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Volume 556: debated on Tuesday 15 January 2013

The Secretary of State was asked—

Vascular Disease (England)

1. What recent assessment he has made of the provision of treatment for vascular disease in England. (136832)

Despite the huge improvements that have been made over the last decade in the outcomes for people with cardiovascular disease, it is still one of the biggest killers in England and the largest cause of disability. That is why we are developing a CVD outcomes strategy, which will set out where there is scope to make further improvements in patient outcomes in this area.

I am chairman of the all-party parliamentary group on vascular disease, which recently produced a report highlighting the need for early diagnosis and intervention, and the additional risks associated with obesity and diabetes. Is the Secretary of State willing to meet me and some of my colleagues to consider how we can improve outcomes for sufferers of vascular disease?

I thank my hon. Friend for his excellent work with the all-party group and for the group’s constructive response to our consultation on the outcomes strategy. I am more than happy to meet him and other representatives of the all-party group. With an ageing population and rising levels of obesity, we cannot be complacent about cardiovascular disease and have much to do.

The Prime Minister promised before the election that there would be no reconfigurations or closures unless there was clinical and local support. Why then has the Secretary of State decided to break up the existing vascular network centred on Warrington hospital, meaning that emergency patients face a trip to Chester by ambulance, when this has neither clinical support nor support in the local community? When did that policy change, or was it just an election promise that the Conservatives never intended to keep?

We believe in the clinical networks, including the network for cardiovascular disease. We have increased the funding for those networks by 27%. However, we want them to include mental health and maternity services. We think that it would be wrong to do what the Labour party wants, which is to concentrate that funding on cardiovascular disease and cancer, and deprive of the clear benefits of such networks the 700,000 women who give birth on the NHS every year and the nearly 1 million people who will be diagnosed with dementia.

Given that the majority of vascular interventions are acute in nature, following trauma or cardiac episodes, is it not reckless for NHS Lancashire and NHS Cumbria to be talking about moving vascular services away from the Morecambe bay area, meaning that people from the south lakes and north Cumbria will have to travel as far as Preston, Blackburn or Carlisle to receive treatment? Will the Secretary of State meet me, other local MPs and local consultants to discuss how we can put the matter right for local people?

We are very keen to ensure that all reconfigurations of services have strong local, clinical support. We are making good progress in this area. There is always a trade-off between access, which I recognise is extremely important in a rural constituency such as the hon. Gentleman’s, and the centralisation of services, which sometimes leads to better clinical outcomes. I am happy to arrange for him to meet me or one of my colleagues to discuss his concerns in more detail.

Those with diabetes, such as myself, are five times more likely to get cardiovascular diseases. Last year’s National Audit Office report indicated that 1 million diabetics did not get their nine checks. What steps will the Secretary of State take to ensure that those checks are made available to all diabetic patients?

I congratulate the right hon. Gentleman on his campaigning work for people with diabetes, and I am aware that there are 24,000 premature deaths every year because we are not as good as we need to be at tackling the disease. It is shocking that only half those with diabetes are getting the full set of nine checks that everyone with diabetes should be getting every year, and when we publish the cardiovascular disease outcomes strategy—which I hope will be in spring—I hope we will address some of his concerns about how we can do a better job for diabetes sufferers.

Deep vein thrombosis is the leading direct cause of maternal deaths across the United Kingdom. Will the Minister consider interaction with the regional assemblies, including the Northern Ireland Assembly, to agree a UK strategy to address that issue?

I am happy to look into the issue of DVT and it should be included in our CVD outcomes strategy. Just as we will look at diabetes, I will ensure that we also consider how we might be able to help on DVT.

Hospital Waiting Times (England)

Latest figures for October 2012 show that 70,000 fewer patients are waiting longer than 18 weeks than at the last election. The Government’s mandate to the NHS Commissioning Board makes timely access to services a priority.

Those figures compare extremely well with those in Wales, where most patients are waiting for 26 weeks, and many for 36 weeks. Would the Minister be willing to share some advice on how to get waiting lists down with his counterparts in Wales, and perhaps discuss with them why patients wait so much less time in the Conservative NHS in England than in the socialist NHS in Wales?

My hon. Friend is right to highlight key differences between the NHS in England and in Wales. The Labour-run Assembly in Wales is cutting funding by around 8%, which will—of course—impact on the quality of care available to patients and other front-line services. At the same time, in England we are ensuring that we continue to invest, with £12.5 billion in the NHS during the lifetime of this Parliament. I would be happy to point that out to colleagues in Wales and the Welsh Assembly, and to make the point that it is the Conservatives and the coalition Government who deliver better patient care through investing in the NHS.

Will the Minister tell the House how many NHS trusts failed to meet the accident and emergency target of 95% of people being seen within four hours last week? When was the last time that target was met nationally?

I am happy to inform the hon. Lady that we are meeting the 95% target nationally for the A and E wait. On the most recent figures available, 96% of patients were seen within that period—96 out of every 100 patients are seen within four hours in A and E. The key difference between this Government and the last Labour Government is that we trust clinicians to ensure that they prioritise those patients in greatest need ahead of purely meeting targets and ticking boxes.

As winter bites, the NHS faces its toughest time of year, but there is mounting evidence that the Secretary of State has left it unprepared. For 105 of his 133 days in office, the Government have missed their own A and E target for major A and Es. Last week, for the first time, the figure fell below 90%. Right now in A and Es up and down England, ambulances are stuck in queues outside, patients are on trolleys in corridors, and people are waiting to be seen for hours on end. Does the Minister accept that there is a growing crisis in our A and Es, and if he does, what is he doing about it?

The right hon. Gentleman is good at putting across figures based on brief snapshots in the year. We know that on an annual basis we are meeting the target, and that 96% of patients are being seen on time in A and Es. We have made allowances for winter pressures, which we know are always difficult during the flu season every year, and we have put aside £330 million to ensure that we support the NHS during those winter pressures. Let me make it clear to the right hon. Gentleman that it is wrong to try and distort figures based on outcomes from a snapshot of just a few days or a week. It is important to put across the clear picture, which is that the Government are meeting targets in the NHS and patients are being treated in a much more timely manner than under the previous Government.

I suggest to the Minister that he needs to get out on the ground in the NHS a bit more. The figures I gave him were for major A and Es. If he got out more, he would realise that his complacency, which we have just seen at the Dispatch Box, is not justified. Let us look at Milton Keynes, which was identified by the Care Quality Commission as one of the 17 understaffed hospitals, and where last week just 72% of patients were seen within four hours. Milton Keynes is one of 15 trusts in England where A and E performance plummeted below 80%. These are the kind of figures that we have not seen in the NHS since the bad old days of the mid-1990s. Ministers like to blame nurses, but it is time they started accepting some responsibility. Will the Minister today ensure that all A and Es in England have enough staff to get safely through the winter?

I reassure hon. Members that, unlike any Member on the Opposition Front Bench, I still work in the NHS every week and I ensure that I see what happens on the ground. That cannot be said of any Front-Bench Opposition Member. The coalition has Ministers who are in touch with what is happening in the NHS on the ground. On A and E waits, we are trusting clinicians to exercise their judgment, which is why we now have a 95% target. We are ensuring—and the statistics show—that we are meeting that target on an annual basis. Patients are being treated in a timely manner. Furthermore, we have put in £330 million to deal with winter pressures. It is wrong of the right hon. Gentleman to try and mislead the House in this way—[Hon. Members: “Oh!”]—and use figures from a snapshot in time, rather than in a generality, which would indicate—

Order. Sorry, the Minister needs to withdraw the suggestion that anybody tried to mislead the House. That simply needs to be withdrawn; that is all.

Indeed. I do withdraw that comment, Mr Speaker, and I apologise for saying that there was any deliberate attempt to mislead the House at all. I was simply pointing out the fact that the right hon. Gentleman is highlighting a snapshot in time—

No, no. Order. I must say to the Minister that when a retraction is required, that is what is required and that is all that is required. We move on.

Leeds Children’s Hospital (Heart Surgery Unit)

3. What representations he has received from clinicians in Yorkshire and the Humber on the decision to close the children’s heart surgery unit at Leeds children’s hospital. (136834)

I know that some are disappointed at the decision by the Joint Committee of Primary Care Trusts and want to see children’s congenital heart surgery continue at their local hospitals. However, the Safe and Sustainable review was an NHS review, independent of Government. Under the circumstances, and given that legal proceedings and a review by the independent reconfiguration panel are under way, my hon. Friend will understand that it is not appropriate for me to comment further.

One hundred and seventy clinicians from across Yorkshire and northern Lincolnshire have written to express their dismay at the decision, stating that for time-critical transfers it

“exposes a number of children to the risk of death,”

largely because it will require transfers to Newcastle, where services are not co-located. Does that not prove that the decision does not enjoy clinical support in Yorkshire and north Lincolnshire and that it is simply not true that this has been a clinically led review?

I have seen the letter to which my hon. Friend refers and I understand that these are extremely complex issues. Let me reassure him that when I take my final decision, it will be on a clinically led basis. I will do that when I have received the IRP’s report, which I am due to receive by 28 March.

The independent reconfiguration panel has already visited Leeds and I understand that it will visit again before that date. If it decided that both Leeds and Newcastle ought to stay open, would that be agreed?

I will make my decision when I have the IRP’s final recommendation. Obviously I cannot speculate on what the final decision will be, but let me reassure the right hon. Gentleman, as I did with my hon. Friend the Member for Brigg and Goole (Andrew Percy), that my decision will be taken on the basis of clinical need—in other words, what will save the most lives.

I note my right hon. Friend’s comments about his final decision being based on clinical advice, but will he also give consideration to patients and families in areas that are more remote from the centre, such as my constituency? This decision causes extra strain and cost to families and will also mean that they will not go to Newcastle, and therefore Newcastle will not achieve its target number of operations.

I am aware of those arguments. There is always the difficult issue of access versus the benefits of clinical specialisation, but I need to wait for the IRP to report before I can give a view on how it applies in this instance.

I understand the Secretary of State’s reluctance—quite rightly—to comment on the processes he is going through, but will he confirm that he expects full transparency in the review process? That means all the minutes of the JCPCT being given to the review process and none of them being redacted.

I do want this to be a transparent process and we will follow all the appropriate guidelines in that respect.

I must say to the House that if we are to get through the questions we need shorter questions and shorter answers from now on.


The Government are committed to ensuring that the number of midwives in training matches the needs of the birth rate. There are now over 800 more midwives working in the NHS than there were in May 2010, and a record 5,000 currently in training.

The Oliver Fisher neonatal intensive care unit at Medway Maritime hospital in my constituency is an excellent charity that looks after approximately 900 premature and sick new-borns each year. What further midwife support will the Government give to such care units?

My hon. Friend is absolutely right to point out the excellent work done at his local unit, which receives funding from the NHS and from charitable sources. We are investing more money into training midwives, and there are now more midwives working in the NHS. It is for local commissioners to capitalise on that, and to invest in support for neonatal units.

With births per midwife rising, maternity services being cut and newly qualified midwives unable to find a job, what on earth happened to the famous boast of the Prime Minister that he would recruit 3,000 more midwives and make their lives a lot easier?

With respect, perhaps the hon. Gentleman should listen to my answers before he pre-prepares a statement. I just outlined clearly that in the past two years there have already been 800 more midwives working in the NHS, and there are record numbers in training thanks to the investment being made by the Government. We are delivering on making sure that we are investing in maternity and investing in high-quality care for women. We are proud to be doing that—something the previous Government failed to do.

NHS Funding Formula (Rural Areas/Elderly People)

5. What assessment he has made of the effect of the current NHS funding formula on rural areas with a large elderly population. (136836)

Age is the main driver of an individual’s need for health care, as reflected in recent funding formulae. This is for the NHS Commissioning Board, but the independent advisory committee recommends continuing to review the case for additional resources in rural areas, particularly as more information on community provision becomes available.

It is disappointing to hear that the NHS Commissioning Board has decided not to implement a fairer funding formula. What does the Minister suggest I say to my constituents who potentially face having services withdrawn, when, in the same region, areas such as Barnsley receive almost 30% per head more in funding?

As a Member of Parliament for a rural area with an elderly community I understand the hon. Gentleman’s concerns, but allocations have to be based on solid evidence. The area where we do not have the evidence is on community services. The data will start to be collected on that and we will therefore be able to demonstrate whether community services cost more in rural areas, as I suspect they do. If that is the case, the allocation formula will be able to reflect that.

The north-east suffers some of the worst health outcomes in the country, despite having excellent care services. On many occasions, the Government have said that they are committed to reducing health inequality, specifically in the north-east. Why then did Ian Dalton say that using the new advisory committee on resource allocation formula

“on its own would have…moved resources from areas where people…have worse health outcomes to those where people have much better outcomes”.

Does that not show that the Government have no commitment to reducing health inequalities?

I think the news on the allocations for public health budgets is actually a remarkably positive story. Every part of the country will see real-terms increases in funding for public health. This is an historic moment where we shift the emphasis away from repair to prevention of ill health. The hon. Lady’s own area will see real-terms increases. Across the country as a whole, there will be an average of 10.8% over two years real-terms increases in public health funding. I am very proud that the Government are doing that.

Patient Experience

Improving the quality of care throughout the NHS is a key priority for the Government, and one of the things we are doing to make that happen is, for the first time, asking all NHS in-patients whether they would recommend the care they received to a friend or member of their family.

My constituents have consistently been let down by the failure of the last Government and a debt-ridden PCT to invest in local community health services. Will my right hon. Friend join me in encouraging the new clinical commissioning groups to respond to Witham’s growing population and health needs by investing in localised community health care?

I am happy to do so, and I commend my hon. Friend for her campaigning, because if we invest properly in community health services, we can allow the frail elderly, who are among the biggest users of the NHS, to stay at home happily, healthily and for much longer. That must be a key priority for us all.

At the last Health questions, the Secretary of State told me:

“Every NHS bed is getting an extra two hours of care per week compared with the situation two years ago.”—[Official Report, 27 November 2012; Vol. 554, c. 122.]

Quoting national average nurse-patient ratios does not help to improve the patient experience, but cutting 7,000 nurses sure does affect it. We have unsafe levels of care in 17 hospitals. Will he treat this issue a bit more seriously and do something about those unsafe levels?

With respect to the hon. Lady, she cannot talk about alleged cuts in the NHS while her Front-Bench team support a policy of real cuts in the NHS budget. In the last Opposition day debate, the right hon. Member for Leigh (Andy Burnham) said that he thought it was irresponsible of the Government to increase the NHS budget in real terms. That means he wants a real cut in the NHS budget, which would make the staffing issues to which she referred much, much worse.

Does my right hon. Friend agree that one of the most effective things we can do to improve the patient experience of health and care is to improve the co-ordination, not just between the hospital service and community-based health services, but between the NHS and social care, and to put in place the infrastructure, including the IT infrastructure, to make that real?

My right hon. Friend makes an extremely important point—in fact, I will be giving a speech on this tomorrow—because, in the end, if it is not possible to see a full medical record of some of these frail elderly or heaviest users of the NHS going in and out of the system throughout the year, it is not possible to give them the integrated, joined-up care that they desperately need. This will be a very big priority for us.

One of the biggest drivers of patient experience on hospital wards is the dedication and care of the nursing staff, but, as my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) said, the Care Quality Commission has identified 17 NHS hospitals that are operating with unsafe staffing levels, putting vulnerable patients and especially older people at risk. Frankly, it is the Secretary of State’s job to ensure that every NHS hospital operates with safe staffing levels, so does he now think it was a mistake to strip out almost 7,000 nursing posts from our NHS?

It is my job, and that is why the Government have protected the NHS budget. The hon. Gentleman’s Front-Bench team, on the other hand, want to cut it in real terms. He has to think carefully before he starts talking about all these so-called cuts, given that his shadow Health spokesman wants to cut the NHS budget in real terms. [Interruption.] That is what he said last December. I agree with the Care Quality Commission that it is totally unacceptable for hospitals to have unsafe staffing levels. The commission also said, however, that budgets and financial issues were not an excuse, because those budget pressures existed throughout the NHS and many hospitals were able to deliver excellent care despite them.

Cancer, Stroke and Heart Disease (Survival Rates)

Our cancer strategy set out the ambition to save 5,000 lives by 2014-15 through earlier diagnosis, cancer screening and improved access to treatment. We are working on an outcomes strategy for cardiovascular disease.

Will my right hon. Friend tell the House how many patients have benefited from the cancer drugs fund to date?

I am happy to inform my hon. Friend that 25,000 people have benefited to date from the cancer drugs fund, which the previous Government failed to introduce. On top of that, 53,000 more people every year are being admitted for chemotherapy and 219,000 more cancer treatments are happening every year than happened in any year under the last Labour Government.

21. I have previously raised with the Secretary of State the opportunity cost—in terms of cost and effectiveness —of the proton beam therapy system. Given that expert opinion—in the form of the national radiotherapy advisory group—is divided, and given that the cost of the proton beam therapy system is 100 times more than other advanced radiotherapy systems that my region and others lack, why is he proposing to spend £125 million on it? (136853)

I recognise that the hon. Gentleman has a long-standing view on this matter. I am guided by clinical advice. Over the next two years, we will publish the cancer survival rates by multidisciplinary team across the country in all the major cancers for the very first time. That will give us a much better objective base from which we can work out what the most effective treatments are.

20. Despite the fact that the incidence of breast cancer peaks in the 85-plus age group, the peak age for breast surgery is for women in their mid-50s and 60s. Does that not confirm the findings of the Royal College of Surgeons-Age UK report that, despite trends towards older people leading healthier lives, many older women are missing out on curative surgery, from which they are perfectly fit enough to benefit? (136852)

My hon. Friend will know that last October we outlawed age discrimination, and if that is the reason for this happening, it is totally unacceptable. We have to recognise that cancer is one of our biggest killers and that the over-85s are a key group if we are going to tackle it. He will welcome today’s news about making available drugs to tackle breast cancer, which may mean that surgery will no longer be necessary.

19. Will the Minister tell us what the reduction in size of the Department’s cancer policy team will be after April 2013, and whether any of the team’s functions will be removed to other bodies or scrapped? (136851)

We are reducing investment in the back office so we can put more money into the front line. The result is that there are 219,000 more cancer treatments every year than there were under the last year of the Labour Government.

Sexual Health Policy

We plan to publish our policy document on sexual health and HIV shortly. Improving sexual health is very important for individuals and communities.

Can the Minister explain why the sexual health policy has been delayed for almost two years? Does he accept that this delay is affecting the ability of PCTs to deliver effective sexual health services?

From April, local authorities will be responsible for commissioning services. Because we have seen this really impressive increase in funding for public health, local authorities will have the ability to maintain and indeed improve sexual health services for their local communities. That is something of which we should be proud.

On the sexual health strategy, the Minister will be aware that nearly half of the national incidence of HIV is in London, so what steps will be taken from April to co-ordinate the prevention of HIV London-wide?

I am very much aware of the situation in London, and I acknowledge that some good work has already been undertaken there. Local authorities are very much aware of their responsibility that will apply from April and are already working with clinical commissioning groups in London to ensure that comprehensive services are in place for the London community.

Pan-London preventive health care is important, but with the devolution of funding to local authorities, there is a great risk of them refusing to pool funds and of preventive health programmes in London collapsing. Can the Minister reassure Londoners that pan-London programmes will continue?

Yes, I can absolutely reassure the hon. Gentleman that there will be comprehensive services, which will cut across local authorities. We have to remember that local authorities will be under a legal responsibility to provide confidential open access to sexual health services and contraception services. Local authorities in London are aware of the need to ensure that comprehensive services are available from April this year.

Health Care Appointments/Operations (Postponements)

9. What recent assessment he has made of the number of health care appointments and operations which are postponed. (136840)

My Department collects data on the number of cancelled elective and urgent operations, which show that these remain very low compared to total activity. We do not collect information on postponed appointments or operations. The NHS must make arrangements locally to minimise postponements and cancellations to avoid the inconvenience to patients.

I thank the Secretary of State for that answer. This is an issue in my area, with the chief executive of South Tees hospital saying that one factor is excessive use of A and E for non-urgent cases, resulting in pressure on hospital resources. What can the Secretary of State do to make sure that A and E units are used only for genuine accidents and emergencies?

My hon. Friend makes a very important point. I am concerned that 114 non-urgent operations were cancelled in the South Tees area between November and January, which is significantly higher than this time last year. He is right that we need to think about the model for an A and E service. Nearly 1 million more people go through A and E every year than they did two years ago. We have to recognise that for A and E services to be sustainable, we need to think about people who would better off seeing their GP or going to an urgent care centre.

Is the Minister aware that health care appointments are still bedevilled by the number of people who do not show up, even for appointments with consultants and senior hospital staff? Is it not about time that we looked at a simple system, in which people could pay up front a small amount of money that they get back when they turn up? I am sure that my constituents, as good Yorkshire people, would take their appointments much more seriously if they got their money back when they turned up?

I am interested to hear that suggestion from the Labour Benches, which is not necessarily where I would have expected it to come from. The hon. Gentleman might be surprised at my response, which is that I would be very concerned about such a system. I understand the issue and I think we need to modernise the process of GP and hospital appointments. Technology can play a good role in that, for example by giving people text reminders of appointments that they have booked. My concern is that the system suggested by the hon. Gentleman would put people off going to see their doctor if they needed to. I would not want to do anything that deterred people from using the NHS who most need to do so.

Accident and Emergency Departments (Waiting Times)

10. What estimate he has made of the number of patients who waited longer than four hours for treatment in accident and emergency departments in 2012; and if he will make a statement. (136841)

In 2012, the NHS saw nearly 22 million people in A and E across the country, with 96% seen within four hours, which I am sure the hon. Lady will agree is a great achievement. That means that the A and E clinical quality indicators for high-quality patient care are being met in the NHS.

Last week, the Manchester Evening News reported that more than 1,000 patients had waited more than four hours at A and Es across Greater Manchester in December. I am sure the Minister is well aware of the planned downgrading of services at Trafford general hospital, and I understand that last night the joint health scrutiny committees of Trafford and Manchester agreed that the proposals should be referred to the Secretary of State for decision. Given last month’s alarming figures, will Ministers assure me that in reaching a decision about the future of Trafford general hospital, full account will be taken of capacity across Greater Manchester?

I thank the hon. Lady for her question. I recognise her concerns for her constituents. As has been outlined, there are seasonal variations, and I am sure that local commissioners will want to take such issues into account when they make decisions, and they must meet the reconfiguration tests set out by the previous Secretary of State for Health, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley).

The Better Services Better Value review of NHS services in south-west London identified that Croydon university hospital does not have sufficient senior doctors in its A and E, and nor did it under the previous Government. The review has been put on hold because Surrey has asked to be included. Will the Minister reassure my constituents that there will be a rapid solution to ensure that we have the A and E care that we deserve?

My hon. Friend is right to highlight a long-standing problem—it has not happened just recently —of a lack of particularly middle-grade doctors in A and Es. Although the number of consultants has increased by about 50%, as A and Es move rightly towards becoming a 24/7 consultant-led service, attracting middle grades to the specialty has been a problem. We set up a task force to consider that, as well as making better use of a multidisciplinary work force and emergency nurse practitioners to meet some of the staff shortages.

The performance of A and E services has an obvious and acute effect on the performance of ambulance services. In London, freedom of information requests show that the number of ambulances waiting more than 30 minutes from arriving at hospital to handing over their patients has gone up by two thirds over the last year, that ambulances are missing their targets in responding to the most serious life-threatening callouts, and that the average length of time that patients wait in ambulances before accessing A and E is going up, and in some cases patients are waiting almost three hours. The Care Quality Commission says that London Ambulance Service NHS Trust does

“not have sufficient staff to keep people safe”.

The question for the Secretary of State is simple: what is he going to do about it?

The hon. Gentleman is right to highlight the unacceptable variations in the quality of triage and handover between ambulance services and hospitals, not just in London but in other parts of the country. Many hospitals, however, do that well, and it is important that local MPs highlight the issue, champion good practice on handovers and ensure that that good practice is carried out at other A and Es. It is unacceptable that patients should wait for handover.

Can the Minister update the House on the roll-out of the 111 service and its effect on A and E admissions and 999 calls?

As my hon. Friend knows, we are developing the 111 service further to improve triage and take pressure off accident and emergency services when that is appropriate. I am sure all Members agree that when patients do not need to go to A and E, it is best for them to be treated in the community or properly triaged.

Specialist Accident and Emergency Doctors

11. What steps he is taking to improve the recruitment and retention of specialist accident and emergency doctors. (136842)

That is a long-standing problem. Recognising that emergency medicine is moving towards becoming a 24-hours-a-day, seven-days-a-week service, the Government have set up an emergency medicine task force to tackle the problem and encourage more recruitment of middle-grade doctors to A and E specialties.

Might it be time for us to take a leaf out of the Department for Education’s book, and consider offering scholarships or bursaries tied to doing the job for a certain number of years in order to improve recruitment and retention in this difficult area?

Bursaries are already available to medical students to encourage recruitment to the medical profession. As for the specific question of A and E recruitment, at the end of last year I published—alongside the report from the Doctors and Dentists Review Body on the consultant contracts and clinical excellence awards—a report on junior doctors in training. That has given us an excellent opportunity to consider what rewards and inducements may be available to encourage junior doctors to move into A and E and other specialties in which the work is particularly intensive and the meeting of staffing requirements has posed a long-standing challenge.

The Government say that the number of doctors in the NHS has increased by 5,000 since they came to power. When did those doctors start their training?

We know that it takes five or sometimes six years for doctors to complete their medical training. The key difference is that under the plans left by the last Government not all doctors were guaranteed places of work in the NHS after completing their training, whereas the present Government are ensuring that they find NHS jobs. That is why we have 5,000 more doctors in the NHS. The same applies to midwives: under the last Government they were not finding places after completing their training, but under this Government they are, and there are 800 more of them.

Alcohol Consumption (Damage to Health)

We published the Government’s alcohol strategy on 23 March 2012, and we are taking a comprehensive approach to reducing the incidence of alcohol-related disease and crime. Our strategy includes the introduction of a minimum unit price for alcohol, actions at local level, and pledges from industry under the responsibility deal.

The number of UK deaths from liver cirrhosis has increased by five times since 1970, while in France, Italy and Spain it has halved, and is now lower than the number in Britain. Even more disturbing is the fact that thousands of babies are still being born every year in Britain permanently damaged by alcohol. When will the Government take urgent, effective action to deal with this crisis?

I entirely share the hon. Gentleman’s concern. The Government have already taken action: we set out a strategy in March last year, and we are now consulting on the introduction of a minimum alcohol price. That could save up to 700 lives a year in 10 years’ time, which would make a dramatic difference. I am sure that the hon. Gentleman supports what the Government are doing.

Damage to health as a result of alcohol consumption often leads to wider social damage. I have seen that at first hand when visiting shelters for the homeless in Rotherham. Many homeless people cannot gain access to rehabilitation services because they do not have GPs to refer them. What steps is the Minister taking to ensure that those services are available to everyone, especially those who need them most?

The hon. Lady has raised a really important point. One of the consequences of the responsibility deal is that by 2015, 1 billion units of alcohol—about 2%—will be taken out of the market, and that will help some problem drinkers significantly. Moreover, the money that the Government are investing in public health gives local authorities an opportunity to invest in prevention services in order to deal specifically with the core group of people to whom the hon. Lady has referred.

Urgent Care Services

The configuration of urgent care services is a matter for the local NHS, and commissioners should ensure that there is provision of appropriate urgent care services locally to provide safe and effective care for patients.

A review of urgent care services by the new GP-led clinical commissioning group for Solihull is causing consternation as it is throwing the future of our highly regarded walk-in centre into doubt. Does the Minister agree that users must be properly consulted, as services must be designed around patients, and that allocation to cost centres must come second to delivering services?

I agree with my hon. Friend. Where there are well-functioning local services that have local support, commissioners should recognise that in their decisions, but it is also important to highlight that any reconfiguration of local services has to meet the four tests laid down by the previous Secretary of State: support from GP commissioners; strengthened public and patient engagement; clarity on the clinical evidence base; and support for patient choice. I hope that reassures my hon. Friend.

One of the ways in which the Government are trying to prevent urgent care and A and E admissions is by holding down the funding for unplanned admissions to 30% above 2009 levels. That is proving very hard in places where many people who arrive for A and E or urgent care are not registered with a GP. What can the Minister do to help with the funding of services in communities where it has proved impossible to reduce A and E admissions?

The hon. Lady rightly highlights that there are challenges ensuring registration with GPs, particularly in areas with large migrant population groups. In some parts of London, each year as many as one third of patients move and change GP surgeries. This is a big challenge and we are encouraging local hospitals to make sure that people who turn up at A and Es inappropriately subsequently register with a GP.

Community Hospitals

The Government are committed to supporting the NHS to work better by extending best practice on improving discharge from acute hospitals and increasing access to care and treatment in the community. Community hospitals play a valuable role in this process.

I welcome my hon. Friend’s reply. Will he give an assurance that going forward there will always be a place for community hospitals in respect of palliative and rehab care, which can be more easily delivered in one place?

My hon. Friend makes an excellent point. Community hospitals can provide a good focus for palliative care, respite care, intermediate care and step-up and step-down care close to home, particularly for people in rural communities who may otherwise have to travel very long distances to attend hospitals. I hope the community hospitals in my hon. Friend’s constituency will have a long and vibrant future.

Topical Questions

We want to make 2013 the year we break down the stigma associated with dementia and transform the care and treatment received by the one in three over-65s who will get the condition at some stage. Today, the Alzheimer’s Society published a map showing the totally unacceptable variations in dementia diagnosis across the country, with some areas diagnosing fewer than a third of people who have the condition, thereby denying them the medicine and support that would help them live happily at home for much longer. We are determined to put this right.

Given that next week is designated as cervical cancer prevention week and we know that many women ignore, or do not recognise, the early symptoms of cervical cancer, what action will the Secretary of State take to raise awareness of cervical cancer symptoms?

That is a very important point. Every year we screen about 3.5 million women for cervical cancer and we think we save about 4,500 lives, but we could save many more. Our “Be Clear on Cancer” campaign is highlighting the four clear symptoms people need to watch out for: unexplained bleeding, weight loss, pain, and lumps.

T3. The Minister of State earlier failed to answer the key question on midwife numbers, so I wonder whether the Secretary of State could take it on. Before the last election, the Prime Minister made a firm pledge to increase the number of midwives by 3,000. Will the Secretary of State tell the House whether that pledge will be honoured or discarded along with all the other promises on the NHS? (136859)

The number is up by 800 already, but as the Labour Front-Bench team knows, it takes some time to train midwives. I say to the hon. Gentleman that none of the investment in additional midwives would be possible if we had a real-terms cut in the NHS budget, which is what his Front-Bench team wants.

T2. Many of my constituents in Jaywick have complained about local GP services, saying that there are too many locums and inadequate provision. In order to attract and retain good GPs in an area with a challenging work load, the local commissioning body needs to be able to offer them more favourable terms. Will the Minister ensure that there is sufficient local flexibility so that the commissioning body can do that? (136858)

My hon. Friend makes a very important point, putting his finger on a key issue: the 24-hour availability of GP services. That is going to be crucial as the NHS goes forward. The NHS medical director, Bruce Keogh, is looking at the whole issue of seven-day working in the NHS and will certainly be examining what flexibility needs to be given to local areas to make that possible.

T4. On 30 December, ambulances in north-east London were diverted from the Whipps Cross, Queen’s and Homerton hospitals, with only the accident and emergency units at the Royal London hospital and the King George hospital in Ilford being open. Last week, on 8 January, Queen’s hospital in Romford was again diverting ambulances. Will the new Secretary of State look at the decision of his predecessor, whom I see on the Bench near him, and cancel the insane decision to close the accident and emergency unit at King George hospital? (136860)

The decision has been taken, but we have made it absolutely clear that we will not proceed with implementing it until there is sufficient capacity in the area, particularly at Queen’s hospital in Romford, to cope with any additional pressures caused by it, and that undertaking remains.

T5. The NHS has confirmed that North Yorkshire is the only part of the country that will inherit a £19 million debt, which has to be carried by the new clinical commissioning groups. That was the situation we were promised we would never be in. What is the Secretary of State going to do to urgently address the chronic underfunding of rural areas for the NHS in North Yorkshire? (136861)

My hon. Friend and I have previously discussed this matter, and she is right to highlight that there are particular challenges to address in rural areas, in terms of both distances to travel and an ageing population requiring considerable health care resources. That will of course be a matter for the NHS Commissioning Board to examine when it considers future funding allocations.

T6. As one in three women who get cancer are over the age of 70, can the Minister say when the newly launched Be Clear on Cancer campaign will be rolled out nationally? (136862)

It is our intention to roll it out nationally as soon as possible, and I will make sure that the hon. Lady gets the exact details.

T9. Many of my constituents are concerned by the Care Quality Commission’s recent findings at Milton Keynes hospital, which came despite an increase in nursing staff since 2010. What reassurances can my right hon. Friend give my constituents that the problems are being rectified and that they will be able to enjoy high-quality care? (136865)

First, let me say that substandard care simply will not be tolerated and it has to be taken extremely seriously. I understand that the trust involved is reviewing its staffing levels so that the necessary improvements can be made. It has also started two-hourly checks, during which nursing staff check that patients have everything they need to be both safe and comfortable. There is clearly a big challenge and the trust has to meet it.

T7. The implications of HIV go well beyond health issues alone, yet the Government have so far refused to implement a new, cross-departmental HIV strategy. The Scottish and Welsh Governments have implemented their own such strategies, but 95% of people in the UK living with HIV reside in England. Will the Secretary of State commit to discussing this issue with his Cabinet colleagues, particularly those in the Department for Work and Pensions and the Department for Education? (136863)

I take extremely seriously the point that the hon. Lady makes. It seems to make more sense to be part of a comprehensive, integrated sexual health strategy, which the Government are planning and which will be published very soon. Services tend to be delivered together in the same units, so it makes sense to have a single strategy to deal with all those issues.

T10. In the light of widespread representations from constituents about the proposals for the centralisation of pathology services, will my right hon. Friend the Secretary of State consider the clinical concerns very carefully before any such changes are sanctioned? (136866)

I thank my hon. Friend for that question and he is right to highlight the fact that any decisions about service reconfigurations must be clinically led, as was outlined in the Government’s tests for any service reconfiguration.

T8. Last week, the Secretary of State refused my request to meet a small group of local GPs, hospital doctors and residents who are opposed to the closure of accident and emergency and maternity at Lewisham hospital, yet in his former role he seemed very happy to trade hundreds of texts with Rupert Murdoch’s lobbyists about the purchase of BSkyB by News Corp. Why is it one rule for Rupert Murdoch’s lobbyists and another for doctors in Lewisham? (136864)

I think that the hon. Lady might perhaps read Lord Leveson’s conclusions before she starts hurling about allegations, many of which came from her side of the House, that were later shown to be totally false. With respect to the decision on Lewisham hospital, I thought that we had a very useful meeting last night with the south London MPs who are directly affected. She understands that the process put into law by her party and her Government means that I cannot reopen the entire consultation and start seeing some groups without seeing all groups that are affected. That is why I am limiting the discussions I have with colleagues, but I think that that is the right thing to do.

The evidence is compelling that improved access to talking therapies for children and adults makes a huge difference to their mental health. Will the Minister therefore assure me and the House that the NHS Commissioning Board will have the necessary dedicated teams to ensure that the adult improving access to psychological therapies—IAPT—programme is delivered and that the new children’s programme is, too?

I thank my hon. Friend for that question. The Government take the development of talking therapies extremely seriously and I can confirm that I met Lord Layard yesterday, together with representatives of the NHS Commissioning Board. There will be a central team and we are absolutely determined to keep driving this approach forward, as there is real evidence of results.

Today’s edition of The Daily Telegraph carries an article on dementia, including a quote from a GP who says that it is not useful to give an early diagnosis when there are no drug or care needs. Does the Minister agree that that GP, like many others, fails to realise that for pre-senile dementias in particular, early diagnosis allows planning and allows families to understand the confusion created by altered personalities, behaviour, emotional responses and language skills?

I know that the hon. Lady spoke very movingly in the debate on dementia last week and I wholeheartedly agree with her. The medicines available for people with dementia do not help everyone, but we do not know that until we try them. By diagnosing only 42% of people with dementia, as is currently the case, we are denying nearly two thirds of dementia sufferers the chance to see whether they could benefit from those medicines and, as she rightly says, the chance to plan their care, which could mean that they could live at home for much longer.

The all-party group on cancer is delighted that the one and five-year cancer survival indicators have been included in the CCG outcome indicator set. We have campaigned for that in the belief that it will drive forward earlier diagnosis, as the Secretary of State knows. Can he clarify how CCGs will be held to account through that indicator set? For example, what action will be taken on underperforming CCGs?

I congratulate my hon. Friend on his campaigning on cancer issues through the all-party group. The NHS Commissioning Board is held to account through the mandate, which clearly states that we must make tangible progress towards having the lowest mortality rates in Europe for cancer and a number of other major diseases. I will expect the board to clamp down hard on CCGs who fail to deliver on what needs to happen for them to deliver on that promise.

Cancer Research UK has expressed deep concern about the fragmentation of cancer services and the climate of uncertainty that makes it harder to improve them due to the Government’s NHS reorganisation. I appreciate that that is not the fault of the Secretary of State, but he has the power to do something about it. Will he listen to Cancer Research UK and stop the fragmentation of cancer services?

Of course, I understand the concerns of Cancer Research, and I know that the hon. Gentleman understands the personal tragedy that cancer can cause. The change in the clinical networks is happening because we want them to cover dementia, which we were talking about earlier, mental health services and maternity and paediatric services. It is right that they should do so, but I want to make absolutely sure that as we go through the restructuring the benefits of the cancer clinical networks remain as strong as ever.

Will my right hon. Friend look at the east midlands cancer drugs fund? While I welcome the cancer drugs fund enormously, the east midlands will yet again underspend, leaving some of my constituents paying for their own treatment because they have been refused funding. Will my right hon. Friend please get his Department to investigate why?

My hon. Friend has mentioned the issue to me before, and I am happy to look into it in detail for her.

It will be very easy to look at the number of lives saved. We will be able to see the impact of the fund, because it only started in 2010.

Kettering has the sixth fastest household growth rate in England, and accident and emergency admissions to Kettering general hospital are now at 12% year on year. Will the Secretary of State ensure that the NHS funding formula reflects the very latest population estimates?

NHS funds are independently decided by the NHS Commissioning Board, and I know that is a key concern of the board. I visited Kettering hospital, so I know that it is a very busy hospital coping well in difficult circumstances.

Penalties on readmission rates were introduced to improve clinical practice, but patients suffering from sickle cell and thalassaemia in my constituency and elsewhere cause hospitals to be fined for readmission, even though it is often in the patient’s best clinical interest. Will the Minister once again reconsider exempting sickle cell and thalassaemia from the penalty?

The hon. Lady is right to raise concerns about specific groups. The direction of travel in reducing readmission rates has to be the right thing; far too many patients were bouncing back to hospital when they would have been better looked after in the community. The longer term answer for some conditions, such as heart disease and possibly sickle cell and thalassaemia, may be year-of-care tariffs, which we are looking at very closely, as is the NHS Commissioning Board.

The Secretary of State just referred to the new strategic clinical networks. As the cancer networks are merged with them, what safeguards are there to stem the loss of expertise in cancer and what specialist support will be available to CCGs trying to achieve the targets we have heard about?

The biggest safeguard is the fact that the Government have made it one of our key priorities to improve mortality rates for cancer to the best in Europe. That means we are putting in a huge amount; for example, we are investing £450 million in early diagnosis. There are many other measures, which shows how seriously we take it.

My 92-year-old constituent, Ron Lewin, was referred for minor oral surgery. He was eventually written to by the specialist, who said that waiting lists were very long and that assessment appointments were available in 18 weeks, but that they did offer an independent service if he wished to be seen earlier. Independent obviously means paying to jump the queue. Is that how the Government propose to cut waiting lists?

It is a decision for front-line medical professionals to outline when treatment should or should not be given. Treatment must always be given on the basis of clinical need, so I am sure the hon. Lady will be feeding that message back to local commissioners. There is an opportunity for people to appeal against decisions when they are not made on the basis of clinical need, as that is clearly not the right thing and not in the interests of patients.

Will my right hon. Friend’s Department make an assessment of the effects on local air quality and public health of a potential third runway at Heathrow, and will he submit those findings to the Davies commission on airport capacity?

I am very happy to look into whether that is an area where my Department should take responsibility.

My constituent, Elaine Catterick, has had a serious operation at the James Cook hospital on Teesside cancelled twice in three months—once with just a few hours’ notice. She has also learned that there are twice-daily meetings at the hospital to decide whose operation should be cancelled next, as staff struggle to cope with spending cuts. I hope that is not what the Secretary of State wanted from his reforms, so what is he going to do about it?

All cancelled operations are a concern. The number of cancelled operations was about 50% higher as a proportion of all operations under the previous Government, but no operation should be cancelled, and we will continue to do what we can to bring down the numbers.

Order. My apologies to colleagues whom I could not accommodate but, as usual with Health questions, demand massively outstrips supply.