British Children: Syria

Debate between Alistair Burt and Andrew Murrison

Tuesday 22nd October 2019 Commons Chamber

[Dr Murrison]

I thank the right hon. Lady, who has taken a very long-term interest in this. I would diverge from the pretext of her question, which is that we have not been doing anything; I can tell her, though I am not going to be drawn on the detail, that actually we have, over the past four days. The ceasefire finishes tonight. I hope that it endures, in which case things become a lot more permissive—a lot easier. We hope that that will be the case. I am sorry to disappoint her, but I am not going to be drawn on precise numbers. I do not recognise the figure that was given earlier on. I do respect the authority that has produced it, but I cannot confirm a number anywhere in that region. I also, I am afraid, do not want to be drawn in this forum on the three precise cases that she referred to. She will understand that we are actively trying to do what we can for them, and I do not want to say something at the Dispatch Box that might prejudice what we do in-country. However, I am perfectly happy to have a conversation with her in private.

[Alistair Burt (North East Bedfordshire) (Ind)]

I thank my right hon. Friend the Member for Haltemprice and Howden (Mr Davis) for this urgent question. I very much sympathise with my right hon. Friend the Minister in dealing with it, because he, with the Foreign Secretary, has a responsibility in this House to work out the practicalities of the respective duties of care of those he would send to rescue those who are trapped in this situation abroad with their needs and everything else. However, sometimes the sheer practicality of difficulties can mask a failure in government to make the decisions they need to make. This is particularly about the mothers of the children. It has seemed to me over a period of time that we have to recognise an international responsibility to take back even those who have been indoctrinated and radicalised in order to protect the children, and that we should have the resources to be able to deal with them, as well as to protect the children, who are the only innocents, by and large, in this situation. Can he reassure me that there is in government now a clear decision being made with the Home Office to bring people back, as they should be cared for here?

[Dr Murrison]

I am grateful to my right hon. Friend. He will know that we are currently trying to better understand the situation in al-Hawl, in particular, to try to identify those who have British nationality, their position and their wishes, and, in particular, trying to enumerate those who might be considered to be vulnerable in this piece. As I said earlier, we are approaching this on a case-by-case basis. That is genuinely the case. It is not easy, because our access is obviously imperfect. I hope very much that the ceasefire holds, and then we will be able to do more than we had perhaps been able to do up to this point.

US Troop Withdrawal from Northern Syria

Debate between Alistair Burt and Andrew Murrison

Tuesday 8th October 2019 Commons Chamber

[Dr Murrison]

I do not think we are into article 5 territory. We continue to support the SDF and the coalition. The principal intent here is the fight against Daesh, which is a clear and present danger that threatens us all. We will do everything in our power to ensure that fight continues and is unaffected by this latest news. It is important that we keep our eye on the ball in that respect. As the hon. Gentleman may be aware, there is a lot of ongoing work against Daesh along the Euphrates valley, and it is important that that work continues. This latest news risks destabilising that work.

[Alistair Burt (North East Bedfordshire) (Ind)]

I am grateful to my right hon. Friend the Member for Bournemouth East (Mr Ellwood) for raising this question.

Security depends on stability and consistency, and the decision taken by President Trump does not help that. It is a reminder, if any is needed, of the dangers of the United Kingdom pivoting too close to United States foreign policy at a time of inconsistency, rather than staying close to our European allies.

May I ask for further reassurance on the global coalition against Daesh? The communications cell, which does the vital work of dealing with the ideology, is based in the United Kingdom. Anything that might give Daesh supporters a sense that the United States is weakening in its commitment against Daesh could be used against the coalition and will materially affect those who are carrying on the vital communications work here. Can the Minister assure me that the United States realises that that coalition work is essential and that it will remain committed to it, no matter what its decision in this case may be?

[Dr Murrison]

My right hon. Friend’s point is well made. I cannot give him that assurance because I am not the US, but I am sure his point will have been heard by our interlocutors. He refers to our allies in the coalition and elsewhere, and he will be aware that we are working very closely with our E3 partners—probably more closely than we have for some considerable time. Some might think that is something of a paradox, given our imminent departure from the European Union, but it remains true nevertheless. Particularly in the region for which I have geographic responsibility, I have been struck by our close working relationship with France and Germany.

Nazanin Zaghari-Ratcliffe

Debate between Alistair Burt and Andrew Murrison

Monday 7th October 2019 Commons Chamber

[Dr Murrison]

I thank the right hon. Lady for her remarks. She dismisses warm words; I have to say that these are more than words. Words are important and it is correct that we get our language right in these matters. She refers to tact, dedication and diplomacy; we just had a question from my right hon. Friend the Member for South West Surrey (Mr Hunt), and I have to say that the tact, dedication and diplomacy that he applied to this issue were exemplary. I very much hope that we all approach this matter in the same spirit.

The right hon. Lady is right to say that we appeal to Iran’s decency in this matter. That is where this issue rests and it is absolutely right that we should appeal to Iran in that way. I still hope that Nazanin will be released, because Iran is, as I said in my earlier remarks, fundamentally a decent, civilised nation. I want the Iranians to find that within themselves in order to do the right thing in this particular case.

In respect of the International Military Services debt, the right hon. Lady will know that the matter is before the courts. However, the Ministry of Foreign Affairs in Tehran has itself specifically decoupled the repayment of debt from Iran’s detention of dual nationals. It is not the UK Government who have done that; it is the Ministry of Foreign Affairs in Tehran itself. The right hon. Lady seeks to join the two; Tehran says no, and that the two are separate. Given that Iran has said no, even if we were minded to do so it would be very difficult for us to proceed on the basis of, as she puts it, quid pro quo.

[Alistair Burt (North East Bedfordshire) (Ind)]

I commend my right hon. Friend on the way in which he is handling this distressing issue, and I again commend the hon. Member for Hampstead and Kilburn (Tulip Siddiq) on the way in which she raises it. The House is united in expressing concern and distress about the circumstances concerning Nazanin Zaghari-Ratcliffe, as it has done before.

I have two questions for my right hon. Friend. First, is it not the case that even if Ms Zaghari-Ratcliffe is treated as an Iranian citizen, she has now served enough time to be eligible for parole, and it is therefore open to the Iranian authorities, without making any concession in relation to the charges against her, to release her? Secondly, although there are no formal linkages related to her case, Iran covers a wide front in terms of its concerns about issues around it and the negotiations it takes part in, so will he simply confirm that the United Kingdom keeps an open mind in engaging in all those discussions, which will help to reduce tensions in the region? A reduction in tension may make it easier for other matters to be considered.

[Dr Murrison]

My right hon. Friend is absolutely right. Of course, he had this file, as it were, as my predecessor, and I pay tribute to him for the time that he spent on this issue. Again, when I arrived in the Department in May, I was struck by how much the ministerial team had put into this matter. I pay tribute to my right hon. Friend. The family need to know that the Government are behind them in doing everything that they possibly can to secure Nazanin’s release. I say that with my hand on my heart.

My right hon. Friend is of course right. Tehran will always say that this is a matter for its judiciary, but the longer this goes on, the more scope it has to be merciful, to do the right thing and to release Nazanin.

My right hon. Friend is right to comment on the general atmospherics. Although I have made it clear that the MFA in Tehran has decoupled the payment of any debt from the release of Nazanin and dual nationals in general, nevertheless we want to reach a position where the atmospherics are greatly improved. Clearly, those atmospherics are broad and wide right now, with recent events in the Gulf and further afield. I hope that we can move this on, and that we can, for example, re-engage Iran with the joint comprehensive plan of action, and give it something of what it needs and, bluntly, the respect that it feels—rightly in my view—is its due. In those circumstances, I think that things become easier—let me put it in those terms. To link things directly with events and actions and with the release of dual nationals will continue to be resisted by the regime in Tehran for the reasons that I have outlined.

Universal Health Coverage

Debate between Alistair Burt and Andrew Murrison

Wednesday 10th July 2019 Westminster Hall

[The Minister of State, Department for International Development (Dr Andrew Murrison)]

I congratulate all involved today on an excellent debate. It is timely because on 23 September we will be discussing universal health coverage at the high-level meeting in New York.

I am pleased to have heard almost universal praise from across the House for the advance declaration that the UK has made in relation to the Global Fund. I am proud of that, and I hope everybody here is proud of it too. Not only is it a significant sum of money and an uplift to what we were spending before, but when taken with the other Global Funds, it propels us to the top of the league table of international development, particularly relating to healthcare.

It is more important still because it is advance notification. The whole point is to encourage others to pledge and commit—the two are slightly different—generous funds aimed at dealing with the healthcare issues we all struggle with, because we are all in this together, particularly in relation to infectious disease. That point has been made by a number of right hon. and hon. Members, because infectious diseases respect no borders.

Having started on a positive note, may I introduce an element of gloom? Strategic development goal 3 and the 17 development goals related to it are not on track to be successfully rolled out. Universal health coverage is an aspiration, but it is not secure; the glass is indeed half empty.

I congratulate my right hon. Friend the Member for North East Bedfordshire (Alistair Burt). It is ironic that I am here potentially answering for decisions that he made in Government.

[Alistair Burt]

All good ones.

[Dr Murrison]

I was about to say that I am really comfortable to do so, because the decisions he made, and those he is associated with vicariously, are good ones. I am happy to have inherited his portfolio, but he is a difficult act to follow, that is for sure.

My right hon. Friend identified all the issues in his contribution, as I would expect him to do. He started by highlighting universal health coverage and its contribution to SDG 3, but he also made the point that universal health coverage touches on the other SDGs as well. In advance of the high-level meeting on 23 September, he was right to ask about the aims and ambitions the UK Government have for that meeting. They are encapsulated in getting more money—obviously—and getting better quality and integrated healthcare. That is something many of the contributions have touched on one way or another. I have been struck by the level of support for an holistic approach to delivering universal healthcare.

We have talked about immunisation and about the mistake we would be making if we simply imagined that going around the world offering people vaccinations and inoculations would be “job done”. It really would not be. Those interventions would be treated with a great deal of suspicion by communities, as they are at the moment, if that were all we were offering. It has to be much more than that; it truly has to be integrated. I look forward to making this point loud and clear in September in New York.

On a broader theme, as I have gone around the world, I have been struck by the roll-out of healthcare systems. Very often, there is a temptation for politicians to roll out shiny things that they can demonstrate to their constituents. That generally means hospitals, and hospitals are great things, but they may not be the right thing in low and middle-income countries.

Gulf of Oman Oil Tanker Attacks

Debate between Alistair Burt and Andrew Murrison

Monday 17th June 2019 Commons Chamber

[Dr Murrison]

I am grateful to the hon. Gentleman for his question. In terms of what we are doing, talking is important, because if we do not talk, there is a risk of misunderstanding and miscalculation, and nowhere is that more likely than in our dealings with Iran, with whom, I think it is true to say, we have not always enjoyed cordial relations. I would not want to downplay that at all. The fact that I hope to go to Tehran very soon is perhaps, I hope, evidence of our desire to make sure that we maintain a dialogue on these matters with Tehran.

The hon. Gentleman tried to press me on intelligence matters. I am not going to be drawn on that. I think he must understand from what I have said that we are quite clear where the blame for this lies. He calls for an independent investigation. I hope that I made it clear in response to an earlier question that this matter must primarily rest with the ship owners, since the vessels are currently in international waters—or they were. They are now on their way to the United Arab Emirates.

On the earlier attack on the 12th of last month, that is, of course, since it happened within UAE territorial waters, a matter for the UAE. We are assisting, in a small way, in that investigation. I have to say again that our assessment is that the authority that is highly likely to have been involved in causing that earlier incident is the same one that we firmly believe is responsible for the latest outrage.

[Alistair Burt (North East Bedfordshire) (Con)]

I thank the hon. Member for East Dunbartonshire (Jo Swinson) for this urgent question and my right hon. Friend the Minister for his response—a measured response that is helpful to the House. He made clear his determination to calm this situation down. It is a complex and very long-standing situation that has very recently increased quite markedly in vehemence.

Will my right hon. Friend continue to emphasise to all parties the risks and dangers of actions such as those at the weekend, and of words that raise the temperature and increase the risk of an armed confrontation by accident or design? Will he say a little about where we are in terms of the improved financial facility as part of our obligations to the JCPOA, which remains unfinished business? Above all, will we make it very clear to all parties in the region that a further war would be a disaster that could not be confined to its boundaries, that the consequences would be long-lasting and incredibly onerous, and that all states owe an obligation to their peoples to desist from such actions and do everything they can to prevent such a risk of war in the region again?

[Dr Murrison]

My right hon. Friend and predecessor knows a great deal about this region. I pay tribute to him because I think this is the first opportunity I have had to do so. I congratulate him on his extraordinary service.

In relation to the cost of what might perhaps happen, my right hon. Friend is absolutely right. About a fifth of the world’s oil passes through the strait of Hormuz. While there are mitigating things that can be done in the event that the straits were closed off again, the impact would be significant. As he knows, a great deal of Europe’s liquefied natural gas comes from the Gulf. Inevitably, after a fairly short space of time, there would be severe economic penalties. Above all, of course, we are concerned about the human cost of another conflict, which has, sadly, been seen too much in this region over the past few years. That is why the most important thing to do is to turn down the heat. He refers very kindly to my measured and well-chosen words. It is important for all concerned to prevail on those who are principals in this matter to engage in talk rather than the alternative, which would be massively expensive for all concerned.

Ukraine-Russia Relations

Debate between Alistair Burt and Andrew Murrison

Tuesday 27th November 2018 Commons Chamber

[Dr Andrew Murrison (South West Wiltshire) (Con)]

In 2015, following a great deal of international pressure, France cancelled two Mistral-class amphibious assault ships that were destined for Russia because of the situation in Ukraine. What more will be done at the European Union Political and Security Committee, to which the Minister referred, to impress on our European partners in particular that it is wholly unacceptable at this time to be engaging with the Russian Federation on arms sales?

[Alistair Burt]

I am grateful to my hon. Friend for his description of what happened. He emphasises how important it is for united and collective action to be taken on this issue. It is important that nations work together on this, and his comments about dealing with the sort of supply that was involved with Mistral are well taken. The United Kingdom will be pressing this point to the various committees that we are attending as we speak.

UK Victims of IRA Attacks: Gaddafi-supplied Semtex and Weapons

Debate between Alistair Burt and Andrew Murrison

Thursday 14th December 2017 Westminster Hall

[Alistair Burt]

Of course, in the particular case of the Lockerbie victims, the UK Government intervened directly to secure compensation. However, as we have discussed, individual compensation is being pursued through private claims, and we have sought to facilitate that work through our contacts and everything we have done in relation to that. We still believe that that is the most appropriate thing to do, and that is why we deal directly with the Libyan authorities. We have approached individual compensation differently. The allocation of the compensation fund illustrates the difficulty of individual compensation, but of course if such claims are successful, that deals with that issue. However, as successive Governments have done, we have supported the individual pursuit of claims rather than doing on it on a Government basis. That is different from those who have chosen to do it another way—that is quite right. That is the process we have chosen, and that is the process we are continuing to support.

[Dr Murrison]

I am following what the Minister has to say closely. He is making a convincing argument, but the central fact remains that our closest allies—the US, France and Germany—have secured substantial reparations from the country responsible for those acts. The legal entity, notwithstanding the Minister’s remarks about Gaddafi, is Libya. We have failed to do that, and it is about time that our victims got a better deal. I am sure the Minister agrees with that. The only debate is about how we are going to achieve it. How we dish the money out is a second-order issue. It is important that we get the money in the first place.

[Alistair Burt]

My hon. Friend is absolutely right. We are continuing to pursue that process by working with the existing Libyan Government and the future Libyan Government to secure that support. That is why a meeting with the Libyan Minister for Justice has been suggested. That is why the Foreign Secretary and the Prime Minister raised this issue, and why I shall raise it.

Hon. Members and victims have understandably asked us to demonstrate even more effort to secure compensation than we have already put in. The ultimate aim is to ensure the Libyan Government is able to respond to the understandable request for compensation for the victims of Gaddafi. That is the position we want to reach. The UK Government, like all of us, are determined to make sure that happens. That is the process we are pursuing.

There are a couple of other things to say. I want to deal with the issue of frozen assets and sanctions. There is no lawful basis on which the UK could seize or change the ownership of any Libyan assets. The UN Security Council resolution under which those assets were frozen, which the UK supported, is clear that they should eventually be returned for the benefit of the Libyan people. To breach that resolution would be a violation of international law. We set that out in our response to the Committee, and that position has not changed.

A veto is an individual response that the United Kingdom could produce, but it would then be used to stop the return of assets. As the Government rightly said, we get no sense from other states that they would support that. Of course, they do not have to do anything—it is our veto—but they would not necessarily understand our vetoing a policy that is designed to return moneys to those who would then be in a position to compensate the United Kingdom and the victims the United Kingdom is pursuing that for. To apply a veto may not be the most appropriate thing. The point that the hon. Member for Poplar and Limehouse and others made is that it is a form of pressure on Libya, which must be correct. We must find other ways of putting pressure on the Libyans so that when they are in a position to respond, they understand that they need to make that response. Our contact with the Libyan Government makes it clear to us that they understand that need, but the money is not there at the moment because it is just not there. We must continue to pursue that.

On the sanctions, when the European sanctions rules are changed, we will have to see whether that provides an extra opportunity. I was interested by what the hon. Member for Bishop Auckland said, and that will form part of a further discussion in the future. I noted what she said about pensions. As far as I am aware, that is something new, but we may come back to it in due course.

That is what we are doing in the immediate future, and as far as the future is concerned we will pursue a twin-track approach. We will continue to help victims engage directly with the Libyan Government, as appropriate, to help them pursue their campaign. That is the policy we have followed. As I said, I have previously informed victims that we are exploring the possibility of a meeting for them with the Libyan Minister of Justice. Our embassy in Tripoli has raised this with the Minister several times, and he has agreed in principle to the proposal. I recently wrote to him to welcome that, and to stress our desire to press ahead with arrangements. Such a meeting would demonstrate the Libyan Government’s genuine desire to address the legacy of the Gaddafi regime. In addition, we will explore with the Libyan authorities the possibility of establishing a communal fund for victims, although I should be honest with hon. Members that the current political and economic crisis in Libya means that progress on that is likely to be slow, as the hon. Member for Bishop Auckland said.

There are complex questions at stake with regard to compensation, such as which groups of victims would be eligible, and what type of compensation and support would be right. We discussed that during the course of the debate. Discussions about what a fund would look like are still at an early stage, but we anticipate that it would focus on community support, rehabilitation and reconciliation, and as I said earlier would be accessible to all victims throughout the United Kingdom. I welcome the recent engagement of Democratic Unionist party colleagues on this issue, and I look forward to further constructive discussions in the future. We recognise victims’ frustration at the slow rate of progress. I fully appreciate that although that is an easy sentence for a Minister to say, it cannot in any way cover the pain and suffering that people have been through, but the political, economic and security realities in Libya are making progress on the issue extremely difficult.

The Prime Minister, the Foreign Secretary and I have all made clear the Government’s support for change in Libya and for the UN process being led by Ghassan Salamé. We are actively engaged in that because the sooner the process can be successful and the sooner Libya has stabilisation and a new Government, the easier it will be to press such matters still further.

I repeat the Government’s sincere commitment to help the victims of Gaddafi-sponsored IRA terrorism make progress. I express my gratitude for the positive way in which colleagues from across the House have engaged with the Government on this issue and my sincere desire for that to continue. I recognise that the slow process is deeply frustrating to all those who represent the victims, as well as to those victims themselves, many of whom have campaigned tirelessly for many years to achieve justice. Today’s debate and the determination of my hon. Friend the Member for South West Wiltshire and other hon. Members in the Chamber make an impression. Clearly, this is an issue on which the Government are committed, but the determination and the desire of the House is plainly that we have to do more, to be seen to do more and to explore further ways in which we can redress the balance.

I am grateful as always for the kindness with which colleagues treat me, and hope that I can play my part in resolving the issue. I take that to heart.

Mental Health Taskforce

Debate between Alistair Burt and Andrew Murrison

Tuesday 23rd February 2016 Commons Chamber

[Alistair Burt]

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

[Dr Andrew Murrison (South West Wiltshire) (Con)]

It is a very sad fact that in healthcare those professionals who add the most to the service do not necessarily receive the same acclamation as those working in more glamorous specialties. What does the Minister think can be done to improve the status of those working in mental healthcare and thus mental healthcare as an attractive career option?

[Alistair Burt]

That is a good question. It is very important that true value is given to those who work in such an area, at all levels. When we have seen examples of poor-quality care and the tragedies that have occurred, we realise the value placed on those who display kindness as well as skill and demonstrate their qualifications. We need to talk about the quality of good care. We need to make sure that people who go into these professions have a career path, whatever their entry level. We want to encourage greater psychiatric awareness in medical training and clinical medical training for those who are leaving medical schools. Again, I know that Simon Wessely of the royal college has done much work in this area. We should emphasise that those who care for those in the most distressed situations, be they in hospital, community or specialist services, deserve our thanks, encouragement and proper training. Increased money for training is included in the package that the Government will be working on, and it will be a vital part of that.

NHS and Social Care Commission

Debate between Alistair Burt and Andrew Murrison

Thursday 28th January 2016 Commons Chamber

[Alistair Burt]

Well, the platform was clearly stunningly successful. I am not embarrassed by being reminded of the Labour party’s NHS platform at the last election, because it did not succeed. For one reason or another, the public did not believe the stories run about us and the NHS, and they did not believe in Labour’s competence to handle the NHS. As we know, the amount of private sector involvement in the NHS is extremely small, and I am not sure that I accept the hon. Lady’s description of how it has all turned out. This is an example of how careful we must all be in dealing with such issues. We must not pretend to our publics that we are something we are not and that our opponents are something that they are not.

My hon. Friend the Member for Stafford (Jeremy Lefroy)—he has great experience, given the work he has done with the NHS—spoke about best practice. He wanted the commission, but again added more pressure in the things it would be doing and considering. I would make the point that such a commission happens at a point in time. I know that it would be designed to look ahead, but it would inevitably consider the circumstances pertaining at the time. We need a process for discussing the NHS and its funding—where the money is coming from and how it is spent. We need to make the process work, rather than thinking that one push into the grass will do the job. Again, I am not sure that the weight will be borne in that way.

[Dr Murrison]

Earlier in his remarks my right hon. Friend talked about having a discussion within the confines of the Palace of Westminster. He appears to be moving in that direction again. Does he agree that there is a need for a more iterative process with the public at large? A commission of the sort that the right hon. Member for North Norfolk has proposed might go some way towards that.

[Alistair Burt]

I think that engagement with all involved is essential. When I am away from Westminster, engaging with patients, the public and staff is fundamental to the visits that I make to the services for which I have responsibility.

There is nothing to stop any of the work that the right hon. Member for North Norfolk is suggesting from starting. It is essential that everybody is fully involved. I do not think that the Government or the Opposition will make any of their decisions on the NHS or its expenditure by excluding anyone.

The hon. Member for Walsall South (Valerie Vaz), in a turbo-charged contribution, also spoke of the importance of getting integration right. She reminded us that Dick Crossman started it all off. I am sure that we have all had election manifestos that have spoken of an integrated transport system and integrating health and social care. Now we just have to make sure it happens. She made the point that no amount of talk or number of recommendations relieves someone of the burden of doing it. At the end of the day, it is doing it that counts. That is the role of the Government, while being appropriately challenged by all others.

I am delighted that my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) spoke of the importance of the workforce, particularly the workforce in social care, who have a very difficult time of it. They have great skills and need to be on a career pathway where they can acquire more. They also need to be valued. Again, my hon. Friend believed that the current mechanisms were better than others for dealing with these difficult problems.

To conclude, I will give my sense of the debate. I found it slightly hard to distinguish what the foundations of the debate were—whether it was about the quantum of funding or how the funding was gathered into the health budget in the first place. The commission is expected to cover a breadth of issues, but I am not certain that it can bear the weight. Decisions need to be made, no matter how the information comes forward.

We do not need a commission to deliver the process or to take the heat out of the debate. We have to be careful about how we speak about these subjects. By and large, what happens upstairs gives the public a good sense of how we deal with witnesses who come in from outside, members of the public and each other. We can do much more of that without the need for a commission. We must remember to handle things carefully.

I am not sure that structural change could be handled through a commission. That is very much a local decision. This is not all about funding; it is about how the funding is used. We have to ensure that we do not get into the trap of measuring everything by what we put in, rather than by output. One of the most telling points was when the right hon. Member for North Norfolk said that in the Commonwealth Fund analysis that gave the NHS such a good rating, the one thing it dropped down on was outcomes—treating people and whether people stayed alive. To most people, that is probably the most important outcome of all. We have to make sure that, for all the other good things that we are doing, such as the work the Secretary of State is doing on transparency and all the efforts we are making to give people more information, we recognise the importance of that.