23/05/2016 House of Commons

Hello and welcome to BBC Parliament's live coverage of the

House of Commons. The first item of business today is an urgent question

tabled by Labour's Keith Vaz on the childhood obesity strategy. After

that the Conservative MP Bernard Jenkin will ask another urgent

question on a post-EU rum assessment of the UK economy. The Chancellor of

the Exchequer publish as Treasury analysis saying a Leave vote will

cause a profound economic shock, with growth lower. MPs will spend

the rest of the day debating last week's Queen's Speech, focusing on

public services. Remember to join me for a round-up of the day in both

Houses of Parliament at 11 o'clock tonight. First we can now cross live

to the chamber for that urgent question on childhood obesity

strategy. THE SPEAKER: Order. Urgent question,

Mr Keith Vaz. Thank you Mr Speaker, will the Secretary of State provide

an answer to the urgent question of which I have given him notice?

THE SPEAKER: Minister of State, Mr Alastair Burt. Can I thank the right

honourable gentleman for the question and in the absence of the

Minister responsible for this, who is on Government business in Geneva,

a cruel twist of fate, I am pleased to respond to the question from the

right honourable gentleman. Tackling the unacceptable level of childhood

obesity in this country is a major priority for all of us in this House

and Government. We know obese children are much more likely to

become obese adults. In adulthood it is a leading cause of serious

diseases such as Type 2 diabetes, and some cancers. Tackling diet in

children is one of our mainly priorities. Evidence shows that

obesity is a complex issue to which there is no single solution.

Tackling childhood obesity needs collective action by Government,

businesses, health professionals and individuals. Our comprehensive

childhood obesity strategy, which is being launched this summer, will be

a key step forward in helping our children live healthier lives. It

will look at the range of factors that contributes to a child becoming

overwait and obese, and set out what more can be done by all. It is a

cross-Government preach led by the Department of Health, based on the

scientific evidence of Public Health England. On the views on how to

prevent obesity and Type 2 Dubai business public health England has

described this as irresponsible, as they don't reflect the totality of

the evidence base. Public Health England's dietary advice is based on

advice from independent experts, which is based on all available

evidence. SSCN conducts full scale consultation on reports and goes to

great lengths to ensure no bias. International health organisations

agree that too much saturated fat raises cholesterol, increasing the

risk of heart disease and obesity, and is caused by consuming too many

Kabul lis. THE SPEAKER: For the avoidance of

doubt and particularly for those attending our proceedings not within

the chamber, these matters should be self contained and relatively

intelligible. Mr Keith Vaz. Can I thank you Mr Speaker for granting

this urgent debate and the Minister for his answer to the question? The

National Obesity Forum's report published today has led to public

outcry and conclusion. The conclusions of this report

contradict much of the health style advice issued by the Government and

the NHS over the last decade. Ordinary people are caught in a

whirlwind of advice when they desperately need clarity,

consistency and straight talk. They don't know where the turn. The Royal

College of Physicians, the Faculty of Public Health and the British

Heart Foundation have raised concerns about this report. Some

have claimed that local authorities, schools and the NHS are receiving

guidance from organisations whose funding and motivations are not

known. I welcome the use by the Minister of the word irresponsible

in respect of this report. The critical issue however is the

delayed publication of the childhood obesity strategy. We were first told

this would be published in December 2015, and then February 2016. It is

now expected at the end of summer. You, Mr Speaker, will know doubt

confirm there is no clear indication from the Government as to what the

end of summer actually will be. Other voices are filling the void. A

strategy is clearly required on what steps are needed to prevent and

tackle the growing levels of obesity which at current rates are expected

to reach 60% of the adult population by 2015. We need a definitive date

for the publication of the strategy. Will the Minister give us a date?

Today. In the Queen's Speech last week the introduction of a sugar tax

was confirmed, which I welcome. This could prevent 2.7 million people

from being obese by 2025. Finally, Mr Speaker, obesity is a leading

cause of Type 2 diabetes, as the Minister indicated. Just as the

rates of obesity are set to increase, the number of people with

diabetes is expected to rise to 5 million by 2025. As a Type 2

diabetic and Chair of the ATP for diabetes I live with how stark the

situation is. Sadly today's information soon amy has

demonstrated a lack of leadership in public health. Although the Public

Health Minister should be commended for all the work she has done, the

Government must go further. A failure to act now will jeopardise

the future of our nation's health and the solvency of our NHS. Can I

again thank the right honourable gentleman for taking the opportunity

of the publication of this report to give the Government a chance to

respond? And hopefully to try and put in the public realm a degree of

concern about the report in order to back up the sort of comments that

he's been making. I think I can do no better at this stage than to

quote from what the chief knowledge officer of Public Health England,

Professor John instituteton said today. Suggesting people should eat

more fat, cut out carbs and eat more calories conflicts with the broad

evidence base and internationally agreed interpretations. He goes on

to say, this opinion paper from the National Obesity Forum is mot a

systemic review of all the rel ant elements. It does not include the

methodlogical studies and should not be confused with the evidence

produced by our process. This paper highlights one trial suggesting high

dairy intake reduced the incidents of obesity while ignoring

29 trials which concluded that increasing dairy did not increase

the risk of weight gain. I am pleased he has provided the

opportunity for us to agree with him and others that have said this

report is irresponsible. To turn, if I may, to his questions in relation

to Government, it is absolutely clear that the childhood obesity

strategy will be much welcomed, has got to be soundly based. I have much

as I would like to give the right honourable gentleman a date, I have

to say that its launch will indeed be in the summer. The summer is

indeed in parliamentary terms a flexible period. I shouldn't in

saying that in any way minimise the importance of it to my right

honourable gentleman. The presence of the honourable gentleman for

Crewe and Nantwich demonstrates this is a cross-Government strategy.

Strategy. We know it will be much looked at by many different parties

in order to give the guidance that the right honourable gentleman was

talking about. You can look at any national newspaper any day in the

week, one in particular, and get regular conflicting advice on what

is good and what is bad. While that might be a source of amusement at a

news programme, for parents looking at what's right for their children,

it is important they have advice they can trust. That's why the

childhood obesity strategy, much commented on in this place, is so

important. In relation to diabetes and the right honourable gentleman

is an important voice in terms of dealing with diabetes, just to say

that the healthier you, the national diabetes prevention programme, based

on international evidence, will start this year in 27 areas,

covering approximately 45% of the population and making up to 10,000

places available to people at high risk of developing diabetes, and

will roll out to the whole country by Twenty20. The right honourable

gentleman is right to raise the importance of diabetes. I hope he

will recognise that it is recognised very much by the Government.

THE SPEAKER: Mr David Nuttal. Thank you. Does my right honourable friend

agree instead of having this conflicting nanny state advice it

would be far better if children were simply advised to move about more

and eat less? Well, I am delighted to welcome the question from my

honourable friend for Bury North, may God bless all who live there. I

had a short bet with the Secretary of State how long it would be before

the words nanny state emerged. I wasn't disappointed. But just to

say, my honourable friend's question is absolutely right. We still want

to encourage children to move more and eat less. That's nothing

contradictory. But there are, it is clear that it is important, a

Government that takes the issue of its children's health importantly,

whether it is in relation to dentistry, in relation to

deprivation and environment, or in relation to their physical health,

weight and wellbeing, it is everybody bit as entitled to make a

comment on this as anybody else. Whilst encouraging that physical

activity that the honourable gentleman talks about, the childhood

obesity strategy won't contradict that. I hope there'll be parts in

this he and everyone in Bury North will genuinely welcome. Thank you Mr

Speaker, obesity and in particular childhood obesity is one of the

biggest public health challenges facing our country. So today's

report not only questions official Government advice but it says that

it may have had disastrous consequences. Whether that is right

or wrong is a matter for debate. So let me start by asking the Minister

about today's report. It makes a number of recommendations, but

perhaps the most credential has been the call to stop recommending the

avoidance of foods with a high saturated fat

content. And I am pleased he has also

reaffirmed the evidence on the current dietary advice remains

valid, but does he share the views of experts including the British

Heart Foundation who have today stressed the importance of official

guidance being informed by" robust evidence free from interference by

industry"? Turning to the childhood obesity strategy, as my right

honourable friend has said, in September we were told it would be

published book for -- before Christmas and then at the New Year,

then in the New Year we were told it would be published in the spring,

and now we are told it will not be published until the summer. Can the

Minister come to the dispatch box and explain this delay? Can we now

have a cast-iron guarantee that the strategy will be published before

the House prizes for the summer recess, so members will have the

chance to question ministers on the contents of that strategy? We

welcome the recent announcement of a sugar tax but does the Minister

agree that alongside action on cost we also need action on advertising

and labelling because perhaps the real cause of rising childhood

obesity has not been the Government's dietary guidance but

their failure to take tough action on the marketing and packaging of

unhealthy products? Will the Minister confirm the strategy will

contain comprehensive and quarter native action to tackle this growing

public health challenge? -- coordinated action. Some of the best

advances in public health have been because past ministers have shown

leadership and vision. Enough of the delay. It is now time to act. Well,

Mr Speaker, I am quite sure my honourable friend, the member for

Battersea, will be able to pick up a number of issues that honourable

gentleman has made, but in response to some, firstly, in relation to the

report itself, as I emphasised by putting the remarks from Public

Health England, it is absolutely essential that any advice that goes

out into the public domain, which is to have any credibility and upon

which people should want to rely, it has got to be fully evidence -based

and researched as thoroughly as possible. If there is any doubt

about that, if the evidence appears scant, it is quite right such advice

should be dismissed as a responsible and we should continue to urge

people to look at for more in-depth studies and that generally -- into

generally accepted international views on health and well-being. I

made that point and I am pleased that honourable gentleman agreed. In

relation to the Government's activity, as I said, the childhood

obesity report will come forward and the strategy will come forward in

due course. But in the meantime, the sugar tax has been taken forward,

and I can assure the honourable gentleman that looking at

advertising, labelling and promotion definitely comes into the strategy

and will be looked at. I am quite sure, having spoken to my right

honourable friend the Secretary of State, the intention is to get this

report out at a time when the House will be able to consider it and

there is little likelihood of the house not having an opportunity to

discuss and debate such an important matter but it is important to get it

right. It is important it needs exactly the challenges the

honourable gentleman has made from across the dispatch box because if

it is not seem to be thorough, well researched and well evidenced, it

would fall foul of the sort of concerns were dealing with in

dealing with this irresponsible report today. I am grateful for the

honourable gentleman's support of something we all want to see and I

can assure my honourable friend we will be studying his remarks

closely. Can I join my honourable friend from Bury North in urging to

curb the Department of Health's natural nanny state instincts when

it comes to childhood obesity strategy? If they sugar tax is part

of that childhood obesity strategy, perhaps he can explain why the tax

is being directed at a certain number of products when other

products with far more sugar in them are not going to be covered by the

sugar tax? Can I ask him to abandon this policy and encourage the

Chancellor to abandon this policy before it becomes the new pasty tax

policy? Tempting though it is to use my temporary position for a whole

range of announcements in relation to this area, I think it would be

unwise. I have my honourable friend on an accumulator with his

honourable friend and I am not saying who is the final part of

that... But the Government will stick to its declared policy in

relation to sugar Ray drinks but I should also say perhaps he might

welcome that all the money for that -- from that is going into physical

activity and sports in schools which I know it's something he is really

keen on as well -- sugary drinks. Thank you, Mr Speaker. The

honourable member mentioned the importance of evidence -based

research in the strategy put forward. Can I ask, when this was

last debated on the 20th of January, it was brought up that it looked at

evidence breast-feeding can contribute, because the evidence is

there and makes as it never can contribute I would like to ask the

Minister if this will get prominence in the report when it comes to

published? Yes, I am very conscious of the issues surrounding this and I

know the honourable lady already has a meeting with the Minister

responsible for this area when these issues can be furthered. Height I

welcome the Government's words on the childhood obesity strategy and

the necessity to make sure it is authoritative when it is published,

but is the real point in the light of today's unhelpful reports not

that it is absolutely critical that that strategy actually deals with so

many of the myths out there? That it is truly authoritative and

conclusive when it does report? My honourable friend is absolutely

right. It is important. The strategy has been awaited and we know this.

If it is to do the job and wanted to do, it should also deal with the

myths and concerns raised and do so any proper evidential manner so I

thank my honourable friend for his question. -- do so in a proper. Can

I join any partial and rather surprising alliance with the member

opposite in questioning the sense in taxing just one particular type of

product? Would the Government not instead, and this is where I part

company with the honourable member opposite, consider taxing sugar as

an ingredient for reformulation of products to reduce sugar content

across the rather than just picking on one thing? I thank the right

honourable gentleman. He was not immaculate as that has gone down.

LAUGHTER Just to see, this is exactly what

the strategy does, what he is calling for. It is designed to be

quite wide and take into account the possibility of other actions in

other places. He is absolutely correct on that. Far from the nanny

state situation, I welcome the Government's proposals regarding

sugar and actually there is a difficult issue, not only about

child obesity but actually around the industry, around the shocking

information and shocking evidence showing young children today have to

go through procedures they should not have to, and in the late of that

with the Minister reissue that guidance today and warning to all

parents? I have a son who is 19. Many people, Mr Speaker, will be

shocked to hear that. He was 16 and had not had fizzy pop. By the age of

18, having had them for two years, he had had 12 fillings in that time.

With the Minister reiterate the dangers of fizzy pop? Dangerous

territory as I am the Minister responsible for dentistry and I can

thoroughly concur with what the honourable lady has said whilst

sharing their House's astonishment at her news. The issue of clearances

of young children of their teeth is a scandal. I will be speaking about

this. There is a conference of the British dental Association on Friday

in Manchester that I am going to and this will form a part of my speech.

The question on how to reach those parents and carers who have charge

of their children to make sure they have access to the sort of treatment

is available and how we work through schools and also through dentistry

itself to try to make more provision available for those who can be

reached, so that we deal with this terrible problem. There are some

good experiments going on, in Nottingham, the honourable gentleman

for Nottingham North, I think he is partly responsible for those, so

that honourable lady is right, dental issues are a serious matter

to be dealt with in the overall health strategy. , first of all

declare myself a believer in the nanny state. It was the nanny state

that stopped children being sent to the mains and up the chimneys. --

can I first of all declare. -- mines. One eating peanut butter

sandwich I found rather sweet I checked the jar and found it had

sugar in it. Can there be some means of stopping sugar being put in

inappropriate foodstuffs? What we have is no sugar at which means the

next time the honourable gentleman is going the supermarket -- what we

now have is a sugar app, and the honourable member can use that and

my own family have used it and found it is an product in which they never

expected. Yes, it is making sure there is a reduction in sugar

content where that is possible and appropriate but also making sure

consumers can be alerted to the amount of sugar is really important

and I shall make sure my honourable friend gets the details about the

app that he can use. I know the Minister is a very reasonable man so

can he explain to my constituents how it is reasonable that the public

health budget in Hull has been cut by 1.56 million pounds per year.

Local authorities lead on obesity public-health issues, do they not?

Yes, and I just have to see all parts of Government are making the

sort of efficiencies they need to make in relation to these areas and

that there can be no different. Could the Minister, prior to the

reported publication in the summer, make sure he discusses very

carefully with the Welsh assembly the coordination of the strategy

because in border areas such as mine advertising crosses the border,

labelling crosses the border, and people from my constituency will

find themselves having their resources put into sport in England

but not necessarily in Wales. It is important we consult with the

assembly. Height Mr Speaker, that follows on from the last answer I

gave when I was last at the dispatch box. The answer is yes. Where is the

fellow? I find it very hard to believe the honourable gentleman is

in Brussels! LAUGHTER

It is a considerable discrepancy when I grant the honourable

gentleman's urgent question application and he is not here at

once. He should be in the chamber. This must not happen again. The

honourable gentleman is a very conscientious and serious

parliamentarian but if you put a question in, man, be your! I am

sorry to be annoyed but I am annoyed because the House's interests are

involved. -- be here. It is not just about the honourable gentleman but

the rest of the House. Who have bothered to beer. Let's hear from

the honourable gentleman. Thank you, Mr Speaker, and I accept that

admonish and with good grace. Following the result of the EU

referendum, on that report published today, would he make a step in? Last

month the Treasury published a detailed report on the long-term

impact of EU membership and our economy. Today the Treasury has

published a full assessment of the immediate impact of leaving the EU.

It provides yet further evidence to support the Government's firm belief

this is in Britain's best interest to remain in the European Union. Mr

Speaker, this analysis makes clear that a vote to leave would cause

profound economic shop providing on stability and uncertainty and would

only be compound it by the negotiations that would follow --

economic shock. The effects of this would be to push the UK into

recession and lead to a sharp rise in unemployment. Two scenarios have

been brought up to provide analysis of the adverse impact on the commie,

a shock and a severe shock. In the shock scenario of vote to leave

would result in your long recession, a spike in inflation and a rise in

unemployment. >> anchor-2-mac: Years our economy

would be around 3.6 times -- 3.6% smaller than if we remained a member

-- the second scenario is that our commie would be around 2.6% smaller.

Unemployment would rise by around half a million affecting people in

the regions of the United Kingdom. If we look at the severe shock

scenario the effects are even starker. GDP is 6% lower than it

would otherwise be, if of 15% in the value of sterling and unemployed up

by more than 800,000. If negotiations with the EU were to

take longer than two years to conclude, or if the outcome were to

be less favourable than expected, the UK economy could be subject to

further instability which would depress further UK economic

prospects. This would undermine the hard work of the British people in

forging an economic recovery since the crash of 2008. Mr Speaker, as I

set out at the start, today's paper forms part of the case the

Government is making that Britain is stronger, safer and better off if we

stay in the European Union. It is based on serious evidence -based

analysis and I commend this document are the House.

THE SPEAKER: In fairness to the honourable gentleman for Harwich, he

is at least here, which is more than could be said than the Chancellor of

the Exchequer, to whom the question was directed.

K the G August, k. -- uncork the Gauk. Mr Speaker, can I just first

of all say to the Minister that we all know these forecasts are

rubbish, produced by a Government now obsess by producing propaganda

to get its way in the vote rather than enlightening the public? Has

this been produced by the professor? Will he confirm that the so-called

shock scenario suggests nothing more serious than the economy will remain

the same size as it was last year? Does this not demonstrate how

Ministers have become preoccupied with dossier honestly talking down

Britain's economic prospects, which is irresponsible. Why doesn't the

Government agree with Lord rose, who says nothing is going to happen if

we come out of Europe in the first five years. There is will be no

change, unquote. The Business Secretary in February last year

said, and I quote, as I said before, a vote to leave the EU is not

something I'm afraid of. I would embrace the opportunity such a move

would create and I have no doubt that after leaving, Britain would be

able to secure trading agreements not just with the EU but many others

too. And what does the Minister say in response to Lord Lamont, who

said, quote, a lot of the Government's so-called forecasts

depend on so-called business confidence, which is the Government

is doing with its best to undermine. We have nothing to fear but fear

itself, which the Government is doing its best to stir up, unquote.

The Government says that wages will fall, so why did Lord Rose tell the

Treasury Select Committee that wages would rise if we leave the EU? Is

this produced by the same Treasury which failed to foresee the banking

crisis and the recession which followed that? Why don't the

Government's post-referendum assessments look at the risks of

remaining in the EU? In 2014 the United Kingdom contributed to

failing economies. What effect would the collapse of the economies have

on the EU Budget as a whole and the net contribution in particular?

Doesn't the Government's entire campaign reinforce the unfortunate

impression that today's political leaders will say anything they think

will get them get what they want, whether it is true or not? Does he

not realise that my right honourable friends the Chancellor and the

reform are contributing to cynicism about politics and a sense that

voters should not trust their rulers but should make their own choice and

their own judgment, which is why they will vote Leave on 23rd June?

THE SPEAKER: Minister Gauke. Mr Speaker, the economy is a key issue

in terms of the debate and the choice the people will make on 23rd

June. This analysis is an attempt to help the British people make an

informed decision based on the likely consequences of the United

Kingdom leaving the European Union. Indeed there've been many supporters

of the Leave campaign who've been prepared to acknowledge that leaving

the European Union will at the very least have a short-term impact upon

our economy. It would create a shock. Now, in terms of the analysis

that's been produced by the Treasury, as my right honourable

friend has alluded to, it has been signed off by a former Deputy

Governor of the Bank of England. A very distinguished macroeconomist.

He has said in respect of this analysis this comprehensive analysis

by the Treasury which employs best practice techniques, provides

reasonable estimates of the likely size of the short-term impact of a

vote to leave on the UK economy. Let us be clear, Mr Speaker, this is not

the United Kingdom's Government alone highlighting the risks of

leaving the European Union. It is the IMF. It is the OECD. It is the

leadership of pretty well every ally that we have. It is the business

groups and many respected independent economists have all made

it clear that this country would lose out from leaving the European

Union, and however one wants to look at it, that's the central fact that

we cannot get away from in this debate. Well, unusually perhaps I

find myself agreeing with a great deal of what the Minister has said

to the House today. The honourable member for Harwich tries to rubbish

this report and refers to trade agreements. If we were to leave the

European Union we would have to negotiate in short order trade

relationships with the rest of the world, including over 50 other

countries. Rome was not built in a day. There would be huge uncertain.

As the honourable member will know, and I know for having been in

business myself, one of the key concerns of business always is

uncertainty. But let's put this in the context of the economy at the

moment. The economy in terms of jobs is in great shape. But terms of jobs

is in great shape. But on almost any indicator - productivity, balance of

payments, the housing crisis, investment in infrastructure, in

terms of the national debt, up two thirds in the last six years, the

economy is already got some red lights flashing, as almost every

economist said. Were we to leave the European Union, that would become

considerably worse. I welcome the fact that the Prime Minister and the

Chancellor of the Exchequer are now recognising that the large majority

of the problems we faced in 2008 and onwards were not caused by a Labour

Government but by a world recession. But what we need now is not a Tory

Brexit but we need an economy which is strong and will remain stronger

if we stay in the European Union. But still needs considerable changes

to take place, particularly in investment in infrastructure, in

skills and so on, and our security both economically and militarily

will be strengthened frontbench we remain within the European Union. We

should build on a strong economy by investing, not by leaving the

European Union. THE SPEAKER: Dr Liam Fox. If I may,

Mr Speaker, I will do... Do... First of all, in terms of the honourable

member's point about uncertainty, he is absolutely right. There is

clearly uncertainty in the economy at the moment as a consequence of

the referendum on Brexit. It is right that we have that referendum.

But that uncertainty can resolve itself very quickly on 23rd June. If

there's a Remain vote or a Leave vote we face at lowest two years of

uncertainty, possibly longer. As far as the state of the economy

is concerned. This is where perhaps the honourable gentleman and I may

differ, we have taken steps to address the long-term challenges

that the economy faces. But there is no doubt that the last few years

have been difficult for the British economy. We are now one of the

fastest growing major economies in the world. But the progress we have

made over the last six years would be put at risk were we to vote to

leave the European Union. THE SPEAKER: Dr Liam Fox. Thank you

Mr Speaker. I'm sorry that my right honourable friend has had to come to

the House to defend this disreputable, shabby and misleading

report. In the last Treasury report there

were three asks set out, including membership of the EEA. Why was it

left out of this report? And was the Permanent Secretary in agreement

with this major departure Well, in terms of membership of the

E the EA, as I understood what the Leave campaign was saying, they have

made it clear they want want to go down the Norway route. Be members of

the EEA, balls that would require continued contributions to the EU

Budget. Continued compliance with EU regulations. And continuing to be

signed up to free movement of labour. Given that essentially the

Leave campaign is focused almost exclusively on the issue of

immigration, it would be strange to suggest that one of the options we

would take would be one that's been dismiss bid the campaign to leave

the European Union. THE SPEAKER: Roger mull in. Here we

go again, the Government seems determined to recycle Project Fear,

based on Treasury projections based on the back of its neoclassical fag

packet. If they have nothing to offer by fear, they do the cause of

the EU no favours. There are no possible reasons for staying in the

EU. I asked the Minister, why is there noable sis of the emerging

trading opportunities for business? Why is there no analysis of the

value of appropriate immigration to the labour market? And why is there

not more respect for those of us wanting to make a positive case for

the European Union? Well, with I must admit I'm slightly confused by

that contribution. I understood the position of the SNP was to favour

remaining part of the European Union. If we want to poz it a case,

in two years' time, according to the shock scenario we have put out,

compared to that the UK economy will be 3.6% bigger than it would have

been had we left the European Union. Can I also remind him, as he

Christmases, wants to refight the referendum, can I remind him, not

for the last time I suspect, that the unionists won the Scottish

independence referendum? Why does the forecast leave out the very

beneficial impact of spending another ?10 billion, which we would

get back on contributions on our own priorities, jobs and services here,

which would boost the economy, and why does he leave out the lower

interest rates and big injection of liquidity which the Bank of England

says it will grant the economy at the time of the vote? Well, first of

all in terms of this report, this is a report for the next two years. As

my right honourable friend will be aware, even if we vote to leave the

European Union, we will continue to be members of the European Union for

those two years as we would negotiate our departure. During that

two-year period, we would continue to make contributions to the EU

Budget. Can I point out to him what the IMF have said, which was

essentially if the economy shrinks by 1% or more, any fiscal gain from

seeking to make any contributions to the EU would be wiped out by

smaller, lower tax receipts and greater costs. Died, under the

central scenario, set out in this report, the public finances will be

?24 billion worse off as a consequence of us leaving the EU. In

terms of his point on interest rates, it's the case that the

assumption within this report is there to be no changes in miscal or

monetary policy. I do point out to him that one of the predictions

within the report is we would see the pound falling in value and

inflation increasing. As the MPC have made it clear, they would have

a difficult trade-off in terms of trying to get the economy going at a

time when there would be clearly a slowdown, while at the same time

seeing the pound falling and inflation rising. In those

circumstances, the safest thing is to make no assumptions as to what

monetary policy would be. Thank you Mr Speaker. Can I ask the Minister

whether any assessment has been made around the impact of companies like

Siemens if we were to leave the EU on 23rd June? The honourable member

raises an important point. It is a point particularly significant in

terms of the long term impacts. It has to be said, it is very clear to

any of us who engage with those who invest in the UK, businesses that

make decisions as to where to locate investment, that access to the

single market is an important attribute for the UK. It is very

clear within the report that we've set out that business investment

would fall significantly as a consequence of leaving the EU. Both

in the short term and the long term. Mr Speaker, leaving aside the

Treasury's notorious incompetence at forecasting, would my right

honourable friend, for whom I have friend, for whom I have a lot of

time - normally - not agree that this document really does plumb new

depths in Project Fear? What the Government is trying to do is scare

the public wit.less? If the consequences are so dire, why did

the Prime Minister say on record that Britain could prosper perfectly

well outside the EU? And why has the Government produced in this report

saying that as our economy transitions to a worse trading

arrangement with the EU, does my right honourable friend not accept

that is utterly dishonest, that with the Europeans exporting ?72 million

more to us than we export to them, it will be in their interests to do

a deal with us and we'll have a Government capable of negotiating

more capably than the current Government has been able to do? I

have a lot of time for my honourable friend, normally, but I do disagree

with the points that he is making here. In terms of a trading

arrangement, it is impossible to see how we could negotiate a trading

arrangement as strong as the one we have at the moment. Access to the

single market and the benefits, particularly in the context of

non-tariff barriers are very important. Therefore we are

undoubtedly going to be a lows-open economy as a consequence of leaving

the European Union. But in terms of this report and trying to scare

people, it is worth pointing out what the assumptions are and what

the Treasury is not suggesting is underlying what's going to happen.

We are not putting forward a view there is going to be an immediate

financial crisis, a current account crisis for example. We are saying

that we can reach a deal within two years, which is ambitious. We are

not saying under the shock scenario that there would be any economic

contagion as a consequence of the UK leaving the European Union. If we

wanted to put a much more dramatic, scary report together, there are a

number of things we could have included which we did not. This was

a cautious, careful, small c conservative report and it has been

signed offer by perhaps the leading authority in this area in this

country. Isn't the premise that the Treasury

spokesman is trying to convince people of that the economy under

this Government is doing exceptionally well, yet in reality

most of the people that are actually, that actually have a job,

several million are on zero our contracts, they don't know which way

to turn, there are a hell of a lot of people now borrowing money on

loans they can't afford -- zero-hour. Many people are going to

food banks in order to make ends meet each week. The whole idea that

this Treasury announcement is now trying to convey that everything in

the garden is lovely but it will all be thrown away if you do something

else, the truth is it is based on a pony premise. We differ in our

assessment as to the state of the UK economy, but whether he takes the

view he does or I take the view I do, in neither case would our

economy and our constituents benefit from pursuing a policy that would

increase unemployment by 500,000 average wages fall, and I hope that

is an issue he would consider in terms of the impact leaving the

European Union would have on his constituents. A 3.6% higher GDP,

lower unemployment, low inflation and a better exchange rate. Surely

these are things to celebrate, and can we have the argument made that

these are good things that will happen if we remain in the EU rather

than the other way around? Well, I think my honourable friend makes a

good point. Let me put it this way. The UK does benefit from being an

open trading nation. Membership of the single market helps us brochure

that brought it having an open and trading economy. -- helps us follow

that approach. I hope this is one the British people will ensure that

we continue to have. Is the Minister as concerned as I am that the Leave

campaign dismissed the views of the IMF, the Bank of England, the OBR,

and all of these as a conspiracy? Does he hope in June people will

vote with their hearts, and their heads, to stay in the EU, which,

with Nato, has provided peace and prosperity for the longest period of

time since antiquity, according to the outgoing London mayor? I confess

I had not seen that particular quote but I look forward to digging that

out. Actually, I think I have seen it. The right honourable gentleman

reminds me of it. It is the case that there is an overwhelming

consensus on the economic benefits of membership of the European Union,

and I hope the British people, when they make their assessment, whether

it be heart or ahead, look carefully at the economic consequences of that

decision -- or head. Because it is a very important decision and one that

will have an impact not just for a year or two as this report projects,

but for many years ahead. Isn't the simple fact that countries trade

with one another to increase their mutual prosperity and that trade,

without principled trading partners, is easier as a member of the EU?

Absolutely right and access to the single market gets us to a level of

reducing trade barriers that is simply impossible to find outside

the singer market. The institutions and individuals forecasting economic

doom if we leave the EU have got it wrong time and again in the past and

seem likely to do so again. The exchange rate mechanism debacle, the

whole Europhile spectrum, the prediction the skies would fall if

we did not join the euro, the complete failure to foresee the 2008

crisis coming down the road, they show just how helpless they are.

With the Minister except that a plausible opposite case could also

be made that we could be better off outside the EU and if they cannot I

could happily provide him with one. Look forward to hearing that

plausible case whenever it is made. I look forward to some analysis with

the support of leading economists making that case but we have not

heard that case and can I just also make a point, in terms of the EU,,

our membership of the euro, and he and I agree on that. If we were to

highlight two politician the mac in this country responsible more than

anyone else for keeping us outside, I would highly Gordon Brown from his

party and William Hague from mine, both of them believe we should

remain within the European Union -- if I can highlight two politicians

in this country. Following are predictions of world War we now have

a forecast recession equating to that of the great depression should

we leave. May I suggest to the Minister, and actually let's be

absolutely honest about this, with the Minister accept that the

Treasury got it absolutely wrong when it forecast and economic shock

when we left the ERA. And the Treasury, the Bank of England even,

they didn't even see the last recession, the IMF is all. Canales

appointed it was the Treasury -- can I also point out it was the Treasury

and I think the same civil servants who made the test on taking us out

of the euro? We are not making any claims of the sort he suggests in

terms of the greatest depression since The Great Depression of 1929.

We are suggesting the shock scenario involves the economy shrinking by

3.6%, as compared to the base, which is the forecast over the next few

years. This is actually a very measured, conservative, with a small

fee, analysis of the impact, but nonetheless there is an impact and

that will result in 500,000 more people being unemployed that needs

to be the case -- small c. When does the Minister think those advocating

Leave will actually level with the British public and provide their own

economic assessment? Have of them think they can leave the EU and stay

within the single market and the other half say, no, we will not be

part of the single market at all. Is it not useful that there analysis

today does both that snapshot of what the severe shock would look

like if we were still in the single market, but also can he see a bit

more about the severe shock analysis, followings falling back on

those membership rules and how that would lead to potentially 800,000

people unemployed -- analysis, falling back on. He is right that

unemployment would increase by 800,000, GDP would be 6% lower than

it would otherwise be and these are significant numbers. They are not

equivalent to The Great Depression, but still very significant numbers

that would have an effect on his and my constituents. I think he does

raise an important point. I hope we will get greater clarity as to

exactly what leaving the European Union would involve because it seems

to me there is a pretty clear trade-off. The closer you are to

membership of the EU, such as for example the EEA model, the more you

continue to have attributes of EU membership. The further away, then,

yes, you have that greater freedom and flexibility, if you like, but

you're clearly facing a much bigger economic shock. Investment is

crucial to this analysis and my constituency attracts investment

from China, Australia, the United States as well as from Japan. One of

the crucial factors that has led me to believe we are stronger in the

EU, all of those countries and businesses from them want to see us

as part of Europe and indeed some of those have European headquarters.

What has he made of the potential relief rally about investment in

this country? I think that is an important point and I think anyone

who has met with international investors who are considering their

choices as to where to locate their European headquarters, they will be

aware that membership of the European Union is something that

they value and support, and that without that I think it would

clearly be harder to attract all that -- some of that inward

investment. I think he also raises an important point in terms of

whether we would see a recovery. I think there is evidence to suggest

they would be a slowing -- has been a slowing down of investments due to

the uncertainty of a religion shook with European Union, but the

evidence I think, and the Bank of England I think have supported this

view, is not the IMF, that there is likely to be a reasonably quick

recovery were we to vote to remain on the 23rd of June and that we

would see that investment coming back without their having been a

long-term detrimental impact. Mr Speaker, the north-east is a

manufacturing region and manufacturing is by recent analysis

already in recession. Could I ask the Minister does the Treasury

analysis, with the detail of distinctive regional impact on

regions like the north-east, in terms of the shocks and with the BBC

if we left the EU? It used to be said, when America sneezes, Britain

counts its coal, but when Britain counts its coal the north-east gets

pneumonia. He raises an important point and it is this. The

unemployment numbers that we would see, the increase in unemployment we

would see, would affect every region of the United Kingdom, and of course

the north-east of England is not immune from that. Indeed, as an

important exporting region it would be perhaps particularly vulnerable,

and the assessment of Treasury has set out suggests there would be

something like 20,000 more unemployed people in the north-east

of England as a consequence of leaving the European Union. Thank

you, Mr Speaker. When the Chancellor set up the Office for Budget

Responsibility he said the public and the markets have completely lost

confidence in Government economic forecasts. He went on to say, again

and again, the temptation to fiddle the figures, to nudge up a growth

forecast here, Ridgers and number here, to make the numbers add up, it

has proved too great, but I am the first chance to remove the

temptation to figure to Lee by up control over the economic fiscal

forecasts. Why does the Minister now disagree with the Chancellor and why

does the Chancellor and I disagree with himself? -- to fidget with the

numbers here. It is set out in legislation and he can only set out

the forecast in accordance with Government policy but in terms of

the report we have here today, it is a report, as I said earlier, that

has been signed off by Sir Charles Bean who has said this conference of

analysis by the Treasury which employs best practice techniques

provides reasonable estimates of the likely size of the short-term impact

of a vote to leave on the UK economy. We do have third parties

endorsing this having worked through the details. Isn't the truth that

this report simply echoes the concerns that the adverse impact of

Brexit, already expressed by businesses in all of our

constituencies up and down the land, Saronic in my area representing

manufacturing, and in recent days our biggest private sector employer

representing international services -- ceramics in my area. With the

Minister agree, therefore, that all the evidence not only suggests but

shows there is absolutely bull-mac economic rationale for the UK

leaving the European Union? -- no economic rationale. He makes a very

good point. Every business survey has pointed

towards business being in favour of remaining part of the European

Union. He is consistent with the likes of the IMF and the OECD and

the Bank of England, all of whom have highlighted the risks of

leaving the European Union. Thank you Mr Speaker. Given that the

independent think-tank Open Europe, who are plot taking sides in the

referendum debate, have stated that it is a mistake to think that

short-term forecasts are inevitably any more accurate than long-term

forecasts, can the Minister say in percentage terms, what are the

chances of these forecasts actually being true? Of course, I hope none

of those forecasts turn out to be true, because I hope that the high

pot thinks, that we leave the European Union, does not happen.

Inks, that we leave the European Union, does not happen. -- the

hypothesis. The former Mayor of London's former economic adviser

warned of an economic shock in the wake of Brexit. Does the Minister

agree that it is not project fear that the other other side are

complaining about - it is project fact. Does he agree with me that the

Leave campaign argument would be a lot stronger if they had produced a

single shred of credible evidence to demonstrate that Britain is better

off out? When the mainstream economic opinion in this country and

around the world is that our economy is stronger by remaining in the

European Union? He is absolutely right that the mainstream opinion

does support the UK being part of the European Union. I would be

fascinated to read a similar type of report arguing the other case. We

obviously produced our long-term report last month. I look forward to

receiving a proper, detailed response to that. The reality is,

and I think the reason why no such analysis has been produced, is

because there is insufficient support for such a view. That, I

hope, is a point that become more apparent over the course of the next

month. Thank you Mr Speaker. Each year we have a Budget statement and

an Autumn Statement in which the Chancellor corrects the forecasts

from the previous statement. LAUGHTER. Can we have an assurance

from the Minister that after we vote for Brexit the Chancellor will come

regularly to the House to correct the forecast contained in this

document? The scenario that's been set out has been done using

perfectly normal widely used techniques. It has been signed off

by the leading economist in this area. What I would put to him is

that there are a number of assumptions that we have taken

within this report that have been cautious, that have not sought to

exaggerate the risks by any means. I have to say to my honourable friend

that there's a real risk to the UK economy. This is not fearmongering.

This is not scaremongering, this is simply setting out what the risks

are to the British people, matters that the British people should be

aware of when they vote on 23rd June. Much as I'm enjoying the Punch

and Judy show within the Conservative Party, can I remind the

Minister that Leave and Remain have negative campaigns and the most

negative campaign will win? While we should be helping the electorate,

they will be turning off in their droves, which doesn't serve

democracy well. What we are during is making it clear what the risks

are to the British people were we to leave the European Union. All I

would say to the SNP is that if they've got a positive contribution

to help the Remain case, let them make it rather than lecturing others

on how to put across what are really important factors that will sway, I

hope, the British people, because the British public are after

information as to what the consequences of leaving the European

Union would be. This Government has a duty to provide that information.

Thank you Mr Speaker. It is right that we should deal with scare

stories as quickly as possible. I think the Minister as done a very

good job on this. Would he comment on the comments of the employment

Minister in Leicester last Thursday, when she brought a very big red bus

and parked it in front of the biggest temple in my constituency

and announceded that if we stayed in the European Union all the curry

houses in Leicester would have to close down, because the EU is

responsible for a crisis in chefs? Will he confirm that the issuing of

visas is a matter for the UK Government and it has nothing to do

with the EU? And that if the British people vote to stay in, we can still

eat curry in Leicester, but if they vote to go out, Leicester City will

still play in the European Champions League? Well, what I would say what

I would say is that, as a - I will try not to be drawn too much on to

curry or Leicester City, although of course let me congratulate Leicester

City and I look forward to their season, and possibly more, in the

Champions League. What I would say to the right honourable gentleman is

that when it comes to immigration policy for those outside the

European Union, clearly that is a matter for this Government. And

Government policy and for this House. And that will continue to be

the case whatever the result on 23rd June. Thank you Mr Speaker. Airbus

Industries, which employs 7,000 people across North Wales and

north-west England and many thousands others elsewhere in the

United Kingdom have, with the full support of the trade unions, written

to every employee of Airbus to explain to them why they should vote

yes in the forthcoming referendum. Will the Minister confirm that the

risks he has outlined today in the report, short term and long term,

are the very reasons why companies such as Airbus have come off the

fence strongly to support a "Yes" vote on 23rd June? Thing are makes a

good point. S" vote on 23rd June? Thing are makes a good point. -- the

right honourable gentleman makes a good point. Businesses are entitled

to write to employees where they see a risk, and the consequences should

be made clear. It is striking how the concerns of businesses, big and

small, about the consequences of leaving the European Union are

consistent with some of the concerns that we have set out within the

Treasury document. Frankly, the UK would be poorer outside the European

Union and that we are stronger, safer and better off within the

European Union. THE SPEAKER: Order. The clerk will

proceed to read the orders of the day. Queen's Speech, adjourned

debate on question. That a Humble Address be presented to Her Majesty,

as on the order paper. I call the Secretary of State for Health.

Secretary Jeremy Hunt. Thank you Mr Speaker. Today's debate chosen by

the opposition is about defending public services. So I want to start

by stating very simply that this Government does not believe in

private wealth and public squalor. Quite the opposite. We believe in

prosperity with a purpose, and building high-quality public

services is perhaps the most important purpose of all. But

there's a difference between the two sides of the House. Indeed there are

more than one difference. One of them is that on this side we are

prepared to take the difficult decisions necessary to build a

strong economy that in the end is how you have to fund those public

services. A second difference is that we go further and say securing

funding from a strong economy is not enough. The battle for higher

standards will as important as the battle for resources, because

without high standards, you let down not just the taxpayers who fund our

public services, but the vulnerable citizens who depend on them. So yes

we are proud to have protected schools funding since 2010, but we

are even proud they are 1.4 million more children are in good or

outstanding schools. Yes, we are proud to meet our 2% of GDP defence

spending pledge but even prouder of the professionalism of our Armed

Forces operating in the Mediterranean today to help find the

wreckage of the tragically lost Egyptian airliner. Yes we are proud

to have protected science and research funding, but even proud

they are this country continues to win more Nobel prizes than any

other, apart from the United States. And yes we are proud that despite

the deficit, we have increased NHS funding since 2010, more at loathe

elections than promised by the opposition. But even prouder that

failing hospitals are being turned around, M RSA rates have halved and

cancer survival rates have never been higher. So with that, let me

turn to the NHS. And say up front that nowhere is the importance of

ortance of those two challenges - proper ortance of those two

challenges - proper funding and high standards - more stark. Let me start

by paying tribute to the 1.3 million staff who work in the NHS. Whatever

NHS staff have thought over the years about the politicians running

their service, their dedication to patients, their hard work night and

day, and their commitment to the values the NHS stands for is the

invisible glue that has always held it together, what temperature

challenges. I know I speak for the whole House in thanking them for

their service. Let's look at what they have achieved in the last six

years. Compared to 2010, every single day we treat 100 more people

for cancer. Every single day we treat 1,400 more mental health

patients. 2,500 more people are seen within four hours in A

departments. And every single day we do 4,500 more operations. All at the

same time as seeing hospital harm falling by a third and patients

saying they have never been treated with more dignity and respect. In

the wake of the tragedy of Mid-Staffordshire, we should also

recognise the huge efforts of staff at the 27 trusts that have since

been placed into special measures. 11 of those trusts have now come

out. Three of them are officially rated good. Neither Stafford

Hospital nor Morecambe Bay, nor Basildon, three of the hospitals of

greatest concern, are now in special measures, thanks to excellent local

leadership and superb commitment from staff. But all NHS staff want

to know about the funding of their service. So let me start there. The

NHS's own plan, published in October 2014, asked for a front-loaded ?8

billion increase in funding. Not just to keep services running but to

transform them for the future. Some said to quote the then Shadow Health

Secretary that the Conservative promise to deliver that funding was

a cheque that would bounce. But in the Spending Review last autumn, we

delivered that promise to the British people. Not an ?8 billion

increase but a ?10 billion increase. Not back-loaded as many feared but

front-loaded, with ?6 billion of the ?10 billion being delivered this

year. I give Tway. I'm grateful to the Secretary of State. With regard

to his point about what the NHS asked for, is it not right though

that the forward view set out three different scenarios for efficiency

savings? It wasn't a case of them asking for ?8 billion. And does he

really believe that the ?8 billion or ?10 billion is going to be

efficient to meet the demands of the NHS? He will have heard Simon

Stevens being asked that question on The Andrew Marr Show yesterday. He

was clear that ?8 billion was the minimum of additional funding he

thought the NHS needed. In fact we supplied ?10 billion that. Does come

with wit some very important requirements in terms of annual

efficiency savings. Indeed, for that ?8 billion, the NHS recognises that

you need ?22 billion of annual efficiency savings by 2020. Even

though funding is going up, demand for National Health Services is

going up even faster. I will come to talk about how we are going to meet

those efficiency savings. But I will give way in a moment. I want to make

some progress. Some in this House have observed that without ?70

billion of PFI debt, without ?6 billion lost in an IT procurement

fiasco, without serious mistakes in the GP and consultant contracts a

decade ago, this efficiency asked might have been smaller. I give way.

We all hear what the Secretary of State says it is always somebody

else's fault, but the fact of the matter is, surely, I've been told at

the highest level, I don't with a watch The Andrew Marr Show often,

I've been told by senior health professionals the, there are only

two Health Trusts in this country not in debt. Is the that right? That

isn't true, but what we do all accept is there there is financial

pressure throughout the system. But the question that's always ducked by

members of the party opposite is how much greater that financial pressure

would have been under Labour's plans which involve giving the NHS ?5.5

billion less every year than promised by the Government. I just

point out that when the party opposite condemn the ?22 billion of

efficiency savings, as the Shadow Health Secretary in March, as

politically motivated, they can't have it both ways. ?5.5 billion less

every year was what her manifesto offered the NHS compared to this

Government, which means... She shakes her head, but what do the

King's Fund say? The can fund says it falls short. It

was absolutely black and white. Labour was committing to a two and a

half increase in the NHS budget, not the ?8 billion this Government

committed to -- The King's Fund. It would not be ?22 billion needed but

22.5 billion pounds, that would be the equivalent of laying off 56,000

doctors are losing 129,000 nurses are closing down around 15 entire

hospitals. I give way to my honourable friend. I welcome his

policy that foreign businesses should be asked to pay for nonurgent

treatment they get when they are here and that European visitors

should have to recoup it through their national systems. Why do we

need extra legislation and how much money does he think we can get from

that? We do need extra legislation to expedite the prices. That is

another policy opposed by the party opposite that all the time say we

should be doing more to grip NHS finances then all the time or pause

every policy we put forward in order to do precisely that. But the

honourable gentleman's question is that the issue with the NHS is

primarily that we are not very good at collecting the money to which we

are entitled from other European countries because we are not very

good at measuring wind European citizens are using the NHS and what

this legislation will help us do is put those measurement systems in

place so we can get back what we hope will be around half ?1 billion

a year by the end of this Parliament. We will no doubt you

later this afternoon the charge that the Government has lost control of

NHS finances, a charge that we strongly reject. But the House may

want to ask about the credibility of that accusation, from a party that

is at the same time proposing a funding cut to the NHS and

criticising the difficult decisions we need to sort out NHS finances. I

give way to the honourable gentleman. Two months into this

year's financial year, can he say whether or not the demand of health

broke its budget for last year and it? We will find out those figures

when the full audit is complete. I will just say to the honourable

gentleman, efficiency savings are never easy, but the party with the

true interests of NHS patients at heart should support those

efficiency savings because every pound saved from avoiding waste is a

pound we can spend on improving patient care. Let me outline to the

House what we are doing to deliver those efficiencies in order to

support their NHS Trust to return to financial balance. Firstly, tough

measures to reduce the cost of agency staff including caps on total

agency spent and limits on the rates paid to those working for agencies.

So far this has saved ?290 million with a market rate for agency nurses

down 10% since October and two thirds of trust saying they

benefited. Our plan is to reduce agency spent by ?1.2 billion during

this financial year. Secondly, introducing centralised procurement

under the Carter reforms. Already 92 crosseds are sharing for the first

time information on the products they purchase in real-time -- 92

trusts. Thirdly, given the pay bill is around two thirds of a typical

hospital's cost base, support for the gross inefficiency of the

largely paper-based systems used at present, and this should also

significant weight increase flexibility and work- life balance

for staff as we announced last week -- significantly increase. There

will also be a dramatic transformation of out of hospital

care as outlined in the five-year forward view. If we make our

ambitions we will reduce demand by over ?4 billion a year through

prevention, improved GP provision, mental health access, integrated

health and social care. I will certainly give way to my right

honourable friend. Will my right honourable friend agree that

unfortunately arguments about the NHS, from what I can member, always

get reduced to simplistic arguments about whether or not enough money is

being spent and efficiency is being improved, and I do think this

Government in the present financial circumstances has increased spending

and pursued efficiency at least as well as its predecessors. Would he

agree the real issues are the rapidly rising changing nature of

the man and on this important service? Is he going to have time to

move on to things like moving on to a seven-day service, actually ending

the curious division between the hospital service, GPs, community

care and local council social services, and actually providing for

an ageing population with chronic conditions, while at the same time

giving extra emphasis to mental health and all the things that have

been neglected in the past? You should be spending more, we would

spend more, all of this is the sterile nonsense pressured by every

opposition that I can recall when they cannot think of anything really

positive to say. As my right honourable friend speaks with great

wisdom, as he did during the junior doctors' strike, perhaps based on

his own experience, as someone who ignored medical advice across the

country from the BMA as he was smoking his cigar, but I do think

he's right. The crucial issue for the future of the NHS is the simple

statistic that by the end of this parliament we will have 1 million

more over 70s to look after in England. And they have very

different needs to the needs of the population were having to look after

20 or 30 or 40 years ago. In particular, the need for being

looked after well at home, before the need that... The transformation

which is why a core part of what we're doing is transforming the

services and mental health and also in general practice which I will

come onto the letter. I will give way. He's speaking about

transmission -- outlook on to that later. We have to start focusing on

quality. In the East Midlands, our area, the Ambulance Service has just

been judged by the Care Quality Commission as inadequate when it

comes to patient safety. Things are in a real state of difficulty now

within our NHS. Those Ambulance Services need improvement. What is

he going to do about it? Absolutely agree with him. This is what I

wanted to come on and speak about the tension, which is the tension or

perceived tension between money and the quality of care. Until three

years ago we did not have an independent inspection regime going

round and build services, telling both the service and the public and

his constituents and members of Parliament how good the quality of

care is in each area. I think the first step is to have that

inspection regime so we know the truth. Then things start to happen,

as is beginning to happen in services to the country. But the big

point, which is actually precisely what I wanted to move on to, is the

worry that many people have that and efficiency asked of the scale we

have might impact on patient care. And I will give way but I will

finish this point, if I may. They should listen to the Chief Inspector

of hospitals, Professor Sir Mike Richards, who point out that

financial rigour is one of the routes to excellent quality and that

there is a positive correlation between hospitals offering the best

care and those with the lowest deficits. In other words, it is not

a choice between good care or good finances, you need both. I will give

way. I thank the honourable gentleman for giving way. Before he

moves on I want to return to the issue of charging people

internationally for the NHS, for non-EU citizens the Government no

charges ?200 per person as part of their these application. Would he

say why he has chosen the figure of ?200 which does seem extremely low

when an equivalent private health care policy for a year would be up

to 100 -- ?1000 and an equivalent level of travel insurance would be

400 or ?500. There is -- is there not an opportunity to cure this as

people rely more on the NHS as they get older? -- tier this. Understand

why he has asked the question and there is thinking behind this. The

reason it is set that low and I recognise it is quite a low charge

is that because a large number of the people paying it are actually

students who attend to have, to be low users of the NHS and we want to

make sure we do not create an in adventure at this incentive for

people coming to the UK -- and in inadvertent disincentive. There is a

differential charge for students, he will of course be aware of that, and

would he go away and look at whether there is a possible before charging

high earners who come to this country more because it seems so

low, and would he specifically look at whether there is possible to

charging people who are older more as they are much more likely to rely

on the NHS? Can I just repeat to the honourable gentleman that we do keep

this constantly under review, but the important thing is that we are

now for the very first time charging people who come to the UK on a

long-term basis for their use of NHS resources and that is something that

did not happen before. Let me return to what I think is the crucial

question for us to consider in the House this link between the quality

of care and good finances. Why is it that it is so important not to see

this as an artificial choice between good care and good finances? Very

simply, because poor care is about the most expensive thing a hospital

can do. Fall in a hospital will cost the NHS about ?1200. As the patient

typically stays for three days longer -- a fall in a hospital. A

bedsore adds about ?2500 to NHS costs, with a patient staying on

average 12 days longer. Avoidable mistakes and poor cost the NHS more

than ?2 billion a year. We should listen to inspiring leaders like

Doctor Gary Katzman of the hospital in Seattle, one of the safest and

most efficient hospitals in the world, when he says the path to

safer care is the same as the path to lower costs, which rings me onto

the second way this Government is fiercely defending our public

services -- brings me onto. Our restless determination to raise

standards so people on lower incomes can be confident of the same high

quality provision as the wealthiest. To its credit, the last Labour

Government succeeded in bringing down NHS waiting times, and I hope

that their kid is from memory as one when access to NHS services

improved. -- I hope that decade is remembered as one. But we should

surely ensure this decade is one in which we transform the safety and

quality of care. This was the lowest point in the history of the NHS we

must make it a turning point, not to offer just good access to care but

care itself as the safest and highest quality care of noble. The

record of the last three years shows we can do just that. The King's Fund

has given credit to the Government for its focus on safety and quality

of care. Patient campaigners has said the NHS is getting safer and

the main indicators of hospital mortality and harm are going in the

right direction. But there is much more to do. What are our plans?

Firstly, we must deliver a seven-day NHS. It should never be the case

that mortality rates are higher for people admitted at weekends and

during the week. Last week's junior doctor contract agreement was a big

step forward but we also need to reform the consultants' on track,

improve the availability of the Kent diagnostic services and increase the

number of weekend consultant led procedures -- consultants' contract,

and improve the available the of weekend diagnostic services. With an

integrated health and social care system that needs to operate over

busy weekends as well as during the week. It also means more GP

appointments at convenient times which is why we want everyone to be

able to see a GP in the evening or weekend and are back -- were back in

general practice with an increase in their budgets. I will give way. We

particularly need -- people who particularly need integrated care

those whose life chances are blighted they need full recovery. I

look forward to hearing from the arts minister to conclude the debate

and perhaps look into his department in terms of how terminals are

affected by blood communities and the high stakes. Shall we have -- we

should have an all-round approach to life chances. It is a pleasure to be

on the bench again with my honourable friend from the CMS for

the first time for several years and I will leave him to respond to that

point -- DCMS. It wants to make a broader point in response to what he

says. The whole change we need to make in the NHS is to prevention

rather than cure. If we can stop people getting addictive in the

first place, whether to drugs, alcohol or gambling, then we will

reduce the cost to the NHS and the long-term and that is the purpose of

many of our plans. Thirdly, a seven-day NHS also means a big

improvement in access to 24/7 mental health crisis care so that whenever

a problem happens, we are there promptly for some of our most

honourable people and we will deliver this alongside our broader

plans for a million more people with mental health problems to be able to

access support annually by 2020 -- most vulnerable people. I will give

way. Can I commend the Government for

accepting the majority of the recommendations and allocating ?1

billion to implement those recommendations. Can I urge the

Secretary of State, talking about systems change in the NHS, and in

relation to mental health, in order to deliver on the recommendations of

the task force we need systems change within the NHS to make sure

that we have the kind of mental health services that people in this

country deserve. My honourable friend speaks with great knowledge

and has also been chairman of the APPG and he is right, we need

systems change, and the change we need is really about stopping

putting mental health in a silo, and understanding that it has to be part

of the whole picture treatment when someone is in hospital, with a GP,

and it has to be integrated with physical health needs and we have to

look at the whole person. We won't get all the way there in this

parliament but that task force gives us a very good and healthy ambition

for this Parliament. I will give way one more time. I'm pleased to hear

him addressing the importance of quality of care in mental health as

well. It is area is like learning disability where there are highly

burnable individuals and the shocking Expose from Southern

Health, does he think accountability over that organisation which has

presided over dreadful things and unexpected deaths that have not been

investigated, really have to be held accountable and move on? As he knows

the chair of the organisation has stepped down. When it comes to

accountability he is absolutely right. The accountability needs to

be not just about individual organisations within the NHS but

also the people commissioning mental health care and care for people with

learning disabilities which is why from July we will further first time

be publishing Ofsted ratings for the provision of services for people

with learning disabilities so that we can see where weak areas are an

sort them out. I want to conclude on the quality area. By saying that

important though a seven-day NHS is we need to go further. If we really

are to make NHS care the safest and highest quality in the world. Every

week, according to the respected Hogan and black analysis we have 150

avoidable deaths in the NHS. 3.6% of all hospital deaths with a 50%

chance that that death could have been avoided. In the United States

Johns Hopkins University said earlier this month that medical

error was the third biggest killer after cancer and heart disease,

causing 250,000 deaths in the United States alone every year. This year

England will become the first country in the world to lead a

transparency revolution in which every major hospital will publish

its own estimate of its avoidable deaths and its own plans to reduce

them. This year we will give particular focus to reducing

maternal deaths, stillbirths and neonatal harm with plans I will

outline soon. If we are to do this and most difficult of all, we need

to transform a blame culture inside to many parts of the NHS. It still

makes it far too hard for doctors and nurses to speak openly about

medical error. Amongst other measures we therefore have setup a

new health care investigation branch to conduct no blame investigations

when we have tragedies, modelled on the highly successful air accident

investigation branch. Like the airline industry, our model must be

transparency, openness and a learning culture that supports

rather than blames front-line professionals who, in the vast

majority of cases, are doing their best. Part of the new culture of

responsibility and accountability must be a return to proper

continuity of care which is why this Government has brought back named

GPs were every patient which was abolished in 2004 and is introducing

lead consultants for people who go to hospital with complex conditions.

In conclusion, fending the NHS involves higher standards of care,

wise use of resources and secure funding from a strong economy. And

because the challenges we face in England are the same as in Wales,

Scotland and Northern Ireland, indeed the same as developed

countries all over the world, we should exercise caution in

politicising those pressures or we simply invite scrutiny of the

relative performance of the NHS in different parts of the UK, which

often shows that those who complain loudest about NHS performance in

England are themselves responsible for even worse performance

elsewhere. What we want is simple, a safer seven-day service, backed by

funding from a strong economy, we have already delivered more doctors,

nurses, operations and better care than ever before in NHS history. I'm

just concluding now so I will finish. With that comes renewed

ambition that the NHS should continue to blaze a trail across the

world for the quality and safety of care and that is how this Government

will to defend our biggest and most cherished public service. Thank you.

Can I start by thanking the house secretary for joining us today, I

know he doesn't always choose to respond to me when I bring matters

to this Chamber, so I am grateful to him for being here. I'm also

conscious that if the cabinet deckchairs shift around after the

referendum, this may be our last Parliamentary exchange, and if that

does indeed turn out to be the case, let me put on record my best wishes

for whatever he goes on to do. May I gently suggest that a future career

in resolving employment disputes may not be for him. The topic of this

debate is defending public services and as you would expect I will be

focusing my remarks on what is happening to our health and care

service. Listening to the Health Secretary today, you could be

forgiven for thinking that all is well. You would have no idea that

hospital finances are at breaking point. That waiting lists are

approaching a record high. And the NHS is facing a workforce crisis

with endemic understaffing and broken morale. But together, this

triple whammy of challenges on finances, quality of care and the

workforce, but the NHS in a very precarious position. I want to take

each of those challenges in turn today. First, finances. I know the

right honourable gentleman the Member for Rushcliffe may

sterile nonsense but it is fundamental to whether hospitals and

GPs can continue to deliver the care needed for our ageing and growing

population. One of the Secretary's favourite sound bites recently has

been to claim that the Government is giving the NHS the sixth biggest

funding increase in its history, indeed, he has made this claim six

times in this Chamber over recent months. So I have to say, I was

surprised it didn't feature in his speech today. But I think I may have

an explanation for this omission. Last week the King 's fund and

health foundation, Sid independent think tank 's looked into his claim

and in fact I have a copy of their analysis here. Let me quote what it

says. We are afraid to say, although perhaps not surprised, that we have

very different figure. They go on to say, rather than being the sixth

largest funding increase in NHS history, we find that this year it

is in fact the 28th largest funding increase since 1975. I will give

way. I completely defend the methodology we used to come up with

our figure but though she not see the irony that she is here

criticising a ?3.8 billion increase in NHS funding this year when

Labour's plans in the election last year were for a ?2.5 billion

increase, ?1.3 billion less than this Government has delivered. I am

grateful to the Health Secretary for that. He may want to rake over the

last general election but it's clear that he doesn't want to talk about

the crisis in NHS finances today. ?2.45 billion deficit among

hospitals at the end of this year. Cuts to public health, ?4.5 billion

out of the adult social care budget over the past five years, so I'm

quite happy to debate NHS finances with him. The truth is, the NHS is

actually getting a smaller increase this year than it got in every

single year of the last Labour Government. I quoted the King 's

Fund and the Health Foundation and they concluded by saying, getting

public spending figures right is important otherwise they can mislead

and detract from the real issues. The fact is, the NHS is halfway

through its most austere decade ever with all NHS services facing huge

pressures. I will give way. May I recommend the honourable lady reads

recently book by Tom Bower which shows the utter failure of the Blair

Government, who pumped billions of pounds over a period of years into

the NHS but had no control over it and made no attempt to increase

productivity, so that performance flat lined from 1998, for six years,

and then the then Health Secretary was forced to bring back health

policies that they had abandoned in 97. I'm grateful for the reading

advice from the honourable gentleman. I would simply say this,

I'm very happy to defend the record of the last Labour Government, when

we travel the NHS budget, when we have the highest ever public

satisfaction and the lowest ever waiting lists. Mr Speaker, I was

talking about the crisis that we face today and we should be crystal

clear about this, the decade from 2010 to 2020 is set to be marked by

the biggest sustained funding squeeze on the NHS ever. As a

percentage of GDP, spending on health is set to fall from 6.3% in

2009/10 to 5.4% by the end of the decade. I will give way. I'm sorry

but people who are listening to this debate will want clarification, is

the honourable lady denying that if Labour were in Government they would

have... We wouldn't have increased NHS spending in the way this

Government has, I think she needs to be clear on that. We were very clear

at the last election that we would have had an emergency budget to put

every penny that the NHS needs into its funding. I was talking about the

reduction as a proportion of GDP on NHS spending. In terms of real

funding the House of Commons library has shown that if spending as a

percentage of GDP had been maintained that Labour levels then

by 2020, ?20 billion more would be spent on the NHS each year. That

demonstrates the scale of underfunding we have already seen,

and just how to the coming years are going to be. That's not to mention

the deep cuts to adult social care which have piled the pressure on

hospitals and the ?22 billion worth of so-called efficiency savings that

this Government has signed up to. I have yet to meet anyone who works in

the NHS who thinks that efficiency is on this scale are possible

without harming patient care. I will give way. I don't disagree with her

at all that there are big pressures on the horizon. But can she say how

much beyond Simon Stephens' own predicted casts her party is now

pledged to spend on the NHS? So far all we have heard is provide. --

prevarication. I won't be drawn into giving figures at the dispatch box

today but the life sciences Minister was tweeting that we need a big

public debate about NHS funding. Three days ago, the scale of this

crisis was laid bare. NHS improvement, the body responsible

for overseeing hospitals published figures showing that NHS trusts

ended 2015/16 with a record ?2.45 billion deficit. That is ?2.45

billion. To give honourable Members some context that is travelled the

deficit from last year. What is the cause of this? Spiralling agency

spending because of staff shortages. When this Government talks about

more money going in, let's remember, before it gets to the front line,

the bulk of it is going to be spent on paying off the bills from last

year. I will give way. I wonder if the honourable lady could give us an

idea of how many extra personnel she thinks we need to deal with current

levels of migration? I am grateful to the honourable

gentleman for that intervention. I think the health service benefits

more from migrants than they cost it. We on the side of the House are

not going to take any lessons on NHS spending from a party that has

created the biggest Black hole in NHS finances in history. It has got

so bad the House secretary cannot even guarantee his department will

not blow its budget. It is chaos. Ministers blame hospital bosses,

hospital bosses blame ministers, and all the while it is patients who are

paying the price. When faced with this crisis, you might have thought

the NHS would get more than a passing reference in the Queen's

Speech, but no. Instead, what is this Government's and so when it

comes to the NHS? Fear not, they will be introducing a bill to crack

down on health tourism. With all the problems NHS is facing, this

Government wants to focus Parliament's time debating a bill

that could risk turning NHS staff into border guards. Mr Speaker, let

me be clear. If these measures are about getting the taxpayer a better

deal and ensuring fairness in the system, then we will not oppose

them, but I have to ask, with everything happening in the NHS

right now, is it really Ministers' number one priority to introduce

legislation to charge migrants and their children to go to A? If so,

then my fear is that we are going to see the kind of dog whistle politics

that got so rejected by the people of London earlier this month and

which will hopefully get rejected again on June the 23rd. The truth is

this. The crisis in the NHS with cash is not the fault of migrants.

It is the fault of ministers. I will give way. I have no doubt that the

honourable lady has a desire for a wider public debate but would she

agree that to have a meaningful debate and to add value to her

critique, she does need to set out what she sees as the financial

requirements of the NHS going forward? Otherwise it is actually

not a very hopeful debate to have. I am very grateful to the honourable

gentleman. He will just have to watch this space. The truth is, as I

was saying, the cash crisis in the NHS is not the fault of migrants but

the fault of ministers. Cuts to nurse training places in the last

parliament have created workforce shortages and led to a reliance on

expensive agency staff. Cuts to social care have left older people

without the help and support they need to remain independent at home,

putting huge pressure on NHS services. The underfunding of GPs

has left too many people unable to get timely appointments, meaning

they are often left with nowhere to turn it A The financial crisis is

a massive headache for NHS and attendance, but we all know it could

mean life and death for patients. -- for NHS accounteds. Targets that

exist to ensure swift access to care, NHS targets, have been missed

so often that failure has become the norm. I give way. I thank the

honourable lady for giving way. She has made a very political attack and

in that context would she care to explain why it is in Labour run

Wales the target for A admission is far worse than in England? Would

she care to explain why that is? I would have thought better of the

honourable gentleman. It is clear they want to speak about anything

apart from their record in England. A performance is currently the

worse since records began. Taking us back to the bad old days of the

1980s when patientss were left waiting on trolleys in hospital

corridors. Mr Speaker, the figures speak for themselves what I will

give way again to the Health Secretary. I wanted to ask her to

consider again what I honourable friend was saying. If A

performance is the fault of Conservative politicians in England,

is it not also the fault of Labour politicians in Wales where it is 11%

worse? Thank you, Mr Speaker. From my memory icing to think the budget

going to the NHS has been cut from Westminster. Let's look at the

figures. -- from my memory I seem to think. In March 2011... The Health

Secretary would do well to listen to these figures because I am about to

tell him the record of his term in office. In March 2011, 8602 patients

waited over four hours on trolleys because no beds were available. Four

years later, the figure is up sixfold, 253,000 641. In March 2011,