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Volume 582: debated on Tuesday 10 June 2014

The Secretary of State was asked—

Challenge Fund

1. What recent assessment he has made of the role of the Prime Minister’s challenge fund in improving access to GP services. (904103)

Mr Speaker, it is a pleasure to see you again so soon.

The Prime Minister’s challenge fund will be rolled out over 1,100 of the 8,300 GP surgeries in the country. It will improve access out of hours, at weekends and electronically, and it will benefit up to 7.5 million people.

I am glad that this Government, unlike the previous one, whose disastrous contract negotiations led to a decline in GP access, is making sure that out-of-hours care is as widely available as possible. Will the Secretary of State assure me that he will do whatever he can to ensure that places, such as Worcester, that have not yet been reached by the challenge fund will also see the benefits of this approach?

My hon. Friend is right to say that some bad changes were made. What will most benefit his constituents, whether or not they are part of the initial tranche of the Prime Minister’s challenge fund, is the reintroduction of named GPs for the over-75s. For people with complex long-term conditions, continuity of care is extremely important, and every single one of his constituents aged 75 or over will now get a named GP.

We are very pleased in Old Trafford to have secured funding for 80 extra care beds for one of the most deprived parts of my community. We also hope to be able to bring health care services, including GP surgeries, on to the same sites, but we are experiencing difficulty in unblocking funding via the NHS area team. Will the Secretary of State meet me to discuss this issue and how we might be able to move forward?

Yes, I would be more than happy to meet the hon. Lady and see what I can do to help her to improve health care in her area.

I thank my right hon. Friend the Secretary of State for his recent visit to Erewash. He has kindly offered to come back another time. We welcome the Prime Minister’s challenge fund being allocated to Erewash. May I reassure my right hon. Friend that our excellent GPs are working very hard to make sure that services and support are appropriately allocated in our community?

I thank my hon. Friend for her work to promote good health care in her area. I very much enjoyed meeting her local GPs. I was disappointed that it was only for about five minutes. I very much hope to go back and have a proper discussion. They were very enthusiastic about the Prime Minister’s challenge fund, and are making some very innovative changes.

May I push the Secretary of State on this matter? What my constituents want is to be able to get to see a GP when they really need one; they do not want to turn up in A and E just because they cannot get an appointment for a week. Is not poor management of GP surgeries—poor management from top to bottom—at the heart of this problem?

Actually, I agree with the hon. Gentleman. I think that we do have a problem. We have some fantastically good GP surgeries and some brilliant GPs, but we have not in the past had structures in place to make sure that we deal quickly with underperforming GP surgeries and, indeed, underperforming GPs. We need to have much more transparency of data so that we can see where the problems are. We have introduced a rigorous new inspection regime, with a new chief inspector of general practice, and I hope that that will go some way to addressing the issues he raises.

People ringing their surgery this morning only to be told that no appointments are available for days will be listening to the Secretary of State’s answers today and thinking that he is living in a different world. People’s real experience is that it is getting harder and harder to get a GP appointment under this Government, but for some it could get much worse. I recently visited a practice in east London that faces closure in October because of this Health Secretary’s changes to GP funding. NHS England says that 97 other practices are in the same position, affecting thousands of patients. Will he today give a guarantee that no practice will have to close?

Let us address this issue head on. The right hon. Gentleman knows perfectly well that it is totally wrong to have a system in which two neighbouring GP practices can be paid different sums of money for doing the same amount of work. We must have an equitable funding formula for GP practices, which is why we are phasing out the minimum practice income guarantee. That is a sensible decision. We are also taking measures to ensure that we do not affect patient care in the process. Of course we are looking at the individual cases carefully, but I am sure that he would agree that we have to fund GP practices equitably.

Polypropylene Transvaginal Mesh Implants

The Department of Health, NHS England and the Medicines and Healthcare Products Regulatory Agency—the MHRA—have been working collaboratively with the clinical community to address the serious concerns that have been raised about transvaginal mesh implants. A working group, chaired by NHS England, has been set up to identify ways to address them. The group will also have patient representation.

Last week, I attended the Scottish Parliament’s Public Petitions Committee to hear from and support women who have suffered from the horrific adverse effects of mesh implants. Women spoke from wheelchairs or on crutches and were in constant pain. They could not possibly have been told about the risks of TVM implants because there are simply no accurate data available. Will the Minister or the Secretary of State meet me and mesh campaigners from across the country, so that they can fully understand the urgency of the situation and the kind of action that is required to end this scandal once and for all?

I would be very happy to meet the hon. Gentleman. It is important to note that work is under way to collect better data on urogynaecological procedures generally and on mesh implants, because the complications that occur post-surgery are often multifactorial. An NHS England-funded audit on urogynaecological procedures for stress urinary incontinence is currently taking place, which covers all procedures, not just mesh implants. I am sure that we can discuss that and what the working group will do to review the procedures when we meet.

Care Costs

Everyone will be protected against catastrophic costs by the insurance the cap provides from April 2016, in line with the Dilnot commission’s recommendations. We are working through the detail of how it will operate in partnership with stakeholders. We will publish draft regulations and guidance for consultation towards the end of the year.

I thank the Minister for that statement. I have constituents who are very concerned about how they will continue to fund ongoing care costs in the interim period, when the proceeds of an asset or house sale have dissipated. What reassurance can my hon. Friend give my constituents?

I thank my hon. Friend for that question. Another reform that we are introducing is universal access to a deferred payment agreement for everyone who would otherwise be forced to sell their home to pay for care—something of which we should be very proud. That will be introduced in April 2015 and it will mean that no one has to sell their home during their lifetime to pay for their care.

The amount that will count towards the clock running to reach the cap will be based on what the local authority determines will be the cost of meeting a person’s eligible care needs. That is exactly the model that Andrew Dilnot recommended, and we are implementing it as he recommended.

Last Thursday, the first ever care home diabetes audit was published. It showed a significant lack of support for the 37,000 people with diabetes who live in care homes. Will the Minister confirm that when a person in a care home has diabetes, there will be no lack of funding to help them?

I pay tribute to the right hon. Gentleman for his tireless campaigning on diabetes. He has played an essential role in ensuring that it is brought to public attention. It is critical that people who require care for diabetes get access to the care they need, whether they are living in a care home or in their own home.

One-year Cancer Survival Rates

4. What assessment he has made of the role of the comprehensive delivery dashboard in holding clinical commissioning groups accountable for their one-year cancer survival rates. (904106)

NHS England uses a range of data, as my hon. Friend will know, including data from the delivery dashboard, to assess the performance of CCGs. That includes the data from the composite cancer one-year survival indicators. NHS England will take action— it has quarterly assurance meetings between area teams and CCGs—if there are concerns about CCGs’ performance.

May I suggest to the Minister that if the Government are to meet their target of saving an additional 5,000 lives a year and to promote diagnosis, we need to hold underperforming CCGs to account. Why is it, then, that the one-year survival rates, which are designed to promote earlier diagnosis, are not in the delivery dashboard, which, unlike the outcomes indicator set, has teeth, particularly given that CCG chief executives have said that they see no reason why the one-year figures could not be included in the dashboard?

We will certainly look at that, but I emphasise that all those things are important as part of the conversation between area teams and CCGs. I remind the House that the CCG outcome indicators set for 2014-15 include a range of important indicators for cancer, including one-year survival for all cancers, one-year survival for breast, lung and colorectal cancers combined, cancers diagnosed via emergency routes, and cancers diagnosed at an early stage—something I know my hon. Friend has, quite rightly, championed consistently in this House.

Does the Minister agree that the inclusion of more innovative drugs in the NHS medicine cabinet is essential for improvements in one-year cancer survival rates? Does she also agree that information shared between the devolved Assemblies, such as the Northern Ireland Assembly, is a vital part of that process of improvement?

We want people in England to have the best cancer outcomes, and to bring those outcomes up to the best in Europe. We know we are not there yet, but we have done a range of things to try to make that happen, including putting a lot of money into early diagnostics. In my area of public health there are award-winning public campaigns such as Be Clear on Cancer, and I know that the cancer drugs fund has been appreciated by many people. I hear what the hon. Gentleman says about the Northern Ireland example.

High-quality data will play an essential role in improving cancer outcomes. Will the Minister confirm that NHS England has addressed the concerns raised about the programme, and that we are on track for a successful roll-out?

Last month, for the first time ever the NHS missed a target for beginning cancer treatment within 62 days of patients being urgently referred. Cancer Research UK stated:

“This isn’t just a missed target—some patients are being failed,”.

We know that the key to ensuring that more people survive cancer is to start treatment as soon as possible after diagnosis. Is it not shocking that cancer charities, including Macmillan Cancer Support and Cancer Research UK, now say that cancer is being overlooked in this Prime Minister’s national health service?

We all appreciate the wonderful work done by cancer charities such as Macmillan Cancer Support and Cancer Research UK, and the Department works closely with those charities. We want outcomes for cancer patients in England to be among the best in Europe. As I said, we know we are not there yet, but a great deal of effort and money is going into getting there. The NHS is treating more cancer patients than ever. Since 2009, we have seen numbers rise by 15%—that is 1,000 more patients with suspected cancer referred to a specialist every day. That is the success of some of the early diagnosis and awareness raising activity. Of course we want any local dips in performance to be addressed, but let us give credit where it is due to clinicians who are diagnosing more cancers and catching them earlier, because that is the key to treating cancer successfully.

Accident and Emergency Units

I met the chair of the College of Emergency Medicine four times in the last six months and I will meet him again next week.

I thank the Secretary of State for his answer. Will he tell the House what progress has been made by Health Education England, along with the College of Emergency Medicine, to recruit trainee doctors from India in an attempt to address the serious staffing shortages in emergency medicines departments? Will he work with Ministers from other devolved regions to address the serious shortage in A and E doctors, which is having an impact on waiting lists in hospitals the length and breadth of the UK?

The hon. Lady is right that operational pressures on A and E are happening throughout the United Kingdom. We have made good progress in recruiting 50 A and E doctors to help relieve pressure this year in A and E departments, but that is a short-term measure. The long-term issue is to get more doctors going into A and E from training, and we are looking at contract structures and at what we can do with training schedules to make that more attractive. We will certainly work with colleagues in devolved Administrations and tell them what we have learned.

I welcome the fact that waiting times have halved under this Government, but the Norwich walk-in centre should stay in its city centre location to continue to move people away from A and E when they do not need to go there. Will the Secretary of State meet me to discuss urgent and primary care provision in Norwich?

I would be delighted to meet my hon. Friend, and she is right to say that the long-term solution to pressures in A and E is to find alternatives in out-of-hospital care that are easy for people to find. That means improving GP access and any other alternatives, and I am sure we can find a good solution in Norwich.

There is not one person in my constituency who does not want to see the accident and emergency unit stay open. If this is made clear in any consultation, will the Secretary of State commit today to scrapping the callous closure proposals?

As the hon. Lady knows, local service changes are the responsibility of the local NHS, but when they get referred to me, through local authorities, I will never take a decision that is against the interests of patients, including her constituents. Were such a proposal to come to me, I would indeed listen to any representations that she makes.

Does my right hon. Friend agree that a critical problem that A and E units will face in the future is antibiotic resistance? Is he aware that the Science and Technology Committee, of which I am a member, has been looking at this issue, and it also interests the Health Committee, of which I am also a member? Can he assure me that he is talking to the Prime Minister about how to stimulate new antibiotic research, and will he also remember that nature has its own remedies, such as tea tree oil?

My hon. Friend is right about the seriousness of the issue of antimicrobial resistance. Some 25,000 people die in Europe every year as a result of the failure of antibiotics—more than die in road traffic accidents. I raised the issue at the World Health Assembly and I have discussed it closely with the Prime Minister.

The Health Secretary will be aware that the chair of Morecambe Bay trust has stood down today, ahead of what is expected to be another critical report from the Care Quality Commission about services. What guarantees can the Health Secretary give the worried people who are served by the Furness general hospital that its A and E department will be protected and the vital national industries that depend on its services will continue to be able to rely on them?

First, I thank the hon. Gentleman for the work that he does locally, in particular with people such as James Titcombe, who has campaigned extensively to improve the quality of care at Morecambe Bay. I assure the hon. Gentleman that whatever the problems are at Morecambe Bay, we will be transparent and open, and we will make sure that we deal with them promptly. That is why we have had these independent inquiries. We will look closely at what the report says and make sure that we act quickly.

The College of Emergency Medicine says that the use of agency doctors has become endemic in the NHS, and that hospitals are increasingly relying on more expensive agency nurses, just as Labour warned when jobs and training places were cut. It is clear that NHS finances are going backwards under this Government. Will the Minister now confirm Monitor’s latest figures, which show that annual spending on agency staff in foundation trusts has soared to £1.4 billion, a staggering 150% higher than trusts planned at the beginning of the year, and will he explain how that makes any financial sense?

Let us look at why the number of agency nurses has increased. It is because trusts have responded to the Francis report, published just over a year ago, and are seeking to end the shocking under-staffing of wards that was endemic under the last Labour Government. Of course we want people to recruit full-time nurses on proper contracts, and that is happening. That is why we have 3,000 more nurses—not agency nurses, but proper full-time nurses on proper NHS contracts—than when the hon. Lady’s Government were in power, and we will continue to make progress.

Kettering General Hospital (A and E Department)

6. What recent assessment he has made of the performance of the A and E department at Kettering general hospital. (904108)

We are aware that the trust did not meet the four-hour standard for a period, and obviously Monitor took action and worked with the trust. In the week ending 1 June 2014—the most recent period for which data are available—99.7% of patients who attended Kettering A and E were treated, admitted or discharged within four hours, continuing a recent improvement in performance. I am sure that the staff are justly proud of that, and I know their local Member of Parliament will want to champion it.

In April 2013, Kettering general hospital was one of the worst performing acute hospitals in England on the A and E target, admitting only 74% of patients within the four-hour A and E target time. Now, as the Minister has said, it is almost 100% and the hospital is one of the best performing trusts in the country. Will the Minister congratulate all involved at the hospital on that rapid turnaround, and tell the House how the lessons learned at Kettering might be applied elsewhere?

I absolutely join my hon. Friend in congratulating everyone involved in turning that performance around—it is really, really impressive. He is right to say there are lessons to be learnt everywhere from people innovating, joining up services and the various things that have gone on in the background. I know that the local Members have been involved and engaged in the process and I congratulate them on that. That is really valuable and I urge everyone to get involved. We should congratulate A and E staff everywhere on dealing with the pressures they are under. We know they are considerable, but they do a great job.

May I congratulate my hon. Friend the Member for Kettering (Mr Hollobone) on the work he has done to help with this amazing turnaround? The Minister is aware of the plans to have a community urgent care centre at Isebrook hospital in my constituency, which will mean that my constituents will not have to go to Kettering hospital. Is this not another way forward to improve A and E results?

My hon. Friend highlights that there are a lot of different approaches to reducing the pressures on A and E. The great thing is that we are seeing real innovation from local clinicians, supported by local Members of Parliament. That shows what can be done when we address these problems with an innovative approach, and think about how we can reduce these pressures and ensure that as many people as possible are served in the right way and treated outside A and E, if that is not the place they should be.

Cancer Drugs Fund

We have committed to continuing the cancer drugs fund until the end of March 2016. We will consider carefully with NHS England how, in the longer term, we can support patients in accessing cancer drugs that could benefit them, at a cost that represents value to the NHS.

I thank the Minister for that answer, but is it not true that last year the cancer drugs fund was again underspent—funds that could be used to pay for advanced radio therapy? Every MP has received a letter from the England rugby legend Lawrence Dallaglio asking for a meeting to highlight this problem. Why is the Secretary of State refusing to meet Mr Dallaglio, along with top cancer clinicians in Cancer Research UK?

First, if only it was underspent. More than 50,000 patients have now benefited from the fund, which is fully spent. More than £1 billion will have been committed in the full period of the fund. I have confirmation from the Secretary of State that he has already met Lawrence Dallaglio. I hope that will reassure the hon. Gentleman.

Dental Care

Between May 2010 and December 2013, 1.5 million more patients were able to see an NHS dentist. We are committed to reforming the current contractual arrangements to promote improvement in oral health and to increase access to dentistry services.

What specific advice would the Minister give to my constituents who are trying really hard to access good quality, local dental care on the NHS?

A recent HealthWatch report highlighted this issue in west Yorkshire, where access to dental services has been a long-standing challenge. NHS England is looking at the financial arrangements in west Yorkshire and will report back soon. I am happy to meet my hon. Friend and representatives from the local NHS to take this issue further forward and ensure that local patients get the service they deserve.

NHS Whistleblowers

9. What steps he is taking to ensure that whistleblowers in the NHS are protected from (a) dismissal and (b) other punitive measures by their employers. (904111)

I am most grateful for any encouragement I can get.

The NHS needs to change its culture to be much more open to whistleblowers. That is why we have banned gagging orders in contracts and funded a whistleblowing helpline and website, and why we are working with brave whistleblowers, such as Helene Donnelly from Mid Staffs, to reform the training of NHS clinicians to make it easier.

I am grateful for that answer. About 10 years ago, two people, a nurse and a consultant surgeon from the same hospital, came to my surgery and showed me evidence of filth—mouse droppings—in even consulting rooms and the operating theatre. They were frightened to leave the documentation with me, because they thought they would be sacked if it was found that they were the whistleblowers. Will they now have the assurance that they could give me or others evidence without fear of retribution?

I hope so, but I want to be honest with the House. It takes time to change a culture, and that is the big change we have to make. Whistleblowers are now coming forward from Coventry, Cambridge, Ealing and all over the country. That is why I am afraid that I profoundly disagree with the shadow Health Secretary, who said that the lessons of the Francis report were about a local failure. This is about a systemic problem and we have to change it across the NHS.

Given there are so many emerging cases of whistleblowers—both current and historic—being treated with injustice, a precedent will not be set for accountability until these injustices are actually faced. Will the Secretary of State set up a truth and reconciliation committee to look at historic and current cases so that accountability becomes a reality?

First, I commend my hon. Friend for her campaigning on this issue in the House and on the Health Committee. We have not done everything we need to do to change the culture within the NHS, and we are looking at what more needs to be done to get a culture change profound enough to make it easier for people to speak out. This is not just about whistleblowing. If it is whistleblowing, we have failed because it means that someone has had to go to the press or outside their organisation when they were worried. We need an NHS where people within their own organisation are listened to when they have concerns, and we are looking at what we need to do to take that forward.

Alcohol Consumption in Pregnancy

10. What statistics his Department keeps on babies damaged by alcohol consumed in pregnancy; and if he will make a statement. (904112)

Hospital episode statistics include finished admission episodes where there was either a primary or secondary diagnosis of a foetus or newborn affected by maternal use of alcohol or foetal alcohol syndrome. I have supplied some detail on that in parliamentary answers this week. These records cover both patients treated in NHS hospitals in England and by independent providers whose services are commissioned by the NHS.

The Minister has confirmed that thousands of babies are born every year damaged by alcohol, and yet there is still no statutory requirement for all alcoholic drinks containers to display specific health warnings about the dangers of drinking in pregnancy. When will the Government introduce the necessary legislation?

Before I respond to the substantive point, it is worth saying that there is a spectrum of disorders and some of the diagnoses on certain parts of the spectrum are quite difficult. We have statistics on foetal alcohol syndrome and there is no evidence that that is increasing, although we seem to be diagnosing more in younger children. Also, the women to whom this tends to happen are extremely difficult to reach through public education campaigns as many are subject to additional, complex factors.

On bottling, through the responsibility deal, there was a commitment to get 80% of alcoholic drinks on the market labelled. That is being independently audited and is something we champion, not just with messages about drinking in pregnancy, but through guidance from the chief medical officer on drinking generally.

Prevention is of course better than cure. What is my hon. Friend’s Department doing on better guidance and support for midwives and other groups such as the National Childbirth Trust to discourage expectant mothers from drinking alcohol?

One of the slight challenges in this area is that quite a lot of pregnancies are unplanned and people have sometimes been drinking alcohol before they know they are pregnant. However, a lot of advice is available. Along with health visitors and midwives—we are putting more resource into those areas—Public Health England’s “start for life” campaign provides advice to pregnant women. There are National Institute for Health and Care Excellence guidelines, including for those women to whom I referred earlier with complex social factors. A lot of information is available, and the chief medical officers are reviewing the guidance to people generally. The simple message to women who are hoping to conceive or who are pregnant is that it is best to avoid alcohol.

Minimum Practice Income Guarantee

11. What assessment he has made of the potential effect on health outcomes of phasing out minimum practice income guarantee funding from GP practices in England. (904114)

The minimum practice income guarantee payment is unfair because practices serving very similar populations are paid very different amounts per patient. The payments are being phased out over a seven-year period to allow practices time to adjust. The money released by doing this will be reinvested in the basic payments made to all general medical services practices, which are based on numbers of patients and key determinants of practice workload, such as the age and health needs of patients.

The minimum practice income guarantee was introduced to meet the specific needs of specific practices. Those needs have not changed. NHS England has drawn up a list of 100 practices across the country that will be threatened by its withdrawal. Five are in Sheffield and two are in my constituency. Will the Minister give a guarantee that no practice will close as a result of the withdrawal of the minimum practice income guarantee, and will he provide the funding to achieve that?

The point is this: the funding system set up by the previous Government was based on historical funding and did not necessarily recognise the needs of patients. One practice might have been paid more for historical reasons than another practice next door that might have been treating more patients. That was unfair; we have changed it. NHS England is working at local level with practices that are, for whatever reason, in financial difficulties to make sure that it can help them get to the right place.

The GP practice in Watton in my constituency is struggling with the recruitment of GPs and is now two short, which is putting pressure on services. Today I heard of the proposal from NHS England to deregister 1,500 patients and transfer them to neighbouring practices in the constituency, raising a whole series of issues. Will the Minister agree to meet me to talk about what should happen, including whether NHS England could fund some sort of locum service?

Yes, I would be delighted to meet my hon. Friend. It is important to see, where possible, collaboration between GP practices on back-office services and other savings that could be made—something the public sector needs to do more generally so that more money can be invested in patients. The Government are training more GPs; in future, we will see 50% of postgraduate medical training taking place in general practice, leading to a big increase in the number of GPs.

Will the Minister look at the decision by clinical commissioning groups in north-west London to move funding away—contrary to what NHS England has proposed—from GP practices and primary care in deprived areas such as Hammersmith to areas that have much better health outcomes?

I do not believe that that is the case. In looking at the changes, we need to factor in the point that the minimum practice income guarantee, which was a historical payment and not based on patient need or patient demand, is being phased out in order to achieve a more equitable solution. As a result, we can see that the global sum payments to GPs have risen from £66.25 per patient in 2013-14 to £73.56 per patient in 2014-15. Clearly, the global sum payment to GPs per patient has increased, which is a good thing for patients and the equitability of services.

Historically, there used to be a payment for the distance GPs or their patients travelled. The removal of minimum practice income guarantee funding may make certain rural practices unviable. Will the Government address that issue, and will the Minister look particularly at rurality and sparsity in order to address what is a very real issue for rural GPs?

My hon. Friend makes a very good point, and we know that rural practices have unique challenges. The point is that because the money from the minimum practice income guarantee is going to be reinvested in a global sum payment, and because the global sum payment per practice is increasing, one of the key determinants of that payment is, in fact, rurality, so that should be of benefit to many rural practices.

The situation is far more urgent than the Minister’s complacent answer suggests. One practice in a deprived part of London has said that it is weeks away from laying off staff and just months away from closure. The Royal College of General Practitioners says that 1,700 practices could be affected, with over 12 million patients potentially facing even longer waits for appointments. Is it not the case that until we have a Labour Government, GP services are going to be marginalised and patients are going to face ever-longer waits?

I am afraid that the distance between the real world out there for patients and the Labour Government’s record is very clear. Under the Labour Government’s record on general practice, 20% of patients were routinely unable to get a GP appointment within 48 hours, and a quarter of patients who wanted to book an appointment more than 48 hours in advance could not get one. That was what happened under Labour; that is Labour’s commitment to general practice and GP patients. Under this Government, we are making sure that there is equality of finance per patient according to patient need, and that is how health care decisions should be made.

Order. I encourage the Minister to learn to provide more succinct answers. They are always too long.

Congenital Heart Disease

The review is being undertaken by NHS England, which has been engaging with a wide range of stakeholders, of whom my hon. Friend is one. He is a doughty champion for his city, and for these services. I understand that NHS England will consult on draft service standards later this year, but will not do so in July as was previously expected. All information relating to the review can be found on the organisation’s website, which is updated fortnightly. I spoke to officials yesterday in order to update myself, and I know they will post another update very soon, if not today.

According to the mortality case section of the Secretary of State’s review of the closure of services at Leeds, many of the recommendations could apply more widely to other units throughout the NHS. Given that no other unit has received anything like as much scrutiny as Leeds, will my hon. Friend ensure that any continuing audits take place in the other units as well, so that standards can be maximised?

That is a very good point. This Government and this Secretary of State have championed transparency more generally, because we all believe that it is essential to our ability to build on the success of the health service and maximise its service to patients.

Am I right in understanding that the Minister has just announced a further delay? The key recommendation to the Government on children’s heart surgery, which was made in 2001, was that fewer units should be centres of excellence, because that was in the best interests of patients. Now, 13 years later, none of that has actually happened. Do the Government still accept the premise that fewer units should be centres of excellence, and will the Minister tell us what accounts for the delay?

I understand the right hon. Gentleman’s frustration, but the review is very important. NHS England has confirmed that it will not be able to consult quite as early as it had wished, but it should be appreciated that this review is more comprehensive than the last one. For example, NHS England has developed a comprehensive set of commissioning standards which have never existed before. For the first time, the whole patient pathway will be covered, from foetal detection through childhood, into adult services and all the way to palliative care—on which one of my hon. Friends led a debate relatively recently—and bereavement.

It is always frustrating when things do not happen according to schedule, but what really matters is getting this right and being as transparent as possible. The level of engagement with stakeholders has been much more satisfactory than before, and we continue to make progress.

Community Hospitals

13. If he will bring forward proposals to widen the range of services and treatments available in community hospitals in rural areas. (904116)

Responsibility for the commissioning of local NHS services lies with clinical commissioning groups. Community hospitals have an important role in achieving more integrated care across health and social care services in rural areas by providing better out-of-hospital care, particularly for frail older people and those with long-term conditions.

A new community hospital is to be built in Berwick, which is 50 miles from major hospitals. Will it be free to offer a wider range of services, along the lines envisaged by the NHS chief executive in his recent comments?

I know that my right hon. Friend has been campaigning for that hospital. I welcomed the comments of the chief executive of NHS England, who has argued for a much more flexible and adaptable NHS, and for ensuring that GPs locally, working with community services, can offer the maximum range of health services to the local community as close to them as possible.

Two and a half years ago, my right hon. Friend the Member for Chelmsford (Mr Burns), then Minister of State, opened the St Luke’s hospital day care unit in Market Harborough, which serves a large rural area in my constituency. During those two and a half years it has been open for only 131 days, which is a huge waste of public money. I wrote to the Secretary of State yesterday. He will not have had a chance to read my letter yet, but will my hon. Friend and his colleagues look into the matter, and ensure that we do not waste public money on opening hospitals that do not provide a service?

My hon. and learned Friend has raised an extremely important point. It is essential that the maximum possible use be made of investment. I know that the Secretary of State will look into this issue when he has received the letter, but we must ensure that all such facilities are properly used.

Health Services (East Midlands)

Decisions about local services should be made as close to patients as possible, by those who are best placed to work with patients and the public to understand their needs. Clinical commissioning groups commission the majority of health services, working with health and care professionals to design services for local populations.

In large rural areas like Lincolnshire, the air ambulance can make the difference between life and death, particularly for car crashes where roads are blocked. What plans does the Minister have to strengthen the services of the East Midlands air ambulance service?

I will be very happy to discuss the issue with my hon. Friend, if he would like to do so. I pay tribute to the extraordinary work the air ambulance services undertake across our country. I have witnessed that in my own community and I would be very happy to talk further about what more can be done to strengthen the work they do.

Child and Adolescent Mental Health Services

15. What recent assessment he has made of the adequacy of child and adolescent mental health services. (904118)

We know that there is a varied picture of services across the country, where decisions on spend and allocation of resources are made by local commissioners. NHS England is preparing to publish a report based on its recent analysis of tier 4 child and adolescent mental health services, along with a service improvement plan. We expect these to be published in the coming weeks.

A recent survey conducted by the Royal College of Psychiatrists found that over a quarter of trainee psychiatrists have had to send a child or young person more than 200 miles away from their family in order to access an appropriate bed. What is the Minister going to do about this totally unacceptable situation?

I agree, and that is why NHS England undertook the work to analyse exactly what the position is across the country. In fact it is very varied. There are some regions where it is fine, and others where it is not acceptable. I think we would all agree that it is completely unacceptable for children to be sent sometimes hundreds of miles away from home. When it publishes its report, it—[Interruption.] If the right hon. Member for Leigh (Andy Burnham) would just listen, when it publishes its report, it will be publishing an action plan of the steps it will take very soon to meet any shortfalls in provision.

Although I supported the Health and Social Care Bill at every stage, I have always harboured some concerns about the ability of GPs to commission mental health services. Mental health is a fast-growing problem and a challenge to the NHS for the future. What assurances can the Minister give me that GPs will receive the appropriate specialist guidance, if required?

I thank my hon. Friend for that question, and it is a legitimate one. A lot of work is being undertaken by NHS England and the national clinical director Geraldine Strathdee, a highly regarded individual, to strengthen the quality of commissioning of mental health services. It falls short in many areas at the moment and it is essential that it is improved.

Ministers say that they are committed to parity of esteem between mental and physical health, yet we have already learned from an NHS England report that three quarters of children with anxiety or a diagnosable depression are not receiving the treatment they need. This is plainly unacceptable. It would not happen to children presenting with a broken arm or asthma, so can the Minister please tell the House when he will translate his rhetoric into reality?

Absolutely, and we are doing it. One of the problems we are having to confront is that when the Labour Government introduced the 18-week waiting standard, unbelievably they left out mental health. When mental health is left out from a standard of that sort, that determines where the money goes, and ever since then mental health has lost out. We are committed to changing that.

Topical Questions

Almost a year ago, following the Keogh report, we put 11 NHS trusts into special measures, the first time such a large number of trusts have been put into special measures. Yesterday I was pleased to report to the House that the first trust, Basildon, has come out of special measures. I am pleased to tell the House today that across all the trusts in special measures, an additional 1,202 nurses and an additional 118 doctors have been recruited. The programme is making good progress, and the whole House will want to commend the efforts of all the staff in those hospitals on the tremendous efforts they are making.

I join the Secretary of State in commending the management and all the staff of Basildon hospital for their excellent work and a great team effort. The hospital is now no doubt on an upward trajectory. I should like to raise with him the matter of the human papilloma virus vaccination programme for young women. It has been a success, and there is mounting evidence that is should be extended to young men. Will the Government now look into the feasibility of doing that?

My hon. Friend is right, and I am grateful to him for mentioning how proud we are of the HPV vaccination programme for girls and women. It is one of the best in the world, and we are getting an 86% take-up rate among eligible 12 to 13-year-old girls. He is also right to say that we now need to look at whether the programme should be extended to men and boys. A decision was taken at the time that it did not need to be, but we are now reviewing that decision. We will shortly be getting advice from the Joint Committee on Vaccination and Immunisation—which, as he will know, gives us independent advice on these matters—and we will take its advice seriously.

I am sure that, like me, the Secretary of State will have been shocked to the core by the serious case review into the Orchid View care home. It spoke of institutionalised abuse and of residents dying of sheer neglect. This is just the latest case of appalling abuse in care homes, following that of Winterbourne View and the recent “Panorama” programme on Oban House. People are asking how many more times we must see abuse of this kind in our care homes before we take decisive action to stop it. Will the Secretary of State give serious consideration to the central finding of yesterday’s review, which was that the same principles of patient safety that apply in the NHS should now be applied to the care home sector?

I thank the right hon. Gentleman for that question. He is absolutely right to suggest that the lessons of Francis need to be applied to the care home sector, to general practice and to all out-of-hospital care every bit as much as they are applied to NHS hospitals. That is why we have legislated in the Care Act 2014 not only for a chief inspector of general practice but for a chief inspector of adult social care, Andrea Sutcliffe, who has made an excellent start. She is going around all the care homes, and she is bringing back the rigorous Ofsted-style analysis that was unfortunately taken away by the last Government. That will mean that we have proper transparency in standards. Going back to an earlier question from my hon. Friend the Member for Lichfield (Michael Fabricant), we also need to do more to help whistleblowers working in care homes. Because there are so many care homes, we cannot depend solely on the inspectors to get this right. We have also introduced the ability to prosecute offenders, which did not exist before.

T3. The fears of the people of the Ribble valley that the old Clitheroe hospital would be closed and not replaced were allayed when the new hospital was built. It recently opened with 32 in-patient beds, radiology, diagnostics and other facilities. Will the Secretary of State come to Clitheroe to have a look at this brand-spanking-new hospital, which is being welcomed by the local community, and to say thank you to the staff there for all they do? If he does so, I promise to take him for a pint of healthy real ale afterwards in the Campaign for Real Ale pub of the year in Pendleton in the Ribble valley, to celebrate the opening of the new hospital. (904095)

Well, I must say that that sounds like a pretty irresistible offer, and I will give it careful consideration. Local community hospitals have an important role to play in our NHS because of the high standard of compassionate care that they deliver, and because they are easy for relatives to get to. I am delighted to see my hon. Friend campaigning for his local hospital, and delighted that it is doing so well.

T2. A Birmingham trust has recently announced that it will be possible to cut 1,000 beds across the city by setting a maximum stay of seven days for most patients. Not surprisingly, this has caused some alarm. Are Ministers aware of that proposal? What guidance, if any, can they offer in regard to such proposals? (904094)

As the hon. Gentleman will be aware, patients need to be treated according to clinical need, and bed stays should not be determined by anything other than that. So if what he describes is actually the case, it would be very disturbing. If he would like to raise the issue further with me, I would be happy to look into it for him.

T5. Like other rural communities, Herefordshire has long suffered from chronic underfunding in health care. Does the Secretary of State share my view that setting clinical commissioning group allocations should be an evidence-based process that takes into account factors including sparsity and old age? Also, will he ignore the calls from the shadow Health Secretary, who was seeking to cut the previous NHS allocations in areas such as Herefordshire? (904097)

I agree with my hon. Friend that it has to be done on the basis of evidence. Part of that is an important change that the Government have made, which the Labour party criticised a great deal. We have depoliticised the process by giving it to NHS England, where it is decided at arm’s length from Ministers on the basis of need. It is challenging to do it fairly. There are some historical imbalances, and we have to do what we can to address them, but we have to do it in a way that is fair and is not tarnished by party politics.

T4. Health inequality on Teesside is a major issue, but the Government axed plans for our new hospital four years ago. I am told that Ministers now accept that a new hospital to replace the two hospitals at North Tees and Hartlepool is the right way forward. When will they remove the barriers to the project and give the support that is needed? (904096)

T6. The new specialist emergency hospital is nearly 60 miles from Berwick. Given the serious delays in ambulance attendance in recent cases in Northumbria, how can we be sure that serious cases will get paramedic attendance and delivery to the hospital within the critical hour? (904098)

My right hon. Friend is right to raise concern. The North East ambulance service has traditionally been a good performer, but any deterioration that has been identified needs to be addressed very speedily. I urge him to monitor this closely, and if he wants to talk about it further with me, I will be happy to do so.

T10. Last October the Secretary of State said that Hammersmith accident and emergency would be closed when it was safe to do so. Imperial proposes to close it on 10 September, when on its own admission there is insufficient capacity at St Mary’s and it is not safe to do so. Will he keep his promise and ensure that Hammersmith A and E does not close, especially when there is not sufficient capacity in the system? (904102)

I keep my promises, but may I point out to the hon. Gentleman that the way in which he has campaigned on those issues has been totally irresponsible? He put out leaflets in the local election campaign saying that Charing Cross hospital would be demolished. He failed to mention that it was going to be rebuilt as a brand-new hospital with an A and E department. I hope that he will not be invited to it when it is reopened unless he apologises to his constituents for the way he has presented this issue.

T7. The Government can be rightly proud that there are fewer managers and more doctors in the NHS than in 2010. However, recent research by the TaxPayers Alliance shows that in the Greater East Midlands commissioning support unit more than £1 million a year is being spent on 26 administrative jobs of dubious value such as communications managers, communications officers, three communications and engagement leads, and two equality and diversity managers. The list goes on, Mr Speaker, but I will not. What further steps can my right hon. Friend take to ensure that the NHS budget is spent on front-line medical services? (904099)

My hon. Friend is right to highlight the fact that as much money as possible always needs to be put into front-line patient care. Under the previous Government, spending on managers and administrators more than doubled from £3 billion to £7 billion, and we have seen the number of administrators fall by 20,000. There is clearly work to do in his area, because as much money needs to go on front-line patient care as possible, and I hope that local commissioners will be looking to share back-office services as much as possible with other commissioning groups to reduce costs and put money into front-line patient care.

Earlier the Secretary of State and his Minister said that the minimum practice income guarantee was unfair. What is unfair is that so many practices in Hackney and east London are set to close, in an area where there is great deprivation. What are they going to do to make sure that patients still have practices to go to?

We have had this discussion. A payments system that is almost 20 years out of date and is not funding patients according to clinical need or is not per head of population will not deliver good care. The payments system needs to be changed and NHS England is working with practices that are facing challenges to address those challenges and ensure that high-quality patient care can still be delivered locally.

T8. Following the recent speech by the new NHS England chief executive Simon Stevens about the important role of local hospitals, can my right hon. Friend confirm that district general hospitals such as Macclesfield will continue to play a vital role in delivering local health services in the years to come? (904100)

I can confirm that. What my hon. Friend said was profoundly important. There is not an automatic link between size and quality. We know that for certain types of treatment, there is huge benefit in centralising services, as has happened for stroke services in London, but other services can be delivered extremely well at smaller units, and we will continue to support those.

The Minister has just talked rather piously about spending NHS money on front-line services, but the NHS is spending £300,000 on a university secondment for a staff member who has left. How does he justify that sort of abuse?

I just point out to the hon. Lady that in the Queen’s Speech we made it clear that we are cracking down on inappropriate payments to people who leave the NHS, many of which are the result of contracts set up by her Government.

T9. My constituent, Beth Charlton, recently lost her father to pancreatic cancer and notes that patients have only a 3% chance of surviving five years. That is much lower than the survival rates for other cancers and has not improved in 40 years. Will the Minister invest more in early detection and diagnosis of this silent killer? (904101)

Spending on health care research, including cancer research, has considerably increased under this Government, and much of that funding is allocated independently. It is important to note that pancreatic cancer is, as the hon. Gentleman says, a silent killer, because presentation is often very late in the disease process. Patients can present suddenly with painless jaundice and are often only three months away from death. It is therefore important that we look at the causes of pancreatic cancer and focus on primary prevention and on helping people to develop a healthy attitude to alcohol.

In the last hour I have heard the Secretary of State and his Ministers complain about the problems with A and Es; I have heard them talk about the problems with GPs; now we hear that they have lost control of care of the elderly. Instead of continuing to blame the last Labour Government of four years ago, why does the right hon. Gentleman not admit that the NHS is not safe in his hands? Let us have an election and get a Labour Government.

Because we are making the NHS safe. We are taking action to deal with the issues that the hon. Gentleman’s Government swept under the carpet. The NHS is getting safer and more compassionate. It is delivering more care to more people than ever happened under the Labour Government. We are proud of our record on the NHS, and we will not make the NHS better by pretending that problems do not exist when they do.

Stockport Mind reports that it takes on average 12 months to receive the first appointment for cognitive behavioural therapy after diagnosis. What action can be taken to improve that standard in Greater Manchester?

I mentioned earlier that when the last Labour Government introduced the 18-week waiting time standard they left out mental health. That is at the heart of the problem. We are committed to changing that and to introducing access standards in mental health, and we plan to start next year.

The Stitch project in Bristol has contacted me with concerns about the number of overdoses by people on prescription medication and suggested that allowing medication to be dispensed in instalments would be a better way of handling those vulnerable patients. I was disappointed in the response that I got from the Department, and I urge the Minister to think again on this issue.

I am very happy to meet the hon. Lady to discuss this further and see what we can do because it is important that the vulnerable patient groups she highlighted are looked after in the right way.

As he heralds an era of transparency, can the Secretary of State update us on what steps he has taken to ensure that private providers in the NHS are every bit as transparent and accountable as public ones?

I think they absolutely should be, and the changes that we introduced in the Care Act 2014 relating to the transparency of the inspection regimes apply to private providers supplying services to the NHS just as they do to NHS providers. Let us be absolutely clear: poor care is poor, whether it happens in the public sector or the private sector, and we must clamp down on it wherever it happens.

The Minister said that he was dealing with the chronic shortage of staff who help vulnerable children and young people, who cannot get access to mental health services. Will he tell us when there will be enough staff delivering those services to that important group?

I mentioned that NHS England will very soon publish a report following its analysis of existing facilities across the country, so the hon. Gentleman will get the answer in the next few weeks.

When will the public health Minister publish the regulations for the plain packaging of tobacco products, on which she proposes to consult?

As my hon. Friend knows, Parliament has already granted us the regulation-making powers in the Children and Families Act 2014 and we have said that we are minded to proceed with those. We are still committed to consult. The regulations are being drafted. I had hoped to publish them before the end of April. We were caught by the pre-election purdah period, but I hope to publish them soon.

Order. We are very pressed for time, but I want to accommodate a couple of remaining colleagues.

I am grateful, Mr Speaker. In Brent we have the highest incidence of TB and of type 2 diabetes in the country. We have just received a cut of £450 million in the money allocated to the CCG. The Secretary of State says that this is fair, but my constituents want to know whether it is in accordance with need.

The hon. Gentleman is right to draw attention to the problem of TB in London. As a London Member myself, I know what he is talking about. I encourage him to participate in the current consultation on Public Health England’s comprehensive TB strategy. It is a very important document which marks a step change in the way we confront the problem. That will help us to allocate resources to need and to address serious problems.

Will the Minister give us an update on the proposed licensing of e-cigarettes by the Medicines and Healthcare Products Regulatory Agency? Does her Department believe that e-cigarettes could be used in smoking cessation programmes?

When I brought the regulations before Parliament, we were clear that those e-cigarettes for which a medicinal claim is made must be subjected to medicinal licensing arrangements. Once they are licensed as medicine, they can be prescribed as part of NHS smoking cessation services.