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Volume 584: debated on Tuesday 15 July 2014

The Secretary of State was asked—

Primary Care (Older People)

It is a particular pleasure to be here this morning, although I appreciate that that feeling may not be reciprocated on all sides of the House.

Our NHS will not be sustainable unless we totally transform out-of-hospital care. That is why we have introduced the £3.9 billion merger of the health and social care systems, and reforms to the GP contract. We are encouraging clinical commissioners to be responsible for all out-of-hospital commissioning.

I am delighted that my right hon. Friend is answering questions today. Will he confirm that the changes announced will mean that frail elderly patients in Gravesham will have a single person to co-ordinate their care?

There is agreement across the House that we need a focus on frail elderly patients and a system in which everybody knows, for their mum, dad or grandparents, that there is someone in the NHS where the buck stops in relation to complex, long-term conditions. That is a condition of the better care fund, so I hope that that will make a big difference in my hon. Friend’s constituency.

The Secretary of State mentioned integration. Good care and support for older people in their own homes are vital, yet a constituent visited me recently to say that she simply could not find a decent trustworthy care company to look after her relative. Will the Secretary of State join me in calling for all local authorities to sign up to the ethical care charter?

I do not know what the charter says, but I am happy to have a look at it. I agree with the hon. Lady’s sentiments. The important change we need to make is to understand that it is a false economy not to look after people who are vulnerable—those who need help washing, getting out of bed and feeding every day. Scrimping on such care is incredibly dangerous: it costs the NHS more, but most of all it means that those people are not treated with the dignity and respect that they should be.

A recent Age UK report shows that older people are many times more likely to be moved multiple times in hospital, and that there is an attitude that they should not be using up hospital beds. What does my right hon. Friend suggest to tackle the problem, for example through improved guidance?

The attitude to which my hon. Friend refers is totally unacceptable. It is not specifically an NHS problem; we need to change the way of thinking across our society. In particular, I worry about people with dementia who are sometimes in hospital wards where they are not able to speak up for themselves. That is why we have introduced probably the toughest inspection regime of any hospital system anywhere in the world, and I hope it will make a real difference.

In view of the fact that there are currently 10 million people in the UK over 65, and the latest projections are for a further 5.5 million elderly people in 20 years’ time, what plans have the Government made to allocate and prioritise resources for the future care of older people with complex needs?

The hon. Lady is absolutely right. The figure always in my mind is that by the end of the next Parliament we will have more than 1 million additional over-70s. We need to totally change the way we look after those people, through the single point of contact and a different attitude to continuity of care. One of the things that matters most to those people is the feeling that there is someone in the NHS who knows about their particular needs, their family and their carers. That is the big challenge for the NHS in the next few years.

The Health Secretary does not seem to realise that continuity of care is actually getting worse under him. The GP patient survey shows that the proportion of people who cannot regularly see their preferred GP has risen from 34% in 2012 to 39% in 2014, an increase equivalent to 1.2 million people. Experts say that that is one of the reasons why A and E is under so much pressure. Will he confirm that on Friday it will be precisely one year since hospital A and E departments last met his Government’s own A and E target?

What I will confirm is that the worst possible thing for continuity of care was Labour’s scrapping of named GPs in 2004. The single thing that makes the biggest difference is to have, for every frail and elderly person in our NHS, someone who is responsible. That is what we are bringing back.

Antimicrobial Resistance

We are leading cross-Government action to address antimicrobial resistance—AMR—at national and global levels. We published details of how we will measure the success of the UK’s AMR strategy, and we will publish an annual progress report in November. We are considering recommendations in the Science and Technology Committee’s AMR report. I gave evidence to that Committee and we will publish our response in September.

I very much welcome the Government’s international lead on antibiotic resistance, led by the Prime Minister. Does my hon. Friend agree that increasing the unit price of antibiotics and tackling their growing misuse in developing countries is absolutely vital if we are not to face a return to the medical dark ages?

My hon. Friend is quite right to highlight this as a major challenge facing us. I pay tribute to the chief medical officer and to the Prime Minister for the international leadership they have given on this. My hon. Friend will be pleased to hear that the antibiotics market will be considered in its totality by the O’Neill review, which was announced by the Prime Minister on 2 July. It is of course important to bear it in mind that while we look at tackling global antibiotic misuse, we need to balance the need for global conservation measures with accessibility for lower-income countries.

Food Safety (Local Authorities)

3. What assessment he has made of the adequacy of resources made available by local authorities for the regulation of food safety. (904850)

The allocation of local authority food law resources is a local matter. Authorities are increasingly using a risk-based approach to target these resources and looking at ways in which they can work smarter. The Food Standards Agency monitors and audits local authority controls to ensure appropriate resources are in place effectively to regulate food safety.

Food safety standards in this country are generally very good, happily, but that is very much dependent on the work of local authorities and of laboratories. What consideration has she given to the recommendations of the interim Elliott review that there should be better coordination and integration of local authorities and also, possibly, a public analyst service?

Obviously we are awaiting the final Elliott report but, as my hon. Friend would expect, consideration is being given across government to the interim report. The Government are committed to improving co-ordination and intelligence sharing. We can see some of that in, for example, smart back-office sharing, on which his authority, I believe, has taken a lead. We are working across government, local authorities and industry to protect food integrity. Professor Elliott said that we have one of the safest systems in the world but there is always more we can do to work more closely together. I know that the FSA is working more closely with local authorities and that Public Health England has begun to have constructive discussions around the issues. But we will obviously respond in more detail when we have the final report.

Sugar is one of the most deadly parts of our daily diets. What can be done to regulate the amount of sugar in our diets locally that will result in a decrease in the number of people with diabetes?

I congratulate the right hon. Gentleman on the creativity with which he has introduced sugar into this question. He is right to highlight the fact that sugar is an important factor in considering how we get the nation healthier, which we see in the overall context of trying to encourage people to consume fewer calories. A lot of work has been done. He will be aware that we have just had a very detailed scientific report on sugar and carbohydrates more generally. We are considering that but he will be pleased to know that Public Health England has already started to roll out that advice at both a local and national level to consumers and families. We will of course consider what more we might do.

Does my hon. Friend share our concern on the Select Committee that not enough regular food analysis is being done by local authorities? Will her Department press for this to prevent any further adulteration or food scares in the future?

We have discussed this with the FSA and we will respond in more detail when we have the final Elliott review. But it is worth noting that the FSA is supporting local authorities financially and with expertise, but is also very much encouraging people to work smarter so that a lot of inspection is based far more on risk. That is right, as we do not want businesses with excellent records of compliance being subjected to the same regime of testing and inspection as those who give rise to greater risk. I hope my hon. Friend would agree that an intelligence-led approach is the right thing to do.

Hospitals in West London (A and E)

The NHS is, as the hon. Gentleman knows, implementing the plans for hospitals in west London under the “Shaping a Healthier Future” scheme. This will include 21st-century health care facilities for the local community, and it is very much led by local clinicians to provide better care for patients in the hon. Gentleman’s and other west London constituencies.

Is the truth not that two west London A and E departments will close eight weeks tomorrow? Although the local NHS is paying M&C Saatchi to spin that decision, so far no one has told the 300,000 people in the catchment area for the Central Middlesex and Hammersmith hospitals that their A and Es are going to close and no evidence has been produced to show that it is safe to do so?

Unsurprisingly, that is another example of the hon. Gentleman putting politics before patients. We have had a slew of information put out to people in his area and surrounding areas, much of which did not highlight the new facilities that are being introduced. I would love to hear the hon. Gentleman talk up the new facilities coming into that area. Charing Cross hospital will be redeveloped as a 21st century health care facility, in line with my right hon. Friend’s decision based on the independent reconfiguration panel’s advice. Charing Cross and Ealing will have a local A and E with 24/7 access to full diagnostic support, consultant advice and specialist care—and it would be really refreshing if the hon. Gentleman, rather than following his usual line, could tell some of his constituents the good news about health care in his part of London.

General Practice

We are working hard to improve standards of care in general practice. We have brought back named GPs for those aged 75 and over, introduced a new inspection regime and are doing everything we can to recruit more GPs to improve capacity.

When will both political parties be honest about the massive looming black hole in health funding, with an ageing population demanding ever better care? We cannot afford to pay for it out of general taxation, so are we going to be honest and have an open debate about moving to the French system of social insurance in which people are charged and repaid if they do not have the means, giving them an infinitely better health service?

I do not agree with my hon. Friend; let me explain why. The first and important point is that independent studies, such as that which was done last month by the Commonwealth Fund, have ranked the NHS top out of 11 major health economies, including the French example. Money is, of course, tight throughout the NHS, but we have been able to find efficiency savings of £20 billion over the last five years, and we will continue to find them. What I would not support, however, is any system of charging that would make it harder to access NHS services, particularly for older people whom we need to access more services more quickly if the NHS is to be sustainable.

Let me reassure the Secretary of State that Opposition Members are pleased to see him still in his post today, but if I were him, I would not take that as a compliment. On GP access, what is he actually doing? Survey after survey shows that patient satisfaction with access to their GP is getting worse and worse. That has been borne out in my constituency surgery in a significant number of cases. One constituent recently came to see me who had been discharged from hospital with significant care needs and he was told that he would have to wait three and a half weeks to see his GP. What is the Secretary of State actually doing about it?

I am delighted that the hon. Lady is delighted that I am in my position here today—we can all be delighted about that wonderful piece of news. Let me tell her that we are doing a lot to improve access to GPs. We have recruited 1,000 more GPs over the course of this Parliament. Let me gently say to her that we can afford those 1,000 GPs only because we pushed on with difficult reforms, getting rid of the PCT bureaucracy and removing 19,000 managers. We would not have been able to afford them if we had listened to her party and continued to spend money on bureaucracy and management.

In every area, there are some very good GPs and some less good ones. How does my right hon. Friend think that clinical commissioning groups should celebrate those GPs who go the extra mile and provide an example for others to follow?

My hon. Friend has made a very good point. We have learnt from the big efforts to improve standards of care in hospitals—of which I think everyone in the House should be proud—that the best way in which to improve those standards is to be transparent about how well people are doing. What the new chief inspector of hospitals has done is identify not just the failing hospitals that have been put into special measures, but the good and outstanding hospitals, so that they know what they should and can aspire to. I think that we shall hear shortly how the chief inspector of general practice intends to implement the same regime in general practice.

Order. If the right hon. Gentleman would face the House, it would greatly avail us. I understand the natural temptation to look backwards—[Laughter.]—as in, behind him! But he must face the House.

On 20 June, I wrote to the Secretary of State informing him of the claims of doctors in Cumbria that unless drastic action were taken to reduce the pressures on GPs’ work loads, patients could die. I have not even received a response. Why, having being given such a stark warning, is the Secretary of State sitting on his hands? There are fewer GPs today than there were during Labour’s last year in office. How can standards in general practice be improved when surgeries are dealing with a recruitment crisis?

Let me give the hon. Gentleman his answer now. According to the Royal College of General Practitioners, 40 million more appointments with GPs are being made in every single year than were made when Labour was in office, and we have 1,000 more GPs than we had when his party was in power.

Let me say very clearly that the way in which we will deal with this problem is by increasing the capacity of general practice and the capacity of primary care. The hon. Gentleman should be supporting that—and he might just think about the 48-hour target that Labour has been talking about. If a new target for GPs is introduced, they will simply cut the amount of time that is available for them to deal with the most frail and vulnerable patients, and that would be wrong.


Under the Care Act 2014, rights for carers that are equal to those for whom they care will be enshrined in law for the first time. That includes support to meet their needs. My Department has also separately provided £400 million for the NHS to enable carers to take breaks from their caring responsibilities.

As a condition of the better care fund, areas are being asked to choose local indicators, which will accompany national measures, to show progress towards the integration of health and social care. How many areas have chosen carer-reported quality of life as their local indicator, and how can more areas be encouraged to make carers a priority in their delivery of services through the better care fund?

My right hon. Friend is absolutely right to focus on the importance of better care fund plans, including the interests of carers. The planning guidance that was issued in December made it clear that the plans should include the well-being of carers. Updated guidance will be issued very soon, and will reinforce the central importance of carers’ being part of the plans. We do not yet have a final picture, but we are keen to ensure that all plans include the interests of carers.

Last week I raised with the Prime Minister the case of a 62-year-old man who is caring for his wife, who has Alzheimer’s. When he sought an urgent GP appointment for her, he was told that it would take five weeks for her to see her GP and two weeks to see any GP, or he could take her to Salford Royal hospital’s A and E department. Does the care Minister think that that is acceptable, and will he now back the creation of a duty for NHS bodies to identify carers, so that they and the people for whom they are caring are given the support and the priority that they deserve?

No. I do not think that that level of wait is acceptable, which is exactly why we are promoting the better care fund. We want to bring together disparate parts of the system so that care is shaped around the needs of patients, and that has been widely supported throughout the system. I should also mention that the hon. Lady’s party colleague Baroness Pitkeathley was incredibly positive about the Care Act, saying that it was the biggest advance in her 30 years of working in the interests of carers. I wish that at some point the hon. Lady would just acknowledge all the good things that the Government have done in carers’ interests.

Born in Bradford Research Study

By tracking the lives of 13,500 children and their families, the Born in Bradford research study is providing information that will help us to understand the causes of common childhood illnesses, and to explore the mental and social development of a new generation.

In the Born in Bradford study, 63% of Pakistani mothers are married to cousins, and within that group there was a doubling of the risk of a baby being born with a congenital anomaly. The report also found that “a larger number” of children born to cousins

“will have health problems that may lead to death, or long term illness for the baby.”

How much do health issues related to first-cousin marriages cost the NHS, and, given those findings, is it not time that such marriages were outlawed?

We do not have any financial information, but it is important to point out that the Born in Bradford study showed that there was an increase in the risk of birth defects from 3% to 6% in consanguineous marriages. However, that clearly highlights that not all babies born to couples who are related have a genetic problem, and the key issue is to help women to make an informed choice before they get pregnant and to direct them to genetic counselling where that may be required.

Learning Disabilities (Community Provision)

8. What the new deadline will be for moving people with a learning disability out of assessment and treatment units and into community provision. (904855)

We are working with NHS England to set out clear expectations for progress and improved rates of discharge. This includes NHS England producing an action plan to measure progress against. The Winterbourne View joint improvement programme is working with local areas to identify issues and to support them to make progress.

Given the severe lack of funding in this area and the need for development of housing and proper support within the community to avoid the recurrence of, for example, what happened in Winterbourne, will the Minister explain how he is addressing this problem and who he is working with?

I applaud the right hon. Gentleman’s work on this, and it is very important that we make it very clear to the public that all of us share the ambition to get people out of institutional care when they do not need to be there. Actually, it is not about the lack of resources. The scandal is that, as a system, we are spending a fortune on institutional care when people could very often be much better cared for in their own communities. The good thing is that Simon Stevens, the new chief executive of NHS England, has shown a personal interest in this. I have discussed it many times with him. We have asked NHS England to produce an action plan by the end of August, demonstrating exactly how it will speed up the progress of getting people out of institutional care.

20. Promises come cheap, but results take sustained action. The fact is that a promise was made to the families of those with learning disabilities to move them out of assessment and treatment units by June 2014. What exactly is the situation now? The latest figures revealed that only 35% of that promise had been fulfilled. (904868)

The truth is that progress is far too slow. This has been a scandal that has dragged on for many years. It is not a new problem, and helping people who are capable of living independent lives with support in the community to get out of institutional care is long overdue. Changing the culture is complex and difficult, but we are absolutely determined to sustain the pressure to ensure that change is achieved.

22. I thank the Minister for those replies, but I understand that Sir Stephen Budd has been asked to lead a working group on these issues, reporting to NHS England. Will the Minister say a little more about the purpose of this group and its significance, in the light of the failure to meet the June deadline? (904870)

That is absolutely right, but Sir Simon Stevens took the view that it was essential to get the voluntary sector much more involved in the whole process. There are brilliant organisations such as Mencap and the Challenging Behaviour Foundation which are absolutely committed to achieving change, and the more we can work with them to achieve that change, the more likely we are to be successful.

After the appalling scandal at Winterbourne View, the Minister promised to stop people with learning disabilities being sent to assessment and treatment units for long periods. He has spectacularly failed: 2,600 people are still in ATUs, including 150 children; more people are now going into these units than are coming out; and half are still on anti-psychotic drugs or subject to physical restraint. Change will only happen with real leadership, but in answer to a parliamentary question, the Minister said he had not even met one of his colleagues at the Department for Communities and Local Government. He must now set a clear, non-negotiable deadline to end this practice in two years’ time and to secure public commitments from the Health Secretary, the Communities and Local Government Secretary and NHS England’s chief executive to make sure it happens.

I caution against sanctimony, because this scandal continued under the last Labour Government, who did nothing to get people out of institutional care. At least this Government are absolutely committed to changing that. What we discovered is that changing the culture is a lot more difficult than I had hoped, but we are absolutely determined to achieve the change, which is so necessary.

Mental Health (Parity of Esteem)

Our mandate to NHS England requires measurable progress in achieving parity of esteem by March 2015. Parity will involve extending and ensuring better access to talking therapies, in particular for children, young people and those out of work. Progress towards better access to these services has been good.

I thank my hon. Friend for that answer. What further measures will be taken to improve access to specialist perinatal mental health services to deal with problems such as post-natal depression, and will we see measurable objectives on that in the NHS mandate?

We had a very good round table discussion about this with leaders from around the country last week. What emerged is that fantastic progress is being made in many places, but it is not uniform. There needs to be a concerted effort to ensure that mothers get access to the same specialist treatment wherever they live across the country, and we are determined to achieve that.

21. The all-party group on suicide prevention has been looking at the money going into suicide prevention as a result of the Government’s suicide prevention plan. It is acknowledged by most local authorities that there is more money for mental health, but suicide has been rolled into mental health and there is a distinct lack of support for those who are suicidal but do not have a diagnosable mental health problem. What does the Minister intend to do about that? (904869)

The hon. Lady raises an important point, which she and I have discussed before: the fact that very many people who end up taking up their own lives have had no contact at all with statutory services. I would be happy to discuss further with her what additional steps we can take to ensure that those people get the support they need.

I am delighted to see all the members of the Front-Bench team in their places this morning—or this afternoon, I should say. The principle of parity of esteem should also apply to consent to treatment. Does the Minister agree that the offer of talking therapies and other therapies must always be based on the principle of informed consent? Has he held any discussions with his colleagues in other Departments?

I completely agree with my hon. Friend. It seems to me to be inherent in the nature of therapy that people go into it willingly. The idea that we could frogmarch them into therapy against their will simply would not work. We could end up with a dangerous and costly tick-box exercise that achieved nothing, so there is no plan to introduce compulsion to access therapy.

I listened carefully to what the Minister said in answer to the Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), but will he confirm that there is no truth to reports that the Government are considering plans that would mean that people with mental illness would have their benefits stopped if they refused treatment? Rather than people refusing treatment, are not the increasing shortage of beds and ever longer treatment delays under this Government the real reasons why people are not receiving the help that they desperately need?

I can confirm, as I already have done, that there is no truth in the rumour. Indeed, in August we anticipate publishing the start of trial programmes to bring together IAPT—improving access to psychological therapies—with Jobcentre Plus. The idea of ensuring that people who are out of work and have mental health problems get access to psychological therapies is incredibly important, and I am very excited about the pilots that we will launch in August.

Food Prices (Public Health)

The Government monitor trends in food prices. We are obviously aware that for some families money is tight, but that is one of the reasons why in my area—public health—we are investing in programmes such as Change4Life. Public Health England has done a great job with Change4Life. Since its launch, more than 1.9 million families have joined, and the Meal Mixer app, for example, has been downloaded more than 1 million times and contains hundreds of quick, healthy and affordable family recipes.

I thank the Minister for that response. Some of the things that she mentioned involve people being in a position to make choices about the food that they buy, and we know the extent of food poverty is such that many people do not have the luxury of being able to do that. Is the Minister aware of the Trussell Trust and Oxfam report, which warns that people in food poverty are buying lower quality food and less food overall, giving rise to a real problem of malnutrition in children?

I am sure that, like me, the hon. Lady welcomes the news this morning that food price inflation is at an annual rate of 0%, so food prices are at the same level as last year. On the issue that she raises, that is exactly why programmes such as Change4Life are important. It is also important that we see other measures across government. The school food plan is important for its emphasis on nutrition, as are free school meals and the Healthy Start programme. The Government are doing lots of things to try to make it easier for less well-off families to eat healthily.

Will the Minister applaud the work of Colin Kaye in my constituency, who, on his own farm, is producing cheap, good quality food to help reduce the cost of food so that people can eat more healthily and have lower food bills?

That sounds like a fantastic local initiative, and I thank my hon. Friend for highlighting it. Taken together with our advice and support for families on how to use healthy food to make healthy meals, initiatives such as that are to be applauded.

Failing Hospitals

The new special measures regime for failing hospitals is designed to introduce honesty and transparency for hospitals in difficulty. The new chief inspector of hospitals will report later this week on progress in the first year. I am sure that the whole House will welcome the fact that the new regime has made really encouraging progress.

Medway NHS Foundation Trust is not in my constituency, but is used by many of my constituents. It was announced last week that Medway is to remain in special measures because of the inadequacies of its A and E department. What steps can my right hon. Friend take to ensure that Medway receives the help needed to improve the service it provides to my constituents?

I thank my hon. Friend for his question. He is right that the chief inspector raised concerns about some issues that persist at Medway. It is important to praise the staff for the progress that they have made in the past year. We have put in place 113 more nurses, the Bernard dementia unit, which has made some really good progress, and a twinning arrangement with University Hospitals Birmingham, which is one of the best in the country. There are some encouraging signs. I wish to reassure him and his constituents that we will stop at nothing to ensure that we turn that hospital around

The former chief executive of Hull and East Yorkshire Hospitals NHS Trust, Phil Morley, left his post suddenly just before the publication of a very poor Care Quality Commission report, leaving behind a culture of bullying in the trust. Is the Secretary of State as surprised as I am that he has now been appointed chief executive of a hospital in Essex?

I do not know the details of the individual case, and it would not be right for me to comment. However, what I will say is that we have changed the rules to prevent people who are responsible for poor care from popping up in another part of the system. From now on, when trusts appoint people to boards, they can check their prior records on a central database administered by the CQC. Let me tell the hon. Lady that we are absolutely determined to change the culture in the NHS so that we stamp out the bullying and intimidation that were such a factor for so many doctors and nurses for many years.

23. Will the Secretary of State join me in congratulating the management and staff of Basildon hospital who have worked hard to turn the hospital around so that it is now rated as good? Will he confirm that his Department will continue to support it so that the hospital can carry on making progress?


I am delighted with the progress that has been made under Clare Panniker’s leadership. The hospital now has 241 more nurses, and the first maternity unit in the country to be rated as outstanding. My hon. Friend will want to know why it is that when there was a CQC report under the previous Government, it was sat on for six months and nothing was done.

19. In 2005, Littlehampton’s community hospital was demolished to make way for a new community hospital. Weeks later, the plans were put on hold because community hospitals went out of vogue. Sussex Community NHS Trust now wants to increase the number of in-patient beds at community hospitals. Will the Secretary of State ensure that NHS Property Services rebuilds Littlehampton community hospital to deliver those beds where they are needed? (904867)

That is not actually a matter for NHS Property Services Ltd; it has to be locally driven. However, my hon. Friend is absolutely right that we need to enhance community care services, whether in community hospitals or through services delivered at home. My hon. Friend has a high proportion of older people in his constituency and the transformation will be incredibly important for all his constituents.

Will my right hon. Friend join me in welcoming the National Institute for Health and Care Excellence’s statement today on the establishment of safe staffing levels on hospital wards? He will be aware that I have been campaigning on the matter for many years. The 1:8 ratio is certainly not a target but a baseline against which safe staffing and patient care can now be measured.

I welcome what NICE has done today, because it is incredibly important that we end the scandal of short-staffed wards in our NHS, which was a feature for many years under Governments of both parties. The lesson of Mid Staffs is that the oldest and most vulnerable patients, such as people with dementia, can be forgotten when a hospital is under pressure, so NICE’s guidance will be welcomed and useful. It is important to say that it can save money, because nothing is more expensive than unsafe care.

NHS Trust Deficits (England)

We have regular conversations with the NHS Trust Development Authority and Monitor about the provider sector. For 2014-15, the TDA, NHS England and Monitor are establishing a joint package of support and financial improvement measures for some of the weakest local health economies.

Even if the Department were able to achieve every possible efficiency saving, both Monitor and the King’s Fund are forecasting a substantial deficit in next year’s budget. What is the Department’s policy response to that? I understood that the Secretary of State ruled out charging in answer to an earlier question, so that leaves either applying more money to the problem or restricting the service.

The right hon. Gentleman asks a valid question about how to make efficiency savings. Under the previous Government, there was a requirement in 2009 to make £20 billion of NHS efficiency savings during this Parliament, which is being delivered at £4 billion a year. Improving procurement practice at hospitals, improving estate management, greater energy efficiency measures, ensuring more shared business services in the back office and reducing bureaucracy are all measures that will continue to ensure that the NHS meets the challenge and frees up more money for front-line patient care.

Stafford hospital has struggled with deficits for many years, but it has substantially improved its care. On Friday, however, it was announced that 58 beds will be closed due to staff shortages. My constituents and others are extremely concerned that the trust special administrator’s plans, which the Secretary of State endorsed, to keep A and E, acute medicine and many other services at Stafford are at risk. Will the Minister reassure them and staff that that is absolutely not the case and that the TSA’s plans will be enacted as a minimum?

The most important thing in delivering local services is to ensure high-quality patient care and patient safety, so I would want the TSA’s plans to be delivered as quickly as possible to ensure that high-quality services are delivered locally and that patients’ best interests are protected.

Stroke Care

Mortality from stroke has fallen by over 40% in recent years. Awareness of stroke symptoms is being raised through the Act FAST campaign. The strategic clinical networks are sharing best practice in stroke care by, for example, working with commissioners and providers to improve stroke rehabilitation services.

I thank the Minister for that reply. Effective stroke care is extremely difficult to deliver in my county of Herefordshire, because patients are often scattered and inaccessible and the necessary treatment is highly time-critical. What are the Government’s plans to protect and enhance stroke care in rural communities, especially at Hereford hospital?

My hon. Friend raises an incredibly important point. I have the same experience in my county of Norfolk. Clinical commissioning groups are responsible for commissioning stroke care. The Herefordshire CCG is working with Wye Valley NHS Trust to improve the quality of stroke services and is seeking to establish a sustainable, hyper-acute service in the county, and it is clearly necessary that that is achieved.

Emotional and psychological support after stroke can be just as important as physical care, yet many patients do not get the care they need even though research shows that investment in this area can not only benefit patients but save the NHS money in the long run. What steps will the Minister take to ensure that all stroke survivors get the right emotional and psychological support after stroke?

The hon. Lady is absolutely right. The cardiovascular disease outcomes strategy, which was published last year, acknowledges the importance of access to psychological therapies. Indeed, there is some really innovative work going on. A psychiatrist called Andre Tylee in London is doing work with heart patients, bringing in psychological therapies and improving their physical as well as their mental health outcomes, and the hon. Lady is absolutely right to make the case for that.

National Dementia Strategy

Dementia is one of the most important issues we face at the moment and we are having detailed discussions with stakeholders about the best way to ensure that the very successful Prime Minister’s challenge on dementia continues into the next Parliament.

I am grateful for that answer and have no doubt that the continuation of the challenge is very important, but both the Prime Minister and the Secretary of State have told the House from the Dispatch Box that there will be a successor to the national dementia strategy. My question was very straightforward. Is there a timetable for delivering that strategy, given that the current strategy ends this year?

I should clarify for my right hon. Friend that the Prime Minister’s challenge was a successor to the national dementia strategy. The Prime Minister’s challenge finishes at the end of this Parliament and that is why we are having discussions about what should succeed it, because we all have an interest in ensuring that we maintain the tremendous momentum of the past few years.

Healthy Child Programme

16. What assessment he has made of the adherence by NHS trusts and clinical commissioning groups to the healthy child programme (a) in general and (b) in respect of the provision of perinatal mental health services. (904864)

NHS England commissions the healthy child programme and the NHS England mandate includes an objective to reduce the incidence and impact of post-natal depression. NHS England is held to account through its regular assurance processes and we are well on track to deliver an additional 4,200 health visitors by 2015 who will provide individual one-to-one support for women in the post-natal period.

The National Childbirth Trust found that just 3% of clinical commissioning groups have strategies to provide these services and 60% have no plans to put them in place at all. The Minister might be aware that the all-party group on conception to age two, superbly chaired by the hon. Member for East Worthing and Shoreham (Tim Loughton), has recently announced an inquiry into factors affecting child development, with the first session last week considering this very issue. In advance of its conclusions, will the Minister give a pre-emptive guarantee that all expectant mothers will have access to perinatal mental health services and that it will not just depend on where they live?

The hon. Lady makes a very important point. We know the importance of good perinatal mental health not just for the mother but for the life chances of the child. That is very important if we are to ensure that we get the commissioning of maternity services right in the future. There is a commitment in the Health Education England mandate that by 2017 all maternity units will have specialist perinatal mental health staff available to support mums with perinatal mental health problems.

Topical Questions

I am pleased to tell the House that on 19 June the Prime Minister hosted a very successful global dementia summit as a follow-up to the G8 dementia summit. We are currently diagnosing and treating 70,000 more people every year with dementia, but the big challenge is, as he set out at the G8 summit, finding a cure or disease-modifying therapy by 2025. We had useful discussions on what barriers need to be eliminated to ensure that the research happens to find such a cure.

What assessment has the Secretary of State made of the need for a single hyper-acute stroke unit in south Essex?

I know that discussions are going on on that very topic and the CCGs are very interested in putting a hyper-acute stroke service at Southend hospital, which I know has excellent stroke services. We still need further improvements in the ambulance services for the east of England if we are going to do that and that is what we are currently discussing.

I shall begin by congratulating the Health Secretary on surviving the massacre of the moderates. This was no real surprise for those of us on the Opposition Benches, however, because we know that his real views on the NHS are anything but moderate. On his watch, there has been more privatisation and now there is an accelerating postcode lottery. Today, the Royal College of Surgeons has revealed that some people waiting for hip replacements are being denied treatment that is available elsewhere because of arbitrary pain thresholds that are so harsh in places that people must be in severe debilitating pain before they can be treated. This is in direct contravention of National Institute for Health and Care Excellence guidance. Will the Secretary of State today condemn the fact that people are being denied treatment in that way, and act immediately to end the practice?

Of course it is absolutely right that people should follow NICE guidance, including all clinical commissioning groups, but if the right hon. Gentleman looks at what has happened over the past four years, he will see that we are treating more people, not fewer, with 6,000 more people getting their knees replaced and 9,000 more getting their hips replaced every year. That is possible only because we have 7,000 more doctors in the NHS because we took the difficult decision to get rid of the primary care trusts. Will he now accept that he was wrong to oppose those reforms and wrong to put politics before patients?

The Secretary of State says that CCGs should be following NICE guidance, but they are not. Seven out of 10 are not following that guidance, and people who are waiting for operations today will be left in pain because he is not acting. The truth is that the reorganisation has resulted in a postcode lottery writ large, and it is worse than we thought, because there is now a proposal in one area to end the provision of hearing aids on the national health service. That is totally unacceptable. Action on Hearing Loss warns that that would set a dangerous national precedent, leaving millions unable to live their lives. So, no ifs, no buts—will he condemn that proposal now and guarantee that patients will not be forced to pay for hearing aids on his watch?

I make it absolutely clear that everyone should follow NICE guidance. As the right hon. Gentleman has talked about the reorganisation, will he please accept that we are now doing 850,000 more operations on the NHS every single year? That means that more people are getting help with their hearing, their hips and their knees, and with all the other things that they need. He bitterly opposed that reorganisation, but he must now realise that he was wrong to oppose it then and he is wrong to oppose it now.

T2. I recently had the pleasure of meeting my constituents Susan Childs and Doreen Smulders, who raised the issue of the inequalities that exist for men with prostate cancer. Will my right hon. Friend tell me what steps are being taken to address the shortfalls in care and support that such men are receiving across the country? (904874)

My hon. Friend is right to suggest that we want to drive consistency across the country, and NHS England is taking great notice of the cancer patient experience survey in a number of areas of cancer care. It has been a real driver of change where it has identified variation. I am sure he will welcome the fact that the overall range of variation for many indicators relating to prostate cancer has narrowed. None the less, we want to see NHS England working with NHS Improving Quality—NHS IQ—and others to ensure that struggling organisations are brought up to the standards of the best. The survey is a good way of driving that.

T3. Since 2010, the percentage of patients who say that they can see their GP within 48 hours has halved from 80% to 40%. Given the pressure on the NHS, and especially on accident and emergency services, will the Secretary of State explain why the Government’s reforms are threatening to close 98 surgeries around the country, including five in Tower Hamlets? Will he publish the full list today? (904875)

Let me gently explain to the hon. Lady that she has excellent GP provision in Tower Hamlets, led by Dr Sam Everington. It is a model of what can happen under the Government’s reforms. The way in which we are going to make it easier for people to see their GP is with additional capacity. We have 1,000 more GPs during this Parliament, and we have achieved that only because we took the difficult decision to get rid of 19,000 managers, which was bitterly opposed by the hon. Lady and the Labour party.

T4. Now that the Medicines and Healthcare Products Regulatory Agency has concluded its consultation on the use of generic asthma inhalers by schools in cases of emergency when a child does not have his or her own inhaler, will my hon. Friend update the House on the next steps? In particular, does she expect schools to be allowed to keep these inhalers in the new school year? (904876)

I congratulate my hon. Friend on her great campaigning on this issue, and on the really good results that she has had. As she says, we have recently consulted on changing the regulations under the Medicines Act 1968 to allow schools to hold inhalers in the way that she has described. There was overwhelming support for such a change, and we will lay the necessary statutory instrument this week to enable the change to come into force on 1 October.

T6. On nurse-patient staffing ratios, it has been reported in the Health Service Journal that out of 139 trusts surveyed, 119 failed to fill their registered day nurse hours, 112 failed to fill their registered night nurse hours and 105 failed to fill their registered nurse hours across day and night. Is it not time for Ministers and NICE to state straightforwardly that a ratio of one nurse to eight patients or better is the only way for patient safety? (904878)

NICE has taken the sensible decision to issue its guidance. It does so independently, but we are not making it mandatory on the advice of the chief nursing officer and many other chief nurses across the country for the simple reason that if we have a mandatory minimum, that can become the maximum that trusts invest in and many wards need more than 1:8. That is why NICE’s guidance was so important today.

T5. The Chavasse report on improving care for members of the armed services and veterans builds on the improvements that we have already made and has been welcomed by the Department of Health and indeed the Ministry of Defence. We owe it to our armed services to carry on making improvements to their care, so will the Minister encourage NHS England to look favourably on its recommendations? (904877)

My hon. Friend is right to highlight the importance of the Chavasse report. Its focus on improving care for veterans is warmly welcomed. There is a lot that we can work with to deliver better care and build on the specialist care centres already in place for veterans who have lost limbs and need prosthetic services and to provide additional support for veterans with mental health problems.

May I remind the Secretary of State that it takes seven years to train a doctor and most of the doctors he boasts about were trained under a Labour Government? What is he doing about the disparity between GPs surgeries and the service that they offer? Some months ago I made some visits in Coventry and I was amazed by the difference in the levels of service.

It does take seven years to train a GP, but we also have to have an NHS that is able to pay for GPs when they are trained. That is why it was so important to take the difficult decision to reduce the amount of money that we spend on back-office and management costs. The hon. Gentleman is right to say that there is too much disparity in the services offered by different GPs. That is something that the chief inspector of general practice is thinking about, and he will publish his plans shortly.

T8. From my regular discussions with local GPs in Swindon, I know that the reasons behind recruitment issues are often complex and localised. Will my right hon. Friend assure me that those responsible for commissioning GP services will place daily access to general practitioners at the heart of their considerations? (904880)

I know that they do that, and I know that people recognise that access is a critical issue. That is why the Prime Minister introduced a £50 million fund last year that has been taken up by 1,100 of the 8,000 surgeries across the country to improve access in evenings, at weekends and by e-mail and Skype. I hope that those will benefit his constituents.

SSP Health runs a number of GP practices in my constituency and across Merseyside. When it took over, it promised full-time GPs and an improvement in services, yet after well over a year several of the practices are still run by locums. We have seen vulnerable, elderly people unable to get appointments for many days, if not weeks, and those who can have gone to other practices. Will the Secretary of State look at what is going on with SSP Health in and around Merseyside and give me and other hon. Members an answer?

I am happy to do so, because the service that he describes—I have not seen the details—sounds totally unacceptable.

T9. Given that last year, more than 7,500 people with a mental health crisis found themselves in police cells rather than anywhere appropriate such as a hospital, given that 263 of those people were children and young people, and given that they stayed for 10 and a half hours in a police cell, is it not time that we took the evidence of street triage, which we know works, and rolled it out across the country? (904881)

The fascinating thing is that street triage is spreading across the country because forces and mental health trusts see the enormous value of it. The really exciting news is the significant reduction in the number of people who end up in police cells. That is in part due to the standards that we set through the crisis care concordat for the first time for mental health crisis care.

I welcome the Secretary of State’s commitment to getting rid of as much bureaucracy as possible, so will he look into what is happening with NHS England in south Yorkshire that is delaying approval for a much-needed GP surgery in my constituency? Given that it is in partnership with the local authority, the delay risks us losing the surgery altogether.

I am happy to look into the details of that case and be as much of a bureaucracy buster as I can.

T10. Is my hon. Friend aware that nurses are paying an extra £200 a month and patients an extra £40 a week for ever-increasing hospital car parking charges? Will he look into the problem, meet me and do everything he can to end the great hospital car parking rip-off? (904882)

I share my hon. Friend’s concerns that the car park charges in some hospitals are just too high. I understand that hospitals have financial pressures, as do many parts of the system, but I am happy to talk to him on another occasion about what specifically can be done on this issue.

Annually 30,000 applications for funeral payments are rejected, leaving families committed to expensive funerals that they cannot afford. People who are approaching end of life are not advised, as part of their palliative care, about planning for funeral costs or their eligibility for support. What is the Secretary of State going to do to remedy this?

The hon. Lady raises an important issue and I am very happy to discuss her concerns further with her.

The Secretary of State will be aware of the campaign run by the Milton Keynes Citizen, my hon. Friend the Member for Milton Keynes North (Mark Lancaster) and myself for an expanded A and E department at Milton Keynes hospital. What assurances can he give me that A and E services at the hospital will be able to meet the needs of an expanding population?

No one could have campaigned harder than my hon. Friend and his hon. Friend the Member for Milton Keynes North (Mark Lancaster) for improving the services at their local A and E department. A consultation is currently taking place. There is no question of closing both A and Es in that area, and I understand that a very good capital bid for £2 million for his local A and E has been put in which, subject to the usual value-for-money requirements, looks like it is very strong.

My constituent, 81-year-old Rita, was taken seriously ill on holiday and had to spend two weeks in hospital. She was discharged with a letter saying that she needed very urgent surgery, but has had to wait five weeks before she even sees a consultant, let alone getting any treatment. What can the Secretary of State do for Rita and others like her?

We are working extremely hard to make sure that people do not have those long waits. We are doing about 3.5 million more diagnostic tests, for example, every year in the NHS than four years ago. I am happy to look into the individual case and see what lessons can be learned and to see whether we can help the hon. Lady’s constituent.

Is it ever acceptable, as reported to me in my constituency surgery last week, for a GP to tell their patient, “There is nothing I can do, so I don’t want to hear any more about your mental health”?

No, that is entirely unacceptable. What we see in some of the best parts of the country such as Torbay, one of the integrated care pioneers, is that they are completely integrating mental health with primary care, delivering better results for patients. The sort of attitude that my hon. Friend describes has to end.

There is lots of evidence to show that chronic traumatic encephalopathy is now a major cause of depression, dementia and in many cases suicide, but the World cup showed that many sporting bodies are still not taking concussion seriously enough. Will the Minister, perhaps with colleagues in other Departments, bring in all the sporting bodies, the doctors and the teachers so that we can take concussion in sport seriously?

The hon. Gentleman makes a very good point. As we commission NHS services, it is increasingly important that there is more focus on sports injury and rehabilitation, not just in relation to our elite sports people, but in relation to those people who play sport regularly at weekends, to ensure that they are properly looked after. If it would be helpful, I am happy to meet the hon. Gentleman to discuss the matter further and see how we can take it forward.


Protective Headgear for Cyclists Aged Fourteen Years and Under (Research) Bill

Presentation and First Reading (Standing Order No. 57)

Annette Brooke presented a Bill to require the Secretary of State to commission research into the merits of requiring cyclists aged fourteen years and under to wear protective headgear; to report to Parliament within six months of the research being completed; and for connected purposes.

Bill read the First time; to be read a Second time on Friday 12 September, and to be printed (Bill 74).

Amenity Land (Adoption by Local Authorities) Bill

Presentation and First Reading (Standing Order No. 57)

Annette Brooke presented a Bill to amend section 215 of the Town and Country Planning Act 1990 to allow local authorities to adopt areas of amenity land which are unregistered or vested in the Crown, for the purposes of maintenance; and for connected purposes.

Bill read the First time; to be read a Second time on Friday 12 September, and to be printed (Bill 75).

Sugar in Food and Drinks Bill

Presentation and First Reading (Standing Order No. 57)

Geraint Davies, supported by Jeremy Lefroy, Mr Mark Williams, Mrs Madeleine Moon, Mrs Linda Riordan and Dr Julian Lewis, presented a Bill to require the Secretary of State to set targets for sugar content in food and drinks; to provide that sugar content on food and drink labelling be represented in terms of the number of teaspoonfuls of sugar; to provide for standards of information provision in advertising of food and drinks; and for connected purposes.

Bill read the First time; to be read a Second time on Friday 7 November, and to be printed (Bill 76).