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Oral Answers to Questions

Volume 588: debated on Tuesday 25 November 2014

Health

The Secretary of State was asked—

Mental Health Services

Parity of esteem has been set out in law, and we are delivering it for people. More than 2.6 million people have entered talking therapy treatment through the Improving Access to Psychological Therapies programme since 2008, and we have secured an additional £120 million over 2014-15 and 2015-16 to support the introduction of the first ever waiting time standards in mental health services.

According to the recent chief medical officer’s report, mental illness is responsible for 70 million sick days a year, at an estimated cost to the economy of around £100 billion a year, so parity of esteem is essential. What more can be done through early intervention to help people with mental health illness by preventing their chronic problems from becoming acute?

My hon. Friend is absolutely right about the importance of early interventions. Next year, we are introducing for the first time a six-week maximum waiting time standard for access to psychological therapies to start treatment for conditions such as anxiety and depression, and a two-week standard for starting treatment for those suffering a first episode of psychosis. I am also calling on every FTSE 100 company to sign up to Time to Change, so that they can show leadership in how they deal with their employees.

It is one thing to say it, but completely another to do it. I am sure that the whole House will recognise improvements that happen, but does the Minister understand the scale of the crisis, not simply in the NHS but in the education system where more and more young people are increasingly finding that they simply cannot get anything like the support they need at increasingly difficult points in their lives?

I completely agree with the hon. Gentleman about the importance of children and young people being able to access treatment and support. If the truth be known, it has always been like this. It has always been the Cinderella of the Cinderella service, which is why we established a taskforce this summer, bringing in a whole load of experts and, importantly, consulting children and young people so that we can develop a modern health service for the mental health problems of children and young people. We hope to report early next year.

19. As the Cabinet taskforce sets out on this important work, will the Minister reassure me that it will bear in mind the important finding of the Health Committee’s inquiry into CAMHS—Child and Adolescent Mental Health Services—that it is the tier 1 and tier 2 services that really make the difference in preventing the need to access the service when children are much more unwell? (906238)

I very much appreciated and supported the findings of the Health Select Committee report into children and young people’s mental health services. The hon. Lady is absolutely right that we need to focus far more on preventing ill health and preventing a deterioration of it. If we can get into schools and work much better at maintaining people’s mental well-being, we can achieve much better results.

Despite what the Minister says, in South Shields, financial challenges have contributed to the closure of Bede wing mental health ward. This means that acute in-patient services are no longer provided in our borough. Can the Minister explain why mental health services are, in fact, being eroded under this Government?

Over the past decade and a half, there has been a very substantial reduction in bed numbers, and it is a trend that we should thoroughly support because we want to move away from institutional care towards supporting people at home in their communities. With children’s mental health, we have invested an extra £7 million this year to ensure that children get access to beds close to home when they need them.

Will the Minister ensure that the taskforce he mentioned considers the evidence that one in five mothers suffers from mental health problems during pregnancy or within a year of giving birth because the costs of that to society are massive and three quarters of those costs are borne by the child and subsequent generations? Is it not time to make sure that we focus on perinatal mental health because it can make such a big difference?

I very much agree with my right hon. Friend. Accompanied by my hon. Friend the Member for Torbay (Mr Sanders), I visited a brilliant perinatal mental health service in Torbay recently. My right hon. Friend is absolutely right. The London School of Economics has done a lot of work, showing evidence that if we invest in perinatal mental health, we get a return on the investment, but most importantly, we change people’s lives. I am determined to pursue that.

The Minister talks about parity of esteem, but it is under this Government that mental health budgets have been unfairly cut, and 1,500 beds and 3,300 nurses have been lost. He has already received a damning Select Committee report on child and adolescent mental health services. Ill people are being locked in police cells, or are travelling hundreds of miles to find a bed. The Minister could not have brought about more disparity if he had tried—and now we hear that there is to be yet another review. He is the Minister in charge. I ask him again: what action is he going to take today?

Inexplicably, when the last Labour Government introduced access and waiting time standards, they left out mental health. That was an extraordinary decision, and it drives where the money goes. The introduction of mental health waiting time standards next year, for the first time ever, will help to achieve equality for mental health. We have also published a vision of the next five years explaining how we will secure genuine equality for mental health, which is something that the last Labour Government did not achieve.

The Minister will know that the statutory guidance of the adult autism strategy in England is the keystone of the provision of services under the Autism Act 2009. The updating of that guidance is now imminent, and concern has been expressed to me about the draft wording produced by the Department. Can the Minister assure me that the Department does not intend to weaken the requirements for local authorities to provide services for people with autism and their families?

I am delighted that my right hon. Friend has become chair of the all-party parliamentary group on autism. She has fought for many years to secure a fair deal for people with autism. I am grateful to her for alerting me to the issue that she has raised, and I shall be sure to look at the guidance. It is absolutely not the intention to water down guidance for local authorities in any way.

Student Health Services

All patients are eligible to register with local primary medical care services, and that includes students who are moving away from home and starting university.

I do not think that the Minister has entirely engaged with the question. Those who run the student health services at Bristol university are warning that young people’s health is very much overlooked and underfunded—particularly mental health, which accounts for a quarter of all consultations. They are being hit by the GP funding changes and by cuts in public health spending on sexual health advice, and they have had to introduce their own meningitis vaccination programme because the Government have not introduced one. What support can the Minister give specifically to student health services?

I certainly remember being actively encouraged to register with a local GP when I was a student at Bristol university, and I understand that that continues today. As for the important question of children’s and young people’s mental health, the children’s mental health and well-being taskforce is looking at the mental health and well-being of students. Student Minds is involved in the process, and that in particular will help to inform the work of the taskforce in improving access to students with mental ill health.

Students do register with a practice in their university cities, but I was told recently by one of my constituents that she had experienced difficulty in gaining access to timely health care as a temporary resident when she was back at home. What options are available to ensure that students remain registered in the place where they are likely still to be spending half the year?

We recommend that all students register with university services, or with a GP in their university areas, but if patients are away from the GP with whom they are registered for more than 24 hours and less than three months—and that would include students—they can see a GP in the area where they are staying as temporary residents. GPs should be aware of that entitlement.

Students with long-term illnesses such as diabetes find it extremely difficult to manage their conditions, and there is evidence that a number of students are skipping their insulin injections. What further steps can be taken to make them aware of the necessity for them to take that important medication?

This is an incredibly important area of health care. How do we support young people through periods of transition? We know that people with long-term illnesses may struggle particularly, and diabetes and epilepsy are two of the conditions that have been identified. NHS England is currently examining transitional care tariffs to support people during the transition between children’s and adult health services, and educational support is part of that ongoing work.

My right hon. Friend the Minister for Universities, Science and Cities recently announced that there would be no cap on the number of students wishing to study pharmacy. Does my hon. Friend agree that Plymouth university should now press ahead with the setting up of a pharmacy school given that it is the Peninsula medical school?

My hon. Friend makes an important point. I visited the Peninsula medical school and his local university to highlight some of their excellent work in training medical and dental students. I believe that there is ample scope to expand provision to train other health care professionals in what is becoming an outstanding medical and health care training facility.

NHS (TTIP)

3. What representations he has received on exemption of the NHS from the provisions of the transatlantic trade and investment partnership. (906220)

The Government will not allow TTIP negotiations to harm the NHS. Any suggestion to the contrary is both irresponsible and false. I am grateful to the former Labour shadow Health Secretary for confirming that.

That is an interesting answer but, without specific exemption from TTIP, how can the Secretary of State give any reassurance that predatory organisations such as the Hospital Corporation of America, which was prosecuted for fraud in the US, will not use the TTIP provisions to seek contracts in our NHS?

The best assurance I can give the hon. Gentleman is not what I have said, but what the EU Trade Commissioner, Karel De Gucht—I challenge colleagues in Hansard to spell that correctly without looking at my notes—has said. In an interview in September, he said:

“Public services are always exempted—”

from TTIP—

“there is no problem about exemption. The argument is abused in your country for political reasons but it has no grounds.”

Colleagues in Hansard may not even rely on the Secretary of State’s notes; they may have their own source material. They are very special people those reporters.

I thank my right hon. Friend for that concise answer. I reiterate the message to the unions, which are sticking up billboards in my constituency, that Cameron and Hunt are not selling off the NHS.

I thank my hon. Friend for his comments. I was quite amused to see that I have a future career as an estate agent, along with the Prime Minister, when our hopefully long careers in politics are over, but the point is that this is scaremongering and it is wrong to scaremonger about something as important as the NHS. To suggest that the NHS is being privatised is fiction. What is not fiction is Labour’s legacy of poor care.

The Secretary of State’s definition of “harm” is not the definition that Labour Members have. My Bill, which was passed overwhelmingly on Friday, would require the Secretary of State to bring the matter back to this House should TTIP apply to the NHS in any way whatsoever. Will he support my Bill going into Committee without delay, so that we can discuss the detail and answer the questions he has?

Given the uncertainty of the French and German Governments on the investor-state dispute settlement mechanism, as well as the indication by EU Commission President Juncker that he will not back it, why have this Government not done more to protect the health service from a practice that would leave it vulnerable to private sector intervention?

This is what the EU chief negotiator said to the former Labour shadow Health Secretary, who is chair of the all-party group on TTIP:

“the rights of EU Member States to manage their health systems according to their various needs can be fully safeguarded…There is no reason to fear either for the NHS as it stands today or for changes to the NHS in future as a result of TTIP.”

It could not be clearer than that.

Patient Episodes

4. How many patient episodes there were at Kettering General Hospital in (a) 2010 and (b) the last year for which figures are available; and what assessment he has made of the reasons for the change in the number of such episodes. (906221)

In 2012-13 there were 85,497 in-patient finished consultant episodes at Kettering General Hospital NHS Foundation Trust, compared to 84,602 in 2011-12. There has also been an increase in the number of accident and emergency attendances, from 76,099 in 2010-11 to 84,055 in 2012-13. That increase is largely attributable to a high demand for services from a growing, ageing population.

Kettering general hospital serves one of the areas with the fastest population growth and greatest ageing in the whole country. Today’s report from the Care Quality Commission shows that, while the hospital has some of the most caring staff in the whole of the NHS, many areas of the hospital require considerable improvement. Will the Minister ensure that future NHS funding decisions are better targeted at areas such as Kettering which have such costly demographics?

My hon. Friend will be aware that the NHS funding formula is set independently, free from political interference. It is reviewed annually. I should like to reassure him that the Nene and Corby clinical commissioning groups have both received higher than real terms growth in their funding allocations and will do so again next year, to move them closer to their target allocations.

I have been working closely with the hon. Member for Kettering (Mr Hollobone) in recent years on a campaign to support the hospital. We recognise the issues that the CQC has raised, and we support the journey that the hospital is taking towards improvement. When the hon. Gentleman and I come to see the Minister in a few months’ time, will he look favourably on our bid for £20 million of funding to improve our accident and emergency department, whose physical environment has been described by experts as being among the worst in the country?

I am looking forward to that meeting in the new year. I should like to reassure the hon. Gentleman and my hon. Friend that the Department has provided a total of £5 million of temporary public dividend capital funding and a further £1 million of emergency capital to the trust in the past three months, so support is going into the delivery of high-quality services.

Cannabis

Cannabis is classified as a class B drug under the Misuse of Drugs Act 1971, as my right hon. Friend knows. To sell cannabis or preparations made from it as a medicinal product would necessitate obtaining a licence from the Medicines and Healthcare products Regulatory Agency. Cannabis in its raw form is not authorised as a medicinal product in the UK. However, certain cannabis extracts are contained in Sativex spray, which is the only medicine produced from the cannabis plant that is approved for use as a medicinal product in the UK. It is licensed for use in treating spasticity in multiple sclerosis and was approved in June 2010.

Over the last year or so, I have met a number of credible people from all walks of life and with a range of medical conditions who have told me that the only substance that helps their medical condition is cannabis. However, they cannot secure it through the NHS and they risk getting a criminal record if they try to obtain it for themselves. Will the Minister look at the much wider availability of cannabis for medicinal purposes in other countries and try to find a way to help those in need in our country?

As a former Home Office Minister, the right hon. Gentleman will be aware of the difficulties of getting this policy right. I do not believe that anyone in the House thinks that we ought to allow the prescription of a controlled substance willy-nilly without good evidence. I should like to draw his attention to this evidence from Cancer Research UK, which states:

“At the moment, there simply isn’t enough evidence to prove that cannabinoids—whether natural or synthetic—work to treat cancer in patients, although research is ongoing. And there’s certainly no evidence that ‘street’ cannabis can treat cancer.”

We continue to keep this matter under close observation, and there is good evidence of science being done by companies and by the National Institute for Health Research.

Has the Minister assessed whether the use of cannabis can result in paranoid and deluded behaviour, leading people to believe, for example, that it is possible in this country to mount a huge conspiracy to pervert the course of justice involving the police, the ambulance services, the security services, the Government of the day and the media, and to pretend that someone who had killed themselves had actually been murdered?

The hon. Gentleman makes an interesting parliamentary point, but my responsibilities cover only the licensing of cannabis for medicinal purposes.

Cannabis no doubt has some limited medicinal benefits for some illnesses, but will the Minister put it on record that it is not the Government’s intention further to liberalise any licensing of cannabis, especially in the light of the Institute of Psychiatry’s empirical evidence that abuse of the substance can lead to severe mental illness?

My hon. Friend makes an important point, and I am happy to give him that undertaking. We have to be careful to maintain a distinction between recognising the damaging effects of the recreational use of cannabis and the specific medicinal benefits of some of its derivatives, when tested and proven, in medicinal products. We intend to make that distinction very clear.

Cancer Drugs Fund

6. How many patients have received treatment through the cancer drugs fund since the inception of that fund. (906224)

More than 60,000 patients in England have received treatment through the cancer drugs fund since its inception in October 2010. They and their relatives will be very concerned at the suggestion made by the shadow Health Secretary last month that a Labour Government could abolish the fund.

I congratulate the Secretary of State on that very high figure. Is he aware that some of those people who are being treated have had to sell up their homes and move here from Wales, where they are routinely denied life-prolonging cancer drugs by the Labour-run Welsh Assembly Administration. What does that teach us about the respective differences between the health services in England and Wales?

I thank my hon. Friend for raising that point. The last Labour Government did leave us with one of the lowest cancer survival rates in western Europe, which is one of the reasons why we introduced the CDF. Unfortunately, the current Labour Government in Wales are continuing with those policies, which is why 6,500 Welsh cancer patients were admitted for treatment in English hospitals last year. [Official Report, 12 January 2015, Vol. 590, c. 5-6MC.]

So will the Secretary of State then publish the assessment of the CDF by the chemotherapy intelligence unit before 7 May 2015?

We are, on the NHS, the most transparent Government in history, and I can see no reason why we would not publish that. We are very proud of what the CDF has achieved. We are very proud that the level of cancer diagnoses has increased by more than 50% compared with what it was under the previous Labour Government, and so we are finally starting to win the battle against cancer.

We all remember the horror stories before the CDF existed locally, and all Government Members certainly support its continued use. Before any drugs are delisted from the CDF, will the Secretary of State make available the scoring of those drugs? Will he also outline what the provisions will be for consultation with patients and their families?

We will absolutely go through a transparent process on that. My hon. Friend is right to talk about the CDF’s success, which is why we have put its budget up by 40%. As part of the fund’s success, we want to make sure that it is allowing access to the latest drugs and to drugs that really work. Obviously, science has moved on since the fund was set up four years ago, which is why we want to make room for new drugs and take off existing drugs where there is evidence that they are not working as well as possible. However, the process must be transparent.

Last Wednesday, the Prime Minister denied that there is a problem with cancer care, yet the target for cancer patients to start their treatment 62 days after a general practitioner referral has been missed for nine months in a row. Cancer Research UK says that this target is vital for ensuring swift diagnosis and treatment so that we have the best survival rates in the world. Some 15,000 patients have already waited too long. This is a serious problem requiring serious action, so what is the Secretary of State going to do?

I think cancer patients in the hon. Lady’s constituency will welcome the fact that under this Government Leicester hospital has 194 more nurses and 120 more doctors, many of them involved in cancer care.

Let me answer the hon. Lady’s question directly. There is pressure on one of the cancer standards, and that is because every year we are now diagnosing 460,000 more people than happened under the last Labour Government, who left us with such a disappointing survival rate. When that many people are being diagnosed, it of course puts pressure on the diagnostic labs and the people doing those processes. But Cancer Research UK is also saying that we are seeing record increases in survival from cancer, and that is happening because of this Government’s policies.

Tobacco Packaging

7. Whether the Government have made a final decision on whether to introduce standardised packaging of tobacco products. (906225)

The Government have not yet made a final decision on whether to introduce standardised packaging. We are carefully considering a large number of responses from the summer consultation, together with detailed responses from EU member states.

I thank the Minister for her answer, albeit a disappointing one. Given the majority support for standardised packaging in this place and the fact that elected Members have backed it, perhaps she could explain why the Government have not come to a decision? Will she consider having a debate in the House on the subject, with a vote that people can take forward so that they believe that this Government actually care about people who are trying to stop smoking?

We are taking this forward. Not everyone in the House may be aware that we are obliged to go through a process with Europe, whereby we notify this policy to EU member states and there is a statutory three months during which member states can give a detailed response. If any member state does so, there is a six-month pause. Four states—Bulgaria, the Czech Republic, Portugal and Romania—have given that detailed opinion, and the window has not yet closed. The House might be interested to know that Ireland received eight detailed responses on this subject. That is part of the process.

I welcome the Minister’s statement that she will wait for the evidence before moving forward rather than relying on emotion. She knows that the policy, if implemented, would threaten 1,000 jobs in my constituency. Furthermore, will she agree to await the outcome not only of the evidence from Australia but of the tobacco tax directive that is being pushed through Europe?

I am encouraged by the evidence from Australia. We have seen some really impressive statistics regarding the cessation of smoking. The Government have not yet made a final decision on the matter, but Health Ministers are on the record as saying that we are minded to move forward on this, and we want to make progress. I regret the loss of jobs in the hon. Gentleman’s constituency, but I know that he will be working hard to assist his constituents in looking for other employment.

If plain packaging were introduced, what assessment has there been on whether that will make life easier or more difficult for the counterfeiters?

That is one issue that we will weigh up before making a final decision. Obviously, we received a large amount of evidence from the consultation, and we are looking at it in detail. Some of it was around that matter, although it is also the case that Sir Cyril Chantler made some robust statements in his report, rebutting some of the claims, but that is all part of the final consideration that the Government will make.

Innovative Medicine and Health Care Technology

8. What steps his Department is taking to accelerate access to innovative medicine and health care technology in the NHS. (906226)

Accelerating access for patients to innovative medicines and health care technology is central to my mission as the UK’s first Minister for life sciences. Breakthroughs in genetics and the use of data are unlocking a new era of precision medicines, earlier diagnosis and remote monitoring, which can dramatically improve patient outcomes, and the efficiency of our health service. That is why I announced last week a major review of the role of the regulators, the Medicines and Healthcare Products Regulatory Agency and the National Institute for Health and Care Excellence, in accelerating innovation in the NHS.

I know that the Secretary of State has already visited Airedale general hospital to see its telemedicine service. Earlier this month, I visited Marsden Grange care home in Nelson to look at the service from a patient’s perspective. The service is reducing pressure on the ambulance service, local GPs, A and E departments, and, crucially, improving patients’ experiences. How can we ensure that telemedicine is much more widely used?

My hon. Friend makes an excellent point. As with Airedale, the Marsden Grange care home initiative shows that we can improve patients’ outcomes, deliver more health for the same amount of money and make our system much more efficient. That is why we so strongly support telemedicine, why NHS England has undertaken a rapid review of the 3 million lives programme and why, last week, we launched our review to accelerate the adoption of innovative med-tech and e-health technologies into the NHS.

What is the good of innovation if we do not use it? For the 1 million people who suffer from atrial fibrillation, the three new NICE-approved drugs are a life saver; they make life worth living. But only about 6.5% to 7% of people have been prescribed the new drugs, as they are being blocked by clinical commissioning groups and GPs. What will the Minister do about that?

The hon. Gentleman is right to raise the matter. We have all seen it coming in recent years. Extraordinary advances in science are developing a huge range of new products, which our system is having to adjust to cope with, and that is precisely why I launched the review last week with NICE and the MHRA. We must look at these transformational technologies that bring new opportunities to our services and at how we can design a system that is better able to target innovations to the patients who need them.

18. Dementia is an abhorrent disease that affects thousands of people across the UK, and a significant number in my constituency of Fylde. With that in mind, what steps is the Minister taking to ensure that dementia sufferers have access not only to the most innovative medicine but to the most advanced early diagnosis? (906237)

My hon. Friend makes an important point. Dementia is one of those diseases where the loved ones and the carers of patients often suffer every bit as much as the patients. That is why, under the Prime Minister’s leadership, we have launched the G8 dementia summit to bring together the world to tackle the disease. We have launched a dementia strategy. Diagnosis rates in Britain have gone from 42% to 55% in two years. We have launched a new dementia service and doubled research spending. We will have 250,000 staff trained by next March, and, from April, we will be investing £3.8 billion into the Better Care fund. It is an important disease that deserves our priority.

The Ear Foundation recently published a report that estimates that the real cost of adult hearing loss is at least £30 billion a year. I hope that the Minister has read it. What is he doing to ensure that adults who could benefit from improved hearing technologies, including cochlear implants, do so, and when does he plan to publish the action plan on hearing loss that has long been promised?

I am not aware of the veracity of the £30 billion figure, but I will happily look at it, and I happily undertake to look at the progress of the report and the work that the hon. Lady raised.

20. It is a well-established fact that type 1 diabetics who have insulin pumps are much more able to control their condition than those who do not, yet the take-up of insulin pumps in the UK compared with Europe and America is pitiful. What is the Department doing to increase the commissioning of insulin pumps? In the long run, the costs go down with better control. (906239)

My hon. Friend raises a important example of an innovation that, despite costing a little extra at the beginning, saves substantially downstream. One of the challenges in our national health service is tackling a series of ways in which the system is not well geared to incentivising such innovations. NHS England recently set out its five-year forward view, which has, for the first time, a strong commitment to tackling such issues, and we are working with it to see what we can do to remove barriers and promote incentives for earlier adoption.

What steps are being taken to ensure that emerging treatments for Duchenne muscular dystrophy that receive conditional approval are available through the early access to medicines scheme as early as possible?

I was delighted, when we launched the early access to medicines scheme earlier this year, to see the very strong support that we got from the Duchenne dystrophy group. Dystrophy is one of those terrible diseases that desperately need the fast-tracking of new medicines. As I said, last week we launched a major review of our landscape for the earlier adoption of innovative medicines in the NHS, so that patients in the most severe clinical need can take part in cutting-edge research and we get drugs to patients more quickly.

Off-patent Drugs

9. What recent representations he has received on access to off-patent drugs; and if he will make a statement. (906227)

The hon. Gentleman will be aware of the debate in the House two weeks ago in which I gave a very full statement of the Government’s position on off-patent and off-label drugs. We want to promote their wider use, but we do not believe that the Bill presented to the House is the right mechanism for achieving that.

Will the Minister borrow from the approach taken with the Medical Innovation Bill, and commit to consulting on whether the Government should support, or how they might pursue, the key purposes of the Off-patent Drugs Bill?

As I said in the debate, we absolutely support the Bill’s intention, which is to promote the greater use of off-label and off-patent drugs, but that must remain a decision for clinicians exercising their judgment about what is best for their patients. We do not think it right that the Government should be put in the position of effectively sponsoring new drug licence applications to the Medicines and Healthcare Products Regulatory Agency. I have convened a round table working group with all the stakeholders to try to look at how we can maximise information to clinicians to promote the use of off-label and off-patent drugs.

NHS Trusts and Foundation Trusts

Thirty-three NHS trusts and 60 foundation trusts are forecasting an end-of-year financial deficit, with the remaining 65 NHS trusts and 87 foundation trusts forecasting an end-of-year surplus.

Earlier this year, Monitor announced that the number of trusts in financial breach had nearly doubled over the previous 12 months. How confident is the Minister that the number will not double again next year?

I am very confident that the measures already in place to drive efficiencies in the NHS are on course to save £20 billion during this Parliament. Many of those efficiencies are being delivered by improved procurement practice at a trust level. The Government have also invested £15 billion during this Parliament, which is a real-terms increase of £5 billion in NHS funding to support trusts.

The Government have invested hugely in the NHS in Harlow, including millions of pounds to our accident and emergency unit. However, for historical reasons the Princess Alexandra hospital has financial difficulties. Will my hon. Friend look at this and see what the Government can do to help?

Of course. As my hon. Friend is aware, every local health area—every clinical commissioning group—is receiving an increase in the funding available to it year on year. I would be happy to meet him to discuss the matter further, if that would be helpful.

As the Minister knows, North West London Hospitals is one of the NHS trusts that is in deficit. It has seen the accident and emergency departments at two nearby hospitals close, and its hospital board estimates that an additional 123 beds are necessary. Will the Minister meet me to discuss the problems of its historical deficit and the need for additional funding to make sure that those 123 medical beds are provided?

I can reassure the hon. Gentleman that, in the words of the medical directors of all the hospitals affected, there is a very high level of clinical support for the programme across north-west London, and the changes will save many lives each year and significantly improve the services that are available to local patients. I hope that is reassuring to the hon. Gentleman and to local patients.

Running a deficit can demonstrate short-term problems which, once resolved, will allow a trust to return to balance. Does my hon. Friend agree that there must be flexibility in the system, particularly for trusts such as North Cumbria, which have been in special measures?

It is absolutely right that trusts such as North Cumbria need to face up to challenges when those affect the quality of patient care, and that the focus of Care Quality Commission inspections and special measures is to drive up standards of care. It is also important that we continue to invest and support trusts where we can. That is why we are pleased to be increasing the NHS budget by £15 billion during this Parliament.

Is the Minister aware that the Manchester primary care trust ought not to be incurring a deficit because it does not spend sufficient of its money and resources on investigating cases referred to it and on responding to hon. Members such as myself when they write to it over a period of months? Will he look into this incompetence and examine similar behaviour, or lack of it, by the Care Quality Commission?

It is very important that the NHS faces up to the situation when things have gone wrong so that it can put them right for the benefit of patients in future. If the right hon. Gentleman has concerns about his local NHS not investigating complaints that he has raised with it on behalf of his constituents who are patients of the local trust, I am very happy to investigate those issues for him if he would like to write to me about them, and see what I can do to ensure that he gets the answers that he and his local patients deserve.

I understand that pretty much every hospital in Essex faces a yawning deficit, including Colchester hospital. Can the Minister guarantee that we can address the deficit without having to dramatically and radically reconfigure local services in Essex?

It is important to outline that for the first time this Government have put in place, via section 42 financial agreements with trusts where there is a requirement for interim financial support, measures that will ensure that trusts are held to account for delivering efficiencies—for example, reducing agency staffing costs, improving procurement practice, more efficient estate use and land disposal, and pay restraint of very senior managers. I am therefore confident that the local NHS can continue to deliver efficiencies to direct money to front-line care.

Cancer Drugs Fund

11. Whether it remains the policy of the cancer drugs fund to provide drugs which NICE has rejected for general use in the NHS. (906229)

I pay tribute to my hon. Friend for his tireless campaigning on the issue of cancer drugs. I can assure him that the cancer drugs fund now administered by NHS England continues to fund effective cancer drugs which have been not been recommended by the National Institute for Health and Care Excellence. Over 60,000 patients in England have benefited from the fund since October 2010. That is why we announced a £160 million boost to the fund earlier this year.

Will my hon. Friend look again at the CDF’s proposal to delist 42 cancer drugs, including Abraxane, which was put on the list only nine months ago and is the first new drug in nearly 40 years to produce an extension of life for pancreatic cancer patients?

I am grateful to my hon. Friend for his notice. I have spoken to NICE. It is appraising the use of Abraxane for pancreatic cancer and has not yet published its final guidance. It would not be appropriate for me to intervene at this point. Obviously, we respect NICE’s clinical independence. Abraxane is available through the CDF for patients meeting specific clinical criteria. I understand that the NHS England’s CDF panel plans to reassess the inclusion of Abraxane in the national list, but no decisions have yet been made.

It is a pleasure to follow the hon. Member for Lancaster and Fleetwood (Eric Ollerenshaw). Everyone in every part of the United Kingdom wants to improve access to cancer medicines. When the Prime Minister launched the cancer drugs fund in the home of Clive Stone, he promised to get

“more drugs to people more quickly”.

Mr Stone recently criticised proposals to remove a number of drugs from the fund, writing in his local newspaper that

“People are going to die, there is no doubt about it. Why don’t people keep their promises?”

Additionally, the Breakthrough Breast Cancer campaign has said that it is

“deeply concerned that several very effective breast cancer drugs appear on the list of drugs at risk of delisting”.

We all know someone affected by cancer in some way. What does the Secretary of State have to say to those patients relying on those drugs that are being removed from the fund?

The first thing I would say is that we have given an undertaking that any patients currently on drugs will not have the drug removed. Secondly, we are dealing with some very difficult issues. We have had extraordinary breakthroughs in the progress and rate of development of new cancer drugs, and we need to have a system for ensuring that the cost-benefits—the health economics—are done properly. NICE leads the world in making these difficult clinical judgments and we support its independence in doing so, but we need to ensure that we are not turning this issue into a political football. I notice that the shadow Health Secretary said that this was good politics but not good policy. It is really important that we ensure that when we set a benchmark on this debate we are guided by what is best for patients.

Access to GPs

The Prime Minister’s £50 million challenge fund is improving GP access for more than 3 million patients across England, helping them to get evening and weekend appointments.

Many people in South Ribble will be able to see their GPs in the evening and at weekends, thanks to a locally led initiative by Chorley and South Ribble clinical commissioning group and Greater Preston CCG to extend GP surgery opening hours this winter. Does my right hon. Friend agree that such initiatives, which will give greater flexibility to patients and alleviate pressures on other areas of the NHS, particularly A and E, are exactly what is needed in the busy winter months?

I do agree with my hon. Friend. I took my own children to an A and E department at the weekend precisely because I did not want to wait until later on to take them to see a GP. We have to recognise that society is changing and people do not always know whether the care that they need is urgent or whether it is an emergency, and making GPs available at weekends will relieve a lot of pressure in A and E departments.

I am afraid it is yet more spin from the Government. Everybody knows that it is getting harder not easier to see a GP under this Health Secretary. He has as much as admitted today that emergency departments across England have failed to hit the Government’s A and E target for 70 consecutive weeks, and that is in part because people are struggling to get a GP appointment in the first place. Will he now get a grip on this problem, and call on his Chancellor of the Exchequer in next week’s autumn statement to use £1 billion from banking fines to help ease pressure on the NHS this winter, as the Labour party has pledged?

We will not take any lessons from the Labour party about general practice. It is not just the disastrous 2004 GP contract. The president of the Royal College of General Practitioners says that the shadow Health Secretary’s plans

“could destroy everything that is great and that our patients value about general practice and could lead to the demise of family doctoring as we know it.”

Patient Choice

This Government are committed to patients having greater choice and control over their health care, and decisions as to which treatments are available on the NHS are taken by GPs on the basis of available scientific evidence.

Does my right hon. Friend have any plans to increase personal health budgets, and will he ensure that there is greater awareness of the health professions that are regulated by the Complementary and Natural Healthcare Council, the Health and Care Professions Council and the Professional Standards Authority, which has recently accredited the Society of Homeopaths and the British Acupuncture Council?

I am a strong supporter of personal budgets. People who have complex medical needs want, above all, to have personal control over their own health care, and they will be extremely worried that the Labour party has now said that it wishes to abolish personal budgets.

With regard to reducing patient choice, can the Secretary of State explain the sudden move to remove dialysis from being regarded as a specialised commissioning service, which is of great concern to a constituent of mine who is a renal patient and to the renal community? Will the Secretary of State now agree to a proper consultation—not over the Christmas holidays—and will he think again about that risky move?

We hope to have a public consultation on the matter. We are not seeking to restrict access to dialysis—far from it. We want to make it easier for people to access those vital services, and we have been putting more money into the NHS budget because we recognise just how important they are.

Topical Questions

As we look forward to world AIDS day next Monday, the whole House will want to pay tribute to the 30 NHS volunteers who left for Sierra Leone at the weekend to help in the fight against Ebola. They stand for the very best of the NHS and make us all proud. Last week I formally launched the MyNHS website. It contains 395,000 pieces of information and is the first website of its kind anywhere in the world. It will help people compare vital information about the performance of their local hospitals, GP surgeries, councils, mental health trusts and residential care homes. It will be a vital way to ensure that patients are not kept in the dark about the quality of their NHS services.

Further to the Secretary of State’s answer to the hon. Member for Worsley and Eccles South (Barbara Keeley), he must know that treating renal failure requires complicated, integrated care and that no one part of it can be separated. He must also know that there are 23,000 dialysis patients in the UK, and transplant patients have overlapping clinical needs. Handing responsibility for commissioning dialysis to commissioning groups is unacceptable, especially as it has been done without any consultation. Can he explain the rationale for all this, and will he meet me and colleagues from the all-party kidney group to discuss the matter?

I am happy to arrange a meeting between either me or one of my Ministers and members of the APPG to discuss the matter. I stress that we recognise how important those specialised services are. We want to get the benefits of nationally co-ordinated commissioning with the local integrated care that CCGs are in the driving seat to deliver. That is why we are having this discussion.

T2. Public Health in Cornwall has estimated that 300 people in Cornwall might die from the cold this winter because they are living in cold homes. Last week the Government introduced the first proper fuel poverty strategy to eradicate that totally unacceptable situation by 2030. Will my right hon. Friend join me in praising the work being done in Cornwall by a partnership of over 30 organisations in the Winter Wellness programme to ensure that people stay warm and well this winter? (906244)

Order. On both sides of the House the questions have been too long. It is not fair on other Members who are waiting to contribute. Please cut it out.

I commend my hon. Friend, who, as many of us know, has worked enormously hard on a whole range of health issues in her constituency. In particular, I know that she has helped deliver the Winter Wellness programme with a number of local organisations. It is important to highlight what help and advice is available for people who need it most in order to stay warm. The Government’s cold weather plan has a series of cost-effective and simple measures that people can take to reduce the harm caused by cold weather.

Two weeks ago, news emerged of serious problems at Colchester hospital. People there still do not know the precise details, as Ministers have not made a statement and the Care Quality Commission has not published its report. But Colchester is not the only hospital in difficulty; we have learnt that hospitals in Scunthorpe, Middlesbrough and King’s Lynn have been turning patients away and others are already on black alert, and that is before winter has even begun. We do not have an accurate picture of what is happening in the NHS right now, because NHS England was due to begin publishing weekly reports on 14 November but has failed to do so. Why has that information not been published, and will the Secretary of State today instruct NHS England to do so without delay?

That information is published at the decision of NHS England—[Interruption.] It has said that it will publish it in a fortnight’s time. Let me just say to the right hon. Gentleman that it was this Government who decided to publish that information on a weekly basis, something he never did when he was Health Secretary.

I am afraid that is just not good enough. Who is in charge here? It is not just A and Es that are under pressure; there is a knock-on effect on ambulance services. Reports are now surfacing of serious failures in patient care. Last month, a six-year-old girl from Sunderland was left for three hours with a suspected broken back despite five 999 calls. At the weekend, it was reported that a 56-year-old stroke patient from Huyton was taken to A and E by police on a makeshift stretcher made from window blinds from the man’s home, and he later died. Yesterday, it emerged that a 57-year-old cancer patient from Bishop Auckland died after three ambulances were diverted to other calls. Is it not clear that the situation in the NHS right now is far more serious than the Government have acknowledged, and should not the Secretary of State now make an urgent statement to Parliament setting out what he is doing to reduce the risk of harm to patients this winter?

There are huge pressures in the NHS. That is why we have put a record £700 million into the NHS to help it to get through this winter. May I gently suggest to the right hon. Gentleman that he should not try to politicise every single operational problem? When the NHS is all about politics, patients get forgotten—as he should know, because that is what happened when he was Health Secretary. Whether in Medway, Colchester, Burton or George Eliot, patients were forgotten because for Labour it was politics before patients every time.

T6. Will the Secretary of State look again at the funding formula for hospital trusts so that some adjustment can be included to recognise the issues in trusts such as University Hospitals of Morecambe Bay NHS Foundation Trust which cover large and difficult geographical areas? (906248)

I recognise those issues, and I am very happy to take that suggestion away. I particularly want to put on the record that the scare stories put out by Labour in Lancaster about the potential closure of Royal Lancashire Infirmary are false. It is totally irresponsible to scare people in Lancaster in that way.

T3. My constituent Corron Sparrow was left lying in the road for two hours with a compound fracture of his leg despite a call from a policeman to the North East Ambulance Service pleading for help. Eventually the service responded by sending an ill-equipped St John Ambulance team who then had to call for professional assistance. There are many more failures. It is now three weeks since I wrote to the chief executive, Yvonne Ormston, asking for an inquiry into this, but she has not even acknowledged my letter. Will the Minister intervene and tell the North East Ambulance Service that it cannot just ignore these matters? (906245)

I am very sorry to hear about the difficulties experienced by the hon. Gentleman’s constituents, and of course I am happy to look into those and do what I can to help him with that. However, I would also like to make it clear on the record that because this Government have put £15 billion more into the NHS during this Parliament, we are making sure that we are keeping services running efficiently through the winter for the benefit of patients.

T7. Eighteen NHS trusts have been placed in special measures, while so far six have come out. What progress is being made with the other 12? (906249)

I am happy to answer that, because for the first time we have a proper independent inspection regime. Labour tried to vote that down so that we could not have it, but we pressed on. A third of these trusts have been turned round. We are making good progress across most of the other 12 hospitals in special measures, including 1,500 more nurses, 200 more doctors, and 53 changes at board level. Where there were problems before, we are sorting them out.

T4. Patients with mental health problems who are referred for psychological therapies wait, on average, less than 40 days for treatment, but in York the wait is 125 days. My constituent, Laura Goodacre, has now waited nearly 350 days. Will the Minister look at this worrying case and the need for our mental health trusts in York to reduce waiting times? (906246)

I will absolutely look at that case, and I am happy to talk to the hon. Gentleman about it. This is precisely why we are introducing, for the first time ever, an access standard—a maximum waiting time of six weeks for access to psychological therapies from next April.

T8. After all the cover-ups of the past, what is being done to ensure that the culture of the NHS is always improving, particularly in that patients are treated with dignity and respect and always have the highest standards of safety? (906250)

I thank my hon. Friend for his question. After the Francis report, we now have 5,000 more nurses on our hospital wards. The scores that patients themselves are giving for whether they are treated with dignity and respect are up by 10%. We want to put poor care behind us and behind the NHS. It is time that Labour got on board with this agenda instead of constantly saying that we are running down the NHS by sorting out poor care.

T5. Recent reports indicate that the extent of child sexual exploitation and abuse is more widespread than previously recognised. The trauma of sexual abuse can have massive, life-long consequences on the physical and mental health of victims. Will Ministers consider designating child abuse and child sexual exploitation as a public health priority in the same way as smoking, alcohol, drug use and obesity? (906247)

The hon. Lady is quite right to say that those are incredibly important issues, and we do see this as an important public health issue. We are committed to tackling child sexual abuse. In May the Department published its response to the recommendations of the independent health working group report on child sexual exploitation and we accepted the recommendations in full. We are taking this very seriously.

T9. Do Ministers agree that the patient transport guidance should be interpreted with an understanding of rural needs, rather than telling my elderly constituents to report to a hospital 60 miles away and to get three buses there and three back that do not connect with each other in order to have treatment or consultation? (906251)

It is particularly important in rural areas that patients with complex medical needs who have difficulties mobilising or who perhaps do not have access to a car are supported by the local NHS to access the services they need. There is provision for local hospitals, as well as for CCGs, to give financial assistance to support patients in accessing services and to give them lifts to hospitals, as appropriate.

T10. When I asked the Prime Minister two weeks ago about the financial crisis facing Devon NHS, he seemed completely unaware of it, so could the Health Secretary please explain why Devon NHS faces an unprecedented £430 million deficit and what he is doing to stop the rationing, cuts and total withdrawal of some services that is now being proposed? (906252)

We are not rationing services. In fact, we are doing 1 million more operations every year than were done under the previous Government. I will tell the right hon. Gentleman why that financial pressure exists: we have an ageing population, with nearly 1 million more over-65s than four years ago, and huge pressure to deliver good care in the wake of the Francis report. The NHS will be supported if we have a strong economy that can fund real-terms increases in health spending—something that never happens if the deficit is forgotten.

My constituent, six-year-old Sam Brown, is one of 100 people with the rare disease Morquio. His family live in a state of anxiety because they do not know whether the drug Vimizim will be approved for further use on 15 December. Will a Minister please meet me and Katy and Simon, Sam’s parents, to give Sam the Christmas present he needs and to keep Sam smiling?

Last month one patient waited 35 hours in Medway’s A and E, and in the past year 10 patients have waited more than 24 hours. I was grateful to the Secretary of State for taking up my invitation to visit the hospital. What progress has been made specifically on turning around the A and E department?

There are more doctors and more nurses operating at Medway hospital and I know that when the hon. Gentleman was sitting on this side of the House he was very pleased with the progress that was being made in turning it around from special measures, but, like UKIP’s policy on the NHS, everything changes.

May I welcome the recent launch of MyNHS? Does my right hon. Friend agree that transparency of NHS performance, whether it be that of hospitals, GPs or surgeons, will be a major driver in improving patient care, as international evidence suggests, and help us avoid a scandal such as Mid Staffs, which happened under that lot over there?

Two thirds of the information we are publishing on MyNHS was actually collected by the previous Labour Government, but they refused to publish half of it. That is the difference.

Do Ministers agree that it is a scandal that cold homes are costing the NHS in England more than £1.3 billion every year, with kids growing up in cold homes twice as likely to contract diseases such as asthma? Do they also agree that it is hugely disappointing that not one penny of Treasury infrastructure funding is devoted to energy efficiency? Will they speak to their Government colleagues about that?

The hon. Lady will know from the answer I gave to my hon. Friend the Member for Truro and Falmouth (Sarah Newton) that the Government published the first fuel poverty strategy for England, which aims to address that very issue. It is also really important that all Members do everything they can locally to publicise the Government’s cold weather plan. Members can really assist local public health officials and their local NHS to get the word out to all communities about the simple measures we can take to keep our constituents warm and safe this winter.

One of the key challenges in improving access to GPs is improving recruitment of GPs. Will the Secretary of State work with the Royal College of General Practitioners and other medical groups to see whether there might be merit in introducing a mandatory stint of working in a GP surgery for junior doctors?

I am sure that my hon. Friend will welcome the fact that there are now just over 1,000 more GPs working in the NHS and training than when we came into government, but there is more we need to do. We have committed to delivering 5,000 more GPs for the NHS, and part of that work will be working with the Royal College of General Practitioners to ensure that we can support return-to-practice initiatives for GPs who have taken career breaks.

Order. The level of interest in Health questions today has broken box office records. I am sorry not to be able to accommodate remaining demand, but we must now move on.