T1. If he will make a statement on his departmental responsibilities. (81820)

My responsibility is to lead the NHS in delivering improved health outcomes in England, to lead a public health service that improves the health of the nation and reduces health inequalities, and to lead the reform of adult social care, which supports and protects vulnerable people.

Is the Secretary of State aware that plans to remove vascular services from Warrington hospital will threaten services such as diabetes care, renal cancer care and the co-operation on stroke that has been built up with Whiston hospital? What will he do to protect those services, or is this part of the plan he discussed in February with NHS North West to reduce the number of acute beds and increase competition?

I am glad that on Monday the hon. Lady will have an opportunity for an Adjournment debate where this subject can be—

Answer the question!

I will of course answer the question. The answer is that this is entirely driven by clinical issues in a local context. I can tell the hon. Lady that it is very much about trying to improve vascular services, and the judgments being made are local and clinical.

T2. What leadership role do the Government expect the new health and wellbeing boards to play in determining significant NHS service changes in each local area? (81821)

The health and wellbeing boards will have a role not only in leading improvements in public health and social care but, through the joint strategic needs assessment and the strategy derived from that, in establishing how services should respond to the needs of the local population. The clinical commissioning group should respond directly to that, and any specific service configuration changes should form part of the commissioning plan. In addition, the local authority, through its scrutiny role, will have a continuing ability to refer those plans for review.

T4. Will the Secretary of State agree to meet me, and families living with muscle disease, to discuss the urgent problem of primary care trusts refusing to fund vital cough assist machines, which help to prevent serious and very costly winter respiratory infections for those who are unable to use their lung muscles to cough? (81823)

Of course I, or one of my colleagues, will be glad to meet the hon. Lady to discuss that. I might also say that it was important to have announced, as I did last week, the expansion of ECMO—extracorporeal membrane oxygenation—facilities across England. Those facilities present a life-saving opportunity for people with the severest respiratory disease.

T3. My apologies, Mr Speaker, for having missed my question on the Order Paper earlier.Every five minutes someone in the UK suffers from a stroke, and over 1 million people are living with the effects of stroke. That is why I welcome the establishment of the first “life after stroke” centre—a £2 million investment in my constituency. Will my right hon. Friend join me in welcoming this excellent initiative by the Stroke Association? (81822)

Yes, of course I will join my hon. Friend in paying tribute to all the work that I know personally that the Stroke Association has done over a number of years in raising public awareness of the importance of developing stroke services, which has had an impact inside the NHS. We have improving figures in terms of reducing stroke mortality, and I now want to go further in ensuring that we enable people not only to survive stroke but to recover as many as possible of their abilities afterwards.

T5. Will the Minister with responsibility for public health update the House on her plans to review the criteria whereby people with haemophilia who have been infected with hepatitis C can claim stage 2 payments from the Skipton fund? Specifically, will she tell us how she intends to involve patients and carers in that review? (81824)

I know that the right hon. Gentleman has campaigned hard on this issue. I can assure him that I recently met a group of MPs, and constituents of theirs who are suffering from hepatitis. As he knows, there is a wide spectrum of illness associated with chronic hepatitis C infection. We are aware that people could be suffering financial hardship as a result, and I would urge them to apply to the Caxton Foundation. The Department’s expert advisory group on hepatitis C will continue to keep the evidence under review.

T7. In a number of surgeries in my constituency, and in many across the country, physicians’ assistants play a very important role in enhancing capacity. Can my hon. Friend say whether there are any plans in the Department of Health to allow physicians’ assistants to be able to prescribe medication? (81826)

The medicines legislation governs the range of health professionals who can prescribe. The Government’s policy is that only registered and regulated health professionals should be able to train for that; physicians’ assistants are neither.

T6. After speculation about the future of the Department of Health’s free nursery milk scheme, will the Secretary of State assure families and nurseries that he recognises the value of free nursery milk in preparing young people for a good future and well-being in life? (81825)

I assure the hon. Gentleman that we do recognise the value of nursery milk. The only shocking thing is that the previous Government presided over a scheme whereby nursery milk is now costing double the retail price, and we urgently need to look at that. We are committed to continuing the scheme, but shocked at what has gone on before.

T8. An independent study of the patient assumptions of the Safe and Sustainable review has confirmed what many of us already knew: that, contrary to the review’s claims, most families in Yorkshire and the Humber will travel not to Newcastle but to Leicester or Liverpool. Will my right hon. Friend seek confirmation from the Safe and Sustainable review body that it will revise its options in the light of that new evidence? (81827)

I am grateful to my hon. Friend and I have heard the important point that he has made. No doubt the Joint Committee of Primary Care Trusts will also hear the point that he has made to me. I am sure that he understands that it would be totally inappropriate for me to give any view that might compromise the independence of Ministers on this independent review.

What is the Secretary of State’s estimation of the number of NHS doctors and nurses who, in an astoundingly demoralising way, are having their pay grades downgraded?

I do not have a figure for that. If the hon. Lady and others want to discuss it, I would be glad to see evidence of it—and so should NHS employers, because as part of the implementation of “Agenda for Change”, staff should be banded in grades according to independent criteria.

T9. Last year in Westminster Hall, the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton) rightly praised the work of midwives and the Royal College of Midwives. Does she share my concern that locally, there could be a downgrading of community midwives, leading to an overall reduction in the number of midwives in our area? (81828)

I thank my hon. Friend, and I will take this opportunity to praise again the work of midwives and the Royal College of Midwives. It was a pleasure to be at its conference only last week. I would point out that there are now more than 20,000 full-time equivalent midwives. That is an increase of 2.4% on last year. We have record numbers of midwives in training, with 2,493 this year and an increase on that next year. What matters is that we get the right services for women who are pregnant, ensure that they can exercise the choices that they need, and get the right skills mix.

Figures today reveal that older women are being discriminated against in breast cancer treatment, with some 20% of women over 65 receiving chemotherapy compared with some 70% of women under 50. Will the Minister assure the House that those who are over 65 will receive equitable treatment, and that this discrimination will stop?

I am grateful for that question, and I assure the hon. Gentleman that the Government are determined to root out ageism wherever it might be within the NHS. That is why we have made it clear that there will be no exemptions from age discrimination legislation—and that will have to be taken into account by clinicians when they make decisions.

The recent judicial review concerning the unit at the Royal Brompton hospital said that the Safe and Sustainable consultation was unlawful and the review should be quashed. Considering the concern about this matter and the flaws in the review, is it not time for the Minister to indicate when the Government might intervene? Otherwise, there could be further threats of judicial review.

The straightforward answer is no, because the Joint Committee of Primary Care Trusts has said that it intends to appeal. This is an independent review. It would be inappropriate for me or any other Minister to interfere in such a review, because we could be accused of compromising its independence.

The Prime Minister promised a bare-knuckle fight to save A and E and maternity units at King George hospital, Chase Farm hospital and other hospitals that the Secretary of State now plans to close. When will that fight take place, and where can hon. Members purchase tickets for ringside seats?

I heard what the hon. Gentleman said, and I was disappointed that we did not reach his question on the Order Paper earlier, because he has been extremely concerned about the A and E in his own area in Hartlepool. That decision was taken on safety grounds. Emergency care has been provided at the One Life centre. The decision was taken with the support of the local overview and scrutiny committee, which he will appreciate has democratic accountability. That was the right decision. Where there are clinical reasons for taking such decisions, they should be taken.

Has my right hon. Friend the Secretary of State or any of his ministerial colleagues been able to visit the People’s Republic of China to consider traditional Chinese medicine?

I thank my hon. Friend for that question. He must be psychic, because I recently visited China, and it was fascinating to meet Ministers there. He will also be very pleased to hear, as I am sure the whole House will, that I visited a hospital and community centre that combines western medicine and traditional Chinese medicine.

The coalition agreement states that public sector employees, including health care employees, will be given a new right to set up employee-led co-operatives to run services. Can the Minister detail how many NHS co-operatives have been established and how many employees are involved in them?

I will gladly write to the hon. Gentleman if my recollection is wrong, but I think that something in the order of 25,000 staff have been transferred into social enterprises since the election. That represents something like £900 million-worth of NHS activity across England.

Pension reform is important to those of my constituents who work in the public sector—and, indeed, to the taxpayers who do not. With that in mind, does the Secretary of State agree that the heath service unions should work constructively with the Government on public sector pension reform rather than go on strike next week, potentially putting patients’ lives at risk?

Yes, I am grateful to my hon. Friend. It is very important to me that NHS staff, and other public servants, are valued in their remuneration, including the pensions that they receive. That is precisely why I have myself engaged in discussion with the NHS trade unions and staff side and continue to be engaged directly in negotiations with them about that, on the basis of the conditional offer that the Chief Secretary to the Treasury announced to the House recently, which I think would be fair to NHS staff and to taxpayers. On that basis, I think it is completely irresponsible and unacceptable for some unions in the NHS—not the Royal College of Nursing or the British Medical Association—to intend to go on strike next week.

We are immensely grateful to the Secretary of State. He is testing the knee muscles of colleagues very considerably, and we are grateful to him for that, I am sure.

Today’s report by Macmillan Cancer Support showed that over the past 40 years there has been virtually no improvement in life expectancy for those diagnosed with a brain tumour. Brain Tumour UK and experts such as my city’s own Professor David Walker are calling for action to improve diagnosis and treatment. What action is the Department taking to address their concerns?

I am grateful to the hon. Lady for her question. Macmillan has done a very good job by highlighting the need to focus on survival rates with regard not only to brain cancers but to lung cancers. Through our outcomes strategy, we are focusing on earlier diagnosis and ensuring that the care pathway is faster and delivers the appropriate treatments at the right time.

There are 3,000 cases each year of early stage inoperable lung cancer, but as yet no national stereotactic body radiotherapy treatment for lung cancer. What number of patients does the Secretary of State consider to be the appropriate threshold at which he will instruct his Department to establish a national lung cancer tariff?

I am grateful to my hon. Friend for that question. I do not think I am in a position to say what figure is appropriate, but the national clinical director for cancer has already indicated to the NHS that he wishes us to develop a national tariff for stereotactic radiotherapy. A quarter of centres across the country already provide it, and our intention is to ensure that that is supported by a national tariff as soon as possible.

Regrettably, there are still many thousands of attacks by dangerous dogs every year that end up with people in A and E, and occasional fatalities. Has the Secretary of State carried out any assessment of the cost to the NHS of treatment for attacks by dangerous dogs? If not, may I ask him to instruct his officials to do so?

I do not have those figures to hand, but I will gladly see whether we have them available, and I will write to the hon. Gentleman.

rose—

Order. I apologise for disappointing colleagues, but Health questions are invariably box office, and usually a sell-out at that. We must now move on.