Accident and Emergency Departments

Baroness Coffey Excerpts

Tuesday 10th September 2013 Commons Chamber

[Mr Hunt]

The hon. Gentleman is right to say that that is one of the key issues in the underlying pressures on A and E departments. About a quarter of the money announced today will be used to increase the capacity of A and E departments, including increasing consultant cover. In the end, however, we need more trained consultants; we need more doctors who want to work in A and E departments. That is a longer-term challenge, but one of the ways in which we will make A and E more attractive is by convincing doctors that we have a long-term, sustainable strategy to make sure that it does not become an impossible job. That is what the measures on improving GP access, IT systems and the social care system aim to achieve.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

The Secretary of State may be interested to know that in a parliamentary seminar earlier this year the College of Emergency Medicine said that walk-in centres provided temporary help with A and E attendances but that their closure has had no impact at all. More importantly, does my right hon. Friend agree that we should praise those hospital trusts that have not needed extra money and that that is a ringing endorsement of their leadership?

[Mr Hunt]

My hon. Friend speaks extremely wisely, as ever. She is right. The reason why the 100 or so hospitals that have not benefited today did not get money is that our assessment is that they have outstanding leadership and will be able to cope. That is not, however, to minimise the pressure they will be under or the fact that it will be extremely hard work. I pay tribute to them because, as good hospitals, they often have to deal with more people wanting to go through their doors than through those of other hospitals with less good reputations. We need to support everyone and my hon. Friend is right to say so.

East of England Ambulance Service

Baroness Coffey Excerpts

Tuesday 25th June 2013 Westminster Hall

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

It is a pleasure to serve under your chairmanship, Mr Howarth. I thank my hon. Friend the Member for Witham (Priti Patel) for leading this debate so well; her speech was a tour de force. I will bear in mind your time limit, Mr Howarth, although I could take the whole 90 minutes to tell the sad tale. It is a pleasure to follow my hon. Friend the Member for North West Norfolk (Mr Bellingham). The East of England Ambulance Service NHS Trust is actually responsible for out-of-hours care in Norfolk, so the left hand should be talking to the right hand.

I also thank the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), and the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who started work on the issue. It was right for my hon. Friend the Member for Central Suffolk and North Ipswich, a doctor, to take the lead on such matters in Suffolk, but pushing on, consistent performance from colleagues across the counties in the east of England has brought the issue to the fore.

As I suggest, this is a sad tale that started some time ago. My timelines of the issue start in the middle of 2011. We are driven by the experiences of our patients —those who have suffered. Let us be honest: the vast majority of people in our constituencies have a good ambulance service. Once an ambulance arrives, care is very good; nobody denies that. However, too often that excellence of service is concentrated in certain areas of the region in order to meet a false regional performance target, and almost everything else is put aside. It does not matter if only 50% of people in south Norfolk get an ambulance within 90 minutes as long as the regional target is met. That is all that matters to the leadership and the board of the East of England Ambulance Service NHS Trust.

We have had a long series of meetings, Care Quality Commission inspections and promises of change. Transparency has been lacking. The trust has been dragged kicking and screaming into showing its performance targets in a meaningful way—first by county, now at clinical commissioning group level—but that took a long time. It used to say, “You can look in the minutes of your local primary care trust to find response times.” It is unacceptable for those at the very top to say, “Well, that’s all right; we’re hitting our regional target.”

I have used the constituency of the hon. Member for Copeland (Mr Reed) to say that if it can happen in Cumbria and Cornwall, it can certainly happen in Norfolk and Suffolk. It is important that the Opposition spokesman does not try to drag party politics into this debate or talk about finances. The issue is about those at the top having wrong priorities and forgetting that every patient matters.

I have never had to call an ambulance in the east of England, or indeed at all, but I like to think that if I did, I could have some confidence that it would arrive in time. In reality, however, there are not enough ambulances and not enough staff. Mr Andrew Morgan recognised that early on when he came into office as interim chief executive. As Dr Marsh pointed out in his excellent report,

“the current leadership from the board just isn’t strong enough to take them forward…there is a lack of focus and grip from the board which has contributed towards the deterioration of performance across the trust.”

Many of the issues breaking open at the moment have been deteriorating for some time. The non-executives have not shown leadership by asking hard questions and going beneath the surface; they have relaxed and considered only the top regional performance target.

I thank our local newspapers, the East Anglian Daily Times and the Eastern Daily Press. Nigel Pickover and Terry Hunt have done good things to keep up the pressure and stand up for their readers, our constituents, who are patients of the East of England Ambulance Service NHS Trust.

[Robert Halfon (Harlow) (Con)]

And the Harlow Star.

[Dr Coffey]

And the Harlow Star, apparently.

In December 2011, we finally got a meeting with the Health Minister and a range of other people around the table who could have fixed the issue. We were promised that there would be change and more focus at county level, and that patients mattered. The postcode data released in November 2011 showed that that had not been the case. We have never been able to get data at that level since then, because the trust does not want to share it with us and, frankly, I am not sure that I should spend all my time on freedom of information requests.

One of the things agreed at that meeting was that contracts would change. That did not happen, which is one issue relating to trust. In October 2012, Hayden Newton resigned. Coincidentally, that was a week after a series of complaints, including about the case of Nora Dennington, whose family finally went to the press to get an answer after three months. To be fair to Maria Ball, the former chairman of the trust, she got answers to those complaints then and there, and within a week, Hayden Newton resigned.

However, Newton was still on the payroll until the end of March 2013, and the chair at the time gave him a glowing tribute, saying that he would be greatly missed and

“a hard act to follow”

and that under his leadership, front-line staff were still being recruited and quality of care had improved. The chair also said:

“Thanks to Hayden’s stewardship, EEAST is now a stable, sustainable and financially sound organisation”.

I am afraid that the Marsh report blows that out of the water.

I could go on about all the different meetings, but I will not, as I am conscious of the time. What I will say is that patients’ complaints were not being answered, and patients were not being treated as individuals. The board should have seen it in the survey and the climb in sickness rates, and the CQC should have done more than tick the box saying that the trust had passed staff compliance on the basis that appraisals had been done. There was an element of external scrutiny by the CQC, the strategic health authority and, to some extent, Monitor, which did not approve the foundation trust status application, but passed the trust on the governance rating. All those different regulators, as well as the leadership of the board, need to look at themselves to understand why they, in effect, let people down. The board was fixated on getting foundation trust status; it was only focused on the regional target, and it did not matter that residents in Suffolk were being failed, as long as the regional target was okay.

Moving forward, my hon. Friends who have spoken are absolutely right: it is imperative that the remaining non-executive directors resign their posts immediately and that the NHS Trust Development Authority acts on that. The ideal solution for me would be to ask Dr Marsh to come in, whether permanently or on an interim basis, to turn around our ambulance trust, because he has the skills to make that happen. I want Dr Harris to succeed; however, it is important that we do not rely on the management speak to which my hon. Friend the Member for North West Norfolk referred, but recognise that we need to clean the slate.

There are of course external factors—we need to work with GPs and A and E—but much of the problem is internal, because there were not enough training places or staff. Incidentally, it is right that Whitehall should not seek to control everything, but it is vital that MPs have confidence that the NHS Trust Development Authority will take the matter seriously. Furthermore, CQC needs to be quicker—not to be rash, but not to be tick-box driven. It failed the ambulance trust and, more recently, it decided to withdraw from a meeting with MPs to talk about its reaction to the trust plan issued in April.

I could have spoken for longer, Mr Howarth, and I have spoken for longer than you requested, but I genuinely want to ensure that our patients, constituents and residents can rest assured that we will not stop continuing pursuit of excellence on their behalf, wherever they live in our great part of the country—they deserve nothing but the best. Again, if Cumbria and Cornwall can do it, we can certainly do it in Suffolk, Norfolk, Essex and Cambridgeshire. Frankly, until those non-executive directors go, we will not have confidence in the leadership of the trust to make the difference.

A and E Departments

Baroness Coffey Excerpts

Tuesday 21st May 2013 Commons Chamber

[Mr Hunt]

I can assure the hon. Gentleman that many more walk-in centres would be shut if we had to cut the NHS budget, which is what the Labour party wants to do.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

The issue of out-of-hours care and the additional pressure on A and E has been present in Suffolk since before the election. Just last Friday, I was in Felixstowe to meet the four patient participation groups there, and yet again out-of-hours care was identified as a real problem. I welcome the reforms that might be announced later this week, but can we ensure that patients realise that we are on their side and that we want them to be back with their family doctor?

[Mr Hunt]

Absolutely. It is extraordinary that in this debate in Parliament today, Labour Members have their heads in the sand about the low public confidence in out-of-hours GP care, which is a major driver of the problems in A and E departments. We are going to sort out that problem—[Interruption.] If they do not want us to, they are just going to have to watch while we do it.

Accountability and Transparency in the NHS

Baroness Coffey Excerpts

Thursday 14th March 2013 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

I wish to thank my hon. Friend the Member for Bristol North West (Charlotte Leslie) and the Backbench Business Committee for calling this debate. I particularly wish to remember all those in my constituency and elsewhere, and their loved ones, who suffered so grievously. I wish to pay tribute to those here today who campaigned to bring these things to light. I also thank the Prime Minister, the Secretary of State and all other hon. Members for their response to the report a month or so ago.

One of the main thrusts of the Francis report is to:

“Ensure openness, transparency and candour throughout the system about matters of concern”.

This is not the time to debate the Francis report fully—it was commissioned by the Government and it needs full and prompt consideration in Government time—but it is the time to say that the Francis report is of great importance. Mr Francis rightly dismisses the arguments of those who claimed at the time that the inquiry was unnecessary because Stafford hospital was a solitary exception—it was not. It may have been considerably worse than other places, but appalling standards of care have been revealed elsewhere.

The public inquiry has revealed complacency throughout the NHS and beyond; report after report detailed major concerns, which were either ignored or passed to others to deal with. What lay behind that? Perhaps it was a lack of willingness to shout and continue to shout for help when it was needed; or perhaps it was more often a fear of the consequences—the loss of one’s job or the removal of services from the local community.

Even just last week, when, as the shadow Secretary of State rightly said, a report to Monitor suggested removing most emergency, acute and maternity services from Stafford—something my constituents and I strongly oppose for reasons I set out in the House last week—there were those blaming Julie Bailey for the proposals. That comes on top of disgraceful threats—even death threats—that she has received over her work in revealing what Robert Francis, who should know if anyone does, calls the “disaster at Stafford Hospital”.

Let me make it clear that the proposals in the Monitor report are, in the main, a consequence of the financial and clinical pressures that all acute trusts, particularly the smaller ones, are facing. Stafford’s circumstances have done a little to hasten changes, but what happens at Stafford now will face all other such trusts in the coming years. That it is why it is so important that Monitor and the Secretary of State come to a good solution for Stafford, and indeed Cannock, and I will continue to work with them and with my hon. Friends on that. Nobody should take from the Monitor report the message that whistleblowing or more transparency will result in threats to their local services. Indeed, Monitor would be acting contrary to section 62 of the Health and Social Care Act 2012 if it acted in such a manner.

Let me raise another, perhaps more justified, fear of the unintended consequences of transparency. Only this week, I heard of a case where a patient could have a life-saving operation, but his chances of surviving it are only 50:50, yet without an operation he will die. Some surgeons are, even now, reluctant to take on the operation because if the patient dies, it will be counted against them in their personal mortality statistics. That is an unintended consequence of transparency, so transparency has to be balanced with understanding the context; otherwise, we will end up with a risk aversion that is so great that patients will suffer.

Transparency can also thrive only in a culture that is not led by blame. One of the doctors who gave evidence to Francis said:

“There was a blame-led culture, the culture being that problems had to be fixed or nursing jobs would be lost.”

How can we persuade the most suitable people to take up vital, often voluntary, roles on trust boards if their attempts to raise problems are met by blame or indifference? As my hon. Friend the Member for Southport (John Pugh) said, transparency must start right here in Parliament. He spoke movingly about moral purpose, and I agree with what he said.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

I agree that we do not want to deter people from becoming board members, but surely my hon. Friend must agree that if things are still going wrong and the board is not holding the chief executive and the leadership to account, its members’ positions should be questioned.

[Jeremy Lefroy]

I would never disagree with that. I entirely agree with what my hon. Friend says, but there is a danger that there will be so much adverse scrutiny that people will be afraid to come forward. We must challenge that and say, “You have every right, as a board member, to raise whatever you want, whenever you want.”

As I was saying, we need a proper debate here in Parliament on health care in this country, one not constrained by party dogma or blind nostalgia. It is up to us to have that debate and, as a result, give clear direction, rather than simply to react to whatever is thrown at us. We need to debate, for instance, the nonsense of pretending that it is entirely the responsibility of local trusts to deliver. So much is out of their control, be it per-patient funding, which is still far too variable, clinical standards, which are set almost in a vacuum by the royal colleges, or the impact of the European working time directive on costs, rotas and training. We need to debate the impact of the large number of specialisations in the UK—we have 61 as against Norway’s 30—which is driving up costs and driving out vital general medical and surgical expertise. We need to debate emergency and acute tariffs, which have, for many years, meant that hospitals around the country are squeezed and face forced reconfigurations that may not be in the best interests of patients.

Robert Francis also says that one of the main principles is to:

“Make all those who provide care for patients—individuals and organisations—properly accountable for what they do and to ensure that the public is protected from those not fit to provide such a service.”

He also says:

“There must be a proper degree of accountability for senior managers and leaders.”

Accountability was sorely lacking at Mid Staffs. There were attempts to see that responsibility stopped with the board. As I have already said, that is based on the fiction that it is somehow entirely in control of its own destiny. It is not. That does not absolve the board or management, but the responsibility is shared by those who determine so much of the environment in which they operate, including us here. Professional organisations, for instance, have procedures that make it difficult to dismiss staff who are unsuitable. The Government signed up to the working time directive without preparing for the financial and manpower consequences. And for managers, and indeed politicians, targets became more important than care itself. Again, that is our responsibility.

I have already said how strongly I oppose the blame culture, and I am not going to start blaming, but accountability involves responsibility, and far too few people have taken sufficient responsibility in this case. We must reflect and they must reflect on the message that that sends.

Too many inquiries have been left to gather dust on Department shelves, and not just the Department of Health. I and my hon. Friends the Members for Cannock Chase (Mr Burley), for South Staffordshire (Gavin Williamson), Stone (Mr Cash) and Members further afield, all of whom are affected, will not allow this one to gather dust.

--- Later in debate ---

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

It is a pleasure to contribute to this important debate, and I congratulate my hon. Friend the Member for Bristol North West (Charlotte Leslie), and other Members, on securing it. Transparency and accountability are the hallmark of good governance, but they can involve issues such as whether a patient is on the Liverpool care pathway, whether that is transparent and whether their families know, not solely about the running of a particular trust.

I welcome freedom of information requests, which are among the most useful tools available to a Member of Parliament trying to secure information on data held by hospitals, ambulance services and so on. It is extraordinary, however, that we must resort to those tools to try to get that information and help in holding the people running our services to account.

I accept that the NHS is a complex organisation—imagine a hospital that has issues with bed-blockers, social care, or people trying to find a place in a home, or where ambulances are exceeding their handover targets. Those are interlocking issues. I still think, however, that it is important to hold the chief executives and boards of these trusts to account.

I was late today because I was at a meeting with the chairman and chief executive of our ambulance trust. This is not the first time I have had to work with other MPs to highlight particular failures. In a Westminster Hall debate, I called for the chairman of James Paget hospital to step aside. I have not made that call today. I have asked the chairman of the board to consider carefully the potential issues arising from the CQC report that is due to come out at any moment. It is frustrating that in trying to hit the target people often miss the point. The point is to care for patients.

The Care Quality Commission and Monitor were mentioned earlier. I welcome the changes made by my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) to introduce unannounced spot checks by CQC. A lot of issues were unveiled as a result of the changes and that is to be welcomed. I welcome the recommendation to merge the CQC and Monitor, as there is a risk of ambiguity over exactly which body is holding people to account. I welcome the move by the Secretary of State to have Ofsted-style inspections. I am sure he will learn lessons and ensure that they are focused on clear issues, and not just on myriad matters that get away from the key point of patient care.

MPs in the east of England came together and, by speaking to the CQC and providing evidence, we managed to stop the ambulance trust gaining foundation trust status, because of the issue of care. Politicians therefore can and should intervene when there is evidence of things going wrong, and not just accept the initial recommendation of Monitor.

I pay tribute to David Hill, chief executive of James Paget hospital. He had been chief executive of the hospital before and went elsewhere in the health care system. He came back and within a week I could see that he had made a difference in the attitude to care. A year on, I am delighted to report that all the warning notices have gone and that in the latest unannounced inspection it was given a clean bill of health. That is great news for the patients and great news for the staff. It is a reminder that being brave and being prepared to incur the wrath of people who assume one is attacking the NHS when one is actually trying to defend the NHS and patients, can be worth hile.

That leads me on to the matter of the difficult jobs we have to do. We have to remind all our governors and board members that they are there to represent the patients. They should not feel cowed. They should be tenacious in pursuing the outcomes that everybody wants in the NHS. These are not easy times—I appreciate that. Let us not have too much hand-wringing about how hard it is. We all know it is, but I believe that politicians of all parties are here to try to support the people. We will not do that by ducking the reality that we have to be accountable. That is true in this House if we let down our constituents, but it is also true for the members of boards who do not hold their chief executive to account and demand nothing but the best for their patients.

Oral Answers to Questions

Baroness Coffey Excerpts

Tuesday 26th February 2013 Commons Chamber

[Dr Poulter]

I know that the hon. Lady had tabled a question on this matter. The point is that a foundation trust has autonomy and cannot be coerced or forced into a merger. It is for the board of that trust to make decisions for the benefit of patients.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

T8. Patients in Suffolk are very worried about the performance of the ambulance service. In the past two months, less than 60% of ambulances have hit the target for reaching emergency cases. The strategic health authority and others, including all the MPs in the region, are not happy about that. Will the Government intervene, too?

[Anna Soubry]

With two Ministers in the Department from the east of England, I can assure my hon. Friend that all of us are aware of the concerns that she and other Members have about their ambulance trust and, if I may say so as an east midlands MP, about the East Midlands ambulance trust. I know that Earl Howe, who has responsibility overall, has offered a meeting with Members from the east of England, and I am sure that that meeting will produce the sort of benefits that everyone hopes for.

Oral Answers to Questions

Baroness Coffey Excerpts

Tuesday 27th November 2012 Commons Chamber

[Mr Speaker]

Order. We must find time for Dr Coffey.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

The Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), is my constituency neighbour. He will know that, although the East of England Ambulance trust is hitting its targets for the entire region, it is not helping in Suffolk. Will he advise on what more we can do locally to ensure that it serves all rural patients?

[Dr Poulter]

The problem has affected both Suffolk and Norfolk—the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), also takes an active interest in it. One problem was that the managers of the local ambulance trust were not listening to front-line staff on how to design and deliver services. In a staff survey, only 4% of front-line staff in the East of England Ambulance Service said they were being properly listened to, which is completely unacceptable. This Government, in contrast to the previous one, want to put front-line professionals in charge of running services, meaning that, in future, more patients will be properly prioritised and ambulance response times will be better met.

Care and Support

Baroness Coffey Excerpts

Wednesday 11th July 2012 Commons Chamber

[Mr Lansley]

My hon. Friend will see in the progress report that we need to discuss both the universal options for paying for the Dilnot model of care and voluntary, opt-in systems. The latter could have a character not dissimilar to that he describes.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

I welcome many measures in the paper, including on the transition from being a child needing care to becoming an adult needing care, and on allowing people to choose where they want to end their life in palliative care. I represent a coastal constituency. Many people retire to the coast to enjoy the benefits of the sea air. Will he assure me that Suffolk county council will not be penalised by the fact that, in bringing families together, they will not take on extra care burdens for which they had not planned?

[Mr Lansley]

I completely understand my hon. Friend’s point. We very much reflect the need for care and health care in the allocation of resources to local authorities through the formula grant, and the allocation of resources to the NHS through the NHS resource allocation.

Health Transition Risk Register

Baroness Coffey Excerpts

Thursday 10th May 2012 Commons Chamber

[Mr Lansley]

No. The hon. Gentleman should know that in accordance with the FOI Act, if a ministerial veto were to be considered, it would be considered on the merits of any individual case.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

Will my right hon. Friend confirm that he has followed the policy laid down by the previous Government on the application of the Act and that nothing has changed in that respect in policy terms?

[Mr Lansley]

Of course, Mr Speaker, I cannot comment on the policies of the previous Labour Government. I would be happy, if the right hon. Member for Leigh agrees, to publish the risk management strategy that the Department of Health had in place in 2009, which was not placed in the public domain at that time.

Oral Answers to Questions

Baroness Coffey Excerpts

Tuesday 21st February 2012 Commons Chamber

[Anne Milton]

The only bit of the hon. Gentleman’s supplementary question that I recognise is a diatribe from the Labour party that perpetuates a myth about the Bill and fails to understand that the Bill is about the public of this country. This is about the people—patients—getting the health care that they need and deserve.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

May I pass on the representation of a health care professional in my constituency—one of the general practitioners involved in the commissioning group—who said that he felt the Health and Social Care Bill had been written for GPs, and that it was perfect for improving care in our community?

[Anne Milton]

My hon. Friend echoes many of the comments that I have heard as I have gone around the country. Without the Bill, we cannot strip out primary care trusts and strategic health authorities, which will save £4.5 billion over this Parliament. I cannot see anybody going out on a march to save PCTs and SHAs. The public want the outcomes and the quality of care that they deserve, which they were denied under the previous Government.

Manufacturing

Baroness Coffey Excerpts

Thursday 24th November 2011 Commons Chamber

[Mr Willetts]

The hon. Gentleman says that he is not convinced. I think that if the Minister of State, Department for Business, Innovation and Skills, my hon. Friend the Member for Hertford and Stortford, who has responsibility for business and enterprise, were here, he might have shed a quiet tear at that, because there he is, doing all this work in the Government and being responsible for all these sectors, including manufacturing and delivering the advanced manufacturing growth review. There are arguments about the titles that people should have, but the reality is that he does an enormous amount for manufacturing.

On strategy, if the hon. Gentleman looks at the growth review that we published with the Budget, he will see that there was a range of specific commitments, ranging from our advanced manufacturing review to commitments across a host of manufacturing sectors. We are doing further work on the future of manufacturing through the foresight exercise that my right hon. Friend the Secretary of State is leading. Manufacturing was a crucial strand of the growth review and there is now a forward-looking exercise in the foresight framework.

I will briefly take the House through some of the things that we are doing to strengthen manufacturing, which as I said were covered in the Government’s “The Plan for Growth”. Lowering business taxes is fundamental. That is why we are planning to cut corporation tax year on year. Although some people have criticised our decisions on the structure of corporation tax, it is worth remembering that we have legislated to extend the capital allowances and short-life assets scheme for plant and machinery from four years to eight years to improve the tax incentives.

We are also backing innovation. Several Members from both sides of the House have referred to the importance of the research and development base. I am particularly pleased that we have been able to draw on the lessons from Germany, which has been referred to favourably on both sides of the House, and to learn from its Fraunhofer institutes. Those were a model for the technology innovation centres that we are setting up with £200 million, even in these tough times. We have already identified some of those centres, notably in advanced manufacturing. Indeed, my right hon. Friend the Secretary of State is opening the National Composites Centre in Bristol today. That is the new home of world-class innovation in the design and manufacture of composites. We have also announced that there will be technology innovation centres in cell therapies and offshore renewables, and that there are more to come. We are trying to plug the gap between the pure research in universities and the commercialisation for which individual companies are responsible—the so-called valley of death. The technology innovation centres are one way in which we can plug that gap.

We are also committed to improving our performance on exporting. That is why we launched the national export challenge, a series of initiatives to help SMEs take the first steps to break into new markets. Currently, only one in five companies in Britain export. We want to increase that to one in four. That means reaching out to mittelstand businesses, or SMEs, that have not thought about exporting. That is why we have set UK Trade & Investment the target of doubling its client base to 50,000 businesses in the next three years.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

I have heard a lot of compliments about UKTI. However, when I met my local enterprise partnership earlier this week, the concern was expressed that UKTI reacts to requests, perhaps from bigger companies, rather than having a proactive strategy. Do you have any thoughts on how that might change?

[Mr Willetts]

In the absence of Madam Deputy Speaker responding to that challenge, I will. The Prime Minister urges all of us in his Government to be as proactive as possible whenever we go abroad, ensuring that we are properly equipped with a sense of the key business opportunities that are relevant to the particular mission that we are on. We have asked UKTI to set out what we call a high-value opportunities programme to identify really big projects around the world where there are opportunities for British companies and suppliers to invest and provide. We are systematically reviewing the high-value opportunities provided by large-scale projects around the world, which we believe British companies can take advantage of by going out and battling for contracts. We are improving the tax system, we are backing R and D and innovation and we are committed to improving our performance on exports.