European Union (Withdrawal) Bill

Debate between Heidi Alexander and Anna Soubry

Committee: 2nd sitting: House of Commons
Wednesday 15th November 2017 Commons Chamber

[Heidi Alexander]

I rise to speak to new clauses 22 and 23 in my name. I say at the outset that I will not take interventions because I know other Members wish to speak. I put on record my thanks to George Peretz QC for his help in drafting the new clauses.

New clause 22 would prevent Ministers from using provisions in this Bill as the basis for withdrawing the UK from the European economic area, whether under article 127 of the European economic area agreement or otherwise. It would also ensure that Ministers cannot use the regulation-making powers they seek to give themselves in other parts of the Bill to circumvent that carve-out. It would mean, in effect, that if Ministers wanted to take us out of the EEA, which is the grouping of EU and non-EU countries that together make up the single market, they would need to introduce a separate Bill to authorise that.

Why is this necessary? The UK is currently a member of both the EU and the EEA. Although the bodies overlap, they have different member countries, they are governed by different treaties and they have different guiding principles at their heart. There is one process for leaving the EU, as governed by article 50 of the Lisbon treaty, and another for leaving the EEA—article 127 of the EEA agreement requires a member to give 12 months’ written notice. Parliament should determine whether we trigger article 127 to notify our withdrawal from the EEA, and not the Prime Minister sat behind her desk in No. 10. MPs in this House, the public’s elected representatives, should decide, and there should be a specific, explicit vote that is binding on Ministers.

The Government’s contention that it is not necessary to trigger article 127, and that we do not need formally to leave the EEA as we are a member simply by virtue of our EU membership, does not stand up to scrutiny. All EU states are listed as contracting parties to the agreement, in addition to the EU itself and the three non-EU EEA states.

The Government have changed their argument on article 127 repeatedly over the past year. One minute they argue that our departure would be automatic, and the next that our membership would be unworkable. They assert legal opinion as irrefutable fact. They fail to acknowledge that a basic principle of international law is that a treaty relationship with another state cannot be changed simply by changing a different treaty to which that state is not party and assuming a knock-on effect. And the Government fail to acknowledge that, at a time when we would supposedly be wanting to sign international trade treaties with other countries in our own right, we might be in breach of the treaty that underpins the EEA. This all sounds very legalistic, but the issue has critical importance beyond the legal technicalities.

At its heart, new clause 22 is about democracy and our country’s future. In last year’s referendum there was only one question on the ballot paper:

“Should the United Kingdom remain a member of the European Union or leave the European Union?”

The words “European economic area” or “single market” did not feature. Had Parliament wanted people to take a view on the EEA, we could have legislated for that in 2015, but we did not. Some people say, “Everyone knew it meant we’d be leaving the single market,” but that is simply an interpretation of the result. Some people may have voted to leave it, but others did not. The Government are now rewriting history: they claim that coming out of the single market and customs union is an automatic consequence of the leave vote, not their political choice. If just one tenth of those who voted leave believed that we would stay in the single market, there never was a mandate for the sort of Brexit that the Government are now pursuing.

We spend hours in this place debating all the twists and turns of negotiations, parliamentary processes relating to withdrawal and so on, but we never seem to get to the crux of the issue. That is what new clause 22 would do: give us a parliamentary lever to shape Brexit. Parliament must determine whether we leave the single market. We must decide whether Ministers should notify other countries of our intention to leave the EEA. The process must not be reduced to some sort of back-door authorisation that can be cobbled together by adding up various bits of the Bill, but that is precisely what the Government are trying to do.

I believe that the repeal of the European Economic Area Act 1993 contained in part 2 of schedule 8 will be used by Ministers, alongside the powers they want to give themselves in clause 8, to claim parliamentary authorisation for setting the ball rolling on our departure from the EEA. They will claim that the by-product of Parliament’s voting, as part of the Bill, to remove domestic UK rights for the citizens and businesses of EEA countries such as Norway, is a parliamentary authorisation to notify other EU and EEA countries of our intention to leave.

[Anna Soubry (Broxtowe) (Con)]

I know that an overwhelming majority of the people who voted in the hon. Lady’s constituency voted to remain. Does she share my concern that many such people feel completely excluded from Brexit? Does she think that this sort of debate will absolutely help to bring people back together and, perhaps, to form a consensus on Brexit?

[Heidi Alexander]

I completely agree. My new clause may offer some form of compromise, which I shall set out in due course.

How many of our colleagues actually understand what the Bill will do? Why do the Government want to avoid open and transparent debate? Why is there not a specific clause in the Bill that makes it clear? The answer is obvious: the Government are doing everything they can to avoid an explicit vote on whether the UK should leave the EEA and the single market. They are worried that there might be a parliamentary majority for a so-called soft Brexit, in which we put jobs first and anxieties about immigration and so-called sovereignty second.

Oral Answers to Questions

Debate between Heidi Alexander and Anna Soubry

Tuesday 16th July 2013 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

12. What recent progress his Department has made on negotiations with acute providers on the capital and revenue costs of implementing the recommendations of the special administrator of the South London Healthcare NHS Trust.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

Decisions on funding for each individual hospital are being worked through as part of the implementation planning process, in collaboration with the Department, to ensure value for money for the taxpayer. Decisions need to ensure that capacity is available in the right place and that quality and safety are maintained.

[Heidi Alexander]

Is it true that King’s College hospital wants £109 million in capital funding alone to cover changes at the Denmark Hill site and at the Princess Royal hospital, given that in January the Secretary of State announced £73 million of additional investment for all the other hospitals in south-east London to deal with displaced patients from Lewisham? Will the Minister explain where the money is coming from? Will she also tell us whether all this will be centrally funded, or whether local commissioners will be asked to pick up the tab?

[Anna Soubry]

What I can say is that it will be centrally funded, but as to the other detail in the hon. Lady’s question, I will have to write to her with those answers. As ever, my door is open and I am more than happy to meet her to discuss it further.

A and E Waiting Times

Debate between Heidi Alexander and Anna Soubry

Tuesday 23rd April 2013 Westminster Hall

[Heidi Alexander (Lewisham East) (Lab)]

I congratulate my right hon. Friend the Member for Cynon Valley (Ann Clwyd) on securing this debate.

What struck me when listening to the contributions from all parties represented in Westminster Hall this morning is the consensus that exists about the fact that we need to hear from the Government their vision for accident and emergency services. I agree entirely with the comments of the hon. Member for Cheltenham (Martin Horwood) and my hon. Friend the Member for Stretford and Urmston (Kate Green) when they say that we need clarity about how that vision is developing.

There is a fundamental tension between the centralisation of specialisms in accident and emergency services, and the desire of local people to be treated close to home. In London, there are fantastic A and E facilities in some of our central London hospitals, such as Guys and St Thomas’s hospital over the river, and yet—as hon. Members know—we equally find that hospitals in some of the outer parts of London are, frankly, either being sold off or seeing their services hugely downgraded, such as the downgrading that we are experiencing at Lewisham hospital at the moment.

Before I make some specific remarks about the situation in south-east London and some of the things that I have learned and been thinking about since we have been dealing with the issue at Lewisham hospital, I will quickly pick up on one of the other remarks made by my hon. Friend the Member for Stretford and Urmston. She talked about the problems she had experienced in extracting clear and concise information from the Department of Health about waiting times in Manchester hospitals. I, too, have asked several questions recently, not about waiting times but about the provision of health services at hospitals in London. I have simply been told that the Department does not hold that sort of information and it has been recommended that I make freedom of information requests. That is all well and good, but the public want to be reassured that Ministers at the heart of Government understand what is happening in hospitals out there and that they have an appreciation of the wider picture so that they can develop their vision of hospital services, whether they are A and E services or maternity services, but I am not sure that we feel reassured when we get such parliamentary answers that that is the case.

I will make two specific points about Lewisham hospital. Hon. Members will know that, in January, the Secretary of State for Health announced that Lewisham hospital would have a smaller A and E department, and that it would lose its maternity services. That was as a result of the trust special administration process that took place in the South London Healthcare NHS Trust, which was in huge financial difficulties. The hospitals in Woolwich, Bromley and Sidcup had a very significant operating deficit, and as a result of that we were told that the hospital down the road in Lewisham would have its services decimated. The full A and E department at Lewisham hospital will close; all blue-light ambulances will go past Lewisham hospital to other hospitals; all medical emergencies will not be able to be treated at Lewisham hospital; and yet the Secretary of State still calls it a “smaller” A and E department.

We might think that, on the basis of taking capacity out of the system at Lewisham hospital and—I should say—having to invest £37 million in other hospitals to deal with the displacement of people from Lewisham’s A and E department, everything is operating smoothly and well in south-east London. That is not the case. One in 10 people is waiting longer than four hours at hospitals that used to be part of the South London Healthcare NHS Trust, and now in Lewisham, one in 10 people is waiting longer than four hours to be treated. That was not the case in Lewisham a year ago; in March 2012, 97% of people were being treated at Lewisham hospital within four hours. So there is huge pressure upon A and E departments in south-east London.

Yesterday, I asked Lewisham hospital for information about the number of times that ambulances had been diverted to it from other hospitals. Lewisham hospital told me that, since December 2012—in the last four months—there have been 25 separate occasions when ambulances have been diverted to Lewisham. On 10 of those occasions, ambulances were diverted from the Queen Elizabeth hospital in Woolwich, and on 11 other occasions ambulances were diverted from the Princess Royal university hospital in Bromley. Those are the very hospitals that are meant to be picking up the people who will no longer be able to go to Lewisham hospital when our full A and E department goes. I seek a guarantee from the Minister that no changes will be made at Lewisham hospital until these diverts from other hospitals have stopped, and that no changes will be made until we see that, at the other hospitals I have mentioned, they are dealing with patients within a four-hour window.

I should like to make two general points about some issues that have already been touched on. There is a fundamental problem with people’s understanding of where they should go for the best possible treatment. The Government have asked Sir Bruce Keogh to conduct a review of emergency care, which is much needed and timely. I would rather the Government waited for the outcome of that review before they took decisions about hospitals such as Lewisham.

At the moment, when people are ill, they have no idea where they should go. They are faced with a plethora of places. Should they go to their general practitioner, a walk-in centre, a minor injuries unit or an urgent care centre, or A and E? It is confusing for people. If there was better information about where people can get the most appropriate treatment, potentially people who do not need to be in A and E would not go there. I do not criticise people for going to A and E, because they know that they will get treatment there and will be dealt with—hopefully—quickly. We cannot expect them to understand all the intricacies of what is available elsewhere. That fundamental problem needs to be addressed.

The Government are making the situation worse in Lewisham, when they say that Lewisham will retain a smaller A and E. On the day that the Secretary of State made that announcement, I said to myself, “What is a smaller A and E? What will happen there?” I am not the only one who is concerned about this. On 21 February, the president of the College of Emergency Medicine, Mike Clancy, tweeted:

“We have raised questions about the lack of clarity”—

with regard to Lewisham hospital—

“and that what’s proposed doesn’t meet our definition of an”

emergency department. Even the CEM is saying that the Government are making this more confusing for people. The way that the whole process has been dealt with has been quite deceitful and potentially dangerous. Telling people that there is a smaller A and E when it will be nothing more than an urgent care centre has potentially serious implications.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I am sure that the hon. Lady is not suggesting the Secretary of State was in any way deceitful.

[Heidi Alexander]

I said that the whole process was deceitful and potentially dangerous. A legal challenge about Lewisham is under way. We have to await the outcome of that to see what the future holds for Lewisham. I stand by my remarks. The process was not really open from the outset.

My final point has already been mentioned. We need to work out exactly how we stop people going into A and E who do not need to be there. Yesterday, I was at my grandmother’s funeral. For a number of years, she had been very poorly and was a frequent attendee at her local hospital. Several times when she turned up there, she did not really need to be there. She was a poorly, lonely old lady. If we are to address the number of people who present at A and E when they do not need to be there, we must find proper ways of caring for people well and with dignity, especially towards the end of their lives, in the community. The problem at the moment is that we are trying to reduce the availability of A and Es in local areas when we do not have alternative care in place to stop people having to rely on A and E as the last resort.

I am grateful for the opportunity to speak in this debate. Again, I congratulate my right hon. Friend the Member for Cynon Valley on securing the debate. The availability of high-quality local health services matters to everyone. It will be interesting to hear what the Minister says about how she is going to address those important issues.

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[Anna Soubry]

I know, and I do not understand why that is. I will absolutely make further inquiries, because it is nonsense that the hon. Lady did not get the data.

I will come on to address the points made by the hon. Member for Lewisham East (Heidi Alexander), but, on the data, it is important that we monitor such things. That is precisely why the Department of Health and Health Ministers are very much alert to what is happening in A and E. We share the concerns of hon. Members, which is why we have the Keogh review, why we are considering how to solve the problem and why we are looking at the underlying causes, which, in the short time available, I hope to address. I will ensure not only that the Ministers to whom the hon. Member for Stretford and Urmston has spoken read Hansard, but that a copy of this debate goes to NHS England, which I know also shares those concerns. NHS England also wants to hear about the experiences of hon. Members, and it is taking action to ensure that we are on top of this and, most importantly, that we do what we should do.

[Heidi Alexander]

Will the Minister give a commitment today that no changes will be made to Lewisham’s A and E until there are no ambulances being diverted to Lewisham hospital, and waiting time targets are met in the neighbouring hospitals?

[Anna Soubry]

I took that intervention in good faith, hoping that I might be able to assist. The hon. Lady is more than experienced and knows that I cannot give her any such assurance. She, too, talked about the provision of data in her speech. All I know is that 75% of the people who would ordinarily have gone to A and E in Lewisham will continue to go there, but she makes important points, all of which will be put in the right place.

I conclude by addressing the cause. Well, we do not know. There are various factors, but, as has been said, there is no easy answer and no silver bullet. We know that a seasonal downturn in performance in not unusual, but the dip in performance this year is deeper and longer than in previous years. One million more people—perhaps this is not understood by some hon. Members—are using A and E departments every year, and it is important that we understand why that is. We know that there are nearly 4 million more A and E attendances compared with 2004, when the previous Government carried out what I and others believe was a disastrous renegotiation of the GP contract, which has had a clear knock-on effect on access to out-of-hours services.

Hospital Services (South London)

Debate between Heidi Alexander and Anna Soubry

Tuesday 22nd January 2013 Westminster Hall

[Heidi Alexander]

My right hon. Friend is right to highlight those issues. I would add that the close working between Lewisham hospital and Lewisham council on child protection has been recognised across the country, and I would not want that to be compromised in any way if the proposals go ahead.

I fear that other A and Es will end up hopelessly overstretched, resulting in worse care for my constituents and many other people in south London. I am also concerned that although clinical evidence exists for centralising some emergency care, such as that for those who are involved in bad traffic accidents or who have suffered a stroke, I have seen nothing showing that better outcomes can be achieved by centralising care for other medical emergencies.

When I was in my 20s, my brother got bacterial meningitis. When he arrived in hospital, after an initial incorrect diagnosis by a GP, the hospital doctors said he had got there just in time—a few more minutes and he might not have survived. He had to have a lumbar puncture taken, and it was only after getting the results that he could be treated. It was one of the worst days of my life seeing a grown man lying in a hospital bed. We were unable to do anything, and we did not know what the problem was. That is why I worry about how long it takes people to get to A and E.

Closing the A and E at Lewisham will mean longer journeys for people who need access to emergency care. It is said that, in a real emergency, people will be in an ambulance, and that may be so, but anyone who lives in south-east London and who has ever been stuck in a traffic jam on the south circular will know how hard it can be, even for ambulances, to get through.

I have spoken at length about the plans to shut the A and E at Lewisham, but may I also raise the impact of the proposed closure of the maternity department? The A and E and maternity departments at any hospital are intrinsically linked. Sometimes things go wrong in labour, even with supposedly low-risk births, and emergency support needs to be available there and then to sort out problems.

More than 4,000 babies are born each year at Lewisham. There has been an 11% increase in the number of births at the hospital over the past five years, and the birth rate is rising. Unlike other health services, maternity care cannot be rationed or restricted. Nationally, we are witnessing the highest birth rate for 40 years—it is particularly high in areas such as Lewisham—and the Government want to close a popular and much needed maternity department.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

Does the hon. Lady agree that the Government do not want anything at all at this stage, and that the Secretary of State has not made, and will not make, a decision until 1 February?

[Heidi Alexander]

I acknowledge that a decision has yet to be taken, and I take this opportunity to press the Minister to confirm that the decision will be taken on 1 February. If it will be taken before then, it would be useful to know. We are here to present the case for refusing the recommendation.

--- Later in debate ---

[Anna Soubry]

Will the hon. Gentleman wait one moment, because it is extremely important that I put this on record? The Secretary of State will consider whether to accept the recommendations of that report and will reach a decision by 1 February. As a result of that, bizarre as it may seem to those who do not know the House, I am in some sort of peculiar purdah where I am not allowed to give any opinion of my own. It might be that that is a good idea, I know not, but those are the rules and I stick by them. I am not in a place, as the hon. Member for Denton and Reddish (Andrew Gwynne) well knows, to be able to say whether or not the four tests have been satisfied or, as I have said, to give my opinion. Sometimes, it is extremely difficult for an MP such as myself not to give an opinion.

[Heidi Alexander]

rose—

--- Later in debate ---

[Anna Soubry]

That is a good point well made. I will ensure that the Secretary of State is fully aware of the hon. Gentleman’s views.

Why are we in this position? That was a question posed by the hon. Member for Lewisham East. Let us be absolutely clear about it. South London Healthcare NHS Trust has six PFI schemes. It is not as simple as putting all the blame on the PFI schemes, as some Members have suggested. The two largest schemes are at the Princess Royal university hospital in Bromley with a £30 million PFI scheme, and at Queen Elizabeth hospital in Woolwich with a PFI scheme of £29.1 million. The PFIs were signed off in 1998, but they certainly do not help the situation.

The trust is losing £1 million of public money a week. That £1 million could be better spent on improving and providing services to all whom these trusts seek to serve. This is a trust that has a £65 million deficit, the largest in the country, so doing nothing is not an option. No Government of whatever political colour would stand by and see the haemorrhaging of £1 million a week. When hon. Members gather again on Saturday for their protest, I hope that they make it absolutely clear to all the good people who attend to support their local hospital that that is the real financial situation. Often, when faced with such realities, difficult and tough decisions have to be made. The simple truth is—and I am sure that the hon. Member for Lewisham East will agree with me—that we cannot continue to have that haemorrhaging and a deficit of £65 million.

[Heidi Alexander]

No one disputes the existence of financial problems, but the closure of A and E and maternity departments affects people’s lives and health. Will the Minister confirm that, were the Secretary of State minded to agree to the proposals put before him, the four tests set by her own Government will be applied?

[Anna Soubry]

I am happy to remind us all of those four tests and principles; they remain as firm as ever. First, any reconfiguration should have the support of GP commissioners. Secondly, there should be full public and patient engagement and proper consultation. Thirdly, there should be a clear clinical evidence base. Fourthly, any reconfiguration should be in support of patient choice.

The hon. Lady comes to the House to represent her constituents and to put forward their views, which she undoubtedly shares, and their anger and concern about their hospital. In her speech, she understandably uses the words outrage and disbelief to say that those four tests, in all or in part, have not been made. She speaks with passion and with detail about the lack of support from GP commissioners and consultants at Lewisham and beyond. She says that this is a hospital that has had many successes and a long-standing investment. She makes the point that, given all the arguments that have been advanced by her and other hon. Members, the decision clearly has no merit.

Let me mention here the interventions by the right hon. and learned Member for Camberwell and Peckham (Ms Harman), my hon. Friend the Member for Dartford (Gareth Johnson), the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock), who speaks in accord with others in support of the hospital, and the right hon. Member for Greenwich and Woolwich (Mr Raynsford). There were speeches by the hon. Members for Lewisham West and Penge and for Eltham (Clive Efford) and by my hon. Friend the Member for Beckenham (Bob Stewart).

This is a very serious subject and I do not want to be flippant. The views of all are certainly taken on board. In due course, the Secretary of State will announce his decision. Therefore, as I said at the outset, I cannot be of great assistance in addressing the various comments that have been made, because I am not allowed to give my opinion. I should, however, mention the contribution of my right hon. Friend the Member for Bermondsey and Old Southwark (Simon Hughes)—I think that I missed him off my list. He gave a thoughtful and frank speech in which he talked about his concerns about the legislation that brought about the appointment of the administrator. He has looked at an alternative and he advanced that.

Finally, the hon. Member for Eltham calls for a review of A and E, but he should do so with great caution. There might be merit in that, but when one embarks on such a review, we have to make it clear that, in those circumstances, some tough decisions might be made, and everyone involved in that would have to sign up to it on that basis.