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Oral Answers to Questions

Volume 586: debated on Tuesday 21 October 2014

Health

The Secretary of State was asked—

Transatlantic Trade and Investment Partnership

1. What progress he has made on negotiations relating to the potential effect of the Transatlantic Trade and Investment Partnership on the NHS. (905538)

6. What assessment he has made of the potential effect of the Transatlantic Trade and Investment Partnership on NHS services. (905543)

The Government’s aim and my central mission as the new Minister for life sciences is to accelerate access for NHS patients to the very latest diagnostic devices and drugs by making the UK the best place in the world in which to develop innovative treatments. The US is a world leader in medical technology and TTIP will help NHS patients get faster access to those innovations. Let me be clear: the treaty excludes the NHS from binding commitments. Parliament will retain sovereignty over how we organise and fund our health system and NHS England is free to decide how best to commission NHS services in the clinical interests of local patients, as it does today.

I thank the Minister for his answer and I welcome him to his new post. If his assurances were remotely credible then surely the British Medical Association would not have called for health to be excluded from TTIP entirely. Will the Minister confirm that under the investor-state dispute mechanism, US corporations will be able to challenge our national health policy decisions for ad hoc arbitration tribunals and potentially sue us for millions of dollars in damages for loss of profit in the event of any moves to reverse the coalition’s privatisation agenda and bring the NHS back fully into public hands?

No, I will not confirm that, but the hon. Lady does not have to take it from me. She can take it from the people who are doing the negotiations. The US chief negotiator confirms that the United States has no provision in its trade agreements on health. The EU chief negotiator says:

“I wish… to stress that our approach to services negotiations excludes any commitment on public services, and the governments remain at any time free to decide that certain services should be provided by the public sector.”

Before the election, there was a promise that there would be no top-down reorganisation of the NHS. Given the concern of the Opposition and the BMA, will the Minister meet the BMA to work out how we can get a cast iron assurance that these TTIP talks will not be used to privatise the NHS?

I will happily meet the BMA, but such a request is a bit rich coming from a Labour party that legislated to introduce competition in the health service and to pay private sector providers 11% more, which is now illegal under the Health and Social Care Act 2012. Let me be clear about this, and I can be no clearer than the Labour member of the all-party group for TTIP, who said that

“my direct discussions with the EU’s chief negotiator have helped produce an EU promise to fully protect our health service…TTIP could have no impact on the UK’s sovereign right to make changes to the NHS.”

I am grateful to the Minister for confirming that these negotiations will have no effect on NHS services and how they are provided. With his life sciences hat on, will the Minister also confirm that this treaty gives us a real advantage as UK companies will be able to compete in the American market?

My hon. Friend makes an excellent point. As well as providing a £10 billion boost to the economy, which I am surprised to see that the left is not in favour of, and securing 13 million jobs in the EU, this treaty also helps our NHS pioneers and innovators and our UK life science companies generate revenue for this country from our innovations in health care in the world’s biggest health care market.

Is it not the case that free trade agreements have always grown the economies that have contracted within those agreements, and a growing economy can only benefit the NHS in the future?

My hon. Friend makes an important point. The truth is that we cannot have a strong economy without a strong NHS, and we cannot have a strong NHS without a strong economy. In a modern society, health and wealth go hand in hand, which is why this treaty, with the safeguards that we have secured, is good for Britain and good for NHS patients.

Some 3 million people with diabetes have not received their full health checks, and 630,000 people have diabetes but do not know about it. Will the Minister give us an assurance that nothing in this deal will affect the ability of people to have free diabetes tests?

The last time I checked the TTIP negotiations do not make any specific provision for access to those services within the NHS. All I can do is remind the right hon. Gentleman that over the course of this Parliament, we have invested another £12 billion, hired more doctors and nurses and increased the provision of diagnostics in the NHS. This treaty does not affect that.

Will my hon. Friend confirm that there is absolutely no requirement in TTIP for this or any future Government to open NHS health care services to further competition and private sector provision, and that TTIP will have no effect on the ability of local NHS commissioners to decide who delivers services to patients?

I can absolutely provide that guarantee. UK sovereignty on health is not in any way threatened by TTIP. As I have already told the House, safeguards on this are being built in by both the American and the European negotiators. As my right hon. Friend points out, clinical commissioning decisions in the NHS will rightly remain with the clinical commissioning groups, which include the people who are closest to the patients.

For the avoidance of any doubt, given that health is devolved to Northern Ireland, what assurances can the Minister give us that not just the UK Government, but the devolved Administrations, will be safeguarded from the investor-state dispute settlement mechanism?

The treaty’s provisions apply to the whole United Kingdom, so it will be for the delegated authority of the people of Ulster and their Administration to give effect to the treaty locally.

NHS Facilities (Contracting Out)

2. What safeguards are in place for the sustainability of NHS facilities when clinical commissioning groups contract out local services. (905539)

The previous Government introduced greater competition to the NHS. This Government have ensured that it is for local doctors and nurses through clinical commissioning groups, rather than bureaucrats, to decide how best to procure NHS services in the interests of their patients.

As the Minister is aware, Coastal West Sussex CCG is controversially proposing to award a major contract for musculo-skeletal services to a social enterprise consortium rather than Worthing hospital. While I welcome new ways of working in the NHS, as long as the quality of care for patients remains key, what safeguards are in place to ensure that existing NHS services such as trauma and accident and emergency, which we campaigned so hard to protect at Worthing hospital, are not compromised?

The Health and Social Care Act 2012 ensures that commissioners must also have regard to delivering integrated health care services. I reassure my hon. Friend that the West Sussex CCG has clearly stated:

“The…CCG will continue to commission MSK related trauma from the current providers and the intention is for this to continue for the duration of this MSK…contract”.

23. What is the Minister doing to retain GPs as there is considerable concern in Coventry about the number who are leaving practice? (905562)

I hope that I can reassure the hon. Gentleman that there are now 1,000 more GPs in training and working in the NHS under this Government than when we came to power in 2010. We are committed to training even more GPs to ensure that we can widen access to general practice services.

In what circumstances can clinical commissioning groups treat the NHS as a preferred provider, and in what circumstances are they forced to contract out services?

As my hon. Friend will be aware, when commissioning services, it is important that regard is given not only to competition because, under the 2012 Act, we have ensured that there must be regard to delivering an integrated and joined-up approach for local services. That is an issue for local commissioners to decide in the best interests of the patients they look after.

Are not certain CCGs starting to merge decision-making processes, meaning that some important strategic decisions are removed even further from local communities and there is therefore a complete lack of accountability?

For some more specialist services, collaboration between various parts of the local NHS will always be needed. That is about good health care commissioning and ensuring that services are joined up in a collaborative way. Whereas day-to-day, bread-and-butter services will be commissioned by a local CCG, for more specialist services, clinical commissioners will of course need to work together to ensure that local centres of excellence are commissioned.

The sustainability of NHS facilities is often prejudiced by the millstone of Labour’s private finance initiative deals. What is the Government’s expectation of how CCGs should make the best of the hand that they have been dealt?

My hon. Friend is absolutely right that PFI deals signed by the previous Government have crippled the finances of many hospital trusts, meaning that many of them are unable to invest as much in front-line patient care as they would like. It is important that the Government support the mitigation of PFI deals, when possible, and we have a group that is doing exactly that and supporting local commissioners to deal with the worst excesses of the previous Government’s mismanagement of the NHS finances.

A and E Waiting Times

Of the 21.7 million attendances at all A and E departments in England in 2013-14, 939,000 were not seen and treated within four hours, meaning that 95.7%—0.7% above the national target—were. I am pleased to inform the House that hospitals will have an extra 260 A and E doctors this winter, bringing emergency medics in the NHS to a record high.

The reason for the big rise in A and E admissions in my area is the weekday closure of the hugely popular Alexandra Avenue polyclinic. Will the Secretary of State look again at Harrow’s NHS funding formula to determine whether that popular service could be reopened?

I am happy to look at the point that the hon. Gentleman raises. I have visited the Northwick Park A and E department, where the clinicians on the front line are working incredibly hard. As he knows, the funding formula is decided independently—at arm’s length from politicians—but we have ensured that everyone gets a real-terms rise.

Data published last Friday show that A and Es have missed their waiting targets for 64 weeks on the bounce. They are in a worse state now than they were last winter. What is going on?

First, I caution the hon. Gentleman on his use of statistics, because he is referring to a subset of A and Es, not all of them. Last year we hit our A and E target. I say gently to Labour Members that they need to be careful if they try to politicise operational issues, because people will note that in every year of this Parliament we have hit our A and E targets in England and Labour has missed its targets in Wales.

Does the Secretary of State agree that the figures show that the average wait before assessment in A and Es in England is now down to 30 minutes, as opposed to 77 minutes under the previous Labour Government?

My hon. Friend makes an important point. I just say to the Labour party that the time people wait to be seen at A and Es has reduced while the number of people going to A and Es has increased, but in the end it will not be sustainable unless we invest in out-of-hospital care, which is why we need more personal care by GPs. That is why we have brought back named GPs and why we have 1,000 more GPs than we did four years ago.

May I welcome the outstanding treatment provided at the A and E at the William Harvey hospital—part of East Kent Hospitals University NHS Foundation Trust—which I attended on a family emergency during the summer, and note that the Care Quality Commission is getting striking improvements in East Kent, rather than the sort of cover-ups we used to see in the past?

My hon. Friend is absolutely right. Under this Government, with the new inspection regime, we have had to take the difficult decision to put 18 hospitals into special measures, including East Kent. Six have now come out of special measures. We are tackling these problems in the NHS by being honest about them. I gently say to the Labour party that if it wants to be the party of the NHS, it has to give the country confidence that it will be honest about poor care when it comes across it.

On A and E, does the Secretary of State accept that we must do more to address the appalling statistic that one in four cancers is diagnosed in A and E departments? At the weekend, Labour outlined plans dramatically to reduce the wait for tests and results, paid for through a tobacco levy, which are supported by Macmillan, Cancer Research UK and the Royal College of Radiologists. Will he now back those plans?

I welcome the fact that Labour is thinking about how to improve our performance on cancer, because in 2010 we had the worst cancer survival rates in western Europe. I gently say to the Labour party that the issue is only partly about the amount of time it takes to get a hospital appointment when one has a referral; a much bigger issue is the fact that we are not spotting cancers early enough in the first place. That is why I hope that Labour will also welcome the fact that in this Parliament we are on track to treat nearly 1 million more people for cancer than we did in the previous Parliament. That is real progress of which the whole House can be proud.

While it is working with one of the most outdated A and Es in the NHS, and one that will require fresh capital investment, does the Secretary of State recognise the tremendous improvement at Kettering general hospital’s A and E, which in the past year has gone from one of the worst performing to one of the best performing in the country?

I absolutely recognise that, and I congratulate my hon. Friend on the very close interest he takes in what is happening at Kettering hospital. I have visited the hospital, as he knows, and think that it is working very hard and that it offers a very good example of how, even when times are tough, finances are tough and there is increasing pressure from an ageing population, it is possible to increase and improve A and E performance. It has done a terrific job.

NHS Trusts (Deficit Forecasts)

Jobs at Russells Hall hospital are at risk as managers battle with a £12 million deficit that the chief executive says is critical. Staff are working flat out, but people are still waiting too long in A and E, and too long for other treatment. What will the Secretary of State do to ensure that patients in Dudley and the hard-working staff at Russells Hall get the support they need?

I will tell the hon. Gentleman exactly what we are doing. The Dudley Group NHS Foundation Trust has 350 additional nurses this Parliament, and it has got them because this Government took the difficult decision to protect and increase the NHS budget, because those of us on the Government Benches know that a strong NHS needs a strong economy. We are taking measures, but there is more to do. I recognise that the staff on the front line are working very hard, but I think that he should also give credit when things are starting to move in the right direction.

My right hon. Friend will be aware of the strains placed on the budgets of the Countess of Chester NHS Trust because of the need to treat thousands of patients every year who are fleeing the disastrous management of Labour in Wales. What action is my right hon. Friend taking to ensure that hospitals on the English side of the border get a fair share of resources?

My hon. Friend is right to talk about that intolerable pressure on hospitals on the England-Wales border. For every one English patient admitted for treatment in a Welsh hospital, five Welsh patients are admitted for treatment in an English hospital, which creates huge pressure for them. I have written to the Welsh Health Minister to say that the NHS is happy to treat more Welsh patients, but the trouble is that NHS Wales is not prepared to pay for it. That is why Welsh patients get a second-class health service. [Interruption.]

Order. The hon. Member for Caerphilly (Wayne David) is normally a very calm and reserved fellow—almost statesmanlike. This curious behaviour is quite out of character. He should take some sort of sedative. The hon. Member for Cardiff South and Penarth (Stephen Doughty) can probably advise him.

With hospitals set to be £1 billion in the red this year, the Secretary of State should be getting a grip of NHS finances. Instead, he is starting on yet another reorganisation. First, he put NHS England in charge of commissioning primary and specialist care. Now, NHS England wants to hand this back to clinical commissioning groups. Ministers have already wasted three years and £3 billion of taxpayers’ money. How much will this Secretary of State’s second reorganisation cost?

It is lovely spin from the party that carried out nine reorganisations in 13 years. The difficult truth for the Labour party is that this reorganisation that they fought so hard against has been a success. We are saving this Parliament £5 billion. We have reduced the number of administrators by 19,000. We have hired 10,000 more doctors and nurses with the money, and the result is that our NHS, in very difficult circumstances, is doing nearly a million more operations every single year. That is something that we on both sides of the House should welcome and be proud of.

Private Finance Initiative Costs

PFI schemes have had their contracts reviewed for potential cost savings. A major data collection on the results is currently under way. In 2013, the Treasury launched a code of conduct for operational PFI contracts which contained a number of new guidelines for better working relations between the public and private sector parties.

Thanks to determined work with which I have been closely associated and with outside experts’ advice, Hereford hospital has managed to save several million pounds on its exorbitant PFI contract—money that is already being ploughed back into medicine and services for local people. My studies make it clear that there are hundreds of millions, if not billions, of pounds still to be saved on the PFI across other NHS hospital trusts. Will my hon. Friend press Monitor and the NHS Trust Development Authority to do everything they can to encourage hospitals to take on specialist PFI contract advisers to help them make these savings?

Order. Questions must be shorter. I say with the greatest courtesy to the hon. Member for Hereford and South Herefordshire (Jesse Norman) that to read out a prepared script and be too long is doubly bad, and it really is not excusable.

My hon. Friend is right to highlight the fact that the annual cost of PFI left by the previous Administration is £1.79 billion, which will rise to £2.7 billion. It is right that we do all we can to support hospitals to reduce the costs of PFI that have been inflicted upon them, and we will continue to do that and work with the Treasury to make sure that that specialist advice is available for the NHS to reduce the cost.

I am worried that the members of the ministerial team are living in some sort of parallel universe. At the Calderdale and Huddersfield Trust we had a PFI. A hospital that has a long history of success is now struggling because it cannot get a management that works between the clinical commissioning groups and the trust. That is the truth—it is chaos.

There is nothing wrong with PFI schemes in principle; the point is the way in which they were put together by the previous Government. In 2011, the right hon. Member for Leigh (Andy Burnham) said:

“We made mistakes. I’m not defending every pen stroke of the PFI deals we signed”.

Those PFI contracts have damaged local hospitals and damaged local health care provision—

Order. I just said to a Back Bencher that his question was too long. I have said to the Minister several times that his answers are not just too long, but far too long, and if they do not get shorter I will have to ask him to resume his seat—which frankly, for a Minister, is a bit feeble.

Will the Minister confirm that unlike the PFI agreements for my neighbouring hospitals in north Middlesex and Barnet, which were negotiated badly and ineffectively, the rebuild of Chase Farm hospital will be funded by proceeds from its own land sale and Treasury money, not PFI?

My hon. Friend makes an important point. Hospitals should always look to their own efficiencies first by improving procurement practices and freeing up surplus land to fund local schemes. His hospital has done that very effectively, and it has not pursued the policies of the previous Government, which have put so many trusts into difficulty.

Given the total forecast deficit across English hospital trusts, including PFI schemes, is it still the Government’s position that the situation can be dealt with by efficiency savings alone?

During this Parliament we are set to improve efficiency in the NHS and make £20 billion-worth of efficiency savings. There is much more that we can continue to do on improving hospital procurement practices, sharing business services across the NHS, and freeing up surplus land—which, as my hon. Friend the Member for Enfield North (Nick de Bois) outlined, is happening at his hospital. That is what we need to focus on in freeing up money for the front line.

Hexham hospital is outstanding but was built under a very expensive Tony Blair PFI. Does the Minister welcome the fact that Northumbria NHS trust is the first in the country to buy out the PFI and put it into public ownership, thereby putting millions more into front-line care?

My hon. Friend makes an important point. The PFI schemes negotiated by the previous Government were, quite frankly, disastrous for many hospitals. His hospital has seen that the way forward is to buy out the PFI and free up more money for front-line patient care. We will support as many more hospitals in doing that as can be achieved, because this is about making sure that we deliver more money for NHS patients.

I was fascinated by the question from the hon. Member for Hexham (Guy Opperman). Would not the simple solution be to take all PFI assets back into public ownership, reintegrate them with hospitals’ existing assets, and save millions of pounds for hospitals every year and billions of pounds for the public purse over time?

I understand that the hon. Gentleman is unhappy with the way in which the previous Government negotiated PFI contracts. We are unhappy with it as well, because it is costing the NHS almost £2 billion on current forecasts. We are making sure that we can put in place measures to support hospitals in mitigating the worst excesses of these poorly signed PFI deals.

Ambulance Response Times (London)

First, I praise the hard-working staff of the London ambulance service, who responded to 100,000 more calls last year. We know that the service is under some pressure, and that is why we are providing extra support to the NHS in London, including £15 million for the ambulance service to help to ensure that the trust meets standards in future.

London ambulances are taking, on average, two minutes longer than they did three years ago to respond to the most serious call-outs. The chief executive of the service is quite open about the fact that she does not have enough staff on each shift every day. This is a service in chaos. Will the Minister be explicit about the support her Government are giving to ensure that my constituents, and Londoners, get the service they deserve [Official Report, 27 October 2014, Vol. 587, c. 1-2MC.]

This affects my constituents too, as I am also a London MP and therefore take a very close interest in it. I think it is unfair to say that the trust is in chaos. It is taking urgent steps to address the situation, including recruiting extra paramedics, increasing overtime, and reducing the number of multiple vehicles attending each call. We are working with Health Education England to increase the pool of paramedics, with 240 being trained in 2014, going up to 700 in 2018. Urgent measures are being taken to address the problem right now. I have had those assurances directly from managers in the trust whom I met very recently.

It is a fact that ambulances are taking longer to reach patients in the most critical condition. Today we are publishing figures regarding the increasing use of private ambulances. Nobody expects a private company to respond when they dial 999. Private ambulance usage has grown by 82% in the past two years nationally and by over 1,000% in London over the same period. Will the Secretary of State now admit that he sees no limit to the role of private companies in the national health service?

That is complete nonsense. The previous Government occasionally deployed private ambulances, which trusts use occasionally when they need to do so. This is another part of Labour’s myth of creeping privatisation, which is not true—it is absolute nonsense. It is important, however, in the interests of patient safety and as a short-term measure, that if that is what it takes, trusts must do it, as happened under the previous Government, because patient safety comes first.

Mental Health Nurses

9. What estimate he has made of the number of mental health nurses working in the NHS in each of the last three years. (905546)

Mental health nurses are not identified in the NHS work force statistics. They work predominantly in psychiatric services, but also across a range of settings and the independent sector. The total number of full-time equivalent nurses working in psychiatric services was 39,472 in July 2012, 38,772 in July 2013, and 38,055 in July 2014. Since June, NHS organisations, including mental health trusts, have been required to report ward-level nursing numbers against safe staffing levels on NHS Choices.

I am sure the Minister will join me in praising the hard work and dedication of all the staff at Laureate House mental health facility in Wythenshawe hospital in my constituency. The Government talk the talk, but do not walk the walk in terms of parity. Why has there been a decline in the number of mental health doctors over the past two years?

I also praise the work of the staff at the hon. Gentleman’s local trust. There has actually been an increase of more than 2,800 practitioners in psychological therapy since 2010 as part of the IAPT programme—increasing access to psychological therapies —which I am sure the hon. Gentleman will be very pleased to hear. For the first time, this Government are introducing access and waiting time standards in mental health, and that gives us the basis to achieve genuine equality for mental health for the first time ever.

My local trust in Solihull tries to treat mentally ill patients out of hospital and at home whenever possible. That is commendable, but when a patient needs a bed they have to travel up to 200 miles because the trust operates at 100% capacity most of the time. Does my right hon. Friend agree that that is unacceptable and that more beds should be made available locally?

Yes, I agree that it is totally unacceptable for patients to be sent a long way away from home. In children’s services, we are investing £7 million extra this year to produce 50 more beds, and we are holding NHS organisations to account to ensure that they provide beds locally so that people do not have to travel long distances.

Research published yesterday by the Centre for Mental Health and the London School of Economics shows that perinatal mental illness is costing our economy more than £8 billion each year. Does the Minister think it is acceptable that half of mums do not have access to a service, are being separated from their babies, are being forced to travel hundreds of miles for a bed, or are not getting any help at all? What is he going to do about it?

The position has actually improved significantly. Last week, I visited a fantastic perinatal mental health service in Torbay where mums are getting support locally, as, indeed, they should be. I totally agree with the hon. Lady that it is unacceptable that people have to travel long distances, but across the country things are changing, and changing rapidly.

NHS (North-East and Scotland)

10. If he will take steps to encourage greater co-operation between the NHS in north-east England and in Scotland. (905547)

Of course, it is important that the national health services in all four parts of the UK work together. Good examples of that are happening at the moment on major public health issues, as my right hon. Friend can imagine. Providers in England can and do treat patients referred from Scotland, Wales and Northern Ireland. In England, we put emphasis on enabling patients to choose where they will be treated, not on restricting that choice to providers in England.

Does my hon. Friend agree that if someone’s nearest hospital or health centre is on the other side of the border, the health bureaucracy should not set up artificial barriers to access and any advice the Department gives should reflect that principle?

I am aware that this concern has been highlighted for my right hon. Friend by a very difficult constituency issue with regard to Northumberland clinical commissioning group. To be clear, the CCG is free to commission services from Scottish providers if it wishes to do so. No one instructs a CCG on where to commission services from—that is a decision for the CCG and one of the strengths of the system. Convenience may not be the most important factor in making that decision, but CCGs need to be assured of quality and standards. I am happy to talk to my right hon. Friend further about his particular case.

Leeds Children’s Heart Unit

11. When the third stage of the review into the closure of surgery at Leeds children’s heart unit will be published. (905548)

Safe, compassionate care is an absolute priority for the Government. Publication of the Verita reports regarding the Leeds paediatric cardiac unit is a matter for NHS England. The reports are due to be published on 28 October, and copies will be placed on the NHS England website.

Constituents and clinicians continue to tell me that the children’s heart surgery unit goes from strength to strength, provides high-quality care, and has the full confidence of NHS England. Does the Minister sympathise with patients, families and clinicians who have faced uncertainty because of the delay of the third stage of the review?

Yes, I absolutely sympathise: I understand how important this is to local patients and their parents. As my hon. Friend knows, NHS England’s review of children’s heart surgery goes back a very long way—to the Bristol royal infirmary issues in the 1980s—and I know that Leeds and Newcastle Members are actively engaged on it. I can say that there is no immediate threat to any congenital heart surgery unit. NHS England has held a drop-in session with all MPs, and I encourage Members to make representations to the consultation on the national review.

The reality is that NHS England has made a mess of this. I hope that it will finally apologise when the third stage of the review is published. On the process that we have now, will my hon. Friend confirm that it is an open and fair process that will allow all units, including Leeds, to reach the important standards that we want for all our units?

My hon. Friend makes an important point. This is a matter for NHS England to deal with. I have made inquiries to ensure that the process is being followed as it should be. As I say, there is no immediate threat. The issues around the provision of congenital heart disease services are not limited to Leeds. NHS England is conducting a nationwide review of congenital heart services, which will look at the whole of life care pathways available across the country. The truth is that congenital heart diseases are often very serious illnesses affecting life expectancy and quality of life for patients, who will expect NHS England to put in place the very highest quality care and service available.

Rebalancing Project

12. What contribution his Department is making in support of the health objectives of the rebalancing project on dental checks for three-year-olds, foetal alcohol syndrome and lung screening for people over 60. (905549)

The hon. Gentleman and I have spoken a number of times about his valuable project. He knows that I am very interested in it and its outcomes. The Government are committed to improving oral health, with a particular focus on children, to reducing the incidence of foetal alcohol syndrome and to improving outcomes for all cancers. Results of major trials on lung cancer screening, including our own £2.4 million UK trial, are due in 2015. At that point, the UK national screening committee will review all the available evidence, looking towards a pilot.

The rebalancing project, which covers my constituency, is I hope an innovative way of working that does not require additional money from the Government, but focuses on key health inequalities, such as a dental check for every three-year-old, the foetal alcohol syndrome prevalence study that we are trying to do and lung cancer screening for everyone over 60. Will the hon. Lady keep an eye on this work, use her reputation as a very committed Minister and visit us in Nottingham to see whether the work we are doing can be spread elsewhere in the UK?

All the issues that the hon. Gentleman outlines are extremely important. We, too, are very interested in the prevalence study on foetal alcohol syndrome. He may be aware that the World Health Organisation has just launched some work in that area, which will be of great interest to him. It would of course be a delight to visit the project.

These are splendidly succinct answers. Perhaps the Minister should issue her textbook to her colleagues. That would be extremely useful.

The Canadian Government say that foetal alcohol spectrum disorder is the most important preventable cause of severe childhood brain damage. The Minister told me in Westminster Hall last week that the chief medical officer’s review of the evidence is continuing. Is not the truth, however, that the evidence has been available for years, and that the time has come for the review to be published and for there to be much greater protection for the thousands of children who are damaged each year by women drinking in pregnancy?

We had a good debate last week in Westminster Hall. My reply remains what it was then: there is not complete clarity in clinical evidence on safe levels of drinking. That is exactly why the chief medical officer—[Interruption.] From the Opposition Front Bench, I hear cries of “Yes, there is.” I am sorry, but I am backing the UK’s chief medical officer over Opposition Front Benchers when it comes to the clinical basis for this. The review is important and is under way. I know that all Members will be interested in its outcome, and in how we can help to publicise good guidance to women on this very important issue.

Children’s Mental Health Services

13. What steps he is taking to improve access to and reduce waiting times for children’s mental health services. (905551)

The taskforce on child and adolescent mental health is considering ways to improve access to children’s mental health services. The plan that we published earlier this month, “Achieving Better Access to Mental Health Services by 2020” sets out the ambition to extend waiting time standards across all mental health services by 2020. We are investing £7 million this year in providing an additional 50 beds.

More and more children are being treated on adult psychiatric wards, with many having to travel hundreds of miles across the country for treatment, as has been said today. The chief executive of YoungMinds has said that the increase in the number of children being placed in adult wards was predictable, following the cuts to mental health services. Why did the Minister not see it coming and do something sooner?

We did see a problem emerging. That is why NHS England set up a taskforce to look at that precise problem. Its recommendation earlier this year was to add 50 beds, and that is what we are doing. The indication from October is that there is a significant increase in spare bed capacity within the system, so the problem is being addressed.

I welcome the additional £7 million of investment. Given that 65% of children in Fenland wait more than 18 weeks for access to mental health services, will the Minister write to me to set out how the additional investment will help rural communities in particular?

I would be very happy to write to the hon. Gentleman. I am sure that he welcomes the fact that, for the first time, we are introducing access and waiting time standards in mental health, including in children’s mental health. Until now, there has been discrimination at the heart of the NHS. Labour introduced waiting time and access standards, but it left out mental health. That was completely unjustifiable and I am proud that the coalition is correcting it.

The cost of living crisis has had a huge impact on children’s well-being across Britain as families struggle. That issue has been raised with me by support workers in my constituency who have seen young people come forward with depression. That is compounded by the lack of mental health support services. Does the Minister recognise those issues? Is he happy with the data that he has available on the prevalence of young people’s mental health problems?

I absolutely recognise the problem. I have commissioned an up-to-date prevalence survey so that we have evidence that can help services around the country. If the hon. Lady wants to talk with me further about the problems in her area, I would be happy to do so.

A local report on mental health and emotional resilience among young people in South Lakeland found that the stigma surrounding mental health and the lack of sufficient resources over time mean that distressed and panic-stricken families often do not know how to begin to access the support that their children desperately need. How can my right hon. Friend help us get swift, clear and obvious access to mental health care for young people?

I welcome the study that has been undertaken in my hon. Friend’s area. The brilliant “time to change” campaign has done an awful lot to tackle stigma in mental health. We confirmed recently that the funding for that will continue in 2015-16. I accept that we need to do much more to improve access to children’s mental health services.

Cross-border Treatment (England/Wales)

14. How many patients resident in England have written to him to request that they be treated in Wales. (905552)

Given the perilous state of the NHS in Labour-run Wales, my hon. Friend will not be surprised to know that not a single English patient has written to me asking for funding to be treated in Wales.

My hon. Friend is correct. That will come as no surprise to anyone who has had dealings with the NHS in Wales. In the light of that, will he assure us that he will do everything possible to push ahead with the OECD comparison report into the health systems in Wales and England, on which the Welsh Assembly Government are disgracefully trying to obfuscate and cause delay because they are afraid of what might be discovered?

I am afraid that that says it all. Opposition Front Benchers tell us continually that they are not prepared to condemn what is happening in Wales and that the health service in Wales is performing well, yet here is an opportunity to prove it—an independent study by the OECD of the four NHS systems in the UK—and Labour is trying to block it. This issue matters, because the policies in Wales are what Labour wants to do in England.

Will the Secretary of State concede that for many decades people from north Wales have had to travel to England for treatment? In that respect, both Government and Opposition Front Benchers are culpable.

The Government are happy for people to travel anywhere in the United Kingdom. My concern about health services in England is the pressure created, because for every patient that goes from England to Wales, five want to come from Wales to England.

17. My right hon. Friend will be aware that his new website, My NHS, is providing much more openness and transparency for patients from England. To what extent does the extra information and ability to improve standards in hospitals as a result also apply to Wales? (905555)

This is the big lesson that we have learned after the tragedy of Mid Staffs. The Francis report said that the NHS had become over-dependent on a targets culture that was damaging for patients, and the Government think that the way to improve standards is through transparency, openness, and the pressure of peer review. We have embraced that lesson wholeheartedly, and it is such a shame that the Welsh Labour Government have taken a different tack.

Has the Secretary of State seen today’s Western Mail? If he has, he will know that the Western Mail, which is not a Labour supporting paper, totally condemns the scaremongering of the Conservative party.

When I started speaking out about poor care in England—one of the first things I did in this job—those on the Labour Front Bench said that I was running down the NHS. The result of my speaking out is that we are turning around failing hospitals and have 5,000 more nurses on our wards. The NHS in England is getting safer and better, and we want exactly the same thing for Wales.

Nurse Training

Between 2010 and 2013, 52,528 new pre-registration nurse training places were filled, and this year Health Education England has made 19,206 new places available.

It is interesting that the Secretary of State cannot follow his own advice about not making operational matters in the NHS political footballs. Perhaps we can try again. The number of nurse training places has been cut by thousands since 2010—a key issue given the need of hospitals to reach safe staffing levels. The Royal College of Nursing has said that Labour’s plans for 20,000 more nurses are absolutely necessary. Does the Minister agree?

It is right that hospitals respond when there are not enough staff working there, if that is affecting patient care. That is why under this Government 2,500 more nursing staff are working now than in 2010. That is progress to ensure that we are facing up to challenges in care where they exist at local hospitals.

Russells Hall hospital in the borough of Dudley has appointed 56 new nurses from overseas since the Keogh review last year. Will my hon. Friend join me in welcoming the graduate trainee programme for nursing that Russells Hall has put in place, which will provide for 100 trained nurses over future years?

That sounds like a commendable programme. It is good to hear that my hon. Friend’s local trust, where there was a shortage of nurses, is facing up to that and employing more nurses to ensure that patient care is as good as it can be.

Hospital Walk-in Centres

The NHS walk-in centre in Jarrow sees more than 27,000 people a year, yet the local management propose to close it to pay for the reorganisation that the Government have brought in. Will the Minister intervene on this occasion, overrule the manager and back the local people?

I find the hon. Gentleman’s question slightly mystifying. Responsibility for walk-in centres was passed to local commissioners in 2007, and as I understand, South Tyneside CCG is looking to improve urgent care in the area and reduce reliance on A and E. It reckons that 33,000 people did not need treatment in 2012-13 in the local A and E, so I quite see why it would want to review that. I urge the hon. Gentleman to engage with the consultation, and to get involved with some of the excellent north-east public health projects such as North East Better Health at Work, which is an award-winning scheme that would do a lot to relieve pressure on services.

Topical Questions

Last week, the Care Quality Commission published its “State of Care” report. This affirmed that the pace and scale of change to improve care in the NHS last year has been unprecedented, but it also contained some hard truths. It found that the variation in the quality of health in adult social care was too wide, and that too many hospitals have not got to grips with the basics of safety. This Government want every NHS patient to have confidence that their care will be both safe and compassionate. We have turned around six hospitals put into special measures, and people saying that their care is safe and compassionate are at record highs. We are determined to change the culture of the NHS away from secrecy towards transparency, and away from targets towards personal care where patients’ needs always come first.

In August 2014, 10,616 patients had to wait longer than six weeks for a key cancer test. That is five times the number of people who had to wait that long in May 2010. If the Government do not support Labour’s commitment to a one-week cancer test guarantee, what action will they be taking to reduce waiting times?

As I said earlier, we welcome the fact that Labour is now interested in cancer policy. If we look at the reason for those delays, which we are working hard to address, it is because the number of cancer referrals—[Interruption.] Labour left this country with the worst cancer survival rate in western Europe; we are doing something about it. The reason for the delays is that the number of people being referred for cancer tests has gone up by 50% since 2010. We are treating record numbers of people with cancer because we want to do something about that survival rate.

T2. The Public Health Minister is pursuing a long list of nanny state proposals that we might have better expected from the Labour party, including plain packaging of tobacco, outlawing parents smoking in cars and having higher taxes on alcohol. Will she give us a list of which policies, if any, she is pursuing that have a Conservative flavour to them? (905564)

Following on from the Secretary of State’s previous answer, tobacco control is an integral part of tackling cancer. I am delighted to let the House know that smoking prevalence among adults in England fell to 18.4% in 2013. This is a record low, which means that the Government have hit their tobacco control plan target for 2015 two years early. I am sure that even my hon. Friend would welcome that news.

At their conference, the Tory party promised flat funding for the NHS in the next Parliament, but experts say that the service is at breaking point now and that the funding promised is not enough. Now, the Secretary of State’s own side are saying the same thing. The Chair of the Health Committee said last night:

“The Chancellor is going to have to write a bigger cheque”

or we will

“see reductions in services or waiting times increase”

and

“go down the route of top-ups and charges”.

Does the Secretary of State agree with her, and will he concede that a flat budget for the NHS in the next Parliament will not stop it tipping into a full-blown crisis?

I am afraid that the shadow Health Secretary is misrepresenting what was said at the Conservative party conference. We promised not just to protect the NHS budget but to protect and continue to increase the NHS budget in real terms. I gently say to him that we have increased the NHS budget spend this Parliament by double the amount that Labour promised at its conference. We did that because on this side of the House we understand a simple truth: a strong NHS needs a strong economy.

The House will have noticed that the Secretary of State did not answer my question. There is a very simple reason why the Secretary of State cannot answer my question: his party has prioritised unfunded tax cuts for higher earners, leaving a large black hole in the public finances. There will be nothing left for the NHS if the Tories are re-elected. We on the Labour Benches, in contrast, have promised £2.5 billion over and above what they are committed to. Does that not make the choice on the NHS now clear: under Labour, more money for the NHS; under the Tories, tax cuts for some but an NHS crisis for all?

The right hon. Gentleman cannot have it both ways. The tax cuts the Government have prioritised are for lower-paid people, many of whom work in the NHS. When we had a strike last week, he was criticising the Government for not being more generous, but we have been generous—with the tax cuts he is now criticising. The NHS is facing the biggest financial squeeze in its history partly because of an ageing population but partly because the last Labour Government forgot about the deficit.

T3. In my constituency, waiting times for GP appointments remain long and practices are struggling to recruit enough doctors. Will my right hon. Friend reassure me as to when the improvements he is making elsewhere in the country will take effect in Gosport, and will he meet me to discuss the matter? (905566)

I would be delighted to discuss it with my hon. Friend, who is right to focus on the role of GPs. If we are to transform the NHS by the end of the next Parliament, we need fundamentally to improve out-of-hospital care, and GPs are at the heart of that. We have recruited 1,000 more GPs during this Parliament, but we need many more, and that will definitely include her constituency.

We have a shortage of GPs in Halton. Constituents tell me it is more difficult to get an appointment, and in recent months, two GPs have told me that there are major problems with GP services in Halton and the country as a whole. Despite what the Secretary of State says about increased numbers of GPs, that is not happening in Halton. What is he doing to address the problem, particularly in areas of great deprivation, such as Halton?

There is pressure throughout the NHS because there are nearly 1 million more over-65s than there were four years ago, which puts pressure on GPs, as it does on any department or hospital providing elective care. However, this is not just about getting an appointment; it is also about ensuring that GPs have personal responsibility for the patients on their list and are accountable for the care of some of the most vulnerable people. We have brought back named GPs with personal responsibility for over-75s, and I hope the hon. Gentleman welcomes our going further and bringing it back for everyone.

T4. Meningitis Now, based in my constituency, is a keen supporter of the Men B vaccination for infants. Given the Joint Committee on Vaccination and Immunisation’s recommendation that it start, will the Minister update us on how the roll-out is progressing? (905567)

My hon. Friend is right to highlight this important issue. As he knows, the Department is negotiating with the manufacturer to purchase the vaccine at a cost-effective price, and he will understand that we need to ensure that NHS funds are used as effectively as possible. We are keen to see a positive conclusion to the negotiations as soon as possible so that plans for the Men B immunisation programme can be finalised.

Will the Secretary of State explain why NHS England has entered into a contract with a company based in Kent to provide GP services, when my constituents have just seen a string of locum GPs at a higher cost to the NHS?

Wherever we can avoid it, we do not want to use locum GPs or nurses or agency doctors, because they are much more expensive—our spend on that is far too high—but sometimes when there are issues of patient safety we need a quick solution. That is what has happened in response to the Francis report: as well as recruiting 5,000 additional nurses on a permanent basis, we are using extra agency nurses. However, we hope to bring those numbers down.

T5. I congratulate the Minister of State, Department of Health, my right hon. Friend the Member for North Norfolk (Norman Lamb), who has responsibility for care and support, on securing the introduction of NHS waiting times for mental health for the first time next year. How will he ensure that the resulting treatment is not only timely but evidence-based and effective? (905568)

Last week, Mike Richards told me how waiting-time standards had transformed cancer care, and I think the same can happen for mental health. It is outrageous that somebody with a suspected cancer gets seen by a specialist within two weeks, but that if someone has a first episode of psychosis, who knows what will happen to them. That discrimination has to end, and we are delivering that.

The good people who work in the NHS have faced six years of pay restraint. How much longer must they carry the can for the failures of the people who got us into this mess—the moneylenders, the LIBOR fixers, the people who mis-sold mortgages? How much longer must front-line staff pay for the mistakes of capitalism?

Even in very difficult times this year, all NHS staff, either through their increments or through the 1% increase, will be getting a pay rise. Of course, we would like to do more, but the NHS finances are under pressure, and our priority is to ensure that we employ as many front-line staff as we can. We now have more than 13,000 more front-line staff working in the NHS than we did when we came into government.

T6. Can the Secretary of State confirm to the House whether there are any plans to sell off the NHS and will the NHS remain free at the point of delivery? (905569)

I can confirm that there are no such plans and it will remain free at the point of delivery. Nor do we have any plans to pay private providers 11% more than NHS providers, as happened under the previous Labour Government.

In response to my amendment to the Care Bill earlier this year about the portability of care packages to the countries of the UK, the Minister of State, Department of Health, the right hon. Member for North Norfolk (Norman Lamb), promised that a voluntary framework would be in place by November. It is 10 days until November, so how is progress going?

I thank the hon. Lady for that question. We have drawn up a statement of principles, we have been discussing them with the devolved Administrations and we hope very much that we will be able to achieve an agreed statement of principles in November. I cannot guarantee it, but that is absolutely our objective.

T7. Healthwatch England recently released a report, “Suffering in silence”, that found that almost two thirds of people felt that their complaint about the NHS was not taken seriously and half ended up not receiving an apology or even hearing the word “sorry”. What action is my hon. Friend taking to ensure that complaints are taken seriously in the NHS? (905570)

My hon. Friend makes an excellent point. Following the appalling systemic abuse and neglect described in the Francis report, our response, set out in “Hard Truths”, focused relentlessly on hearing the patient voice, learning tough lessons on patient safety and care, and, in particular, the creation of the new independent chief inspector of hospitals, who is looking closely at all complaints. The health ombudsman has increased its caseload and we are also taking measures to display information on how to complain in every hospital and ward across the country.

Will the Secretary of State join me in paying tribute to Eilish Hoole, who sadly passed away in July from ovarian cancer. She was only 47 and the mother of five children. Following her diagnosis of late-stage ovarian cancer she campaigned tirelessly in Parliament with Target Ovarian Cancer, which led to the recent successful pilot of the awareness campaign in the north-west. Will the Secretary of State commit to roll that out to the rest of the country so that other women in her position get to see their children grow up?

I am very happy to pay tribute to Eilish Hoole, to the many cancer campaigners and to the many people who have survived cancer and put their lives back together again. There is still a huge job to do in getting earlier diagnosis. I think there is agreement across the House about the need for much earlier cancer diagnosis, particularly for ovarian cancer, which makes a huge difference. I know that we would all like to pay tribute to her work.

NHS England has identified south Cumbria as one of just three places in England where travel times to receive radiotherapy are unacceptably and debilitatingly long. Will the Secretary of State meet me and NHS England to talk about how Kendal hospital can be the place for a new radiotherapy centre this autumn?

I would be happy to meet the hon. Gentleman and discuss this important issue for his constituents.

The NHS Litigation Authority is piloting a new approach to improve feedback and learning in response to allegations of negligence. Will the Secretary of State say how patients can find out what feedback the NHSLA has given to individual trusts and how the trusts have responded?

The hon. Lady raises an important issue, which is that the NHS Litigation Authority often picks up on things when they do not go well and when the communication between patients and trusts has broken down. That is one of the things that need to be put right. I will look into the matter and write to her, because it is important that when things go wrong patients are supported in the right way and the lessons are learned.

T9. Currently, there are no psychiatric intensive care unit beds for women in Dorset. One of my constituents was recently sent to a unit in Bradford. Will additional funding be available to address this appalling situation? (905572)

I am very happy to meet my right hon. Friend to discuss the concerns in her area. I heard similar concerns when I was in Devon last week and clearly the objective must be to have facilities close to where people live, rather than their having to travel long distances.

I assume that the Secretary of State has read the National Audit Office’s report on local funding for health care. In the 17 years for which I have been Member of Parliament for Slough, we have never reached our target for funding and now the gap between Slough’s target and our actual funding is greater than ever before. What is he going to do to ensure that areas get the funding they need to provide the health care their residents require?

First, we have made the decision an independent one, taken at arm’s length from Ministers, to try to take the party politics out of it. Secondly, we protected the NHS budget. Thirdly, one of the most important and significant things for the hon. Lady’s constituents has been the way in which the Heatherwood and Wexham Park NHS Trust has been turned round from failing and being in special measures to being taken over and run by Frimley Park NHS Trust—the most successful trust in the country.

Order. We have overrun, principally because of long questions and answers earlier, but I am keen to accommodate a couple more colleagues.

Mitochondrial technique was last tried on humans in 2003 by John Zhang, resulting, I understand, in two still births and an abortion. Last week, one of the members of an expert panel of the Human Fertilisation and Embryology Authority said he had only just become aware of Zhang’s study. What action will Ministers take to ensure that this worrying study is properly examined before any steps are taken to bring this issue before the House?

My hon. Friend takes a great interest in this matter and led the Back-Bench business debate on 1 September. I will certainly ask the HFEA and the expert panel to look at the study to which she refers, but I can provide the reassurance I have given before—that the wide body of expertise and information out there about mitochondrial disease is regularly reviewed over a long period of time.

The Secretary of State makes great play of protecting the NHS budget, but NHS England, the Nuffield Trust and his hon. Friend the Chair of the Health Committee all agree that it needs another £30 billion investment, so how can he tell people that the NHS is safe under his watch?

We have not just protected the NHS budget, but increased it in real terms, which I think is a huge achievement given the state of the economy we inherited. [Interruption.] I simply say to the hon. Lady that the way to protect and secure NHS funding for the future is by making sure that there is a strong economy to pay for it. That is the single most important thing of all.

Thank you, Mr Speaker.

Devon clinical commissioning group is embarking on a major programme of change next year, closing community hospital beds and replacing them with services at home. Do Ministers see that public and staff would have more confidence in the new services if they were being worked up first before getting rid of the existing services? Could the better care fund put money into the transition?

I thank my hon. Friend for that question. The better care fund is the biggest ever transfer of resources to preventive care and for integrated care. I saw last week in my hon. Friend’s own county fantastic integrated care in Torbay and Southern Devon NHS Trust, but I would be happy to discuss his particular concerns as soon as possible.