My Lords, last week, the Prime Minister and President Macron spoke on illegal migration and European security. On Thursday, I will speak to Foreign Minister Séjourné at the G7. I am confident that the

Prime Minister and President Macron will meet again in person before too long. My colleagues, the Defence Secretary and the Home Secretary, and their teams similarly maintain regular, action-orientated dialogue with their French counterparts.

I thank the noble Lord for his question; he clearly has huge experience in this area. The Lancaster House agreement that I signed with President Sarkozy in 2010 expressly sets out areas where Britain and France will collaborate, including the most sensitive areas of nuclear weapon research and nuclear weapons. If what he is saying is that we need to enter into deeper dialogue to think about these things in the future, I agree. Britain’s nuclear deterrent is declared to NATO, and I am in favour of us having deeper conversations with the French about that.

I still maintain that one of the aims of NATO is, as Pug Ismay put it,

“to keep the Americans in … and the Russians out”.

That is still absolutely key to NATO’s future. I missed out a bit of that quotation, the noble Lord will be pleased to note. One of the things we must do is to make sure that we are talking to all parts of the American system, to make sure that NATO is in the strongest possible shape in its 75th year, with more members and more members reaching 2%, so that whoever becomes President at the end of this year can see that NATO is an institution worth investing in.

I think I can give that undertaking. The Prime Minister announced the package of support for Ukraine, at over £2.7 billion, which will ensure that it has the support it deserves from the United Kingdom. The Government are fully aware that we need to step up production, not just for Ukraine but to make sure that we deal with our depleted stocks. However, at the same time, there is a real task to be done across all the countries that support Ukraine to look at any weapons systems that are close to their expiration date. We will not be able to use them, but it could use them now.

I take what the noble Lord says, as a former Foreign Secretary, extremely seriously. What would make a difference is if Israel recognised its responsibilities for making sure that food, medicine and supplies have to be delivered to people in Gaza, and if it recognised that you need the UN staff who have the visas, the equipment and the fuel to help get it around. I will certainly take away the suggestion that the noble Lord makes, but the calculation here is quite simple. Before the conflict, some 500 trucks were going into Gaza every day. I check the figures every single day; we are up to about 150 trucks at the moment. That is not enough. The longer it goes on, the greater the risk of people going hungry and the greater the risk of disease and this humanitarian crisis getting worse. A pause would help, because there is no doubt that it would be easier to get food and other forms of aid in. It would also be very good to make some progress on the hostages, families of whom I met this morning.

Data on the average bed occupancy in National Health Service hospitals in England in each year is held from 2010/11 onwards and is shown in the following table.

Year Total bed occupancy General and acute bed occupancy

2010/11 85.4% 87.1%

2011/12 85.3% 86.9%

2012/13 86.2% 88.0%

2013/14 86.3% 88.0%

2014/15 87.2% 89.0%

2015/16 87.2% 88.9%

2016/17 88.3% 90.3%

2017/18 88.2% 90.3%

2018/19 88.0% 90.1%

2019/20 88.0% 90.2%

2020/21 76.0% 76.6%

2021/22 84.8% 86.5%

Source: NHS England

Note: Data for 2021/ 22 includes figures from 1 April 2021 to 30 September 2021.

Information pertaining to contracts and service categories is not held centrally.

National Health Service commissioners purchase services from a range of independent sector providers. NHS England records independent sector providers through coding identifiers; a sample of independent sector providers sourced from NHS England’s coding identifiers is attached, due to the large amount of data. Some providers do not have separate coding identifiers, therefore there are providers commissioned by NHS England which do not appear in the attached list.

The £8.722 million figure in Departmental accounts is the total value of NHS England commissioners’ contracts with private sector providers in 2015-16. This includes all types of secondary care, but not primary or social care. This does not include services contracted between individual trusts or foundation trusts and independent sector providers or any private finance arrangements.

The information requested on contract awards is not held centrally.

Individual commissioners (clinical commissioning groups and NHS England) are responsible for taking fair and transparent decisions on the award of contracts to the providers most capable of meeting the needs of their populations and providing value for money.

It is therefore not possible to provide an estimate centrally on the number and value of contracts that will be awarded to different types of provider in 2020.

The UK’s specific commitments on trade in health services are set out in the EU schedule of commitments to the GATS. This is a publicly available document and can be accessed at www.wto.org. The UK has not added to its commitments on trade in health services under the GATS since the GATS entered into force. We have not withdrawn any GATS commitments on trade in health services and we have no current intention to do so.

In principle, all EU-level trade agreements covering trade in services will include commitments on trade in health services. For the UK, these commitments are generally quite similar to those contained in the GATS although there are some variations between agreements.

Examples of agreements in force include the EU-Chile FTA, the EU-Mexico FTA, the EU-CARIFORUM Economic Partnership Agreement and the EU-Korea FTA. All EU trade agreements in force are publicly available documents and can be accessed at the Commission website at http://ec.europa.eu/trade/policy/countries-and-regions/agreements/. We cannot deposit the latest drafts of agreements under negotiation. These are not publicly available documents.

In principle, investment in the provision of health services is also protected through the UK’s existing network of investment promotion and protection agreements (which are also publicly available and can be found via http:// webarchive.national archives.gov.uk/20130104161243 /http://www.fto.gov.uk/en/publications-and-documents /treaties/treaty-texts/ippas-investment-promotion/) and will also be protected under the investment protection provisions in EU-level agreements currently being negotiated.

Neither the EU-Canada Comprehensive Economic and Trade Agreement (CETA) nor the EU-US Transatlantic Trade and Investment Partnership (TTIP) will impact directly on the UK’s commitments under the GATS. In the CETA, the UK has sought to limit its commitments in trade in health services to a level similar to that available under the CATS. The negotiations on the TTIP have not yet begun.

The UK’s specific commitments on trade in health services are set out in the EU schedule of commitments to the GATS. This is a publicly available document and can be accessed at www.wto.org. The UK has not added to its commitments on trade in health services under the GATS since the GATS entered into force. We have not withdrawn any GATS commitments on trade in health services and we have no current intention to do so.

In principle, all EU-level trade agreements covering trade in services will include commitments on trade in health services. For the UK, these commitments are generally quite similar to those contained in the GATS although there are some variations between agreements.

Examples of agreements in force include the EU-Chile FTA, the EU-Mexico FTA, the EU-CARIFORUM Economic Partnership Agreement and the EU-Korea FTA. All EU trade agreements in force are publicly available documents and can be accessed at the Commission website at http://ec.europa.eu/trade/policy/countries-and-regions/agreements/. We cannot deposit the latest drafts of agreements under negotiation. These are not publicly available documents.

In principle, investment in the provision of health services is also protected through the UK’s existing network of investment promotion and protection agreements (which are also publicly available and can be found via http:// webarchive.national archives.gov.uk/20130104161243 /http://www.fto.gov.uk/en/publications-and-documents /treaties/treaty-texts/ippas-investment-promotion/) and will also be protected under the investment protection provisions in EU-level agreements currently being negotiated.

Neither the EU-Canada Comprehensive Economic and Trade Agreement (CETA) nor the EU-US Transatlantic Trade and Investment Partnership (TTIP) will impact directly on the UK’s commitments under the GATS. In the CETA, the UK has sought to limit its commitments in trade in health services to a level similar to that available under the CATS. The negotiations on the TTIP have not yet begun.

The UK’s specific commitments on trade in health services are set out in the EU schedule of commitments to the GATS. This is a publicly available document and can be accessed at www.wto.org. The UK has not added to its commitments on trade in health services under the GATS since the GATS entered into force. We have not withdrawn any GATS commitments on trade in health services and we have no current intention to do so.

In principle, all EU-level trade agreements covering trade in services will include commitments on trade in health services. For the UK, these commitments are generally quite similar to those contained in the GATS although there are some variations between agreements.

Examples of agreements in force include the EU-Chile FTA, the EU-Mexico FTA, the EU-CARIFORUM Economic Partnership Agreement and the EU-Korea FTA. All EU trade agreements in force are publicly available documents and can be accessed at the Commission website at http://ec.europa.eu/trade/policy/countries-and-regions/agreements/. We cannot deposit the latest drafts of agreements under negotiation. These are not publicly available documents.

In principle, investment in the provision of health services is also protected through the UK’s existing network of investment promotion and protection agreements (which are also publicly available and can be found via http:// webarchive.national archives.gov.uk/20130104161243 /http://www.fto.gov.uk/en/publications-and-documents /treaties/treaty-texts/ippas-investment-promotion/) and will also be protected under the investment protection provisions in EU-level agreements currently being negotiated.

Neither the EU-Canada Comprehensive Economic and Trade Agreement (CETA) nor the EU-US Transatlantic Trade and Investment Partnership (TTIP) will impact directly on the UK’s commitments under the GATS. In the CETA, the UK has sought to limit its commitments in trade in health services to a level similar to that available under the CATS. The negotiations on the TTIP have not yet begun.

European Union/third-country agreements frequently cover areas of EU competence as well as areas of member state and unexercised shared competence. For this reason, decisions in Council regarding the negotiating mandates and the conclusion of such negotiations are taken by consensus. Through the formal structures provided in the treaty to consult member states and through informal dialogue with Commission officials, the Government are continually assessing what the latest developments from ongoing negotiations might mean for the United Kingdom in practice.

The Government would not agree to a trade agreement that was damaging to the National Health Service. If it seemed that negotiations were heading in a direction that could disturb the NHS, the Government would seek the removal of the offending text. As a last resort, the Government would block the agreement through insisting the agreement be decided by unanimity.