Junior Doctors Contracts

John Bercow Excerpts

Thursday 11th February 2016 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

I am grateful to the Secretary of State for advance sight of his statement. It would have been good to have previewed this exchange during the urgent question on Monday, but we all know that the Secretary of State could not be bothered to turn up. You might also think, Mr Speaker, that the Health Secretary would do me the courtesy of responding to the two letters I have sent to him in the last week, but you would be wrong. So much for a seven-day health service! A five-day-a-week Health Secretary would be nice.

This whole dispute could have been handled so differently. The Health Secretary’s failure to listen to junior doctors, his deeply dubious misrepresentation of research about care at weekends and his desire to make these contract negotiations into a symbolic fight for delivery of seven-day services has led to a situation that has been unprecedented in my lifetime. Everyone, including the BMA, agrees with the need to reform the current contract, but hardly anyone thinks the need to do that is so urgent that it justifies imposition, and all the chaos that will bring.

The Health Secretary said NHS leaders had asked him to “end the uncertainty”, but can he confirm that that means they support “imposing” a new contract? One hospital chief executive, who the Secretary of State claims is supporting him, tweeted this morning:

“I have supported the view that the offer made is reasonable…I have not supported contract imposition”.

For the purpose of clarity, can the Secretary of State say categorically that all the NHS leaders whom he mentioned fully support his actions? Can he not see that imposing a new contract that does not enjoy the confidence of junior doctors will destroy morale, which is already at rock bottom? Does he not realise that this decision could lead to a protracted period of industrial action that would be distressing for everyone—patients, doctors, and everyone else who works in or depends on the NHS? [Interruption.]

[Mr Speaker]

Order. There is far too much noise in the Chamber. Let me say this to Members on both sides of the House who are shouting: do it again, and you will not be called. It is as simple as that. If Members cannot exercise the self-restraint to be quiet while the Front Benchers are speaking, they have no business taking part in the exchanges.

[Heidi Alexander]

I am grateful to you, Mr Speaker.

What impact does the Secretary of State honestly think an imposed contract will have on recruitment and retention? Earlier this week, a poll found that nearly 90% of junior doctors would be prepared to leave the NHS if a contract were imposed. How does the Secretary of State propose to deliver seven-day services with one tenth of the current junior doctor workforce? How can it possibly be right for us to be training junior doctors and the consultants of tomorrow, only to export them en masse to the southern hemisphere? The Secretary of State needs to stop behaving like a recruiting agent for Australian hospitals, and start acting like the Secretary of State for our NHS.

What advice did the Secretary of State take before making this decision? He may not want to respond to my letters, but what does he say to the Royal College of Surgeons, the Royal College of Obstetricians and Gynaecologists, and the Royal College of Paediatrics and Child Health, all of which have urged him not to impose a contract? What legal advice has he taken about how an imposed contract would work in practice? What employment rights do junior doctors have in this context, and what will happen if they simply refuse to sign?

The Secretary of State has been keen to present a new junior doctors contract as the key that will unlock the delivery of seven-day services, but that is a massive over-simplification, and he knows it. Although research shows that there is a higher mortality rate among patients who are admitted to hospital at weekends, there is absolutely no evidence to show that it is specifically caused by a lack of junior doctors. Will the right hon. Gentleman state, for the record, that he accepts that?

One of the real barriers to more consistent seven-day services is the consultants contract. Until now, at least, the BMA and the Government were making progress in those negotiations. Could not a decision to impose a new junior doctors contract put the consultant negotiations at risk, and make the delivery of seven-day services even harder? Will the Secretary of State also make it clear how the definition of unsocial hours will need to change in other contracts in order for seven-day services to be delivered, and which groups of staff that will apply to?

What we heard from the Secretary of State today could amount to the biggest gamble with patient safety that the House has ever seen. He has failed to win the trust of the very people who keep our hospitals running, and he has failed to convince the public of his grounds for change. Imposing a contract is a sign of failure, and it is about time the Secretary of State realised that.

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[Mr Speaker]

Order. I must advise the House that, so far, we have got through eight questioners in 14 minutes, which, by the standards of the House operating at its best, is poor, so we need to do better. That means shorter questions and, frankly, rather pithier answers.

[Kevin Barron (Rother Valley) (Lab)]

I had a further email on this subject from a doctor in my constituency this morning. He thanked me for forwarding replies from the Department, although he did say that they were disappointing. He said that the BMA had proposed a contract that met the Government’s cost-neutral requirements, but that it had been rejected. Is that true?

Oral Answers to Questions

John Bercow Excerpts

Tuesday 9th February 2016 Commons Chamber

[Mr Hunt]

We have plans, as I mentioned, to have 5,000 more doctors working in general practice, and there is a big interviewing process. We need to increase the number of GPs going into general practice by 3,250 every year and I am happy to liaise with the Province to see how we can work together on these plans.

[Mr Speaker]

I call next the medal-wearing member of the team which won the parliamentary pancake race this morning, against the peers and against the press.

[Victoria Atkins (Louth and Horncastle) (Con)]

7. What progress the Government has made on integrating and improving care provided outside of hospitals.

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[Alistair Burt]

As I said, there are ongoing reviews concerning the precise responsibilities of each individual part. There is no doubt that this is a very serious matter—a serious failure—that raises series concerns. We want to know what went on as much as the hon. Gentleman does, so once the reviews have been completed and we have been briefed, I will be very happy to talk to him about their consequences.

[Mr Speaker]

I call the victorious team leader, Mr Stephen Pound.

[Stephen Pound (Ealing North) (Lab)]

11. What assessment he has made of the potential effects on public health of his Department’s proposals on the future of community pharmacies.

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[Jane Ellison]

I reassure the House that the vital funds mentioned by the hon. Lady are protected in the spending review.

[Mr Speaker]

Last but not least, Sir Simon Burns.

[Sir Simon Burns (Chelmsford) (Con)]

14. What assessment he has made of the adequacy of provision of GP practices in Chelmsford constituency.

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[Several hon. Members rose—]

[Mr Speaker]

Order. As in the health service, so at Health questions: demand always exceeds supply, so we need short questions and short answers.

[Ben Howlett (Bath) (Con)]

T4. I am sure Ministers will join me in congratulating Number 18 surgery in Bath on being ranked in the top 10 GP practices in the country. Do they agree that patients having a choice of where they are treated will increase patient satisfaction in the NHS?

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[Greg Mulholland (Leeds North West) (LD)]

rose—

[Mr Speaker]

I will call the hon. Gentleman if his question consists of one sentence.

[Greg Mulholland]

Leeds has a shortage of integrated care beds and pressure on acute services. Will the Secretary of State—[Interruption.] That was a comma, Mr Speaker. Will the Secretary of State please intervene, so that Leeds Teaching Hospitals NHS Trust can open wards at Wharfedale hospital, which it wants to do, while the clinical commissioning group provides the money?

[Mr Jeremy Hunt]

I am very happy to look at that.

[Mr Speaker]

Well done.

[Andrea Jenkyns (Morley and Outwood) (Con)]

By refusing to condemn the junior doctors strike, the hon. Member for Lewisham East (Heidi Alexander) has shown that she has little regard for patient safety. [Interruption.] Will my right hon. Friend repeat his condemnation of this strike, which will seriously endanger patient safety, and assure me that he will continue to press for the new contracts, which will guarantee safer patient care and a better contract for doctors?

[Several hon. Members rose—]

[Mr Speaker]

I am sorry, but demand is so high. Last but not least, I call Kevin Barron.

[Kevin Barron (Rother Valley) (Lab)]

The 6% cut in the pharmacy budget will come in in October—halfway through the next financial year. Will the Minister tell us what the percentage cut will be in a full financial year?

[Several hon. Members rose—]

[Mr Speaker]

Apologies to colleagues. I did stretch the envelope as far as I could, but we must move on.

Junior Doctors’ Contract Negotiations

John Bercow Excerpts

Monday 8th February 2016 Commons Chamber

[Several hon. Members rose—]

[Mr Speaker]

I am sure that nobody who toddled into the Chamber after the urgent question started would expect to be called. That would be quite out of keeping with our parliamentary traditions. I think I need say no more.

[Crispin Blunt (Reigate) (Con)]

I wonder whether the Minister can help me. The messaging I have heard from the BMA is that the dispute is nothing to do with pay. We have heard the issue described as a “nut” by the shadow Secretary of State, yet it has led to a national strike for the first time in 40 years and we face industrial action again. What is going on here?

NHS Trusts: Finances

John Bercow Excerpts

Monday 1st February 2016 Commons Chamber

[Ben Gummer]

I know that the Under-Secretary of State for Public Health was in Whiston last year. I was in Manchester a few weeks ago, and I plan to go back there and to the north-west in the next few weeks. I will be doing a regional tour, and I would very much like to meet the hon. Lady and talk to her trust’s chief executive. She raises an interesting point, which is that chief executives in many trusts across the NHS are of exceptional quality. It is often easy to knock managers in the NHS, but there are some fantastic managers, and I am sure that her constituency has one.

[Mr Speaker]

I say to the Minister in all friendliness that I hope the region is aware of his upcoming tour. It sounds a most exciting prospect.

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

Will the Minister think carefully about what has happened up and down the country? Health trusts such as mine in Calderdale and Huddersfield have run successfully for many years, but recently—I think this is something to do with the destabilisation of clinical commissioning groups—many problems have entered into the general life of those trusts. In Huddersfield we do not want the closure of A&E in our hospital, or the closure of the main hospital and its replacement by a much smaller one. Will the Minister look carefully and forensically at what has happened in the Huddersfield and Calderdale area? It is not just the whipping boy of the unfortunate independent financial arrangement that was negotiated under John Major but signed under Tony Blair.

Access To Medical Treatments (Innovation) Bill

John Bercow Excerpts

Friday 29th January 2016 Commons Chamber

[Nick Thomas-Symonds (Torfaen) (Lab)]

I beg to move, That the clause be read a Second time.

[Mr Speaker]

With this it will be convenient to discuss the following:

New clause 2—Identifying evidence on off-patent repurposed drugs and passing to relevant bodies—

(1) The Secretary of State shall require the National Institute for Health Research to develop and introduce a mechanism for—

(a) gathering and recording existing evidence on off-patent, repurposed drugs, including clinical trial evidence, and

(b) passing this information to relevant bodies.

(2) The Secretary of State shall determine the relevant bodies under subsection (1) and may revise that determination from time to time.

New clause 3—Appraisal in new indications—

(1) Where there is an off-patent, repurposed drug with strong evidence of its effectiveness in a new indication, the Secretary of State shall direct the National Institute for Health and Care Excellence (NICE) to conduct an appraisal in relation to the drug in its new indication.

(2) An appraisal under subsection (2) should include a cost-effectiveness analysis.

New clause 4—National commissioning policy for off-patent new drugs—

Where there is an off-patent, repurposed drug with strong evidence of its effectiveness in a new indication, the Secretary of State shall require NHS England to produce and disseminate a national commissioning policy.

New clause 5—Accessibility of the licensing process—

(1) The Secretary of State shall require the Medicines and Healthcare products Regulatory Agency to consult key stakeholders about steps to be taken to make the licensing process more accessible to organisations or individuals other than pharmaceutical companies.

(2) For the purposes of subsection (1), key stakeholders shall include, but not be limited to—

(a) patient organisations,

(b) medical research charities,

(c) relevant academics, and

(d) the British Generic Manufacturers Association.

New clause 6—British National Formulary: inclusion of off-patent drugs—

The Secretary of State shall require NICE and the British National Formulary (BNF) to review their processes for registering off-label uses of repurposed drugs where there is strong evidence of their effectiveness.

Amendment 10, in clause 1, page 1, line 3, after “treatments” insert “(including treatments consisting in the off-label use of medicines or the use of unlicensed medicines)”

Amendment 13, in clause 5, page 3, line 44, at end insert—

“(1A) For the purposes of section 2(2), the kinds of medical treatment that may be innovative medical treatments include (amongst other things)—

(a) the off-label use of an authorised medicinal product, and

(b) the use of a medicinal product in respect of which no marketing authorisation is in force.

(1B) In subsection (1A)(a), the reference to the off-label use of an authorised medicinal product is a reference to the use of the product—

(a) for a purpose other than one for which its use is specified,

(b) in relation to a person who is not within a description of persons for whom its use is specified, or

(c) in any other way in which its use is not specified.

(1C) In this section—

(a) ‘authorised medicinal product’ means a medicinal product in respect of which a marketing authorisation is in force;

(b) ‘marketing authorisation’ and ‘medicinal product’ have the same meanings as in the Human Medicines Regulations 2012 (S.I. 2012/1916);

(c) ‘specified’, in relation to a medicinal product, means specified in its marketing authorisation.”

[Nick Thomas-Symonds]

These new clauses and amendments, which I support, relate to off-patent drugs. I think it would be useful for me briefly to set out the context in which they arise. The Off-patent Drugs Bill, a private Member’s Bill that I introduced—it was debated on Second Reading on 6 November—is a UK-wide Bill that would create a duty on the Government to make cheap drugs available when pharmaceutical companies had no incentive to do so. The problem, put simply, is that if a drug is shown to be useful for a new purpose after its original patent has expired, a pharmaceutical company has no financial incentive to sponsor that off-patent treatment through the processes normally used to license it and ensure its adoption on the NHS. Those off-patent or off-label treatments are certainly available at low cost. The issue is simply that although clinicians can of course prescribe them, they tend not to be prescribed consistently across the medical sector, or indeed geographically.

The Off-patent Drugs Bill ran out of time that day, but I think it is accurate to say that the Government supported its aims but not the mechanism it proposed. None the less, in recognising that there is a problem, and with a shared position on both sides of the House on the need to encourage greater consistency in off-label prescribing, a lot of work has since been done, and on a cross-party basis. I am proud that new clause 1 stands in the name of Members from no fewer than eight political parties. The concept of encouraging greater use of off-patent drugs, and indeed my Bill, have significant support across the House and outside. I pay tribute to Jonathan Evans, the former Member for Cardiff North, who first introduced such a Bill in 2014. His successor, the current Member for Cardiff North (Craig Williams), has also supported my Bill.

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[Rebecca Harris (Castle Point) (Con)]

rose—

[Mr Speaker]

Order. The hon. Lady had wished to contribute but toddled out of the Chamber at the appropriate moment. I would have called her but did not because she was not here. Does she still wish to speak?

[Rebecca Harris]

Very briefly, Mr Speaker.

I support the Bill and commend all those who have worked towards it in the many iterations it has been through in this House and the other place—I can see that Members of the other place are taking an interest in our proceedings today.

I am chairman of the all-party parliamentary group on brain tumours. Brain tumour research has desperately lagged behind other areas of cancer research, and we desperately need to find new sources of treatment. Sadly, brain tumour is still the biggest cancer killer of the under- 40s—children and young adults. The Bill could be a great step forward in the sharing of information.

I commend the Minister, as all hon. Members have. Without wishing to sound too toadying, we have a Minister who is committed to taking forward progress on research in a way that we have not seen previously.

It should be pointed out that the NHS is a superb innovative organisation that does huge amounts of research. We do not hear that said often enough of the NHS. From my point of view, the most important bit of the Bill is the database, which will mean we can take forward the research we do in the NHS so that people can have access to information—not just patients, but clinicians, who might not know as much as we or they would hope. I very much hope the Bill makes progress.

NHS (Charitable Trusts Etc) Bill

John Bercow Excerpts

Friday 22nd January 2016 Commons Chamber

[Michael Tomlinson (Mid Dorset and North Poole) (Con)]

I beg to move amendment 4, page 1, line 15, after “may” insert “after appropriate public consultation”.

[Mr Speaker]

With this it will be convenient to discuss the following:

Amendment 1, page 1, line 17, at end insert—

“(2A) The Secretary of State may by order or regulations made by statutory instrument make such provision as the Secretary of State considers appropriate to re-establish the Secretary of State’s powers to appoint trustees in respect of—

(a) one,

(b) more than one,

(c) a type, class or category of, or

(d) every

(2B) A statutory instrument containing an order or regulations under subsection (2A) which amends or repeals primary legislation (whether alone or with other provision) may not be made unless—

(a) a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament, and

(b) a draft of the order or regulations was published three months before laying before Parliament.”

Amendment 3, page 1, line 21, at end insert—

“(bA) provision for one trustee to be appointed by the NHS institution, service or function for whose benefit the charitable trust exists,”.

Amendment 2, page 2, line 1, leave out “and” and insert—

“(cA) provision by which the Secretary of State may appoint one or more trustees where—

(i) the Secretary of State has satisfied himself that exceptional circumstances exist, or

“(ii) all the trustee positions in relation to a particular charitable trust have been vacant for a period exceeding three months, and”.

Amendment 5, page 2, line 4, leave out “Subject to subsection (5)”.

Amendment 6, page 2, line 7, leave out subsections (5) and (6).

Amendment 7, clause 2, page 3, line 14, at end insert—

“(8A) A statutory instrument under subsection (8) may not be laid before either House of Parliament without an accompanying statement by the Comptroller and Auditor General that he is satisfied with the treatment of public assets and funds envisaged in the regulations contained within such an instrument.”

Amendment 8, page 3, line 13, leave out subsection (8) and insert—

“( ) A statutory instrument containing regulations under subsection (1) may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.”

Amendment 9, schedule 1, page 9, line 9, at end add—

“(14) The Secretary of State may grant permission for—

(a) one;

(b) any number of, or

(c) a category or type of

charitable trust, established for the purposes of supporting an institution, service or function of the NHS, permission to use the NHS logo or NHS branding in their fund- raising and other communications.

(15) The Secretary of State may, having given 6 months’ notice, rescind a permission granted under paragraph 14 (the notice period may be reduced in exceptional circumstances).”

[Michael Tomlinson]

I want to focus on amendments 4, 5 and 6, which stand in my name and that of my hon. Friend the Member for Erewash (Maggie Throup). Amendment 4 deals with the need for a public consultation; amendments 5 and 6 remove the requirement for the draft to be laid before, and approved by, each House.

I shall turn first to amendment 4 and the principle behind it. It inserts

“after appropriate public consultation”

in clause 1, page 1, after “may” in line 15. It seeks to oblige the Secretary of State to carry out a public consultation that he considers appropriate before making regulations. The principle of a public consultation should be relatively uncontentious. After all, the origins of the Bill being ably presented to the House by my hon. Friend the Member for Aldridge-Brownhills (Wendy Morton), which I fully support, were found in public consultation. The Department of Health conducted a review in 2011, and consulted publicly in 2012. The 2012 consultation set out the rationale for reform. As a result of that consultation and review the Government committed to move to a model of greater independence.

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[Michael Tomlinson]

Again, with respect to my hon. Friend, may I say that she is repeating a point she made before? I did accept that this money would have to come out of the public purse, but I am seeking to persuade her and other hon. Members that the benefits of public consultation will outweigh the costs. I am giving a good example, or at least I hope I am, about fairer funding. I hope she will agree that having fought and campaigned for fairer funding for our schools, for example, those in Dorset and Poole, which are grossly underfunded, it is right that the public and the stakeholders are consulted. It is right that parents, local authorities, school governors and the general public are consulted, and I encourage everyone to respond to that consultation to ensure that we—

[Mr Speaker]

Order. I gently exhort the hon. Gentleman to consider the merits of moving on to one or other of the two other amendments that he has for consideration. I would not want him to be led astray by someone, discontented with his previous answer, somehow feeling that he requires to attend to the point beyond what he has already done. The hon. Member for South East Cornwall (Mrs Murray) has made her point and he has made his, and I know that he would not want to engage in tedious repetition.

[Michael Tomlinson]

I am very grateful for that guidance, Mr Speaker.

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[Mr Speaker]

That would be entirely orderly and would involve no repetition. The hon. Member for North East Somerset (Mr Rees-Mogg) has done us a service in reminding us that his question has, thus far, been unanswered.

[Michael Tomlinson]

In which case, let me turn to that very point. As my hon. Friend rightly says, my amendment 4 contains the word “appropriate”. We can all envisage inappropriate public consultations. I again contend that this term should be relatively uncontroversial, because we all know what it means. An inappropriate consultation would be too short or would take place over a festive period such as Christmas, when either people would not have the opportunity to respond or an insufficient number would have the opportunity to do so. Although I welcome the opportunity to expand on the word “appropriate”, I believe it is pretty obvious what it means.

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[Mr Rees-Mogg]

That is absolutely right, but I think that slipped in is a perfectly fair phrase on Fridays, because the debates then tend to be quiet and relatively poorly attended. However, it is nice to see our Benches so full and well trooped, if I might say so, by people who are in the Chamber to support the Bill. I am rather surprised that our friends from Scotland are all absent, but I suppose that the Bill does not immediately affect them, at least not in the first half.

I want to move on to the comparison between the amendment getting rid of the affirmative route for statutory instruments and the one on public consultation. It seems to me to be an extraordinary approach to take to say that when a regulation is changed by the Secretary of State, it is better that it should be consulted on with a group of self-selecting individuals who take the time to get in touch, taking away the ability of this House to act as that safeguard and check. Surely we are here, with a democratic mandate, as the main people to be consulted on behalf of our electorate, to whom we have to report every so often. Issues should not be put out to local consultation, which, as my hon. Friend the Member for North West Hampshire (Kit Malthouse) said, is often more of a fig leaf and an attempt to consult and either achieve a result that is already intended. If not, the consultation is ignored. Consultation has become immensely fashionable and we should always be cautious of fashion. Fashion ebbs and it flows, it comes and it goes, but there is a permanence to this House and in our way of doing things. We are the democratic sounding board for our constituents, so that there are not endless self-selecting consultations with people who are not necessarily particularly interested in the issue.

[Mr Speaker]

Order. If the hon. Gentleman himself has ever been fashionable, which is in itself extremely doubtful, it can only have been by accident.

[Mr Rees-Mogg]

Mr Speaker, as always, you are correct. I think that I would take being called fashionable as a grave insult, although I know that your ties are regularly a model of fashion.

Oral Answers to Questions

John Bercow Excerpts

Tuesday 5th January 2016 Commons Chamber

[The Minister for Community and Social Care (Alistair Burt)]

NHS England has assured local transformation plans that cover all clinical commissioning groups, ensuring that all the plans address the full spectrum of need for all children and young people, including looked-after children and those who have been sexually abused and/or exploited. Further thematic analysis is being carried out, and the results will be made available in March.

[Mr Speaker]

I think it is a case of wishing the hon. Gentleman a happy birthday.

[Philip Davies]

Thank you very much, Mr Speaker—much appreciated.

Children who have suffered the trauma of abuse may benefit from a range of therapeutic services, but there is a lack of consistent data about the number of abused children in need of therapeutic support and the number of services available. Can the Minister assure me that as part of plans to transform children’s mental health, the needs of abused children will be properly monitored and considered at every level?

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[Martyn Day (Linlithgow and East Falkirk) (SNP)]

T9. Yesterday, the Minister’s offer to junior doctors had still not dealt with the important issue of weekend working and appropriate compensation. As a result, doctors in England will be forced to strike and the Minister will have damaged the patient safety he claims to value. Instead of attacking consultants and junior doctors, will he follow the example of the Scottish Government and work with the medical profession to help the NHS face the challenges of increased demands and private finance initiative-induced deficits?

[Mr Speaker]

Project, man, project! We wish to hear the full gist of what the hon. Gentleman has to say to the House.

[Mr Jeremy Hunt]

We absolutely will work with the medical profession to have proper seven-day services throughout the NHS in England. I hope that the hon. Gentleman and Scotland, which has the same issues with weekend mortality rates, will follow the lead of NHS England.

Mental Health

John Bercow Excerpts

Wednesday 9th December 2015 Commons Chamber

[Mr Speaker]

I can inform the House that the amendment has not been selected.

Cities and Local Government Devolution Bill [Lords]

John Bercow Excerpts

Monday 7th December 2015 Commons Chamber

[The Parliamentary Under-Secretary of State for Communities and Local Government (James Wharton)]

I beg to move, That the clause be read a Second time.

[Mr Speaker]

With this it will be convenient to discuss Government amendment 51.

[James Wharton]

First, I should put on the record my gratitude and that of my colleagues for the representations made by hon. Members who were keen to see the new clause included in the Bill, and to support and empower their local national parks authorities to do the best job they can and to continue to contribute to the communities they represent. In particular, I am grateful to my right hon. Friends the Members for New Forest East (Dr Lewis) and for New Forest West (Mr Swayne) and my hon. Friends the Members for Thirsk and Malton (Kevin Hollinrake), for Penrith and The Border (Rory Stewart), for Berwick-upon-Tweed (Mrs Trevelyan) and for Richmond (Yorks) (Rishi Sunak). I would like to add Councillor Gareth Dadd of North Yorkshire County Council, who made strenuous efforts to convince us of the merits of these changes and kindly arranged for me to meet representatives of the North Yorkshire national park authority and National Parks England.

In the light of this weekend’s flooding, I think it important to reiterate the comments of my right hon. Friend the Secretary of State for Environment, Food and Rural Affairs in the statement that we have just heard, and I offer my sympathy to the people of Cumbria and other affected areas in recognition of the significant impact of what has happened there as a result of the unprecedented weather events.

Before speaking expressly to the content of the new clause and amendment, I would like to say a few words about the role of the national park authorities in water management in the context of what has happened this weekend, and about how the changes might assist them in further performing that role. Although national park authorities do not have responsibility for emergency planning, the planning decisions they make and the development control conditions they enforce can make a big difference to the demands placed on those who do have to respond during an emergency.

National parks have an important role to play in managing the water environment and helping with restoration work. For example, the floods of November 2009 caused severe damage to the rights-of-way network in Cumbria and the Lake District national park. Over 250 bridges were damaged or destroyed and 85 paths needed repair. The function-specific general power of competence that we are discussing with these amendments could be used to enhance the national park authorities’ ability to respond to flood emergencies by enabling them to enter into partnerships, to develop skills and capacity within small rural communities and businesses to assist with the responses needed, to develop specific skills to combat future flood management, and to adapt the network to improve flood resilience.

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

rose—

[Mr Speaker]

Ah, what a rich and delicious choice! I call Mr Robert Neill.

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[Peter Heaton-Jones]

rose—

[Mr Speaker]

Order. The right hon. Member for New Forest East (Dr Lewis) has for some minutes now been poised rather like a sprinter, but he suffers from one disadvantage relative to the hon. Member for North Devon (Peter Heaton-Jones), whose constituency houses Exmoor, namely that the right hon. Gentleman beetled into the Chamber a little after the hon. Gentleman. We will reserve the right hon. Gentleman as a specialist delicacy and reach him in due course.

[Peter Heaton-Jones]

Thank you, Mr Speaker, and I have never felt disadvantaged by my right hon. Friend the Member for New Forest East (Dr Lewis).

As you correctly point out, Mr Speaker, one third of Exmoor national park is in North Devon, and a beautiful part of the world it is. Before I go on with my prepared remarks, which I admit are pretty much a verbal tourist brochure, let me say that I do not recognise a lot of what was said from the Opposition Front Bench about the new clause, particularly the comments about its being slipped in and about insufficient time being given to speak to national park authorities. I, in common with all my hon. Friends, I am sure, had no notice at all. I was first alerted to the wording of the new clause on Thursday afternoon, and since then I have had time to have a detailed email correspondence with the chairman of Exmoor national park, Councillor Andrea Davis, my office has spoken at great length to managers at National Parks UK and two hours ago I came off the phone from a lengthy conversation with the chief executive of Exmoor national park, Dr Nigel Stone. If I can do that, I am sure that with all the voluminous resources available to them, those on the Opposition Front Bench should surely have been able to make some cursory inquiries about what the new clause is all about. It appears that they failed to do so.

Having spoken to those people, I can say that it is the national park authorities and managers who want this to happen. Opposition Members do those national park managers a great disservice by alleging some of the things that they are. They imply that in asking for the new clause those managers will in some way use the powers for nefarious purposes. Nothing could be further from the truth. Opposition Members need to be careful about what they are alleging because in my experience national park managers have nothing but the best intentions for managing our national parks, particularly in Exmoor.

That leads me on to extolling the virtues of Exmoor and why new clause 7, in particular, will be so valuable. One third of the national park is in my constituency and it includes the beautiful, rugged coastline that not only provides opportunities for many leisure activities but is very important for our environment and ecosystem. In the conversations I have had with them, the chairman and chief executive of Exmoor national park have been absolutely adamant that Exmoor in particular would benefit from the measures included in the new clause. Let me give some specific examples of why they believe that it would be beneficial and why they welcome it.

First, there is great pressure on the provision of housing for local communities in Exmoor and other areas of North Devon. Until now, national park authority managers have been hamstrung in the conversations they have been able to have with developers to ensure arrangements for local, affordable housing. Nevertheless, the new clause is not a carte blanche to say that all development will be allowed, and, as the Minister rightly said, nothing in it will allow that to happen.

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[Mr Graham Allen (Nottingham North) (Lab)]

I beg to move, That the clause be read a Second time.

[Mr Speaker]

With this it will be convenient to discuss the following:

New clause 2—Local Government Constitutional Convention: terms of reference—

“The convention must consider the following terms of reference—

(a) the devolution of legislative and fiscal competence to local authorities within the United Kingdom;

(b) the reform of the electoral system for local government;

(c) constitutional matters relating to local government to be considered in further conventions; and

(d) procedures to govern the consideration and implementation of any future constitutional reforms in relation to local government.”

This new clause creates the means by which every UK citizen can engage in a national public discussion of devolution, local government, governance and electoral systems and make recommendations and receive a response from government and parliament to that national debate.

New clause 3—Local Government Constitutional Convention: recommendations—

“(1) The Local Government Constitutional Convention must publish recommendations within the period of one year beginning with the day appointed under section (Local Government Constitutional Convention).

(2) The Secretary of State must lay responses to each of the recommendations before each House of Parliament within six months beginning with the day on which the recommendations are published.”

This new clause creates the means by which every UK citizen can engage in a national public discussion of devolution, local government, governance and electoral systems and make recommendations and receive a response from government and parliament to that national debate.

New clause 4—Local Government Constitutional Convention: composition—

“(1) The Local Government Constitutional Convention must be composed of representatives of the following—

(a) registered political parties within the United Kingdom,

(b) local authorities, and

(c) the nations and regions of the United Kingdom.

(2) At least 50% of the members of the convention must not be employed in a role which can reasonably be considered to be political.”

This new clause creates the means by which every UK citizen can engage in a national public discussion of devolution, local government, governance and electoral systems and make recommendations and receive a response from government and parliament to that national debate.

New clause 5—Commission on devolution of fiscal powers and taxation—

“(1) The Secretary of State shall appoint a commission on devolution of fiscal powers and taxation to local authorities.

(2) The Commission shall consider the following issues—

(a) the desirability, impact and process necessary to implement an Income Tax rate of 10p in the pound on English tax payers;

(b) the desirability, impact and process necessary to give English Councils the same fiscal and taxation powers as those devolved to the Scottish Parliament in the 2012 Scotland Act, and

(c) any other issues that the Commission considers relevant.

(3) The Commission shall produce a report covering the issues listed in subsection (2) no later than 31 December 2017, and shall make such recommendations to the Secretary of State as it deems necessary.”

This new Clause would establish a Commission to consider the possibility of England local authorities being granted the same fiscal and taxation powers already devolved to Scotland in the Scotland Act 2012.

New clause 8—Combined authority functions: cool off period—

“(1) The Secretary of State shall amend any order made under a provision of this Act which transfers a power to exercise of a function from a constituent part of a combined authority to a combined authority, to devolve responsibility for that function back to a constituent part of that authority, if the following conditions are met—

(a) A constituent part of a combined authority requests that the Secretary of State amend an order to return responsibility for the exercise of a function to the constituent part of the combined authority from the combined authority, and

(b) Such a request is made within one year of the first local government election held in the constituent part of the combined authority since the original order was made.”

The intention of this amendment is to create a cooling off period for the transfer of any power to the level of a combined authority. If a constituent part of a combined authority requests that a power is returned to it within one year of next elections held in the constituent part, then the Secretary of State must amend the relevant order to return power to the constituent part.

New clause 10—Governance arrangements for local government: entitlement to vote—

“In section 2 of the Representation of the People Act 1983 (local government electors), in subsection (1)(d) for “18” substitute “16””

This Clause would re-instate the provision in the Bill, as brought from the Lords, allowing votes for 16- and 17-year olds in local government elections.

New clause 11—Review of fire and rescue services in combined authorities—

“(1) The Secretary of State must, within 15 months of this Act being passed, publish a review of the fire and rescue services affected by the provisions of this Act.

(2) The review must make an assessment of the extent to which the provisions of this Act affecting fire and rescue services have worked safely and efficiently for the protection of the public over the first 12 months from this Act being passed.”

This Clause would require a review, after 12 months of the Bill being passed, of the fire and rescue services to make sure the new system is working safely and efficiently for the protection of the public.

New clause 13—Fiscal and financial powers—

“Within six months of the passing of this Act, the Secretary of State must publish plans for further devolution of fiscal powers to local authorities in England, including—

(a) an equalisation model related to the retention of business rates, to ensure local authorities with lower business rate income are not negatively impacted;

(b) greater local authority control over local tax rates and discounts;

(c) provision for combined authorities to set multi-year finance settlements.”

This new clause allows the Secretary of State to ensure devolution continues beyond current devolution deals by setting out plans for further fiscal devolution and greater local freedom and stability in relation to budgets and tax rates. The clause also ensures a model is put in place to ensure authorities with lower business rate income do not lose out from the phasing out of central government grants.

New clause 14—Cooperation with peripheral authorities—

“No later than three months after the passing of this Act, the Secretary of State shall publish guidance to be considered by combined authorities while exercising a devolved function, in order to—

(a) have regard for any significant direct impact of decisions taken by the combined authority on neighbouring authority populations;

(b) encourage cooperation between combined authorities and their neighbouring authorities so as to encourage local growth;

(c) enable greater economic cooperation between combined authorities and their neighbours within a travel-to-work area.”

This new clause asks the Secretary of State to publish guidance to ensure neighbouring authorities are considered when devolved functions are exercised, and encourage economic cooperation between authorities within a regional economy or travel-to-work area.

Government amendments 4 to 6.

Amendment 58, in clause 2, page 2, line 10, at end insert—

“( ) The transfer of local or public authority functions to combined authorities shall not be dependent on an order being made under subsection (1).”

This amendment makes clear that devolution deals must not be dependent on a combined authority having a mayor.

Amendment 2, page 2, line 13, at end insert—

“(2A) An order under subsection (1) may not be made unless the proposition that the combined authority have a mayor is approved by a referendum of the electorate of that combined authority.

(2B) The Secretary of State shall, by regulations, establish the procedures to be followed in conducting a referendum under subsection 2A.

(2C) Before making a regulation under subsection 2B, the Secretary of State must consult the Electoral Commission.”

The intention of this amendment is that elected mayors will be introduced only if that proposal has been approved by a referendum of the residents of the combined authority. The rule for the conduct for such a referendum shall be made by the Secretary of State, in consultation with the Electoral Commission.

Amendment 57, page 2, leave out lines 21 to 26 and insert—

“(7) An order under this section providing for there to be a mayor for the area of a combined authority may be revoked or amended by making a further order under this section; this does not prevent the making of an order under section 107 abolishing the authority (together with the office of mayor) or providing for a constituent part of the combined authority to leave the combined authority and to resume its existence as a separate local authority.

(7A) An order under this section providing for a constituent part of the combined authority to leave the combined authority and to resume its existence as a separate local authority must make fair provision for a reasonable and proportionate division of resources between the former combined authority and the seceding local authority.

(7B) Where a combined authority has entered into a contractual arrangement with a third party and an order under this section is made to enable a constituent part of a combined authority to resume its existence as a separate local authority, that separate local authority shall be deemed to be a contracting party to that agreement unless an alternative agreement is reached with the third party.”

The intention of this amendment is allow for a constituent part of a combined authority to leave a combined authority without the combined authority being dissolved, with provision for “fair terms” for the leaving party (i.e. their resource is calculated on a per capita basis, or similar.) and the impact this may have on contractual arrangement with third parties.

Government amendments 7 to 25.

Amendment 59, in clause 10, page 12, line 32, at end insert—

“(1) Within 6 months of the passing of this Act, the Secretary of State must publish a report on the performance of the Localism Act 2011 and a review of the general power of competence provision in relation to its use by combined authorities.”

This amendment introduces a review of the use of the general power of competence by combined authorities.

Government amendments 26 to 29.

Amendment 1, in clause 15, page 17, line 7, at end insert—

“( ) all local authorities in a mayoral combined authority commencing a community governance review of their whole local authority area within two years of this Act coming into force.”

This amendment introduces further measures to support the creation of new local councils with mayoral and combined authorities required to conduct a community governance review within two years of the Act coming into force.

Amendment 56, page 17, line 23, at end insert—

“(4A) Regulations under this section, so far as including structural or boundary provision in relation to a non-unitary district council area, may be made if at least one relevant local authority consents.

(4B) Local authority in this case is defined as—

(a) a non-unitary district council whose area is, or forms part of, the non-unitary district council area;

(b) a county council whose area includes the whole or part of the non-unitary district council area.

(4C) Relating to 4a and 4b

(a) “non-unitary district council area” means the area or areas of one or more non-unitary district councils;

(b) “non-unitary district council” means a district council for an area for which there is also a county council;

(c) “structural or boundary provision” means provision about the structural or boundary arrangements of local authorities in regulations made by virtue of subsection (1)(c).”

The intention of this amendment is to allow the government to make changes to boundaries of local authorities if it has the consent of at least one relevant local authority.

Government manuscript amendment (a) to amendment 56, after subsection (4C), insert—

“(4D) Subsections (4A) to (4C) expire at the end of 31 March 2019 (but without affecting any regulations already made under this section by virtue of subsection (4A)).”

This amendment provides for the provisions in subsections (4A) to (4C) of clause 15, allowing structural and boundary provision in relation to a non-unitary district council area if at least one relevant local authority consents, to expire at the end of 31 March 2019.

Government amendments 30 to 33 and 36.

Amendment 3, in schedule 1, page 37, line 3, leave out paragraphs 4 and 5 and insert—

“4 (1) The mayor is to be returned under the simple majority system.”

This amendment would require the mayors of combined authorities to be elected using the simple majority system, also known as “first past the post”.

Government amendments 37 to 45, 50 and 52 to 55.

[Mr Allen]

One of the difficulties involved in the debates we have had on this so-called constitutional Bill is that they have taken place on the Floor of the House. If we were upstairs in Committee and having detailed debates about particular places and particular boundary issues, the Minister could say, “The hon. Gentleman has made a very good point. I will take it away, talk to one or two authority leaders and issue a few words of reassurance.” On the Floor of the House, however, given the rather clunky weapons at our disposal—such as a Division of the House—they become much bigger issues. I congratulate the Secretary of State and his team on bringing the devolution process to the House, but rather than it being seen as the first step of many, it is lapsing into the good old confrontational stuff that we seem to enjoy so much on the Floor of the House.

Even under that structure, however, we can do a number of things in the Chamber this evening. We need to seek a more consensual way forward and understand that devolution is an organic process and that it will evolve. Once the deals in England have been concluded, they will make progress and other demands will be made. People will see that they can do things that they could not do before. They will look at neighbours who have concluded deals and say, “I’d like to try a little bit of that. I think I’ll talk to the Secretary of State.” The Secretary of State may well suggest to some places, “Things have been done by another place that you could also do.” To other areas, the Secretary of State and/or councils may say, “Perhaps we bit off a little more than we could chew. Let’s take half a pace back, let this settle and then come forward with other proposals in the future.” That process is not very amenable to debate on the Floor of the House of Commons. Almost by definition, it is better done, first, in Committee, and secondly, by the key players—council leaders and Ministers—talking openly and transparently to take forward the process.

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[Mr Allen]

I am delighted to hear the Liberal Democrats proposing something in opposition that, sadly, they did not propose when they were a key member of the coalition Government during the past five years. Before Labour colleagues smile too much, however, the previous, Labour Government also did very little on this matter. [Interruption.] My hon. Friend the Member for Blackley and Broughton (Graham Stringer) says that they did. Obviously, I would never be so disloyal as to underline such remarks by repeating them on the Floor of the House, but—

[Mr Speaker]

Order. At any rate, the hon. Gentleman would certainly not have done so in those almost forgotten days when he was a Whip.

[Mr Allen]

Indeed, Mr Speaker. We all have scars and sins that are best left unrevealed; otherwise that can turn into rather a destructive process. If we look at the constructive process initiated by the Secretary of State, there is a way forward. To finish my answer to the right hon. Member for North Norfolk (Norman Lamb), double devolution has repeatedly been raised by colleagues from all parts of the House in different ways. Let me restate that it would be ludicrous for England to go the way of Scotland, where there is devolution down to Holyrood, but we can hear the sucking sound—Ross Perot used to hear a “sucking sound” in the United States from Mexico—of powers being sucked up from the localities in Scotland into Holyrood. We do not wish that to be repeated in England, which means, as the right hon. Gentleman said, that there must be a proper localisation of power if the devolution bandwagon and evolution are to continue.

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[Mr Graham Brady]

I beg to move, That the clause be read a Second time.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

With this it will be convenient to discuss the following:

New clause 12—Review of devolution of health services—

‘(1) The Secretary of State must, within 15 months of this Act being passed, publish a review of health services devolved under the provisions of this Act.

(2) The review must make an assessment of the extent to which the health services devolved under any of the provisions of this Act have maintained standards and, in particular, of the quality of services and outcomes achieved by those devolved health services over the first 12 months from this Act being passed.”

This Clause would require a review, after 12 months of the Bill being passed, of the impact of devolving health services in order to make sure that standards and the quality of services and outcomes have not declined.

Government amendment 34

Amendment 60, in clause 17, page 19, line 30, at end insert—

‘(2C) The Secretary of State may revoke health functions from the relevant local authority under subsection (2A) only following advice from an independent panel, whose membership must include representation from local government and the NHS and which is to be convened as and when necessary.”

This amendment would safeguard the devolution of health functions by ensuring that any revocation of these functions is done under the advice of an independent panel, whose membership includes representatives from local government and the NHS.

Government amendments 35 and 46 to 49.

[Mr Brady]

It might help if I indicate now that at the appropriate time I shall seek the leave of the House not to press new clause 8 and amendment 57. Ministers should not take that as indicating that I am entirely satisfied with the responses I have received, but I may be able to find other ways of expressing that dissatisfaction.

The immediate reason for tabling new clause 9 and why I am so concerned about this aspect of the Bill is that we already have a live example in Greater Manchester. I shall not go into huge detail, but because of the difficulties relating to the Healthier Together proposals for the reorganisation of hospital services, the matter will be decided by judicial review this week.

The new clause was tabled in the hope that we can frame the legislation in such a way that proper protection can be given to local authorities and local communities to ensure that this sort of development is not necessary in future. Should, furthermore, the judicial review overturn the existing proposals, it is important to ensure that they cannot simply be imposed in a different way.

The crucial problem is that the existing combined authority arrangements have combined the overview and scrutiny functions of individual local authorities. With the potential downgrading of the University hospital of South Manchester, for example, the usual route of going through Trafford’s or Manchester’s overview and scrutiny committee and referring the matter to the Secretary of State, asking for it to be put to an independent reconfiguration panel, was not available because the overview and scrutiny function was exercised not at the individual local authority level but at the combined authority level.

The Minister for Community and Social Care looks confused, but I assure him that when I had discussions with the Secretary of State he advised me that this was the route to be taken. I then took it to Trafford council, which said that it did not have the overview and scrutiny function and that it was exercised at the combined level. That is the nub of the problem. Significant parts of a conurbation such as Greater Manchester, which may in due course become a mayoral authority, might have no recourse, should a significant reorganisation of health services be proposed that was evidently not in the interest of the local community.

It is a simple proposition that I make in new clause 9. The Minister and I have had some extremely constructive conversations prior to this point, and I hope that he will reassure me that some measure will be introduced—if not today, via a Government amendment in the House of Lords—given that changes to these aspects of the Bill might be made through Government amendment 34. There is, I understand, a peg on which to hang that provision. All I am looking for is the simple reassurance that the Government will ensure that there will always be a route for an individual local authority to make the kind of reference that would have saved enormous cost, uncertainty and trouble in Greater Manchester had it been in place as of today. I very much look forward to hearing the Minister’s response and any reassurance that he might give.

Junior Doctors Contract

John Bercow Excerpts

Monday 30th November 2015 Commons Chamber

[Several hon. Members rose—]

[Mr Speaker]

Order. The Secretary of State is seeking to provide comprehensive and informative replies and that is appreciated. However, progress so far—and it is not entirely down to the Secretary of State, but to the length of questions—has been a bit slow. I am keen to get through everybody if possible, but I remind the House that the next debate is very heavily subscribed, so brief questions and brief answers are the order of the day. We will be led, as usual, in this matter by Gisela Stuart.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

When the Secretary of State chaired his three contingency meetings, did he take account of the fact that last year we had about 43,900 excess winter deaths, which were avoidable and largely caused by almost toxic overcrowding of emergency departments? What provisions has he made to avoid the excess deaths that we had last year and to make sure that that is not made even worse by the present situation?

[Several hon. Members rose—]

[Mr Speaker]

I call Helen Whately—[Interruption.] Order. May I gently remind Members that it is a good idea to continue to stand? One should not stand once and assume thereafter that the Chair is psychic. I had a hunch that the hon. Lady wished to contribute, but keep standing—it helps the Chair and it is also helpful exercise.

[Helen Whately (Faversham and Mid Kent) (Con)]

Thank you, Mr Speaker.

I welcome the fact that the BMA is returning to talks and that there is a potential agreement on the table. The dispute has focused on pay and hours, but I think that its roots might go deeper. For instance, juniors often do not feel valued or part of the team. Does my right hon. Friend agree that the best way to improve the situation for juniors is for them to engage in talking, rather than striking, and that talking, which they are doing, is the right choice by juniors, who are the future leaders of the NHS?

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[Marie Rimmer (St Helens South and Whiston) (Lab)]

This junior doctors dispute is not just about pay. We are very fortunate to have such marvellous junior doctors. My concern, and I know that it is their concern, is about the change to the training of junior doctors in the proposed imposed contract, which will have such a negative impact on the research and development that makes our national health service the greatest in the world. Will you comment on the impact that the change in the contract will have on training and research? Will that be altered, and if not, will you please look at it again, because that is absolutely essential?

[Mr Speaker]

I will do neither of those things, but we will soon discover whether the Secretary of State wishes to do either.

[Mr Hunt]

I hope that the hon. Lady will be reassured by the Government’s November offer, which has specific protection for junior doctors doing research that the NHS needs them to do to ensure that they are not disadvantaged by doing any such research. I am happy to write to her about the plans we have outlined.