deficient and it should not be able to be pursued.

Business of the House

Lord Lansley Excerpts

Thursday 6th September 2012 Commons Chamber

[Ms Angela Eagle (Wallasey) (Lab)]

Will the Leader of the House please give us the business for next week?

[The Leader of the House of Commons (Mr Andrew Lansley)]

The business for next week will be:

Monday 10 September—Consideration in Committee of the European Union (Approval of Treaty Amendment Decision) Bill [Lords] (day 1).

Tuesday 11 September—Opposition Day (6th allotted day). There will be a debate on tuition fees, followed by a debate on a subject to be announced. Both debates will arise on an Opposition motion.

Wednesday 12 September—Remaining stages of the Defamation Bill, followed by a motion relating to the appointment of a new Parliamentary Commissioner for Standards.

Thursday 13 September—A debate on a motion relating to oil markets, followed by a debate on tax avoidance and evasion. The subjects for these debates have been nominated by the Backbench Business Committee.

Friday 14 September—Private Members’ Bills

The provisional business for the week commencing 17 September will include:

Monday 17 September—Second Reading of the Infrastructure (Financial Assistance) Bill.

Tuesday 18 September—Motion on the conference recess adjournment, the format of which has been specified by the Backbench Business Committee.

I should also like to inform the House that the business in Westminster Hall for 13 September will be:

Thursday 13 September—Debate on the dairy industry.

May I say how privileged I am to be appointed Leader of the House? I pay tribute to my predecessor, my right hon. Friend the Member for North West Hampshire (Sir George Young), and to the former Deputy Leader of the House, the hon. Member for Somerton and Frome (Mr Heath), who takes on important new Government responsibilities. Throughout the House, my predecessor was held in the greatest respect and affection, and continues to be. He saw through important reforms, and I can hope to do no better than to emulate him in how he demonstrated that he understood the importance of being not only Leader of the House but a leader for the House, speaking for the House and representing it in government and beyond, and balancing that with the important responsibility of representing the Government within the House. I look forward to these new responsibilities.

[Ms Eagle]

I welcome the new Leader of the House and join him in paying a warm tribute to his distinguished predecessor. The right hon. Member for North West Hampshire (Sir George Young) has given long and distinguished service both in government and to the House. Over the years, he has surprised political pundits with his Lazarus-style tendencies, and perhaps even this time he is merely on a sabbatical and will be back. I also welcome the new Deputy Leader of the House of Commons, and pay tribute to his predecessor, the hon. Member for Somerton and Frome (Mr Heath).

I also welcome the Chief Whip to his new and extremely challenging job. One of the first things he will have to do is console his colleagues who have been sacked in the reshuffle—and not given knighthoods. If it is any help, I can tell them that, in my experience, being sacked from government does not necessarily mean the end of a Member’s ministerial career. I returned to government in a subsequent reshuffle—under a new Prime Minister.

Over the summer, the Olympics and Paralympics have shown the best of our country, and I salute the tremendous achievements of all our athletes and those who volunteered during the games, who contributed to making it such an inspirational summer. I pay particular tribute to those at the London Organising Committee of the Olympic Games and Paralympic Games and my right hon. Friend the Member for Dulwich and West Norwood (Dame Tessa Jowell), who did so much to bring the games to this country and make them a success. Also, in the spirit of cross-party unity and wanting, as always, to be helpful, may I single out the part played by the Mayor of London? No one has asked him whether he is a man or a mouse.

Speaking of the Prime Minister, after his disastrous summer, it is hardly a surprise that we have had yet another Government relaunch. After the reshuffle, we have a new right-wing Justice Secretary, an Environment Secretary who is a climate change sceptic and an Equalities Minister who has voted against almost every piece of equality legislation. So now we know: at the end of the rose garden, turn right. Given her record, can the Leader of the House arrange for an urgent statement from the new Equalities Minister, so she can inform the House of her unique approach to her brief?

The new Secretary of State for Health said before the election that a Conservative Government would “crowd-source” ideas, because Conservatives believe in collective wisdom. Will the Leader of the House commend the Chancellor for going to the Olympics stadium the other night to do his own little experiment with crowd-sourcing, and can he tell us what the Chancellor will be doing with the answer he got?

What the British people want is not yet another Government relaunch, but a real plan for jobs and growth, because the Chancellor’s economic policies have failed spectacularly. We now have an economy in the longest double-dip recession since the second world war. Growth forecasts have been cut and borrowing is up by a quarter. The Prime Minister has been on “Daybreak” this morning making announcements that should have been made to this House. When will he learn that cosy chats on the “Daybreak” sofa are no substitutes for a statement to this House? We should not have to rely on urgent questions.

The Deputy Prime Minister said in an interview with The Guardian over the recess that, given the economic situation, it was right to increase taxes on the very wealthy. The next day the Chancellor rubbished the idea. After the reshuffle, does the new roving Economic Minister, the right hon. and learned Member for Rushcliffe (Mr Clarke), have the casting vote? With the excitement of the Olympics, I thought I must have forgotten about the Liberal Democrats joining us in the Lobby to vote against a Budget that gave a huge tax cut to millionaires, but according to Hansard the Liberal Democrats voted for it. After the Deputy Prime Minister’s disastrous performance at the Dispatch Box this week, the new Leader of the House might find it difficult to coax him back to the Chamber any time soon, but can he try to get us an urgent statement? The impression at the moment is that the Deputy Prime Minister is saying one thing in public and voting the opposite way in this House.

I look forward very much to working with the Leader of the House. I hope that he can set out his views soon on the proposed House business committee. In the meantime, will he put all our minds at rest, on this first occasion at the Dispatch Box, and rule out a top-down reorganisation of the House of Commons?

[Mr Lansley]

I am grateful to the hon. Lady for her welcome. I am also grateful for her very warm tribute to my predecessor. I know that the House will very much appreciate the intention that he should be further honoured, as a Companion of Honour. It is a rare honour, but one that reflects the regard in which we all hold him.

The hon. Lady is quite right: I recall at the last business questions before the recess that the House was looking forward to the Olympics and Paralympics. In truth, I think all our expectations have been wonderfully exceeded. It has been a most inspirational event, and not only inspirational for a generation, as it was intended to be, but a fabulous showcase for what this country can achieve. We, the Government and the people of this country will be able to depend on that reputation across the world in years to come.

The hon. Lady asked a number of questions and made a number of points. Let me tell her that the changes in the Government are all about ensuring that we take forward our reforms and our focus on growth. All of us, as the Prime Minister absolutely said, recognise the difficulties that we encountered when we came into government. We know—and have known for two and a half years—how difficult they are. In a sense, they have been added to by the problems in the eurozone and the international economic situation. We are not alone in the problems we have to face, so we are focused on growth, and that will be true, as the Prime Minister has rightly said, in every Department—whether in the Department for Education, in developing the skills, the qualifications and the standards that are required; in the Foreign Office, which has been focused on delivering trade and investment, and business relationships across the world; or in the Department for Communities and Local Government, in using the powers that the Localism Act 2011 gave to local authorities and the new planning arrangements to deliver increased growth and build jobs. That is what it will mean in all those Departments. The difference between the Government and the Opposition is that the Labour Government were responsible for the mess that the country was in in 2010, whereas this Government are focused on getting the country out of that mess.

[Margot James (Stourbridge) (Con)]

Millions of law-abiding citizens will be outraged that Mr and Mrs Ferrie spent three days in custody after defending themselves against burglars, one of whom turned out to be a violent career criminal out of prison early on licence. May we have a statement from the Home Secretary on the urgent need to include common sense in the training of police officers, and may we have a debate about the rights of householders to defend themselves and their property?

--- Later in debate ---

[Mr Lansley]

I completely understand how strongly my hon. Friend feels about that, and I think many Members of the House feel the same. I hope she sees that there is an opportunity for her on the 18th of this month to raise that issue at Justice questions. I am sure that Ministers will feel as strongly as she does on this.

[Natascha Engel (North East Derbyshire) (Lab)]

Before I welcome the new Leader of the House to his new role, I too would like to put on record my thanks to his predecessor, the right hon. Member for North West Hampshire (Sir George Young). Without his help and good advice, the Backbench Business Committee would not be what it is today, and the Back Benches are a more interesting and more powerful place as a result of his time in office.

I am sure that the Backbench Business Committee will continue to enjoy a good and strong working relationship with the Office of the Leader of the House, and I look forward to working closely with him. May I take this opportunity to say to the House that the closing date for submitting subjects for the mini-recess Adjournment debate on the final Tuesday is Wednesday 12 September?

[Mr Lansley]

I am grateful for the hon. Lady’s kind words. I was pleased that in my first announcements on the business of the House I was able to include not only the pre-recess Adjournment debate but a day for the Backbench Business Committee which is not a Thursday. I want to follow what my predecessor achieved in improving the opportunities for debates for Back-Bench Members and in bringing a sense to this House of being a forum for the nation on issues of importance. I hope that we will continue to do that.

[Jake Berry (Rossendale and Darwen) (Con)]

For more than 100 years the Bacup and Britannia Coco-nutters have been dancing the boundaries of Bacup on Easter weekend. May we have a statement about the cost of road closure orders, as the Coco-nutters face the prospect of not being able to dance this Easter because it will cost £1,000 to close the road? It is endangering our morris dancing tradition.

[Mr Lansley]

I am grateful to my hon. Friend for giving me an early opportunity to understand the encyclopaedic nature of business questions. The limits of my knowledge I have always been aware of, and it does not extend to morris dancing. I will draw the point that he raises on behalf of his constituents to the attention of my colleagues at the Department for Communities and Local Government, and ask them to respond to it.

[Mr Ben Bradshaw (Exeter) (Lab)]

May we have a clear statement from the Government on their policy on regional pay? In May the Deputy Prime Minister said:

“There is going to be no regional pay system. That is not going to happen.”

Yet 20 health trusts in south-west England have announced that they intend to abandon the NHS’s national “Agenda for Change” pay structure and adopt just such a regional pay system. This is causing great concern and anger among thousands of NHS workers and their families across the south-west.

--- Later in debate ---

[Mr Lansley]

I am grateful to the right hon. Gentleman for the opportunity further to reiterate—we have discussed it in the past—that we were not proposing regional pay. I made it clear in my previous role as Secretary of State for Health that we were proposing pay that was more reflective of local labour market circumstances, marketplace and pay. That is capable of being achieved through the “Agenda for Change” framework, and to that extent it is consistent with national frameworks for pay. The consortium of trusts has made it clear that its frustration is borne of the lack of progress in the national pay frameworks.

[Mr Ian Liddell-Grainger (Bridgwater and West Somerset) (Con)]

The Leader of the House will be fully aware that the 2nd Battalion the Royal Regiment of Fusiliers is due to be cut. That decision is wrong on many levels. It is a fully recruited, highly motivated regiment, in whose 6th Battalion I served. May we please have time in this Chamber to discuss what is blatantly a wrong decision and to put forward the reasons why the 2nd Battalion the Fusiliers should be kept as a line regiment doing the phenomenal job that it has been doing and wants to continue to do for this country?

[Mr Lansley]

I completely understand the strength of feeling that my hon. Friend expresses. He will have heard, as I did, the Prime Minister’s response to a question from my hon. Friend the Member for Basildon and Billericay (Mr Baron) yesterday. The Prime Minister explained how the reshaping and the changing character of the armed forces were being developed under the Army 2020 arrangements. He was willing to arrange a meeting to discuss that matter, and I simply reiterate that.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

I welcome the new Leader of the House to his post. We will miss the old Leader of the House, who was essentially a great parliamentarian. He was full of wit and wisdom, and he will be a hard act to follow, but I am sure that the right hon. Member for South Cambridgeshire (Mr Lansley) will have a good go at it.

May I raise an important question as the Member of Parliament for Huddersfield? It relates to Pakistan and extradition. Criminals and suspected criminals who flee to Pakistan are almost impossible to track. Ten years ago, eight members of the Chishti family were killed in an arson attack, including the mother, the older children and tiny babies. Three of the gang that did it were arrested, tried and convicted, but one of the prime suspects, Shahid Mohammed, fled to Pakistan. People in Pakistan know where he is. What can we do to track him down, bring him back to face justice and give comfort to the Chishti family?

[Mr Lansley]

The hon. Gentleman raises an issue that is clearly of great importance to his constituents. I do not know the answer to his question, but I will gladly raise it with my Foreign and Commonwealth Office colleagues and ask them to respond to him.

[Dr Julian Lewis (New Forest East) (Con)]

May I say to my former chief at the Conservative research department what a pleasure it is to see one of the most decent people in political life now occupying one of the most distinguished positions in Parliament? In return for that, may we have a statement from a member of the new Defence ministerial team on the situation of Commonwealth soldiers who would normally be in a good position to apply for citizenship at the end of their service, but who are being prevented by the UK Border Agency, on very questionable grounds such as minor military disciplinary infractions? We owe those soldiers a debt of honour, and they should not be discriminated against in that way.

[Mr Lansley]

I am grateful to my hon. Friend, and I will raise that issue. I know that people feel strongly that service personnel who serve this country should be treated with the greatest respect and honoured as a consequence. My colleagues at the Ministry of Defence will want to reply to him on that matter.

[Mr John Spellar (Warley) (Lab)]

May I also welcome the Leader of the House to his new position? I should like to take him back to his previous incarnation as Health Secretary. Is he as shocked as I was to find out how much typing work is now being outsourced abroad by hospitals? My freedom of information request has revealed that West Middlesex outsourced 230,000 letters in one year, that Whittington outsourced 90,000, that Epsom outsourced 11,000 in a quarter, and that Kingston outsourced 17,000 in a pilot. Medical secretaries are being laid off as a result. May we have a debate so that the Secretary of State for Health can justify taking away British jobs from British workers?

[Mr Lansley]

I will of course raise that issue with the Department of Health on the right hon. Gentleman’s behalf, but he might also like to raise it himself in the pre-recess Adjournment debate, which will give Members the opportunity to mention issues of that kind. I was interested to see, in my own constituency a few years ago, that Addenbrooke’s—a major hospital—had outsourced activities of that kind, but that it brought them back to this country as a consequence of seeing the quality of service that could be delivered here.

[Dr Matthew Offord (Hendon) (Con)]

In July this year, the Prime Minister said that he fully supported the right of people to wear religious symbols at work. That position was supported by the Attorney-General and the Equalities Minister. Will a Minister therefore come to the Dispatch Box to explain why lawyers acting on behalf of the Government are contradicting the Prime Minister in bringing a case against Shirley Chaplin for wearing a crucifix at work?

[Hon. Members]

Hear, hear!

[Mr Lansley]

I think that that response to my hon. Friend’s question demonstrates the fact that we feel strongly about this matter. People should be able to wear crosses and to reflect their faith and beliefs. The law allows for that, and employers are generally good at being reasonable in accommodating people’s religious beliefs. We believe that the law as it stands strikes the right balance between the rights of employees and employers. We also believe that it is better for the UK to look after its own laws, rather than being forced into a change by a European court. We believe that UK law strikes the right balance, and losing that case would place extra restrictions on how employers treat their work forces. We are not seeking that.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

I congratulate the Leader of the House on his new position. May I also express my disappointment that the Government reshuffle did not deliver a Minister for Teesside? I say that because figures from the Office for National Statistics have today shown that South Teesside has moved from 14th to second in the country for its number of households with no work. May we have a statement on why the number of workless households in Teesside has increased so desperately in the past year?

[Mr Lansley]

I am surprised that the hon. Gentleman did not put that in the context of the overall reduction in the number of households with nobody in work, which I believe is very much to be applauded.

[Philip Davies (Shipley) (Con)]

May we have a debate on the appointment of judges, and on how to make them more reflective of public opinion? A great deal of concern has been expressed about lily-livered judges by many people, not least me, and yesterday we heard a judge saying that it took a huge amount of courage to burgle a house, and refusing to send a persistent burglar to prison. How can we ensure that idiots like that do not remain in the judiciary, and that the people who are appointed to the judiciary do not reflect the views of that individual?

[Mr Lansley]

I am conscious that, in my new privileged position, I stand at a constitutional juxtaposition between the legislature and the Executive. One of the last things I would want to do, on my first occasion at the Dispatch Box, would be to trespass on the relationship between the legislature, the Executive and the judiciary, and in particular on the independence of the judiciary, so I will avoid commenting on that. However, my hon. Friend’s observations are on the record.

[Alex Cunningham (Stockton North) (Lab)]

Yesterday, 500 Teessiders, many of them from my constituency, lost their jobs with Direct Line, which is part of the state-owned RBS Group, not long after apparently having been cajoled into signing new contracts. That means that their redundancy payments will be considerably less; they will lose thousands of pounds as well as their jobs. I am sure that the Leader of the House will agree that such actions are abhorrent, and that the managers must be held to account. Does he know whether the Business Secretary plans to make a statement on the decisions of this state-owned business, and would the Leader of the House allow a debate on the issue?

[Mr Lansley]

I share the hon. Gentleman’s view, as I am sure all Members do, that the prospect of losing one’s job can be difficult and that we should all sympathise and do everything we can to help. Indeed, the Government will do everything they can to help, and Governments have done a great deal in the north-east. For example, the Deputy Prime Minister and the Chancellor were there recently to see how new investment was going to the north-east as a result of the enterprise zones. I confess that I was in the House only for the latter part of Business, Innovation and Skills questions, so I do not know whether the hon. Gentleman was able to raise this matter then. That would have been a good opportunity to do so.

[Mike Crockart (Edinburgh West) (LD)]

Six hundred and fifty million silent calls were made in the UK last year, many of them to vulnerable older people. Forty-five million spam texts are sent in Europe every single year, 92% of which are estimated to be fraudulent, and 3 million UK adults will be scammed out of £800 each this year by fraudulent marketing calls. May we therefore have an urgent debate on the effectiveness of the powers of the Information Commissioner’s Office, as it is now clear that we have an industry in crisis and a country under siege?

[Mr Lansley]

I am interested to hear what the hon. Gentleman has to say. I think that all Members and people outside the House will, almost without exception, have been the recipients of such nuisance calls, which can be very distressing, particularly for older and vulnerable people. He will know that this is exactly the sort of issue that it is helpful to raise, for example, in the pre-recess Adjournment debate, not least because that will focus the mind of the Information Commissioner. In any case, I will make sure that the issue, which touches on the responsibilities of Ofcom and the ICO, is raised with the Department for Culture, Media and Sport.

[Paul Flynn (Newport West) (Lab)]

When can we debate the apparent ambition of the Prime Minister to rival the work of King James I and David Lloyd George in degrading the honours system? A Select Committee has already criticised the Prime Minister for setting up in March this year, without the knowledge or consent of Parliament, a new Committee dominated by the Whips, which exists to give honours to MPs. The distribution of consolation prizes to sacked Ministers is likely to bring the honours system into further disrepute and ridicule.

[Mr Lansley]

I do not welcome what the hon. Gentleman says. In this House as elsewhere, we should honour public service. This is a mechanism for honouring public service, and I see absolutely no reason why this Members of this House should be debarred from having access to that kind of honour.

[Jason McCartney (Colne Valley) (Con)]

For the first time in ages, all the shop premises in Holmfirth, a market town in my constituency, are actually let, which is really good news. I know that the Government have been doing their bit to support our town centres with their high street strategy, but could we have a debate on the many “shop local” campaigns, which are working hard to support our local shop centres and businesses and our local producers?

[Mr Lansley]

I am pleased to hear what my hon. Friend has to say, and I welcome what he said about Holmfirth high street. Indeed, we have accepted and implemented virtually all Mary Portas’s review recommendations. I hope that the pilots will show how we can extend some of the lessons further to invigorate high streets across the country—something that, as my hon. Friend illustrates, can be achieved.

[Valerie Vaz (Walsall South) (Lab)]

I welcome the Leader of the House to his new position and place on record my thanks to the right hon. Member for North West Hampshire (Sir George Young) for the helpful and courteous way in which he dealt with Back Benchers. I hope that that will continue.

Can we have an urgent debate on the Sunday trading laws, given that the announcements outside this House are at variance with the undertakings given inside it? If there is any consultation, will the Leader of the House ensure that retail staff, the unions, the Churches and the Association of Convenience Stores are included?

[Mr Lansley]

I am grateful to the hon. Lady for her kind words about my predecessor. I do hope to emulate in many respects the way in which he fulfilled his responsibilities so wonderfully. As to Sunday trading legislation, however, I do not accept the premise of her question. I do not think there is any variance between what the Government said when we introduced the legislation about the extension of Sunday trading hours during the summer and what has been said subsequently.

[Mr David Nuttall (Bury North) (Con)]

In welcoming my right hon. Friend to his new position as Leader of the House, I would like to reiterate and add my voice to the calls for a debate on the proposal to disband the 2nd Battalion the Royal Regiment of Fusiliers? In particular, we should consider how that decision will affect recruitment opportunities in my Bury North constituency, which has a long and proud history of providing new recruits to the Fusiliers.

[Mr Lansley]

I am grateful to my hon. Friend, who reiterates on behalf of his constituency a point that is particularly important to it as a location for recruitment. My colleagues in the Ministry of Defence are, through Army 2020, setting about the process of changing not the size but the shape of the armed services, particularly the Army. In that context, they are looking for something that is sustainable, not least because the Army recruits from across the country. I have already mentioned the opportunity for Members to talk to Ministers about this, but in addition, I hope that Members will recognise that this is the sort of issue that is worth raising in the pre-recess Adjournment debate on Tuesday week.

[Kelvin Hopkins (Luton North) (Lab)]

It was reported yesterday that 50,000 more patients suffering from alcohol problems had been admitted to A and E, bringing the national annual total to a staggering 1.2 million. Again, according to experts, cheap alcohol is to blame. Will the Leader of the House press his Government colleagues to bring forward comprehensive measures to deal with Britain’s growing and serious alcohol problems, including a minimum price for alcohol?

[Mr Lansley]

The hon. Gentleman will no doubt be aware of the alcohol strategy that the Government published several months ago. In itself, that reflected a comprehensive strategy to address the severity of the problem he describes. In that context, data were published only last week on alcohol-related admissions to hospital showing that the previous rates of increase in those hospital admissions under the last Government were considerably greater than those under this Government last year.

[Bob Stewart (Beckenham) (Con)]

I was in the House a lot yesterday, and have been here a lot during the week, but I cannot recall any tribute being given to our armed forces for how they rescued the security of the Olympics. I may be wrong, but I would like to place on record everyone’s thanks to our armed forces. When watching the Olympics on my big television, I often noticed the red and white hackle of the Royal Regiment of Fusiliers. These soldiers were brought in quickly in an emergency to sort out a problem. I reiterate what colleagues and friends on both sides of the House have said: we need to debate what is happening to English regiments, which may well be needed quickly in the future. I would very much like to have a debate on the 2nd Battalion the Royal Regiment of Fusiliers and on my own old regiment, the 2nd Battalion the Mercian Regiment, called the Staffordshire Regiment.

[Mr Lansley]

I am grateful to my hon. Friend. I will not reiterate my earlier points, as the importance of his points is recognised, as are the opportunities to debate the matter before the House rises for the pre-conference recess. I entirely share his view about the fabulous job done at the Olympics by members of our armed services, as I noted from my experience of visiting the Olympic park on one occasion. It is not just that they provided security, but that they did so in such a friendly, welcoming and engaging way.

[Wayne David (Caerphilly) (Lab)]

Can we have a debate on multiple and double jobbing? I am thinking particularly of the large number of Conservative MPs who now have more than one job in government. For example, the hon. Member for Preseli Pembrokeshire (Stephen Crabb) is not only a Wales Office Minister, but a senior Government Whip. Leaving aside the convention that senior Whips do not normally speak in the Chamber, how do we know which job has his priority?

[Mr Lansley]

I am absolutely clear that there is no conflict between having a responsibility as part of the Government’s business management and having responsibilities on policy and administration. I understand that there is no conflict, because I have such a role: I have responsibilities to this House and I have responsibilities in government, and I see them as equally important.

[Several hon. Members]

rose—

[Robert Halfon (Harlow) (Con)]

Can we have a debate on intellectual insanity? The Labour-supporting Institute for Public Policy Research is now arguing that motorists are not suffering enough from high petrol taxes, and is calling for more taxes. Is that not surprising, given that high petrol taxes hit the poorest Britons twice as hard as the rich?

[Mr Lansley]

I am interested by what my hon. Friend has said. I seem to recall that, according to Einstein, one of the definitions of that kind of insanity was “to keep doing the same thing while expecting a different result”. I am afraid that that is what we see from the Labour party day by day.

[Chris Bryant (Rhondda) (Lab)]

I, too, pay tribute to the former Leader of the House. I think it is a bit of a shame that he has not been given a knighthood. I know that he is already a baronet, but I thought he could prove that at the age of 70 it was still possible to do “twice a knight”.

Let me now ask a question of real importance. Given that the Government have a massive hole in their programme for the autumn because we lost the House of Lords reform Bill, which was carried by a three-to-one majority, can the Leader of the House do something on behalf of all the Back Benchers in the House, and ensure that the days that would have been allocated to that Bill—10 days, perhaps—can be allocated to Back-Bench business, particularly private Members’ Bills, so that some of the good ideas on the Back Benches can inform the Government?

[Mr Lansley]

I must confess that I am slightly staggered that the hon. Gentleman now seeks to make a virtue of the fact that he and his party voted by a substantial majority for the principle of House of Lords reform, and then effectively sought to obstruct any progress. My definition of opposition is not obstruction. It may be his definition, but it is not mine.

[Henry Smith (Crawley) (Con)]

I warmly welcome my right hon. Friend to his position. Will he consider arranging a debate on over-zealous health and safety regulation? Apparently my local authority, Crawley borough council, has been told to remove all park benches that are under trees.

[Mr Lansley]

I hope my hon. Friend will not be surprised to learn that we in the Government have been working actively over the last two and a half years to ensure that common sense is at the heart of the way in which we apply health and safety regulations. It must be evidence-based, common-sense and proportionate. Measures have been taken, but I will certainly draw my hon. Friend’s comments to the attention of my colleagues in the Department for Business, Innovation and Skills so that they can continue the process.

[Helen Jones (Warrington North) (Lab)]

This week, in Westminster Hall, Members held a debate on the shambles that is Atos. When will the Secretary of State for Work and Pensions come to the House to make a statement on what is going on in that organisation? In my constituency I have seen a woman undergoing chemotherapy passed as fit for work, and a veteran who was classed as being more than 40% disabled for the purpose of industrial injuries benefit lose his disability living allowance following an Atos report which referred to him as a woman throughout. When are we going to get some answers in relation to what this organisation is inflicting on disabled people?

[Mr Lansley]

In terms of business, the hon. Lady is right. The House had an opportunity to debate Atos Healthcare, and I think that she may have received replies from the then Minister of State, my right hon. Friend the Member for Epsom and Ewell (Chris Grayling). I personally know that the work done as a consequence of the Harrington reviews, and what we announced in July about the recording of tribunal judges’ reasons for overturning decisions on appeal, will enable us continuously to improve the process.

[Mr John Baron (Basildon and Billericay) (Con)]

I welcome the Leader of the House to his new post. May I ask him to consider one further fact relating to the 2nd Battalion the Royal Regiment of Fusiliers? It is the only infantry battalion that is being axed for political rather than military reasons, in order to save the more poorly recruited Scottish battalions ahead of the referendum. In fact, no Scottish battalions are being axed. I am married to a Scot and I believe in the Union, but discriminating against the English is not the way for us to achieve our goal.

[Mr Lansley]

My hon. Friend had an opportunity to raise that with the Prime Minister at Prime Minister’s Question Time, and I hope that he will take the opportunity that the Prime Minister gave him to make his points at a meeting. However, I do not recognise his description of the way in which decisions were made. They were made on the basis of an assessment of how the armed services could be sustainable for the future, and could secure representation and maintain recruitment throughout the United Kingdom.

[John Healey (Wentworth and Dearne) (Lab)]

It is good to see that the Leader of the House is still in the Cabinet, and especially good to know that he will not be steering any legislation through the House in his new position. He will know that the number of university applications from young people in Britain has dropped by nearly 10% for this year, as a direct result of the disastrous decision to raise tuition fees to £9,000. Why will the Government not find time for a debate on the subject—in Government time—rather than leaving it to the Opposition?

[Mr Lansley]

When the Opposition have wished to present an issue for debate and have chosen the issue of tuition fees, I have announced it as a consequence.

I am grateful to the right hon. Gentleman for his reference to legislation. I wonder whether he meant by it the piece of legislation which, shortly after its introduction, he described as “consistent, coherent and comprehensive”.

[Sir Tony Baldry (Banbury) (Con)]

It is clear from what the Prime Minister said yesterday at Prime Minister’s Question Time, and will be clear from the statement that we shall hear shortly, that a considerable number of initiatives are being taken throughout Whitehall to promote growth and jobs. Indeed, it is sometimes quite difficult to keep up with what is being done. Could the Leader of the House arrange for a quarterly statement to be deposited in the Vote Office, in which every Whitehall Department reports to the House on the initiatives that it is taking to promote growth and the progress of those initiatives?

[Mr Lansley]

I will of course reflect on my hon. Friend’s suggestion. However, although he says that it is difficult to keep up, the connection between the things that are being done is often very straightforward. For example, our announcement in July of funding for lending that would allow increased access to mortgages at more affordable rates will be followed up by my right hon. Friend the Secretary of State for Communities and Local Government in his statement shortly. While we wish to create more demand for new housing, we also wish to ensure that some sites that have not been developed can be developed in future.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

For the second time in 12 months, the Department for Work and Pensions is planning to close the Old Swan jobcentre. Unemployment in the Old Swan ward has risen by 3% in the last month. Will the Leader of the House find time for the employment Minister to make a statement to the House explaining why he is making it more difficult for my constituents to find jobs?

[Mr Lansley]

The hon. Lady will have an opportunity to raise that issue during questions to the Secretary of State for Work and Pensions next Monday.

[Mr Graham Stuart (Beverley and Holderness) (Con)]

I, too, welcome the new Leader of the House, who I am sure will do an excellent job. May I take him back to his old brief for a moment, and ask for a debate about the gross distortions in health care funding that we inherited from the last Government? For instance, in Dorset, which I believe has the largest elderly population in the country, £4,000 is being spent on each cancer patient, while in Tower Hamlets, which contains very few elderly people, the figure is £13,000. We have a grossly distorted inheritance from Labour. In the name of deprivation, Labour distorted health funding and cheated people of the health care that they deserve.

[Mr Lansley]

A consultation is taking place on the mandate of the NHS Commissioning Board. It will deal with, among other topics, the board’s responsibility to allocate NHS resources on the basis of equal access for equal need. If my hon. Friend wishes to make his points again, the board will be able to take them into account when it receives recommendations from the Advisory Committee on Resource Allocation.

[Alison Seabeck (Plymouth, Moor View) (Lab)]

I welcome the members of the new team. They will be as surprised as I was to hear what happened to a constituent of mine, a victim of domestic violence. Her screams and the breaking of a window from the inside attracted the attention of the police, but it is she who is now subject to antisocial behaviour powers. Will the Leader of the House please ask the new Home Office team to come to the House and engage in a debate about the way in which domestic violence victims are supported—or not—by police forces around the country?

[Mr Lansley]

I am surprised, and like the hon. Lady, I am obviously disappointed. I will of course ask whether my colleagues in the Home Office can respond to her on the issue.

[Rehman Chishti (Gillingham and Rainham) (Con)]

When I spoke recently to Bishop Michael Nazir-Ali, I was informed that there was persecution of Christian and minority communities in 130 out of 190 countries. May we have an urgent debate on tackling this growing problem?

--- Later in debate ---

[Mr Lansley]

My hon. Friend makes an important point. This matter has exercised Foreign Office Ministers. They have made substantial representations in a number of countries about such situations. I will gladly raise the matter with Foreign Office Ministers and ask them to respond to him.

[Diana Johnson (Kingston upon Hull North) (Lab)]

I welcome the new Leader of the House to his post. Will he explain why only sacked male Ministers received honours, while none of the women who were sacked received honours, despite their having been more senior Ministers?

[Mr Lansley]

Matters relating to honours are matters for the Prime Minister.

[Steve Brine (Winchester) (Con)]

I welcome the new Leader of the House to his post. I know he will do well for the House, as he did day in, day out for the health service in the last two-and-a-half years in government.

My right hon. Friend was present for the end of Department for Business, Innovation and Skills questions, and he will have heard the representations made about the Post Office. May we have a statement from the new Minister with responsibility for the Post Office about the Driver and Vehicle Licensing Agency contract? The Government say they support post offices and making them viable front-office businesses. We need to put our money where our mouth is, so we are not at the mercy of a Europe-wide tendering process. Kings Worthy post office and its customers have made many representations to me over the summer, and this decision could very well close the business.

[Mr Lansley]

I did, indeed, hear the answer rightly given by the new Department for Business, Innovation and Skills Minister. I should put this matter in context. The post office local model is an excellent model, and we are seeing substantial take-up, which is in many instances reviving post office services. The Government are absolutely clear that we will not entertain a process of post office closures, which is what happened under the last Government. On the specific point, this contract process is currently live and it would not be proper for Ministers to comment or interfere during the course of that.

[Kevin Brennan (Cardiff West) (Lab)]

I welcome the new Leader of the House and his deputy to their posts, and as the right hon. Member for East Yorkshire (Mr Knight) is on the Treasury Bench, may I also congratulate him on his appointment to his new post of Vice-Chamberlain of Her Majesty’s Household, prompting the headline “MP4 drummer joins Queen”? May we have the debate on the honours system that has just been suggested, because is not giving honours to losers in a reshuffle to console them an example of the “all shall have prizes” culture that the Prime Minister claims to denigrate?

[Mr Lansley]

I will give the hon. Gentleman the prize of best joke of the day, if I may. I merely reiterate the point I made earlier: in this House, people give public service. It is not simply a job; it is much more than that. People do far beyond what I think people in most jobs would expect to do. They give of themselves and their time, and their families and their lives, especially when they are in government, as many Opposition Members will know from their past experiences. Being in government is an onerous and demanding task. For example, my parliamentary neighbour, my right hon. Friend the Member for South East Cambridgeshire (Mr Paice), has had Front-Bench responsibilities for over 22 years. That is a dramatic contribution to public service, and I think it is right that it is properly recognised.

[Andrew Stephenson (Pendle) (Con)]

Has the Leader of the House had time to see early-day motion 337, standing in my name, welcoming the success of Pendle borough council in promoting tourism over the summer?

[That this House welcomes the success of Pendle Borough Council in promoting tourism; notes that 2012 is the 400th anniversary of the Pendle Witch trials and the 100th anniversary of the sinking of the Titanic, whose Bandmaster Wallace Hartley came from Pendle; commends the opening of the Titanic in Lancashire Museum to remember the many Lancastrians caught up in the tragedy; further notes that over the summer events will include the Trawden Agricultural Show and Barrowford Show, the Trawden Garden Festival, the Pendle Cycle Festival, including the Colne Grand Prix Cycle Race, the Pendle Pedal and the Tour of Pendle; further notes that the highlight of the summer for music lovers has to be the Great British Rhythm and Blues Festival in Colne, spanning four days and featuring some of the greatest names in blues, and that the event was named the Best British Blues Festival in the British Blues Awards 2011; further notes that September brings the annual Pendle Walking Festival, which is now the largest in the UK; believes that promoting tourism is vital for economic development across the north of England; and encourages hon. Members to visit Pendle during 2012.]

I hope that my right hon. Friend agrees that the tourism sector is vital in the north of England. May we therefore have a debate on this vital sector of the economy?

[Mr Lansley]

I will perhaps now become more familiar with early-day motions than I have been in the recent past. I will certainly pay attention to the one that my hon. Friend mentions, and he might like to reiterate his important point about tourism at the soon-forthcoming Department for Culture, Media and Sport questions.

[Nick Smith (Blaenau Gwent) (Lab)]

The “rockets and feathers” strategies employed by oil companies are crucifying motorists in Blaenau Gwent, so I welcome the Office of Fair Trading plans to investigate petrol pricing. May we have a debate on how to help our road hauliers and logistics industries to get our economy moving again?

[Mr Lansley]

I, too, take an interest in this issue, and welcome the OFT call for evidence. I note that the Backbench Business Committee has selected the oil market as a subject for debate, and it would probably be entirely in order for the issues the hon. Gentleman has just raised to be discussed in the course of that debate.

[Andrew Bridgen (North West Leicestershire) (Con)]

May we urgently have a debate about the effectiveness of the Government’s bursary scheme for 16 to 19-year-olds? The latest figures show that the proportion of 16-year-olds classed as NEETs—not in education, employment or training—has fallen year-on-year in the second quarter of 2012. Given that this is the first cohort to be affected by the transition from education maintenance allowance to the bursary scheme, does this not show that, despite the hysterical reaction of the Opposition, the scrapping of EMA has not had a negative impact on the number of NEETs, and that the money is now being better spent and better targeted?

[Mr Lansley]

My hon. Friend makes important points. The coalition Government have put £180 million into the 16-to-19 bursary fund this year, to enable the most financially disadvantaged young people to participate in education. The most vulnerable young people receive, as a standard amount, £1,200 more than they would have received under EMA.

[John Cryer (Leyton and Wanstead) (Lab)]

May I welcome the dear Leader to his new Front-Bench post? I suspect he will be a very effective Leader of the House—probably more effective than the Prime Minister would strictly want. Is there any sign of a Bill to create a register of lobbyists, which we have been promised for over two years? The Prime Minister said this would be the next big scandal in British politics and he has been proved right. When will a Bill be on the statute book?

[Mr Lansley]

I am grateful to the hon. Gentleman. I never expected to be called “Leader”; to be called “dear Leader” was beyond my expectations.

At yesterday’s Cabinet Office questions, the Minister of State, Cabinet Office, my right hon. Friend the Member for West Dorset (Mr Letwin), explained the current situation and noted that there have been many responses to the consultation on this matter. They are being seriously considered and he will make a statement in due course.

[Alun Cairns (Vale of Glamorgan) (Con)]

I congratulate the Leader of the House on his appointment. From his previous post, he will be acutely aware of the different approaches to cancer care across the UK. Sadly, my constituents in Wales have less money spent on drugs, longer waiting times and higher mortality rates than those in other parts of the UK. May we have a debate on cancer treatment and the merits of the various approaches, so we can at least show that Wales is getting a worse deal on cancer drugs?

[Mr Lansley]

I understand, and greatly sympathise with, my hon. Friend’s point, and I will ask my colleagues at the Department of Health to respond to him. The coalition Government should be especially proud of tackling directly the issue of access to new cancer medicines. As a consequence of the Cancer Drugs Fund, more than 12,500 people with cancer have received access to the latest medicines over the last two-and-a-half years who would not have done so under the arrangements the last Government left us.