T1. If he will make a statement on his departmental responsibilities. (900608)

Today we published a report demonstrating that the NHS could recover as much as £500 million from better systems to monitor and track those who should be paying for the NHS treatment and introducing new charges to certain categories of people currently exempt. This is a significant sum of money that could fund 4,000 doctors, and far from being xenophobic, as some in the Opposition have alleged, the Government believe it is right that overseas visitors who do not pay for the NHS through the tax system should make a fair contribution through charges.

Poole hospital, which is much loved locally and has excellent care ratings, has a financial problem relating to tariffs that must be addressed. The £5 million spent on putting a failed case for a merger between Bournemouth and Poole hospitals to the Competition Commission raises questions about processes and openness with the public. I hope the Secretary of State can make some comments today, but will he meet me and other local MPs to discuss all these issues in greater detail?

I am happy to do so. I want to make it clear to my hon. Friend that I am keen to ensure we have a structure inside the NHS that makes it easy for high-performing hospitals that want to work more closely together and share services to do so, if it is in the interests of patients. We need to do more work in this area.

The Secretary of State has been in post for a year, and in that time we have got used to his style: everything is always someone else’s fault, be it lazy GPs, uncaring nurses or the last Government. And today we see more diversion tactics—now immigration is to blame. But there is an inconvenient truth that gets clearer day by day and which he cannot spin away: A and E is getting worse and worse and worse on his watch. We have had ambulance queues, a treatment tent in a car park and now police cars doubling as ambulances, with a patient dying on the backseat. The NHS stands on the brink of a dangerous winter. Will he today set out in detail what he personally is doing to avert a crisis?

I welcome the right hon. Gentleman back to his place. It is a great pleasure to see him there, even if it is not entirely what the Labour leader wanted.

If the right hon. Gentleman is shocked that I breached the A and E target for one quarter last year, he will want to make a full apology for the fact that he breached it for two quarters when he was Health Secretary.

This complacent spin is no good to the NHS. If he wants to compare records, let us do that. Under me, 98 per cent. of people were seen within four hours; under him, over 1 million people in the last year waited more than four hours in A and E—not only a winter crisis, but the first summer A and E crisis in living memory. Today it gets worse. New figures this morning show a further 450 nursing jobs have been cut, taking the total close to 6,000 under this Government. But what were they doing last night? They were voting in the Lords against safe staffing levels. Will he now listen to the experts, stop the job cuts and take immediate action to ensure that all A and Es have enough staff to provide safe care this winter?

We will listen to no one on the Opposition Benches when it comes to safe care for patients in the NHS. They presided over a system where whistleblowers were bullied, patients were ignored and regulators felt leaned on if they tried to speak out about poor care. That is a record to be ashamed of.

T5. There is evidence that a nutritional meal can be a real aid to the recovery of patients, yet the Campaign for Better Hospital Food found that 82,000 hospital meals are thrown in the bin every single day. Will the Minister update the House on the steps being taken to ensure that patients receive a hot balanced meal, served at an appropriate time? (900612)

My hon. Friend is absolutely right to highlight the importance of all patients receiving high-quality nutrition, and a lot of work has gone into promoting time for hospital patients to be fed and into protecting mealtimes, as well as into reducing hospital waste. Hospital food waste is now below 7 per cent nationally.

T2. We have a crisis in community nursing in Hull, with district nurses being stretched to breaking point. Does the Minister not agree that withdrawing funding from this service is economically short-sighted given that the foundation trust’s deputy chief executive says:“If the crisis continues, the nurses will not be able to care for patients in the community and it could result in them being readmitted to hospital”? (900609)

The hon. Gentleman is right to highlight the fact that local commissioners have a duty to ensure adequate community health care provision. I hope that that is an issue that he will take up with them. If he would like help in that fight, I am happy for him to come and meet me, and to bring in the local commissioners to talk this through, as it is important that we have enough community nurses to provide good care in communities and local commissioners need to listen to that.

T6. Can my hon. Friend update the House on what he is doing to support the earliest relationships of new families through early years intervention? Specifically, will he support the cross-party “1,001 Critical Days” manifesto? (900613)

I pay tribute to the work that my hon. Friend has done on the early years, and there are many good things in that manifesto. That is why we are investing in an additional 4,200 health visitors by 2015 and why we are supporting the most vulnerable families by increasing to 16,000 the number of families that will be supported by family nurses by 2015. A lot of investment is going into early years, which pays back to the Exchequer and gives much better care to families, too.

T3. Wirral council has said that anybody who wants to be involved in providing social care must show their commitment to the ethical care charter. Will the Minister congratulate leading councillors Phil Davies and Chris Jones on taking this initiative, which includes a move away from zero hours contracts? Will he say specifically what conversations he has had with the Local Government Minister and with Treasury Ministers about making sure that each and every local authority has sufficient funds to fulfil their legal obligations in care services? (900610)

I pay tribute absolutely to that local initiative, which is exactly the sort of direction we are going in. I have made the point several times that we cannot get great care on the back of exploiting workers. The idea that people should not be paid while they are travelling from one house to another is, in my view, unacceptable. When employers and care providers breach the minimum wage legislation, we should be absolutely clear that that is completely unacceptable. To ensure great care, the Government are introducing in 2015-16 the £3.8 billion integrated transformation fund, which will pool resources between the NHS and social care to ensure that we shift the focus to preventing ill-health and deterioration, and I think that that can make a real difference.

T7. I and my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti) have long campaigned for the maximum hospital facilities at Frenchay hospital, including a community hospital with an outpatients clinic—as was agreed as part of the Bristol health services plan in both 2005 and 2010. Now it seems that NHS managers are attempting to revisit these plans, something to which I am opposed, as is my hon. Friend the Member for Filton and Bradley Stoke, who has recently written to the Secretary of State to ask for a meeting to look into the situation. Will the Secretary of State agree to meet us both and investigate the situation? (900614)

I am always happy to meet colleagues for discussions, particularly when they are championing important health care facilities in their local area. I can confirm that the Secretary of State has received a formal referral from South Gloucestershire council in relation to these proposals, and has referred them to the Independent Reconfiguration Panel. He will of course consider the panel’s recommendations before making a final decision, and I am sure that my hon. Friend would agree that it would be inappropriate to pre-empt those deliberations.

T4. My constituent Jemma Hill is 25 and suffers from chronic hip pain, for which a specialist has recommended hip arthroscopy surgery. However, she has now been told that her local clinical commissioning group does not fund such treatment. Does it not make a mockery of GP-led commissioning when a CCG will not fund the treatment recommended by a specialist to whom the GP referred my constituent in the first place? (900611)

I am very happy to look into that matter, because it sounds like a very deserving case. I will look into the details carefully if the hon. Gentleman gives me the relevant information.

T8. Does the Secretary of State agree that we need to learn from the mistakes of the Safe and Sustainable review of children’s heart surgery services and improve the forthcoming review in two ways? First, we should make the process a lot more transparent. Secondly, areas such as neo-natal, paediatric and adult intensive care unit services and transport and retrieval services should fall within the scope of the new review. (900615)

I agree that we must learn the lessons. NHS England is responsible for conducting the new review into congenital heart disease services, and it is committed to conducting a review that is robust, transparent and inclusive, in the interests of delivering high-quality, sustainable services for all patients.

T9. When the minimum wage increased recently, a working carer on 15 hours a week contacted me because she found herself to be 85p over the threshold for carers allowance, meaning that she would lose £259 a month. What work is the Minister doing with other Departments to ensure that carers are not penalised for caring and working? (900616)

First, we should applaud the work of the many carers around the country who are doing absolutely invaluable work. It is obviously important to ensure that the policies of one Department do not have an adverse impact on the work of another, and I will be happy to look into the case that the hon. Lady has raised.

T10. Dr Elizabeth Stanger, a highly respected Salisbury GP, recently questioned me about the sustainability of providing multiple treatments for complex medical problems for several generations of the same family of foreign nationals. I welcome today’s announcement, and ask the Minister to reassure me that the mechanism to recover the funds will ensure that the money goes back to the clinical commissioning group so that it can provide a benefit locally. (900617)

I absolutely can reassure my hon. Friend about that. The point about the new, improved system for recovering charges is that we want the money to go back to the people providing the services so that they will be able to resource them better. This is not the diversionary tactic that some have accused us this morning of introducing; £500 million could have a huge impact on the NHS front line and allow his GPs to do a much better job.

This evening, the joint health overview and scrutiny committee for Trafford and Manchester will meet to consider whether the preconditions for the reconfiguration of services in Trafford, including those set down by the Secretary of State, have been met. I understand that the NHS area team has already confirmed that it believes the conditions have been fulfilled, but will the Secretary of State tell me what would happen if, as seems possible, the scrutiny committee were to take a different view tonight and decide that not all the conditions had been met?

We will obviously respect the legal processes, but if the scrutiny committee were to take such a view tonight, we would certainly look very closely at its concerns and ensure that we had satisfied ourselves on them before proceeding.

A written answer from the former Minister, my hon. Friend the Member for Broxtowe (Anna Soubry), to my recent parliamentary question has on this subject revealed that people living in the south-west of England are three times as likely to contract Lyme disease as those in the rest of the country, yet I have a constituent doing what he calls drug runs to the rest of Europe to access the medicines necessary to tackle his symptoms. Will the Minister meet me to discuss how we can ensure the continuing availability of treatments for Lyme disease on the NHS?

I learned a great deal about Lyme disease in the course of answering my first parliamentary questions, so I would be very happy to meet my hon. Friend to have that discussion.

Given that at least a quarter of a million children aged 11 to 15 take up smoking across the country each year, does the Minister accept that if we wait for two to three years for evidence to emerge from Australia about the impact of standardised cigarette packaging, hundreds of thousands of children will have started to smoke in the meantime?

On the Government Benches, we are interested in all measures that might stop children smoking. I do not recognise at all the time scales that the hon. Gentleman mentions. We are looking now at what is emerging in Australia and around the world so that we have more information on which to base an informed decision.

When the Secretary of State meets the chairman of NHS England to discuss future priorities for NHS spending, will he ensure a fair deal for rural areas by ensuring that they reflect rurality, sparsity and the number of elderly patients and that we keep the minimum income guarantee for rural GP practices?

I can reassure my hon. Friend, as I am meeting some Yorkshire GPs later this week who have concerns about that very issue. The most important thing about the difficult issue of the funding formula is that it should be fair. That is why under the new legislation we have given the decision to an independent body so that it is taken at arm’s length from Ministers and so that it strikes the right balance between the issues of rurality, age and social deprivation.

The NHS, with its massive purchasing power, can make a real difference to local areas through jobs and through supply chains. Some hospital trusts are enthusiastically implementing the Public Services (Social Value) Act 2012, including Barts and King’s. Will the Minister ensure that his new procurement strategy recognises the importance of social value?

The right hon. Lady makes a good point. We want improvements to the procurement process not just to save money, so that hospitals have more money to spend on the front line, but to support small and medium-sized businesses appropriately, such as by simplifying the qualifying questionnaire process, which is often too complex for small businesses to become involved in and therefore rules them out of the market. There are a lot of good things and I am happy to meet her to discuss the matter further if she would like.

The Secretary of State knows Worthing hospital well; he has rolled his sleeves up there. When I went there a few weeks ago, I was told that the average age of patients in the hospital, stripping out maternity, is 85, yet we have qualified for no winter pressures money and we have a diminishing number of community hospital beds. Will he look into this anomaly, as he well knows the specific pressures we have on the south coast?

I understand my hon. Friend’s concerns and I know that there is a large elderly population in Worthing. I thought it was an excellent hospital with a fantastic atmosphere when I went and did part of a shift there. The winter pressures money went to the third of A and E departments that are struggling the most, so it is probably a compliment to his hospital that it did not receive it. We felt that with limited funds we had to concentrate resources where they were going to have the most impact. I hope that he understands why we had to make that difficult decision.

This week, the report of the trust special administrator in respect of Stafford hospital is being presented to Monitor. Given that the preferred option is that the University Hospital of North Staffordshire should in some way take over, will the Secretary of State urgently meet all Members of Parliament for the north Staffordshire area to ensure that health care in north Staffordshire, where we already have a deficit of £31 million with an extra £18 million set to come over, will not be destabilised?

We are acutely aware of those concerns. In any reconfiguration, and particularly in this one, we want to ensure that there is no instability in the local health economy. We have given the trust special administrator a little longer to come up with a plan for Stafford hospital to try to secure local agreement, so I have not had a recommendation yet and I am going to wait and see what he says.

rose—

Order. I am grateful to the Secretary of State and colleagues, but as usual demand has exceeded supply and we must now move on.