Business of the House
Jim Dowd Excerpts(8 years, 4 months ago)
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Mr Lidington
My understanding is that that was an internal decision by the local enterprise partnership for south Essex, and I encourage my hon. Friend to make representations—I am sure he will do—on behalf of his constituents to the LEP. If that is not successful, I am sure that the relevant Minister in the Department for Business, Energy and Industrial Strategy will be keen to hear from him.
Jim Dowd (Lewisham West and Penge) (Lab)
May I too welcome the right hon. Gentleman to his new post? I well recall the many happy although fruitless hours we spent together on the original European Union (Referendum) Bill. Whatever happened to that? May I support the hon. Members who have raised the issue of Southern Trains and the appalling service that Govia Thameslink Railway is providing? The Mayor of London has written to the Secretary of State for Transport to say that he is prepared to take on the Southern franchise. In arranging a debate in Government time on that matter, will the Leader of the House prevail on the Secretary of State to accept the Mayor’s offer or at least to look into it in great detail?
Mr Lidington
I am sure that my right hon. Friend the Secretary of State will want to consider all options, but it is not the transfer of the franchise that is the answer: it is for the management to get on top of the operational difficulties that do exist and for management and unions to sort out the industrial dispute that is aggravating matters at the moment.
HEALTH
Jim Dowd Excerpts(11 years, 11 months ago)
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Andrew Bingham (High Peak) (Con)
I want to raise the issue of ambulance stations in my High Peak constituency. First, for the sake of clarity, I should explain that the High Peak is a large constituency and as such is covered by two primary care trusts: Derbyshire in the south and Glossop and Tameside in the north. Consequently, the ambulance services are provided by the North West Ambulance Service NHS Trust and the East Midland Ambulance Service NHS Trust. I want to concentrate today on the East Midland Ambulance Service—EMAS—but if time allows, I will also briefly mention the North West Ambulance Service.
“Being the Best” is an EMAS proposal to rationalise the ambulance services and ambulance stations across the whole of the east midlands. I am sure many Members across the east midlands will have their own issues in their own constituencies. I want to highlight the consequences for the residents of a large part of the High Peak of what I believe are badly thought out and ill advised proposals.
EMAS is looking to create a hub-based model. A hub will be, as the word suggests, a large centre where ambulances will be based and where crews will go to collect their vehicles and return them at the end of the shift. The hubs will be supported by what EMAS calls “deployment units”. I have seen a photograph of a deployment unit and I venture to say that, if we in this Chamber saw one, many of us would say it looks remarkably like a portakabin. They look unattractive, which does not go down well in an attractive area such as the High Peak where the scenery is so well appreciated, and also seem to be of very little use. I can see the logic of a hub-and-spoke model, but the crucial decision within such a model is where the hubs are located. That is where I believe EMAS has got things so badly wrong for the High Peak.
There are presently two ambulance stations in the EMAS area of the High Peak: one in Buxton and one in New Mills. Under the EMAS proposals, both of them will be removed, leaving the area without an ambulance station at all, relying instead on a hub that is placed not in or even around the High Peak, but in Chesterfield—at a distance of over 30 miles from New Mills, which is the furthest point. EMAS claims that the ambulances will not be parked there, but merely collected from and returned to the hub. That may be the case, but it creates further difficulties, as I shall explain.
The High Peak gets its name for a very good reason—it is high and there are peaks. The road from Chesterfield into the High Peak reaches at some points almost 1,000 feet above sea level. It is exposed to the elements. Many areas around different parts of the north and the east midlands might see only a sprinkling of snow, but Tideswell Moor, as part of the road is called, can easily be closed: owing to its exposure, only a small amount of snow is required to drift across the road to make it impassable for many vehicles. I use that road every week to catch the train to London. I well remember one occasion when I returned from London, got off the train in Chesterfield and quickly realised that I could go no further. I had to stay overnight in a Chesterfield hotel. I had that option, but somebody in the High Peak who needs an ambulance to use that road does not.
Let us imagine a crew collecting the ambulance to go on shift. They leave the hub, and within a short time a 999 call is received, requiring them to divert to, for the sake of argument, Clay Cross. The ambulance goes to the call, collects the patient and takes them to Chesterfield hospital—a process that could take some time. I have been out with the ambulance crews and I know how long these things can take. From Chesterfield hospital, the crew could get further diverted to, say, Alfreton or Matlock. That could mean the ambulance never reaching the High Peak, leaving my constituency with no ambulance cover at all.
I realise that my case requires a working knowledge of the geography of north Derbyshire, but that further makes my point, as it is precisely that knowledge that was lacking or ignored when the plans were drawn up. In meetings with me, EMAS says that the model has been computer generated. I have to say that it may look good on paper, but it does not and will not work in reality. EMAS also says that “Being the Best” is about improving the service and improving staff welfare. I fail to see how it can even begin to satisfy either of those criteria. How can staff welfare be increased when many of them will face an extra 30-mile journey to work both before and after what could easily be a 12-hour shift?
In addition, EMAS will be committed to compensating staff for excess travel for a certain period following the move. Extra fuel costs will be incurred by the to-ing and fro-ing from the Chesterfield hub—not to mention the cost to the environment with all the extra miles that the staff will have to travel. That means reducing staff welfare while increasing costs and reducing efficiency—to my mind, the direct opposite of what EMAS is trying to achieve.
The knock-on effect will be that, through staff turnover, the High Peak will lose ambulance men and women with the crucial local road knowledge. High Peak residents wishing to become paramedics or to work on the ambulances will now apply to the North West Ambulance Service, whose operational centres are nearer. We will arrive at a situation whereby whatever ambulances we get in the High Peak will be staffed not by local people who know the local towns, villages and hamlets in the area, but by able and excellent staff—I concede that—who will be residents from miles away. They will not be able to find their way around—sat-navs do not work that well in the High Peak—and response times will increase even further.
The fundamental problem is the way the process has been undertaken and how the proposals have been arrived at. The North West Ambulance Service is looking at similar proposals, but it appears to be engaging with others, inviting key stakeholders to help to discuss and shape its plans. At a meeting, it referred to the hub-and-spoke model but, I am told, acknowledged that that method of delivery will not suit all areas. I do not wish to prejudge what NWAS may propose, but there appears to be an acknowledgement that one size does not fit all. EMAS, however, presented its proposals with little or no apparent discussion with anyone, key stakeholder or not, preferring to use what appears to be an off-the-shelf template.
As Members would expect, I am batting for my constituents. We deserve a better ambulance service. We have several large quarries and other industrial premises within the High Peak, and they can be dangerous places. Industrial accidents happen. Safety records in the High Peak are good, but there is still the risk of injury.
Let me also dwell a moment on what happens in the summer months. The High Peak can be flooded with tourists. The population swells, and with it the potential risk and the need for an ambulance rise. Walkers, hikers and runners swarm across the High Peak hills like ants. Theatre-goers fill Buxton and the surrounding towns and villages during the Buxton festival. Coach-loads of people come to my constituency during the summer months. Who will go to them if they need emergency assistance?
The first responders, who perform excellent work in the High Peak, have expressed opposition to these plans. I am a great supporter of Mountain Rescue. It does a fantastic job across the High Peak, and in some cases its specific services are needed to reach people in inaccessible areas. Even it has taken the unusual step of expressing grave concerns about these proposals. Derbyshire, Leicester and Rutland Air Ambulance is also a vital part of the emergency mix in the High Peak, but the main ambulance service is still the one that people call most often. These other organisations embrace their responsibilities, but I am concerned that these proposals are leading to EMAS abdicating theirs.
The consultation has now closed. The whole High Peak community has united as one against these proposals. Two public meetings were attended by hundreds of local residents incensed by the proposals. At one meeting I attended, the chief executive said he was “listening very carefully” to local people. I hope he is. I hope that, when he presents his final recommendations to his board, they are not the same ones that are on the table today, as they are inadequate, unfeasible and unworkable: they reduce, not enhance, the service; they hamper, not improve, staff welfare; and they desert, not embrace, the people of the High Peak in their hour of need. The current proposals may improve some response times elsewhere, in the more populated areas of the east midlands, but they will not improve response times in the High Peak.
Jim Dowd (Lewisham West and Penge) (Lab)
Traditionally, Members raise constituency concerns in the House’s pre-recess Adjournment debates, and I shall raise a subject that has provoked not anger, but fury, and a feeling of unfairness and injustice among my constituents such as I have not known in the 20 years that I have served as a Member of Parliament and the 20 years before that when I was a member of Lewisham borough council. That subject is the appointment in July of a trust special administrator to the South London Healthcare NHS Trust. The TSA was appointed under the unsustainable providers regime, a provision of the National Health Service Act 2006 and amended, I think, in 2009. South London Healthcare NHS Trust does not include Lewisham. It covers the adjoining area, and principally comprises the Queen Elizabeth hospital in Woolwich, the Queen Mary hospital in Sidcup and the Princess Royal university hospital in Farnborough.
This is the first time the Department has used these provisions, so the step taken is ground-breaking, pioneering—
Jim Dowd
Yes, I think that is part of the TSA’s agenda. The way the Department has engineered this situation is disgraceful, dishonourable, disreputable and downright dishonest—and if we have not had enough alliteration, I could add devious, as well as underhand and fraudulent.
Hon. Members will not be surprised to learn that I am no great supporter of what the TSA has done. The Department is attempting to pervert the process because the major impact of what the administrator in the adjoining trust is doing is on Lewisham hospital. The draft report is a considerable document that has cost an awful lot of money and made an awful lot of money for a number of consultants, including McKinsey, KPMG and PricewaterhouseCoopers—they always seem to do well out of these things. The public consultation on the draft report has closed and the Secretary of State is due to reach a decision. The final report from the TSA will be presented in early January and the Secretary of State will be making a decision in February. I appeal today for the Secretary of State to suspend the entire process, because it has been perverted in the way that I have outlined.
I do not hold the TSA personally responsible. I have met him on a few occasions and find him to be a reasonable and rational person. However, I know that the devastating impact of his report is on Lewisham hospital—the impact there is beyond anything that will happen at Queen Mary’s, the Princess Royal or the Queen Elizabeth. The report will result in the closure of the accident and emergency department, and all medical and surgical emergency care, all maternity services, all children’s services and all critical care will cease on the Lewisham hospital site.
I had an Adjournment debate on this subject a couple of weeks ago. My right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) and my hon. Friend the Member for Lewisham East (Heidi Alexander) both raised the issue in the Opposition-day debate on health just last week. If I were to raise this matter every day in this House, I could not adequately reflect the burning resentment and anger that it has caused in the community in Lewisham, as the injustice is so severe. The Department could not appoint a special administrator to look at Lewisham Hospital NHS Trust, because it is a solvent, well-managed trust meeting all its performance and financial targets. What the Department has done is appoint an administrator next door and then, under the bogus and completely facile assumption that everything connects with everything else, focused on Lewisham hospital. That is what is completely devious about this.
At the public meetings the TSA has held on the matter, he has shown a little film setting out what he is trying to do. It included him quoting this age-old homily, “If your domestic finances are in mess, clearly you have to do something about it.” I do not dispute that the finances of the South London Healthcare NHS Trust are in a mess. At the meeting in Sydenham one of my constituents said to him, “If your domestic finances are in a mess, you may well have to do something about it, but that does not include breaking into next door’s house and nicking all their stuff.” That is precisely what is happening under this system. This procedure is being used for the first time. If it is used in that way, the Department will set a template for the rest of the country. It will then, in theory, be able to appoint a TSA anywhere and his or her remit will be such that they can look anywhere; they will not just focus on the area or trust they have been established to look into.
The Prime Minister and the Secretary of State repeatedly parrot four tests for reorganisations and reconfigurations. The first is that they should have general practitioner and clinical commissioning group support. The second is that they should have public engagement. That is a strange use of the vague term “public engagement”; they do not specify “public support”. The third is that the proposals have to be clinically sound. The fourth is that they have to increase patient choice. None of those factors exists in the recommendations for Lewisham hospital, and the TSA does not even maintain that they do. He openly admits that the proposals will reduce patient choice sharply. The clinicians, the hospital board, the CCG, and various groups of GPs across Lewisham and beyond all say that the recommendations are a threat to the standard of care that the people of Lewisham can expect and all are opposed to the TSA’s proposals. I say to the Secretary of State, via the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), that he should abandon the scheme now, as the way it has been undertaken is clearly flawed, and he should protect the services that my constituents and people across south-east London have a right to expect.
Dr Thérèse Coffey (Suffolk Coastal) (Con)
It is a great pleasure to speak in this debate on a particularly important topic, in which the Minister shares an interest, as we are neighbours. First, I wish to thank our front-line staff in the ambulance service, our paramedics, who work very hard. I also thank our volunteers, the community first responders, who do a great job and genuinely participate in helping to save lives in our communities. That is particularly important in the shires, as reaching someone in just a few minutes to provide life-saving treatment is crucial. I thank those people who give up their time.
A reorganisation is taking place in the east of England ambulance service, and I know that that is a concern to staff, who feel that patients will not get the treatment that they deserve. Change is always unsettling, but I genuinely believe that the management are trying to do this for the best reasons. One of the things we need to keep ensuring is that patient safety is the key priority.
The east of England ambulance service is hitting its targets—it has a regional target. Given that our region is so vast, it is no surprise that by focusing on certain cities it is relatively straightforward to hit targets. However, when we break down the performance by county, we start to see a very different story. I know that my colleagues from Suffolk and, indeed, my hon. Friend the Member for North Norfolk (Norman Lamb) have long been campaigning on that issue to try to raise it up the agenda, and it is vital that we do so. The presence of a new interim chief executive may start to help us to tackle that. We need to work hard to keep the chair and the board of the ambulance service on their toes, so that they recognise that saying that they have hit a regional target does not mean that the issue will go away—it will not.
One of the things I call on the board to do is think carefully about its responses to Members of Parliament when we are asking for greater transparency on performance. Belatedly—I am pleased that it has done this—there is an agreement that it will start to publish county by county performance details on a monthly basis. I believe that the board should and can go further. We already know that it provides performance data by postcode to the primary care trusts, and I believe those data should be published—they should certainly be available. Instead of getting into freedom of information exchanges, we need to ensure that, in line with what Sir David Nicholson told the Public Accounts Committee, every Member of Parliament should be able to get access to the data they need easily in order to monitor what is happening for their constituents and not be caught in a bureaucratic nightmare. As we all know, sunlight often brings a change in performance. Somebody trying to get to a village such as Shingle Street finds that it takes 10 minutes to get there just from the main road. When I say “main road” I am referring to a single track road. I recognise that not everybody will be able to do that, but it is still important that we try to get the postcode data published.
Earlier this year, after a successful meeting with my right hon. Friend the Member for Chelmsford (Mr Burns), a Health Minister at the time, I was under the impression that there would be a contract with the county performance targets built into it. Indeed, that was important for the paying of bonuses. Disappointingly, the contract that was agreed with the ambulance service by the person agreeing it on behalf of the primary care trusts in the east of England contained an added caveat about hospital handover times. We know that that is an issue, but another thing that Members of Parliament are doing is putting the spotlight on where there are those problems as well. Ultimately, we want the best ambulance service for our patients. We should not have to put up with sub-standard performance simply because the county is rural.
One disappointing thing about the contract, from which we expected so much, was that there seemed to be a lot of wriggle room. The new interim chief executive knows that well, as he negotiated the contract on behalf of the primary care trusts. He knows the issues our ambulance services face and I shall press him to ensure that the contracts this time make it clear what percentage of people in Suffolk should expect to see an ambulance within the regulated time.
Another thing that went wrong was the complaints process, although I am delighted that the chair of the ambulance trust has fixed that. I pay tribute to her and her staff for sorting that out. All these problems together have led me to voice my opposition—I will continue to do so—to the trust’s being allowed to have foundation status before a quality service is delivered consistently across the region. Simply placing ambulances close to Cambridge, Ipswich, Norwich, Luton and so on—near the big conurbations—is not fair on our rural areas. I point those people who say, “Well, it is a rural area,” to the example of the north-west. Cumbria has very similar characteristics as a pretty rural area with some big towns, yet the service there manages consistently to hit its targets.
Is there light at the end of the tunnel? I hope so. It is clear that MPs from Suffolk and across the east of England will not let up on the issue and I hope that we will have a step change in performance when we meet again in February.
Health care is very important to the people of Suffolk, but I also want to take this opportunity to thank my staff for all the hard work they have done in the last year. They have been extraordinary in helping my constituents tackle all sorts of issues and have also been very helpful this week, as we have sent out a mailshot of nearly 4,000 letters on Sizewell C—another issue that I share with my hon. Friend the Minister—and the impact that could have in the future. On that note, Mr Deputy Speaker, I wish you a happy Christmas.
Jeremy Lefroy (Stafford) (Con)
In September 2012 the Royal College of Physicians published a report, “Hospitals on the edge? The time for action”, which sets out starkly the challenges facing our acute hospitals. It begins:
“All hospital inpatients deserve to receive safe, high-quality, sustainable care centred around their needs and delivered in an appropriate setting by respectful, compassionate, expert health professionals. Yet it is increasingly clear that our hospitals are struggling to cope with the challenge of an ageing population and increasing hospital admissions.”
It highlights the consequences of failing to meet the challenges and refers to the history of my own trust. When the public inquiry reports next month, we will have the opportunity to consider its implications for the NHS. Today I wish to concentrate on the Monitor review of my trust in the light of the continuing rise in pressure on acute services that the Royal College of Physicians highlights.
There are three common themes that I hear in the NHS these days. The first is that we need to do much more in the community and at home and much less in acute hospitals, and that we must therefore close acute hospital beds and use the money in the community. Although I agree with the premise, I dispute the conclusion. Community care is essential, but it must work before it results in a reduction in admissions and lengths of stay. The fact that admissions are rising and, according to the RCP, the fall in length of stay has flatlined in the past three years, even rising for patients over 85, indicates to me that the shift to the community either is not happening fast enough or indeed will not happen as expected.
The conclusion also seems to ignore demography. In the area served by the Mid Staffordshire Trust, the population is expected to rise by some 10% in the coming 23 years. The number of people over 60 will rise by nearly half, and the number of those 75 and older—those most likely to need acute services—will double. I suspect that is the situation in many parts of the country.
Increasing admissions, rising and ageing population, flatlining length of stays—all of these indicate an increased demand for acute services in the coming 20 years, yet the talk is, and has been for many years, of further reductions in acute beds. It makes little sense to do that until community services and other medical advances mean that those beds are proved to be no longer necessary. In Stafford, there is a shortage of step-down beds, so rather than closing acute beds altogether why not keep them as community beds on the same site, leaving the door open for increasing acute services in the future, if and when the need arises?
The second theme is that we need to integrate primary and secondary care more closely. I agree, yet actions sometimes have the opposite effect. The previous Government took away the responsibility for providing 24/7 primary care cover from GPs. I regret that, as it detracts from integration. It may also be responsible for placing a greater burden on accident and emergency departments at night. If out-of-hours care is not to be the responsibility of GPs, let it be centred, where geographically possible, on acute and community hospitals. This makes better use of NHS premises and, by being adjacent to A and E or other emergency units, can help take the pressure off them while providing the hospital with extra income. That would certainly work at Stafford and Cannock.
Tariffs can produce strange results. The University Hospital of North Staffordshire has a block contract for A and E admissions. For any admission in excess of that, it receives only 30% of the tariff, so what is it supposed to do—reject emergency admissions on the basis that they will be loss-making? Of course not. I would propose that emergency departments are funded at what it costs to provide that service safely. In Stafford, the emergency department has a deficit of some £2 million per year based on throughput and tariff. The number of patients attending—more than 50,000—could not possibly be safely accommodated elsewhere. Surrounding hospitals are already at capacity, so it makes little sense to impose a national tariff, which inevitably results in a loss and which in turn puts pressure on the hospital to prove that it is sustainable.
The third theme is that medicine is becoming increasingly specialised, so most work will inevitably migrate to large specialist units. There is truth in this belief, but there is also danger. There are 61 approved medical specialties in the UK, compared with 30 in Norway. As the RCP says, this has
“rendered the provision of continuity of care increasingly difficult.”
For older people, who often have complex and multiple needs, this can result in poorly co-ordinated care. This has not been helped by the introduction of shift-based systems under the new deal and the European working time directive, to replace the teams that took responsibility for individual patients. Specialisation also means that there is a much smaller pool of staff from which to select for each post.
If we were to design from scratch a hospital where those who will need it most— the elderly, as the statistics show—will receive safe and caring care for their complex needs as close to home and loved ones as possible, integrated into primary and community care, we would end up with something pretty much like the district general hospitals and community hospitals up and down the country, such as Stafford and Cannock.
This is not an argument for no change. I believe there must be much closer working between the larger and smaller trusts, for instance, and much more sharing of common services than at present. But it is a warning that national tariffs are not impartial arbiters. They generally work, I believe, against acute care.
Jim Dowd
I am following what the hon. Gentleman is saying most carefully, as this is part of the problem that we experience in Lewisham. Does he feel, as I do, that instead of reflecting the needs of the population across the country and providing services that correspond with that, the Department of Health is trying to implement a template or a framework of its own making and inflict it on the nation?
Jeremy Lefroy
I thank the hon. Gentleman for his intervention. I am not convinced that that is the case at all. I believe Ministers are listening and are considering matters very carefully, but there is a danger, of course, that a template will be inflicted. The hon. Gentleman and I both earnestly trust that that will not be the case.
As I said, I believe that national tariffs are not impartial arbiters. They generally work against acute care, and there is a risk that the constant pressure which they are placing on acute care, particularly in district general hospitals, will make much of the sector unsustainable, yet without it, we do not have an NHS.
Finally, I wish to raise a specific point about Monitor’s review of Mid Staffordshire. Clearly, the population served by the trust is a very important consideration. The trust’s 2011-12 report said that it was around 276,000, yet I have heard reports that the Monitor team considers it to be as low as 220,000 and therefore potentially too small to sustain certain services. The facts that I have clearly support the trust’s figure, not the one that I have heard rumoured.
I have spoken much today about figures, because they are an important part of the Monitor review, but more important is the quality of services, for which Monitor also has a legal responsibility. Early next year, the Secretary of State will bring to the House the report of Robert Francis QC from his public inquiry into Mid Staffordshire. Julie Bailey and the Cure the NHS group, who from their own experiences brought to light the harm that was done, have set out radical and clear ideas for turning the NHS the right way up, with the patient at the top, not the bottom—right first time with zero harm to each and every patient. That is something which caring, hard-working staff in our NHS in Stafford and Cannock—where waiting times and mortality rates are improving, although there is much to be done—and right across the country went into the NHS to provide.
The NHS, as the right hon. Member for Wentworth and Dearne (John Healey) said, and the nursing and medical professions must make it clear that there is no place for anyone for whom quality patient care does not come above all else. The regulations must show that.
The Monitor review is an opportunity for Stafford and Cannock hospitals to become a model of how to provide sustainable high quality emergency, acute and community care to a mid-sized population. If Monitor succeeds in achieving this there and elsewhere, as the hon. Member for Lewisham West and Penge (Jim Dowd) mentioned, it will have done the nation a great service, and I am sure the Minister will be remembered as someone who played a major part in improving our NHS. I urge Monitor to rise to the challenge.
Dr Poulter
My hon. Friend is absolutely right and I pay tribute to him for taking the time to go out with the ambulance service and see first hand the problems that have been experienced in some parts of Suffolk and Norfolk. There have been problems with the handover time at some hospitals in the east of England and that is clearly unacceptable, because if the ambulance and hospital staff are engaged in lengthy handovers, it means that other patients are not being treated and seen in a timely manner. Those issues need to be addressed by some trusts in the east of England.
My hon. Friend the Member for Waveney has written to the ambulance service and his letter was made available to my noble Friend Earl Howe. In it, he highlighted the trust’s decision to publish more performance information online from February and stated that it was important that that was done by geographical area to ensure that there is greater transparency in the quality of response data in areas such as Beccles and Bungay, relative to more urban areas such as Ipswich. That is an important point. I urge him and my hon. Friend the Member for Suffolk Coastal to continue pushing for transparency in the ambulance service’s data, and to continue their fight for improved response times for more rural areas of Suffolk and Norfolk. I know that my noble Friend Earl Howe would be happy to meet hon. Members to discuss the matter further.
Let me turn to the issues that were raised by the other three Members. I will be brief, Mr Deputy Speaker, because I take your hint. My hon. Friend the Member for High Peak (Andrew Bingham) raised concerns about a number of ambulance stations, including one in Buxton. I know that my hon. Friend the Member for Staffordshire Moorlands (Karen Bradley), who lives in a nearby constituency, shares those concerns. A review is currently taking place. We all welcome reviews if they are going to improve the quality of care for patients and improve ambulance response times. However, there are local concerns that the review must take into account issues such as rurality and the difficulties that patients on high land or in harder-to-access areas have in accessing all types of health care services.
I note the concerns that the review is making proposals that do not necessarily take account of those factors. My hon. Friend the Member for High Peak has put those concerns on the record today. If that has happened, I echo his concerns, because it is important, in the review of any service, that issues such as rurality and difficult-to-access areas are taken fully into account. This is, of course, a local health care decision. If he wants to discuss the matter further with Ministers, we are happy to discuss it with him.
The hon. Member for Lewisham West and Penge (Jim Dowd) put across his strong advocacy for Lewisham hospital. I trained in south Thames and have colleagues who work at Lewisham hospital. We all know that Lewisham faces particular challenges. It has demographic challenges, given its difficult population groups with considerable health care needs, and great health care inequalities. It has a large migrant population, which brings particular health care challenges and means that people do not always have English as a first language. Such people need to be looked after properly. It is important that those issues are taken into account during the discussions.
I take on board the concerns of local staff that they are being drawn into the big financial concerns with South London Healthcare NHS Trust. However, we also have to recognise that no one hospital operates in a vacuum. We must ensure that hospital services and the care that is provided reflect the needs of the wider geographical area. My right hon. Friend the Secretary of State will be looking into these issues.
Dr Poulter
I will take an intervention very quickly, but I am pressing on Mr Deputy Speaker’s patience.
Mr Deputy Speaker (Mr Nigel Evans)
Order. Please complete your contribution within 60 seconds, Minister, so that we can move on.
Sittings of the House
Jim Dowd Excerpts(12 years, 5 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Paul Blomfield
As has been pointed out, there are Select Committees that meet earlier and that seem to manage to arrange for witnesses to attend.
The argument for earlier Tuesday sittings, as well as standing on its own merits, provides the opportunity to move the debates on private Members’ Bills to Tuesday evenings. As a Back Bencher, I believe in the importance of our having the opportunity to drive change through the House. Although I acknowledge the other options that the Chair of the Procedure Committee shared with us, moving those debates to a Tuesday evening would give many of us a greater opportunity to attend.
Jim Dowd (Lewisham West and Penge) (Lab)
When we first had sittings on Wednesday mornings, I was the Government Whip responsible for private Members’ Bills. I suggested then—this was before we had sittings in Westminster Hall—that we could move private Members’ Bills to Wednesday mornings. We opened up Westminster Hall to make that easier. The reason I made that suggestion was that if we debated private Members’ Bills during the normal sitting week, it would make it easier for the Government. Is that what my hon. Friend is proposing?
Paul Blomfield
Not for one moment.
As has been pointed out, there are options on how we deal with private Members’ Bills. It is unreasonable that at the moment, those of us who plan our diaries so that we have constituency time on Fridays have to choose between going to our constituencies and attending the House to support private Members’ Bills, whether of our own volition or because we have had representations from our constituents to be there. Over the past two years, I have done that on three occasions. Frustratingly, on each occasion the Bill was talked out. I fear that if we do not agree to change our Tuesday sittings, we will exclude one important way in which the Procedure Committee might address the issue, because the slot will not be available for private Members’ Bills. There are stronger arguments than that, but it is one dimension of the argument.
Sir Gerald Kaufman
I do not understand my hon. Friend’s approach to this. When I first came here we had a five-day week, and Government business alternated with private Members’ Bills on Fridays. I do not want to be arrogant or patronising, but I think I look after my constituency as well as any Member, and I can do it in the hours that we used to have, let alone the current ones. I can get to my constituency and do my jobs. I had eight engagements last weekend, and I managed to fulfil them without having family-friendly hours at the House of Commons.
I have a duty to be in my constituency, but I was elected to come here and represent my constituents. I am a Member of Parliament, not partly a Member of Parliament and partly for hanging around.
Sir Gerald Kaufman
I agree totally. I have surgeries every weekend, and I have people coming to see me who have hardly any money to live on. I have just had letters from constituents in the same situation. It is my job to try to help them against a Government who do not care about them. The very idea that we should spend two days in this House of Commons talking utter and total rubbish about reforming the House of Lords, when people are anxious about their jobs, their NHS and their pensions is absolutely sickening. Now we are spending a whole day debating the House and hon. Members are absorbed by it, offering all kinds of different useful formulae to make this place more attractive to Members. When my father worked at Montague Burton’s tailoring factory in Leeds making suits and clothes, he was not given a chance to make his work more attractive for him. He was bloody lucky to have a job at all.
We are lucky to be here and to have this marvellous opportunity to speak for our constituents, and we are paid very well indeed. Millions of people cannot believe how much hon. Members are paid when they are paid so little—assuming they are not on benefits. It is therefore about time the House stopped this navel gazing. Our job is to hold the Government to account; it is not to say, “I want a tidier and more useful day. I want to be able to get home on a Thursday afternoon.” If hon. Members want that, I suggest they find another career.
Standards and Privileges
Jim Dowd Excerpts(13 years, 7 months ago)
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Mr Barron
No—I shall just carry on for a few minutes, if my hon. Friend does not mind.
The commissioner’s report suggests that the public purse was overcharged by between £80 and £270 per month, even in comparison with assured shorthold tenancies. Property advisers considered that the rent in the right hon. Gentleman’s lodging agreement was between £209 and £370 a month higher than the market price.
The right hon. Gentleman and his supporters say that he acted to preserve his privacy. Extensive press briefings suggested that the breach would be somehow less blameworthy if that were the case, but the commissioner expressed his sympathy for the right hon. Gentleman, and the Committee recognised his motivation. However, there were other ways to preserve privacy. He could have refrained from claiming. Alternatively, he could have designated his main home properly, which would have meant that there would be no need to conceal receipts that might have identified his landlord.
The right hon. Gentleman instead took the decision to preserve his privacy by concocting a rent agreement and, wherever possible, claiming below the receipts threshold. He told the commissioner:
“After the receipts threshold changed I reduced my claims below the threshold.”
Ultimately, as the report says, this case is about the fundamental principles of the code of conduct, which says, and has always said:
“Members shall base their conduct on a consideration of the public interest, avoid conflict between personal interest and the public interest and resolve any conflict between the two, at once…in favour of the public interest.”
As the Committee said:
“We consider the rental agreements submitted between 2003 and 2008 were misleading and designed to conceal the nature of the relationship. They prevented any examination of the arrangements that in fact pertained over the entire period.”
That is why this case is worse than many others in which the commissioner has found there has been a breach of the rules of the additional costs allowance. In many of those cases, the Members concerned had consulted the department of finance and administration, and in some cases both the department and independent valuers, so there was no intention to deceive. In one case, the Member’s circumstances changed, so that arrangements that were expected to be temporary lasted longer than expected.
In contrast, the case before us involved a deliberate attempt to conceal the Member’s real living arrangements that continued for many years. It is clear that he recognised the potential conflict between the public interest and his private interest. By omitting to seek advice, however, he made himself the sole judge of whether that conflict was properly resolved. It was inappropriate for him to be judge and jury in his own case. As the commissioner commented, it can never be acceptable to submit misleading documents to those charged with overseeing public finances. As this case shows, the right hon. Member’s desire for secrecy led him to act in a way that was not compatible with the standards expected of an MP. Whatever the motive, I do not think that is acceptable.
Now I will address the concerns of those who think that we have been too lenient. Since the Committee reported, my hon. Friend the Member for Dunfermline and West Fife (Thomas Docherty) has asked the police to investigate. There is a protocol between the police, the commissioner and the Committee providing for liaison between the commissioner and the police, if either of them has concerns. The police will not comment on individual investigations, and the commissioner is also understandably reluctant to comment on such matters, even to the Committee. However, the fact that the commissioner has reported to us suggests the Member’s behaviour is unlikely to have been criminal.
I have already explained why we felt this case was more serious than others, but there were mitigating factors. As we stated in the report:
“Not only has Mr Laws already resigned from the Cabinet, his behaviour since May 2010 has been exemplary. He quickly referred himself to the Commissioner, has already repaid allowances from July 2006 in full, and has cooperated fully with the Commissioner’s investigation. This behaviour has influenced our recommendation.”
Jim Dowd (Lewisham West and Penge) (Lab)
The Committee said that the right hon. Member’s behaviour had been exemplary since the matter became public knowledge, and the commissioner himself, in paragraph 324 of his report, stated that it was to his
“considerable and personal credit that, when his living arrangements came to public attention”
he referred himself. Did the Committee calculate what he might have done had it not come to public attention?
Mr Barron
No, it did not.
The repayment was one of the mitigating circumstances. The voluntary payments went further than the circumstances at the time required. The outstanding amount related to rent that might or might not have been over-claimed and not to expenses claims that were wholly wrongly based, as in other cases that sadly have come before the House. As in other cases where Members have over-claimed, we have clawed back the overpayment. Given the uncertainty over what a true comparator should be, we calculated the maximum overpayment, and it was only because it was within the amount that had been paid back, over and above housing claims, that we made no further recommendation.
It has been suggested that recommending that the suspension should begin after the recess is part of a plot to reduce the right hon. Member’s fine. It was not put in, as one of the Sunday papers suggested, by political partisans on the Committee. The Committee considered carefully and decided that a suspension of seven days was appropriate. It would have been arbitrary and unfair to have extended the suspension simply because a recess fell during the period. In 2007, the Committee recommended that George Galloway’s suspension should start after the summer recess for precisely the same reasons. In that case, he got himself named in the House and suspended in the last week of sitting, so he lost his salary for the entire summer recess plus the 18 days that the Committee recommended. In this case, we felt that it would have been wrong to have started the suspension today—if that is what the House agrees—because we knew that we are entering a short recess. It would have been unfair and resulted in a longer suspension than the one recommended in our report. If the motion is agreed to, approximately £1,500 of salary will be withheld as a result of the right hon. Member’s suspension. I recommend the report to the House.
Jim Dowd (Lewisham West and Penge) (Lab)
I will not detain the House too long. I realise that we have immensely important business to discuss later, and we should get on to it as soon as possible. However, this matter is not unimportant. Judging from the number of Members seeking to take part in the debate on the report, I fear that it would otherwise have slipped quietly into parliamentary history. We have realised over the past few years just how tainted this House’s reputation has become vis-à-vis not just the conduct of some Members, but how the way in which we deal with them is perceived.
I do not want to go into extreme detail about what the right hon. Member for Yeovil (Mr Laws) has done—or not. The commissioner has conducted a characteristically scrupulous and systematic investigation of the events, and the Committee and all its members have followed in the same vein. I will not seek to divide the House on the recommendation, which I am sure will be agreed. However, I fear that the way in which the case has been dealt with and the conclusion that the Committee has presented create the danger of emphasising the idea that, superficially at least, there is one rule for some Members of this House and other rules for others. Some are taken before the courts—and, indeed, imprisoned—for their conduct; some get barely a slap across the wrist; and others escape scot-free.
I accept that the speculation around this case is nothing to do with the right hon. Gentleman personally, but so much of the comment outside this place—I accept, too, that neither this House nor any Member is responsible for such comment—is about how much time he should serve not before he is brought before the courts or sent to prison, but before he is brought back into the Cabinet. That changes the aspect and the proportion of this case entirely. The report makes it plain that there has been a systematic, calculated and flagrant pattern of behaviour by the right hon. Gentleman, which, describe it as we might—deceit, deception, fraud—amounts to dishonesty. If this House is to rebuild its reputation we need not only procedures that are, to quote an oft-repeated phrase in the report, “above reproach”, but systems that are seen to treat each and every Member of this House in the same fashion. I do not think that we have that at the moment—I do not criticise the report; I am sure that we will pass it and move on—but it is for the authorities and the Committees in this House to ensure that one simple procedure applies to everybody.
As the Chair of the Committee, my right hon. Friend the Member for Rother Valley (Mr Barron), has said, this matter is now under investigation by the police because somebody has referred it. [Interruption.] I am told that he did not say that, in which case, we need to refer it. However, it is equally true that in other cases, the police have not waited for a referral for matters to be investigated, but have taken it upon themselves to investigate whether there was any criminal or corrupt element in Members’ behaviour. Indeed, matters that for a while fell within the purview of the commissioner were passed on, because the police had commissioned investigations into whether criminality and wrongdoing had taken place. There are those who have said that Members found guilty of serious wrongdoing should resign and leave this House, triggering a by-election—so much so, indeed, that the current Deputy Prime Minister said in his first address to the Liberal party conference that he wanted to add a “Derek Conway” clause.
Mr Speaker
Order. The right hon. Gentleman, the Chair of the Standards and Privileges Committee, made a passing reference—it was not, if I remember correctly, an evaluative one—to the police. Of course the hon. Gentleman is perfectly at liberty to make clear to the House his view about the merits or demerits of the report and its recommendations. However, I urge the House to focus on the specifics of this report alone and not to engage in what might be called a Second Reading debate about the differential treatment of particular cases, and we certainly cannot get into a general discussion about whether or when the police are involved.
Jim Dowd
I accept that, Mr Speaker, and I will abide by your ruling. I asked for your guidance before the debate, because I fear that the niceties and technicalities of parliamentary procedure might reduce common sense to zero in this case, and that the public at large will not understand the import of events.
I accept the report, but I still think that we need a procedure that is open and that has clear stages, regardless of whether the matter in question is in the hands of the House authorities, of Members’ Committees or of officials, or of whether it has entered the domain of a public investigation. We have not got the balance right in the report not because of any failing by the Committee, but because our procedures are still ineffective. We have tried to overhaul the expenses system, which was the genesis of this case, but I do not believe that we have got our administrative arrangements right in this House. The Committee continues to do a good job, as does the commissioner, but we must concentrate on creating a system that not only treats everyone fairly and equally but that is seen to do so.
Members’ Salaries
Jim Dowd Excerpts(13 years, 8 months ago)
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Sir George Young
I will come in a moment to the point about whether we should overturn the decision that we took in July 2008. Let me briefly set out the background. On 3 July 2008, the House agreed a new formula for uprating Members’ salaries, which is what I think my hon. Friend was referring to. The annual percentage increase would be the median of a basket of public sector comparators, and this percentage would be calculated by the Senior Salaries Review Body and notified to you, Mr Speaker, in a letter from its chairman. That percentage increase would then take effect automatically from 1 April.
That system has considerable advantages. It provides a fixed uprating formula so that we do not determine our own salaries. It is transparent, as the formula and the SSRB’s determination are there for everyone to see. It is also fair in that it provides a link between the salary of a Member of Parliament and the salaries of others in the public sector. Those are the virtues that the Government usually believe should underpin any system for determining our salaries—independence, transparency and fairness. We have therefore not taken lightly the decision to set aside the pay increase and thereby abandon the formula.
As I said, the Government’s decision to invite the House to agree to a pay freeze is the product of the difficult fiscal situation in which we have to find significant cost savings across the public sector. As my predecessor as Leader of the House, the right hon. and learned Member for Camberwell and Peckham (Ms Harman), said in the 2008 debate:
“given that MPs are paid from the public purse, we should show the same discipline in our pay increases as we expect from the public sector.”—[Official Report, 3 July 2008; Vol. 478, c. 1062.]
Jim Dowd (Lewisham West and Penge) (Lab)
The right hon. Gentleman is a decent fellow, but this is not quite the full story. The full story is that no Government have ever resisted the temptation to poke their nose into this business. We have set up mechanisms, to which the hon. Member for Gainsborough (Mr Leigh) referred, and said that they should be independent and we should go along with them, and then when it suits the Government of the day—not just this Government but any Government—they change the rules. That completely undermines any claim they make to believe in independent mechanisms. Either we come forward with what the independent review mechanism says, or we do not. This Government, like their predecessors, are poking their nose in where it does not belong.
Sir George Young
I should like to address very directly the hon. Gentleman’s point about the independence of the review that we are overturning. He rightly says that by bringing this motion before the House, a Government are once again asking Members to vote on their own remuneration—something that we believed we had put behind us. He asks the very good question as to why we are asking the House to reject the independent findings of the SSRB and whether the SSRB is unable to take on board issues of the kind that I have been talking about. The short answer is this: the system that was introduced in 2008 provided an objective mechanism for determining our pay, but it was a long way from being independent. The formula was devised by the previous Government and endorsed by the House, and in no sense could it be said to be independent.
For those, like the hon. Gentleman, who say that we are substituting our own judgment on this issue for that of the independent SSRB, I remind the House of what the chairman of the SSRB, Sir Bill Cockburn, said in his letter to you, Mr Speaker, on 19 January. He said:
“I should emphasise that the SSRB has no discretion in making this determination but simply applies the formula set out in the Resolution. We were not consulted when the Resolution was drawn up. The resulting figure is not what the SSRB would have recommended had we been able to have regard to all the circumstances including, this year, the Government’s pay freeze for public sector workers paid more that £21,000 a year.”
In a nutshell, the SSRB is saying that if its hands had not been tied by the House, it would not have recommended the 1% pay increase that came before us in January. If the hon. Gentleman looks at the pay recommendations for other professions published today by the SSRB and the Review Body on Doctors’ and Dentists’ Remuneration, he will see that no uplifts are recommended for those earning more than £21,000.