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Oral Answers to Questions

Volume 576: debated on Tuesday 25 February 2014


The Secretary of State was asked—

Out-of-hospital Care

We will ensure that everyone over the age of 75 has a named GP, responsible for delivering proactive care for our most vulnerable older people in the best traditions of family doctors. Through our £3.8 billion better care fund, we are also merging the health and social care systems to provide more joined-up health and social care.

I welcome the steps that my right hon. Friend is taking to improve and enhance the quality of care for the elderly. Given that east Cheshire has one of the fastest-growing ageing populations in the UK, will he tell the House what specific steps he is taking to improve out-of-hospital care in and around Macclesfield? Furthermore, does he agree that it is vital that appropriate funding is in place to take care of the elderly and most vulnerable patients?

May I congratulate my hon. Friend on the campaigning work he does in his constituency on health matters? I commend the Eastern Cheshire clinical commissioning group for its “Caring Together” programme and for the fact that Cheshire was selected as one of the 14 integrated care pioneers. I hope that it will blaze a trail in joining up the barriers that have bedevilled our health and social care system for too long, so that his constituents are not pushed from pillar to post because of arguments about budgets and people can be discharged on time. I think his area is blazing a trail.

The national dementia strategy has been fundamental in improving care for many frail and elderly people with dementia living in the community. The strategy is due to expire in April—in two months’ time. Will the Secretary of State give a commitment to the House now that the national dementia strategy will be renewed? I understand that we have the Prime Minister’s dementia challenge, but, like many of us, Prime Ministers come and go. We need a strategy and not simply the Prime Minister’s challenge.

I can assure the right hon. Lady that this Prime Minister is here to stay. Indeed, I can also reassure her that the national dementia strategy is here to stay. As she has announced that she is stepping down at the end of this Parliament, may I thank her for her campaigning on dementia, which, I think, came from a family connection with the issue? She has attended many of my dementia meetings and the G8 dementia summit. She has made a really important contribution, and I thank her for that.

May I follow up on the question that the right hon. Lady has just asked? The Secretary of State has said that the national strategy is here to stay and that is very welcome, but the national strategy was drafted with the intention that it would expire this year. It would be useful if he now indicated the intention to refresh and update it so that we have a clear road map for at least the next decade.

I know that my right hon. Friend showed great interest in this issue when he was in my Department. When I say that the strategy is here to stay, I mean that it is here to be refreshed and updated. We are subscribing to some big new ambitions, including that by the time of the next election two thirds of people with dementia will be diagnosed and have a proper care plan and support for them and their families. That is a big improvement on the 39% of people who were diagnosed when we came to office. There is much work to do, but I assure him that we are absolutely committed to delivering.

Some hospitals are making a virtue out of quick discharge for their stroke victims. Is the Secretary of State convinced that elderly stroke victims, perhaps those without people to advocate on their behalf, are getting appropriate care and that their care and rehabilitation are not being scrimped on or rationed?

No, I am not convinced. We need to do much better when it comes to the discharge of vulnerable older people, especially when they leave hospital not cured and still with a long-term condition. They may be recovering from a stroke or dementia or any other condition. We need to have much better links between hospitals and GPs and to have named accountable GPs in the communities looking after those very people.

I was disappointed with the allocation of funding by NHS England for care around the country because it did not reflect the demands of the elderly population. People in my constituency have to do a 200-mile round trip to receive support such as cardiac care. Will the Secretary of State ask it to think again for future years?

My hon. Friend is right to campaign hard on that issue. I agree that the funding formula does not always do justice to people, especially those in sparsely populated rural areas. I know that NHS England is trying to do what it can to move to a more equitable funding formula, but it is not something that can be done overnight. I encourage her to keep pressing on that issue.

Welcome back, Mr Speaker. Easy access to GPs is a key part of out-of-hospital care for elderly and frail people. Days after the election, the Prime Minister scrapped Labour’s guarantee that gave patients a GP appointment within two working days, and took away funding that kept thousands of surgeries open in the evenings and at weekends. Now the Royal College of General Practitioners is warning that 34 million patients will fail to get an appointment. Will the Secretary of State listen to the Patients Association, bring back the 48-hour appointment guarantee and help older people to see their doctor when needed?

The reason that we got rid of that guarantee was that the number of people who were able to see a GP within 48 hours was falling in the last year in which the target was in place. It was not working, and that is why the British Medical Association and the Royal College of General Practitioners were against it. In the same survey that the hon. Gentleman quoted, the RCGP said it estimated that there had been a 10% increase in the number of GP appointments compared with when his Government were in office.

Maternity Care

We have made improving maternity services—so that women have a named midwife responsible for ensuring personalised care—a key objective in our mandate to NHS England. Since May 2010, the number of midwives has increased by more than 1,500 and a record number—in excess of 5,000—are now in training. Over the past two years I have set up a £35 million capital investment fund, which has already seen improvements to over 100 maternity units.

My local foundation trust is currently exploring a major service change which would see the creation of a new acute care hospital to handle the sickest and most complex patients. It would leave midwife-led units only in Winchester and Basingstoke, and centre consultant-led services on the new site. Does the Minister feel confident that the clinical case for this kind of centralisation has been made? Would he be comfortable to see it rolled out across the NHS?

My hon. Friend is right to highlight the fact that such decisions are clinical decisions and need to be made at a local level to ensure safe care, both with appropriate numbers of obstetricians in obstetric-led units and to give women the choice to deliver in midwifery-led units where appropriate. I am pleased that we, as part of the fund that I outlined earlier, have been able to give Hampshire Hospitals NHS Foundation Trust £50,000 to provide enhanced facilities in birthing rooms at Florence Portal house.

In 2012 representatives of Group B Strep Support met the Minister and received a commitment that the gold standard of enriched culture medium testing would be introduced, which can facilitate preventive treatment for women in labour. Just before Christmas, Public Health England announced that the testing would not go ahead from 1 January. Can the Minister say why not and when the test will be introduced?

Group B strep is an important issue. I have seen in my clinical practice the devastating effect that the disease can have on newborn babies and on families, so we are doing all that we can to support work on it and ultimately to develop a vaccine to prevent the condition. I would like to correct the hon. Lady on the record. I met Group B Strep Support with the Chief Medical Officer and we undertook to investigate the applicability of the test. The clinical evidence unfortunately does not support its introduction, and we have to be guided by clinical evidence.

17. My hon. Friend has visited the Hexham midwife-led maternity unit, which provides exemplary care. Can he update the House on what steps the Department of Health is taking to prevent excessive screening of pregnant women away from midwife-led units? Surely health care is about choice, not diktat. (902640)

My hon. Friend is right. It was a pleasure to visit and open the new facilities at his local birthing unit. He has been a tremendous champion for the midwifery-led unit in his constituency, and I pay tribute to him for that. He is right that it is important that women have choice. These are local decisions by local health care commissioners, but I hope that it will give him some reassurance that the number of midwifery-led units has increased from 87 in 2007 to 152 in 2013 precisely because of the investment that the Government are making.

During pregnancy, two out of 10 women become diabetic. What additional funding is being given to train nurses to deal with this very difficult situation?

The right hon. Gentleman makes an important point. We need to provide additional personalised one-to-one support for all pregnant women, in particular those who have or who develop medical problems. That is why we are investing in more midwives—we have 1,500 more than in 2010—and why the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists have developed guidelines and protocols to support front-line professionals in making sure that those women get extra support and have a safe delivery.

21. As my hon. Friend is aware, we have been in a two-year battle to secure services at the Alexandra hospital in Redditch, including maternity. Will he meet me to discuss the best way forward to secure safe maternity care for all the mums-to-be in Redditch? (902644)

My hon. Friend has a distinguished record of more than four years of campaigning hard for local health care services in Redditch, and her constituents should be proud of what she has done on their behalf, fighting for Redditch hospital and local services. I shall be delighted to meet her to talk further about the local challenges for maternity care.

In the Minister’s earlier answer, was he saying that enriched culture medium testing is not a safe, simple and effective test for group B strep carriage?

We have had many debates in this House about group B strep and the effects of the disease. The point about enriched culture medium testing is that it takes time for bacteria to grow in culture, and the fact is that there is also evidence from the Royal College of Obstetricians and Gynaecologists. Public Health England has looked at that evidence and it has decided that it is not a test that is effective to be introduced during pregnancy. That is the medical evidence and we have to be guided by it. There are many other things that we need to do about group B strep, not least supporting the development of a vaccine, which is ultimately the best way forward.

Will the Minister tell the House what assessment he has made of the impact of the Immigration Bill on the maternity care of vulnerable women who would be expected to pay for their care?

Of course we need to have a health service in this country that is self-sufficient, and we have a national health service, not an international health service. However, it is right that we ensure that we look at all areas of the health service when we are applying new policies and directives, and make sure that we protect vulnerable patient groups. That is exactly what the Government are doing and we are working with the NHS to ensure that women always receive high-quality maternity care at the point of need.

Cap on Care Costs

Everyone will be protected against catastrophic costs by the insurance that the cap will provide from April 2016, in line with the Dilnot commission’s recommendations. We are currently putting the legislative framework for the cap in place, and will consult on draft regulations and guidance to implement the cap in autumn of this year.

Best behaviour, Mr Speaker.

Does the Minister agree that greater investment in pre-emptive and preventive measures, such as GP annual assessment for those who are getting older, might keep the new old just a little younger?

I start by paying tribute to my hon. Friend for the work that she has done while she has been a Member of Parliament. I know that she has announced her decision to stand down, and she has done excellent work campaigning for elderly people and others in her constituency and beyond. She is absolutely right. The cap will, first of all, help people to prepare and plan for old age, which is an incredible advance. Also, the £3.8 billion better care fund is the biggest ever shift towards preventive health care and GPs will play a critical role in that.

What is the Minister doing to encourage local authorities to provide more places for care, particularly with the reduction in costs? Is he aware that local authorities are finding it difficult, because of Government cuts, to fund those places?

I am conscious that finances in local government are tight, but the better care fund, which I mentioned just now, has been widely welcomed. I was with a director of adult social care last Friday, who told me that his authority was planning to pool not just its share of the better care fund but the whole of its social care budget with the local health budget. That sort of radical, innovative thinking is exactly what we want and it will ensure that we protect services for vulnerable people.

Does the Minister agree that the steps that the Government are taking to reform the funding of care for the elderly represent long overdue action to deal with an issue that has bedevilled this world for more than 20 years? Tony Blair promised the Labour conference in 1997 that he would deal with it, and he did precisely nothing about it.

I remember the quote from Tony Blair well—he did not want to live in a country where people have to sell their homes to pay for care. However, over 13 years of the last Labour Government nothing happened. There were lots of commitments—manifesto commitments and so on. However, I am proud of the fact that this coalition Government are implementing reform, and it is long overdue.

Dispensing Doctors (NHS)

Patients can take their prescriptions to any pharmacy where they wish to have their prescriptions dispensed, but we know that in remote and rural areas, where pharmacies may not be viable, NHS England may authorise GPs to dispense to patients, provided that certain criteria set out in regulations are met.

Dispensing doctors play an important part in rural areas, as the Minister said, but they face particular challenges at the moment. Will she meet me and representatives of the Dispensing Doctors’ Association to discuss these challenges?

I am always happy to meet colleagues. I think that Earl Howe leads on the matter in the Department, and I shall draw the hon. Gentleman’s concerns to his attention. It is for NHS England to ensure that everyone has a pharmacy available to them, and I am aware that the CCG allocation formula includes allowances for rurality, but we know that this is a particular challenge.

General Practice Extraction Service

People can opt out of the programme through their GP surgery. Depending on the surgery, that may well be done online or by telephone.

Is the Secretary of State aware that the Government’s handling of the scheme has been shambolic from the very start and that their failure to communicate is nowhere better illustrated than in Pulse, the GP’s magazine, in which an article states that only 15% of members of the public surveyed knew that they had the right to opt out? What will he do to restore public confidence in a scheme that could be very beneficial?

It is a pleasure—I think for the first time—to take a question from someone who might be one of my constituents in Godalming. However, I do not agree with the hon. Gentleman that the process has been shambolic. The programme has been in place for 25 years, so it is important to understand that this big public debate is happening because this Government did something that the previous Government did not do: we said that if we are going to use anonymised data for the benefit of scientific discovery in the NHS, people should have the right to opt out. We introduced that right and sent a leaflet to every house in the country, and it is important that we have the debate—[Interruption.] The right hon. Member for Leigh (Andy Burnham) complains, but he did not want to give people the right to opt out when he was Health Secretary.

The Secretary of State will be aware of the report in The Daily Telegraph setting out how hospital episode statistics data were sold to insurance companies, which were able to match that information with credit ratings data. Nothing will undermine this valuable project more than a belief that data will be sold to insurance companies, so will he set out the way in which he will investigate how that sale was allowed to happen and categorically reassure the House that there will be no sale of care data to insurance companies?

My hon. Friend is absolutely right to raise that issue and I am happy to give that assurance. That incident is one of the reasons why we set up the Health and Social Care Information Centre through the Health and Social Care Act 2012, in the teeth of opposition from the Labour party. Following the establishment of the centre, the guidelines in place mean that such a thing could not happen. She is also right that it is important that we reassure the public because, let us not forget, it was this important programme that identified the link between thalidomide and birth defects, that identified that there was no link between MMR and autism, and that helped to identify the link between smoking and cancer, so it is vital that we get this right.

20. Virtually everyone wants to improve patient care in the NHS, so why not scrap the underhand way in which the programme has progressed so far, and instead provide a diverse choice of ways to opt in, limit the use of medical data to the NHS and keep the public’s personal information out of the hands of the private sector? (902643)

May I gently tell the hon. Gentleman that the reason why we are having the debate is that this Government decided that people should be able to opt out from having their anonymised data used for the purposes of scientific research, which the previous Labour Government refused to do? When they extended the programme to out-patient data in 2003 and to A and E data in 2008, at no point did they give people the right to opt out. We have introduced that right, which is why we are having the debate.

There are of course huge benefits from using properly anonymised data for research, but it is difficult to anonymise the data properly and, given how the scheme has progressed so far, there is a huge risk to public confidence. Will the Secretary of State use the current pause to work with the Information Commissioner to ensure that the data are properly anonymised and that people can have confidence in how their data will be used and how they can opt out?

I will do that, and NHS England was absolutely right to have a pause so that we ensure that we give people such reassurance—[Interruption.] When we had a pause before, the result was the very good Health and Social Care Act, which is doing good things for patients throughout the NHS. This programme is too important to get wrong, and while I think that there is understanding on both sides of the House about the benefits of using anonymised data properly, the process must be carried out in a way that reassures the public.

When he was appointed, the Health Secretary declared it his personal mission to have a “data revolution” in the NHS, but what he has presided over is a spectacular collapse in public confidence in the use of patient data. The only revolution he has created is a growing public revolt against his scheme. Coming after his NHS 111 shambles and the court humiliation over Lewisham hospital, it cements a reputation for incompetence. When was he first warned about problems with and what action did he take?

The shadow Secretary of State searches for NHS crises with about as much success as George Bush searching for weapons of mass destruction. My first contact with that programme, when I was told about it, was to decide to do something that he never did as Health Secretary: to say that every single NHS patient should have a right to opt out of having their data used in anonymised scientific research. I think that was the right thing to do. Of course we are having a difficult debate, but its purpose is to carry the public with us so that we can go on to make important scientific discoveries.

Again, the right hon. Gentleman never takes responsibility—it is always somebody else’s fault. Even by this Government’s standards, this is a master-class in incompetence. First, we have this useless glossy leaflet. He said that it has gone to every home, but that is not true, because homes that have opted out of junk mail have not received it. Many people report that they still have not had it through their letterbox. Secondly, when people cannot even get through to their GP practice on the phone, as we heard earlier, or get an appointment, he has made it almost impossible to opt out of the scheme. Has this cavalier approach not built an impression that the Government are taking patient confidentiality for granted in trying to force through the scheme, increasing public mistrust and putting the important scheme at risk?

It is intriguing that the shadow Secretary of State has chosen not to talk about a winter crisis, because it has not happened, despite the fact that he predicted it time after time. Let me tell him what was cavalier: the previous Labour Government’s refusal to give patients a right to opt out of giving their data to this programme, even though it was going on for their whole time in office. We believe that we should have a data revolution, but to do that we need to carry the public with us, which is why we need to have this important debate and give people the reassurance they deserve.

Mental Health Crisis Beds

6. What recent assessment he has made of the number of available mental health crisis beds for young people in England. (902629)

14. What recent assessment he has made of the number of available mental health crisis beds for young people in England. (902637)

NHS England has a rapid review under way to identify commissioning solutions to pressures on specialist beds for children and young people. It inherited varied provision across regions and a lack of capacity in some parts of the country for particular need. For the first time, available beds are monitored weekly, and small increases in capacity have already been secured.

I thank the Minister for that answer, but 1,500 mental health beds have closed since 2011, which is causing a wider crisis, and a recent Care Quality Commission report found that, in one area over the previous year, 41 children had been detained in police cells because health-based places of safety were either not available or not staffed—and one of those children was 11 years old. How can that be acceptable?

The reduction in the number of mental health beds has been a long-term trend—it happened under the previous Labour Government—and rightly so, because we have to move away from institutional care. However, crisis beds must always be available. I completely agree that it is intolerable for children to end up in police cells, but that is not new; it has happened for many years and did not start in 2010. When we talk about parity of esteem, we mean it. There must be absolute equality between the ways in which mental and physical health are treated. Last week we launched a crisis care concordat to ensure that children do not end up in police cells.

The clinical director of child and adolescent mental health services in my mental health trust recently said:

“Sometimes we have to make 50 to 100 phone calls around the country looking for a bed… young people shouldn’t be shunted around the country into inappropriate facilities.”

Another psychologist dealing with a case in my constituency told me:

“It is very difficult to get young people into in-patient services at present due to the high number of cases and reductions in funding from NHS England.”

Is that not an intolerable situation in which to leave traumatised young people? How quickly will the Minister’s review be completed so that we can end that tragedy?

The review being undertaken by NHS England will report in March. I agree that that situation is intolerable, but I have made it very clear on many occasions that there is an institutional bias against mental health in the NHS. Interestingly, the Health Committee report on deficits in 2006-07 specifically made the point that mental health was particularly targeted, so that always happens when NHS finances are tight. However, it cannot happen, because there has to be parity of esteem, including in the way in which money is distributed in the NHS.

In Stafford hospital, many young people with mental health problems are extremely well treated in normal in-patient wards. That should not be the case, but no other facility is available. What will happen if those in-patient beds are no longer there?

As far as possible, we should be trying to ensure that children with mental health crises can remain at home; it does not make sense, in very many cases, to put them into in-patient care. However, we have made it clear, as has NHS England and as was confirmed in the crisis care concordat last week, that beds should be locally available whenever they are needed.

19. Will the Minister indicate when a clear strategy for the commissioning of tier 4 mental health beds will be determined and what additional resources will be made available to support the mental health needs of children and young people? The current situation is intolerable. (902642)

I mentioned earlier that the rapid review that is being undertaken by NHS England will report in March. It is essential that we have sufficient beds available, as close to home as possible, for children and young people. As I also said earlier, as far as possible children should be cared for at home, and only as a last resort should they go into in-patient care.

The pressure on children’s mental health beds is now intolerable. Earlier this month, the 14-year-old daughter of one of my constituents desperately needed a bed but the local trust’s chief executive told me that not a single bed was available anywhere in the country in the NHS or the independent sector. The Minister has said that this is unacceptable as though it is nothing to do with him, but he voted for an NHS reorganisation that is wasting time and money as vulnerable children are forced on to adult wards or transported hundreds of miles across the country. When the review reports, what action will he take and by when will it be implemented?

For a start, we now have 15,000 more clinicians working on the front line than when this Government came into office in 2010. Also, in the reforms that the hon. Lady mentions, we legislated for parity of esteem so that mental health is treated equally with physical health. However, I have accepted her case and agree that the situation is intolerable. We have to make sure that beds for children and young people are available when they are needed.

Alternative Medicines (NHS)

7. What proportion of medicines prescribed in the NHS are alternative medicines; and what the annual cost is of dispensing such prescriptions. (902630)

The net ingredient cost to the NHS of homeopathic preparations dispensed in the community in England was £143,000 in 2012, which represents 0.002% of the overall NHS prescription cost in the community for the same period. The prescription cost analysis data from which we extract this information do not separately identify other alternative medicines.

I thank the Minister for that answer. At the urging of Councillor John Nicholson, Isle of Wight council has asked the health and wellbeing board to recognise the value of alternative and complementary therapies and elect a representative to the board. Will the Minister and her Department work with that representative to evaluate the cost-effectiveness of such treatments?

I am aware that there has been interest in this matter in my hon. Friend’s clinical commissioning group. The provision of alternative and complementary therapies is decided by CCGs, which have to take into account National Institute for Health and Clinical Excellence guidance and local health needs and priorities. The responsibility is with CCGs to achieve value for money and to make sure that they are delivering improvements in the quality of care and patient outcomes, and it is against those standards that we would expect them to measure those therapies.

In the past 12 months there has been great advancement in new medications and alternative medicines, with new drugs for multiple sclerosis, for type 2 diabetes and for hepatitis C, and advancements in heart operations, rare diseases, and so on. Will the Minister indicate the time scale for the announcement of new medications and their availability on the NHS?

The hon. Gentleman, who follows these matters closely, is aware that medicines go through a process by which they are approved and recommended. Once they are in that position, it is, as I say, down to CCGs to make decisions about which treatments are appropriate for their patients and to measure them against the standards that I laid out.

I congratulate right hon. Friends on setting up the herbal working group to improve regulation of herbal medicine and its practitioners. Is the Minister aware that there is a problem of supply, in that most people have to pay for their herbal medicine and it is not necessarily available from clinical commissioning groups? Will she issue guidance? Perhaps we should have a mapping exercise in order to understand where the demand is in this country.

As I have just said, there is guidance for CCGs on how to operate in the area of alternative and complementary therapies and we have no current plans to add to that guidance.

Female Genital Mutilation

We recently announced that all NHS acute hospitals must provide information on patients who have undergone female genital mutilation, but that is just one element of a wider-ranging programme of work that is under way in order, most importantly, to improve the way in which we care for girls and women who have undergone FGM and to follow up on, respond to and prevent FGM. I will make further announcements in due course.

I congratulate my hon. Friend on all the work she has done to combat this abhorrent crime since she entered Parliament. Will she confirm that the data reported to her Department will be used to mount educational campaigns to stamp out FGM in the vicinity of hospitals reporting patients who have been abused in this way?

We anticipate that we will be able to share the data collected with all appropriate Government Departments and partner organisations. On local education campaigns, I see no reason why requests to access the data would not be approved. We want to build a proper national picture of what is going on with FGM so that we can do all we can both to care for victims and to stamp out this abuse.

On the issue of widening education, could the Minister encourage her colleagues at the Department for Education to write to schools to raise awareness of this abhorrent practice?

Fahma Mohamed, the brilliant young woman who has led the campaign on this, will meet the Education Secretary today and there is a lot of work under way across all Government Departments. There was recently a cross-Government declaration on the things that are going on to stamp out FGM and to care for its victims. The hon. Gentleman’s question is a matter for the Department for Education, but I assure him that the Government as a whole are hugely committed to wiping out FGM within a generation and to caring for its victims.

Veterans’ Health

We are rightly proud of the courage and dedication of our armed forces and it is our duty to ensure that veterans receive the best possible care. We continue to improve the health care of our veterans. The Government have invested £22 million in providing enhanced mental health and prosthetic services over the past few years.

Alex Bentley, who chairs the Royal British Legion in Skipton and is the most incredible, passionate campaigner for our armed forces, has serious concerns about how the armed forces covenant is being applied by hospitals and local councils. Is there anything the Minister can do to champion the cause of this excellent Government scheme at local level?

Aside from the cash investment of £22 million directly in veterans services, we have made it a clear priority in the NHS mandate to make sure that the armed forces covenant becomes a reality in the NHS. We have now identified nine specialist prosthetic centres for veterans who have lost limbs and been injured in combat, and a massive amount of investment is going into services for veterans with mental health problems, including a 24-hour helpline. A lot of investment is being made at the national level and locally, and there will also shortly be dedicated resource for training local professionals on the ground.

I welcome that response. Will the Minister reassure me that he will properly join up his work with that of the Department for Work and Pensions and the Ministry of Defence? Like many other Members, I know of at least two veteran constituents who clearly need joined-up health and welfare. The voluntary sector helps—including the Matthew Project’s new “Outside the Wire” service in Norfolk—and I expect the same of the Government, who have rightly signed the armed forces covenant.

My hon. Friend makes an important point. This is not just about providing good health care services, but doing so in a joined-up way. We now have a seriously injured leavers protocol to help the transition of servicemen and women who leave the armed forces and return to civilian life. That is about taking a holistic view of their health and care needs, and any other needs that they may have, in providing the right support when they return to civilian life. It is being rolled out very effectively across the country.

Mental Health Services

Our mandate to NHS England makes it clear that everyone who needs it should have timely access to the best available treatment. NHS England is currently gathering information about access to and waiting times for mental health services. We will use this information to set new national access standards for the first time, to be introduced from 2015.

The Safe Haven in Corby provided crisis out-of-hours support to 1,300 people with mental health problems last year. For the first time ever, it has been asked to tender for its future funding. It was eight minutes late with its tender, and the service is going to be cut. What will happen to the people who need that service in the future? Will the Minister meet me to discuss it?

I am very happy to talk to the hon. Gentleman about that. My understanding is that the local CCG undertook a retendering exercise with a view to maintaining and, indeed, improving mental health services locally. As he says, Safe Haven did not submit its tender in time. It had a right to appeal, and it chose not to appeal. The CCG is absolutely committed to ensuring that it improves mental health services locally.

Not only do mental health services not get the attention that they sometimes deserve, but the condition of individuals is often exacerbated by the inability of the benefits system to recognise episodic illness and by the insensitivity and incompetence of Atos in work capability assessments. Will the Minister talk to his colleagues in the Department for Work and Pensions so that we can have a system that is suitable and fit for people with mental illness?

I thank my hon. Friend for his question. Indeed, I share the concerns that he raises, and I have recently met my hon. Friend the Minister responsible for benefits specifically because I have those concerns. There needs to be much closer working between mental health services and the benefits system locally.

The Minister knows that early intervention therapy or talking therapies can relieve pressure not only in access to beds, but in helping individuals. He has just told the House that he will look at assessments of waiting times. Will he tell the House exactly what force or lever he will have to ensure that local trusts implement such targets?

I think it was a big mistake to leave out mental health when the 18-week maximum waiting time limit was introduced for physical health services. To me, that is inexplicable, so I am determined to correct it: from next year, there will be waiting times standards for mental health. Indeed, when the Care Quality Commission inspects and regulates providers, it will ensure that those access standards are met, in the same way as applies for physical health.


11. What reports he has received on the possible reclassification of ME/CFS by the World Health Organisation. (902634)

The World Health Organisation is currently developing the 11th version of the international classification of diseases, which it aims to publish in 2017. No discussions have taken place between the Department and the WHO on the reclassification of ME/CFS, but the WHO has publicly stated that there is no proposal to reclassify ME/CFS in ICD-11.

I thank the Minister for her answer. Many people will be greatly relieved about that. As chair of the all-party group on myalgic encephalomyelitis, I receive many representations about GPs in this country still not necessarily recognising the condition. Will she look into that, and will she work with her counterparts in the DWP on the benefits side as well?

I am aware that this is a very difficult, complex and emotive area. I have heard before the point that the hon. Lady makes about GPs. I am very happy to take up her points and discuss them with her.

Private Health Care Sector

In the past three months, I have had two meetings with private sector health care providers, both in China, helping them to win export orders. In the same period, I have had 20 meetings with traditional NHS providers.

Private health companies with strong links to the Conservative party have been awarded contracts to run NHS services worth about £1.5 billion, which surely raises serious questions about the level of influence of Conservative donors on health policy. In the interests of transparency, will the Secretary of State commit to publishing a list of private health care companies that have made donations to the Conservative party?

The difference between donors to the Conservative party and donors to the Labour party is that our donors do not write our policies. While we are talking about private sector health care providers, I remind the hon. Gentleman of what an unnamed shadow Cabinet Minister told The Independent last week:

“We all remember when Andy was Health Secretary and happily contracting out bits of the NHS to the private sector… You have to ask yourself what’s changed.”

The NHS diagnostic centre in Wycombe, which is operated by the private sector, does a fantastic job. Will the Secretary of State join me in congratulating and thanking Opposition Members for all that they did to extend private and independent provision in the NHS?

I am happy to do that. My hon. Friend may be interested to know that in the last four years of the last Government, private sector contracts in the NHS doubled—something that this Government have not been able to match. It is important to look at the facts before we start any hares running with respect to privatisation.

Sex-selective Abortion

The Government will publish more detailed guidance on compliance with the Abortion Act 1967 shortly. That will include guidance on sex-selection abortions and restate our view that abortion on the grounds of gender alone is unlawful.

Britain’s biggest abortion provider, the British Pregnancy Advisory Service, has advice on its website claiming that the law is “silent on the matter” of gender-selective abortion. In a leaflet, it actually states that it is not illegal. How does the Minister propose to address that, and to send out the clear message that strong legal action will be taken against anyone who is involved in that wholly unacceptable practice?

Although the Abortion Act does not mention gender specifically, the Government are clear that abortion on the grounds of gender alone does not meet the criteria set out in the Act. If evidence comes to light that doctors or organisations are sanctioning abortions for that reason alone, we will refer it to the police.

The Minister is quite right that the Abortion Act does not state that the practice is illegal. Organisations such as Marie Stopes International operate under an ethical and professional framework in which they state that they will not perform abortions on the basis of sex selection. However, the chief executive of BPAS has said that

“there is no legal requirement to deny a woman an abortion”

if she wants to abort a female. The Government commission abortion services from BPAS and Marie Stopes. Does the Minister not think it is about time to have a closer look at BPAS, which is headed by a chief executive who condones sex-selection abortions?

That is exactly why we want to reissue the guidance on this matter. I cannot add to what I have said. I say with complete clarity that the Government’s view is that sex-selection abortion—abortion on the grounds of gender alone—is illegal and we will report it to the police if we are given evidence of it.

Accident and Emergency Attendances

16. What assessment he has made of trends in the number of attendances at type 1 accident and emergency departments since 2009-10. (902639)

We have debated the hon. Gentleman’s concerns about the A and E services in his area in the past. I want to reassure him that, despite the overall growth in attendances at A and E—we know that there is pressure on A and E—the changes that are recommended for his area have enormous clinical support across all the local CCGs and trusts.

I thank the Minister for her response. Will she explain why attendances at hospital A and E departments increased by 16,000 in the last three years of the Labour Government, but by 633,000 in the first three years of this Government?

As the hon. Gentleman knows, we have often debated in this House the many reasons for the increased pressure on A and E. However, the rate of growth in the first three years of this Government has been lower than the rate of growth in the last three years of the last Government. We are responding to the pressures. That is why the Secretary of State has addressed issues such as named GPs for older patients and the integration of social care. We acknowledge that there is pressure on A and E; it is the action that the Government are taking to respond to it that really counts.

Ministers again deny that England’s A and E departments are in crisis. The Secretary of State did so in response to my right hon. Friend the Member for Leigh (Andy Burnham) earlier. It just will not wash any more. In the past two weeks, 10,743 patients waited on trolleys for up to 12 hours because no hospital beds were available and 52 patients waited for even longer. Does the Minister really think that it is acceptable that patients are experiencing the worst fortnight in A and E this winter while she is complacently sitting on her hands?[Official Report, 27 February 2014, Vol. 576, c. 10MC.]

There is no complacency on the Government Benches, and attendances are half what they were under Labour. Week after week we have heard those on the Opposition Front Bench come to the House to talk up a crisis in our NHS, but the NHS has responded incredibly well throughout the winter. I pay huge tribute to the staff of the NHS for what they have done in responding to this. The Government are taking long-term action to reduce pressure on A and E; even the College of Emergency Medicine rebuts the Opposition line that there is a crisis in A and E this winter.

Topical Questions

I would like to thank Public Health England and the NHS emergency services for their extraordinary work during the recent floods, and say that this House is proud of their dedication and commitment to help those in great need. Since the previous Health questions, we have also had the first anniversary of the Francis report on Mid Staffs. As a result, I am proud that the Government have taken significant steps to restore compassionate care to all parts of our NHS, with a regulator now free from political interference, failing hospitals being turned round, and more nurses, midwives and health visitors in our NHS than at any time since 1948.

The family of my eight-year-old constituent Ben Foy have been fighting for more than two years for the funding of sodium oxybate—a drug that his doctors feel could help him cope with narcolepsy and cataplexy. This is a particularly distressing condition for Ben and his family, but sadly, after all this time there is still complete confusion as to who has responsibility for Ben’s commissioning request. Will the Secretary of State look into the matter and clear up that confusion?

I reassure my hon. Friend that I have looked into Ben Foy’s case, and NHS England has confirmed that it is responsible for commissioning his care. The particular drug that my hon. Friend mentioned is not recommended by the manufacturer for use by children and adolescents, but I am happy to arrange for him to meet NHS England and get to the bottom of the issue.

I want to return to—an important scheme that needs to be saved from the incompetence of this clownish coalition. The Secretary of State said earlier that I was in search of a crisis, but now I will offer him a solution. If the Government work with us to introduce a series of tough new safeguards to protect patients, we will work with the Secretary of State to help rescue this failing plan. Those safeguards include tougher penalties for the misuse of data, Secretary of State sign-off on any application to access data, full transparency on organisations granted access, and new opt-out arrangements by phone or online. Will he meet me to discuss changes to the Care Bill to put that important scheme back on track?

The right hon. Gentleman has still not addressed the fundamental question of why he did not introduce an opt-out for the use of personal data, which this Government are doing. We have taken more steps than his Government ever did, and we will continue to work hard to ensure that this important scheme goes ahead. The right hon. Gentleman should know better.

T2. There is great unmet need among older people in our communities, particularly for dementia care and support. In Portsmouth we are holding a community summit to join up local agencies to meet that unmet need. Will the Minister meet me to discuss what central Government can do to ensure that advice on additional funding streams is clearly and readily available? (902659)

I thank my hon. Friend for that question and pay tribute to the agencies in Portsmouth that are coming together to hold the summit and discuss that critical issue. The Prime Minister’s challenge on dementia has made real progress in improving diagnosis rates and the way that society treats dementia, and I would be happy to meet my hon. Friend to discuss the issue further.

T4. Further to the answer given earlier to my hon. Friend the Member for Wansbeck (Ian Lavery), the lobbyist John Murray and an organisation funded by large pharmaceutical companies led a consultation and co-wrote a report for NHS England on the future of commissioning for £12 billion of NHS services. Will the Secretary of State tell the House whether it is now Government policy to have lobbyists and big drug companies drafting reports that directly influence the commissioning of NHS services? (902661)

Let me say this to the hon. Lady: we have very clear rules, and for people who are involved in industry and have a self-interest we have important protections to ensure there is no conflict of interest. Let us be clear: the private sector has an important role to play in the NHS, but it grew far faster under the previous Government than it has done under this one. We are not going to take any lessons about being in hock to the private sector.

T3. As the NHS comes through another winter, when it has delivered an outstanding service to more patients than ever before, how does my right hon. Friend assess the damage done by the unfounded scaremongering talk of crisis by the Opposition and some parts of the media? (902660)

My hon. Friend is absolutely right. I encourage those on the Opposition Front Bench in particular to talk to a few people in A and E and ask whether they think they have been supportive, in a very difficult winter, by whipping up all these scare stories when, in fact, because of their hard work, we are seeing 2,000 more people every single day in less than four hours than when the shadow Secretary of State was Health Secretary. A and E is performing better than ever.

T5. There are nearly 500 UK-trained medical practitioners now working in Australia, of whom 6% never return owing to the better conditions available there. What steps will the Secretary of State and his ministerial team take to ensure that we retain those qualifying in emergency medicine this year, to keep local A and E departments open in Britain and Northern Ireland? (902662)

I would like to point out to the hon. Lady that it is not unusual for doctors in training to work overseas to improve their medical experience. Many of my contemporaries did that, and every one I know has returned to work in the NHS in the UK. It is a common phenomenon that benefits doctors’ experience. What we have done, unlike the previous Government, is ensure that we now have a 100% fill rate for people entering A and E common stem training.

T6. What assessment have the Government made of the decision by the National Institute for Health and Clinical Excellence not to recommend ipilimumab as a first-line treatment for advanced melanoma, except in clinical trials? Will the Minister join me in calling on NICE to reverse this decision and ensure that patients receive earlier access to this treatment to improve their chances of survival? (902663)

I know that my hon. Friend is really concerned about this, but NICE is an independent body so it would not be appropriate for me to interfere in an ongoing appraisal. NICE has recommended a number of other treatments for advanced melanoma, and NHS commissioners are required to fund them where clinicians want to use them. I want to give her some encouragement: this spring a trial will begin of an awareness programme on melanoma in the south-west of England, working with Cancer Research UK.

T7. I am grateful to the Minister for her previous answer on female genital mutilation. With that in mind, what action will she take regarding the three Tory MEPs Nirj Deva, Sajjad Karim and Timothy Kirkhope who voted against the motion, in the European Parliament on 11 December, strongly condemning the disgraceful practice of FGM? (902664)

I am aware of this case. The point made is rather unfair. My colleague Marina Yannakoudakis MEP has dealt with this issue in correspondence with other Members. The motion was a composite motion. All Conservative MEPs completely condemn FGM, but there was a technical reason why they voted in that way. It is clear that the Conservative party—along, I think, with all Members—absolutely condemns this practice. I am happy to give the hon. Gentleman the detail on that vote afterwards.

T8. Papworth hospital is a world-renowned heart and lung hospital. For years, it has wanted to move to Cambridge, supported by Addenbrooke’s hospital, Cambridge university, the British Heart Foundation, AstraZeneca and many more, but it has been put on hold yet again. Will the Secretary of State make sure that this move, which will help patients, help to develop new treatments and save money, will happen? (902665)

My hon. Friend will be aware that local commissioners take decisions on local services. I will be happy to meet him to discuss this matter further, so we can talk through his concerns and ensure that local health care services are as strong as possible.

T10. The village of Melling has grown in recent years, yet its surgery hours have been cut drastically. Elderly and disabled residents now face a four-hour round trip by public transport to see their doctor. How can cuts in surgery hours, like those in my constituency, be justified if the Government are serious about having a first-class NHS? (902667)

We absolutely want to make primary care more accessible and that is why we are introducing named GPs for everyone aged 75 or more from April. This is a significant and important reversal of, I think, a mistake that everyone now agrees was made in 2004 when named GPs were abolished. Its purpose is to make GPs more accessible to the people who need them the most.

T9. The father of one of my constituents passed away at the weekend, one of 8,700 people who are diagnosed with pancreatic cancer each year in the UK, of whom only 3% will survive beyond five years. That survival rate has not changed in over 40 years. Will my right hon. Friend update the House as to what the Government are doing to improve patient outcomes for those with pancreatic cancer? (902666)

I thank my hon. Friend, and I know that many hon. Members have raised this issue because pancreatic cancer outcomes remain extremely difficult. We want to see the best outcomes for all cancer patients. There has been a big investment by the Government in diagnosis and screening—£450 million—and last year we were involved in piloting a tool to support GPs in diagnosing cancer earlier, including pancreatic cancer, in over 500 GP practices. That pilot is currently being evaluated.

The Manchester Evening News recently highlighted the enormous pressures faced by Wythenshawe accident and emergency after the downgrading of Trafford accident and emergency. Will the Secretary of State meet me to discuss this and to tell me when Wythenshawe will receive the extra funds that it has been promised?

I welcome the hon. Gentleman to the House and congratulate him on representing in his constituency a fantastic hospital; I have been to Wythenshawe hospital and it is superb. Some big changes are happening in the Greater Manchester area that will lead to that part of the country having some of the best NHS care in the country. Obviously there is a difficult transition in A and E services between Trafford and Wythenshawe, and I am happy to meet him to discuss it further.

Does my right hon. Friend agree that it is unacceptable that investigations into failures in hospital services take so very long? There has recently been one in my constituency: a very sad and badly handled case connected with mental health. Does my right hon. Friend agree that the authorities need to provide answers very promptly to families who are left completely beleaguered by such behaviour?

I absolutely agree with my right hon. Friend. One of the tragedies that the Francis report helped us to uncover was that so many failings had been allowed to persist for so long: in the case of Mid Staffs, between 2005 and 2009. We owe it to families to be much quicker, which is why there is now a time limit on the failure regime: hospitals must be turned around within a fixed period of time or go into administration. Otherwise, we will not have safe hospitals in our areas.

The Minister earlier told the House that 1,500 new midwives had come on stream since the Government started, but, of course, the Government promised that there would be 3,000 delivered by 2015. Midwives are very good at delivery; how good is the Department?

We have trained more midwives. To go back to a previous question, it was under the previous Government that trained midwives from this country were having to go and work overseas. That is no longer the case. We now have 5,000 more in training—a record number—to make sure that we provide more midwives. I would also like to welcome the hon. Gentleman back to this country.

Last year I spent a busy and informative day with the East Midlands ambulance service on the road. It was clear speaking to those professionals that a large proportion of individuals taken to A and E would be better served by going to their GP or by accessing other services. However, the ambulance service felt completely disempowered to advise or even to refuse to take anyone to A and E who requested it.

That is one of the things we need to be much better at—linking up the services offered by ambulance services. I would add that pharmacies have a big role to play in this, as one in 11 or 12 A and E appointments could be dealt with at a pharmacy. My hon. Friend is absolutely right that this is something we need to do better.

A hugely expensive review of A and E services is going on in Telford, the Wrekin and Shropshire. The Secretary of State was in Telford a couple of weeks ago but did not have the courtesy to let me know. Will he say whether we will retain full 24-hour, seven-day-a-week services at Telford and whether there will be downgrade of our A and E?

First, I apologise to the hon. Gentleman if my office did not let him know that I was visiting, an oversight for which I take responsibility. I had a good visit to the Redwoods, a superb mental health in-patient unit where I learned a great deal. I am not aware of any plans to change or downgrade his A and E.

Order. Time is up. As usual, demand has exceeded supply. Before we come to the ten-minute rule motion, we have a point of order.