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Volume 593: debated on Tuesday 24 February 2015

The Secretary of State was asked—

NHS Staff

1. How many NHS staff have been made redundant and subsequently re-employed by the NHS since May 2010. (907642)

9. How many NHS staff have been made redundant and subsequently re-employed by the NHS since May 2010. (907650)

Over the four and a half years between May 2010 and October 2014, 5,210 people—equivalent to, annually, less than 0.1% of the NHS work force—have been made redundant and then returned to work elsewhere in the NHS.

But at a time when A and E is in crisis and there are not enough nurses, how on earth can the Minister possibly justify firing and rehiring thousands of NHS staff? What greater sign could there be of a Government with their priorities totally wrong?

I am not sure I recognise that picture of the NHS. We know that there are between 6,000 and 8,000 extra nurses, midwives and health visitors working in our NHS than there were under the previous Government. Also, in respect of A and E, the average length of stay in hospital has steadily come down from about eight days in 2000 to about five days now. So our NHS is getting better and improving under the current Government.

Last year the Prime Minister promised to recover redundancy payments from people who have been rehired. Can the Minister tell us how many payments have been recovered and at what cost?

The hon. Gentleman will be aware that it was the previous Labour Government who in 2006 set these eye-watering redundancy payments for the NHS, and we have committed to making sure we reform and change that. Therefore, as part of our negotiations and pay offer to NHS staff we want to introduce a redundancy cap of £80,000. Since many Opposition Members are supported by trade unions, I hope they will encourage union members to back that pay and redundancy cap.

Can the Minister confirm that according to the latest figures there are more nurses working in the NHS now than there were in 2010, including an additional 391 at East Lancashire Hospitals NHS Trust and an additional 59 at Airedale NHS Foundation Trust, the two trusts that serve my constituency?

I am delighted to confirm that, and we have made a conscious decision to reduce NHS waste and bureaucracy. NHS administration spending is down from 4.27% under the previous Government to only 2.77% now, which has resulted in £5 billion of efficiency savings and meant we can invest in about 6,000 more nurses, midwives and health visitors.

The extra NHS staff my hon. Friend talks about are welcome, but my constituents want to know that standards of care are the best as well. What progress is he making to ensure that hospital patients get the best possible care?

The most important thing we have done is support our front-line staff with additional investment in the NHS, which Labour called irresponsible, and there is about £13 billion more going into the NHS during this Parliament. We have also increased transparency to make sure that where there are isolated pockets of poor care, the Care Quality Commission can intervene and make recommendations to improve the quality of care for patients in those hospitals.

20. Given the significant challenges facing the NHS and the fact that this top-down reorganisation has led to this hiring and firing and therefore a distraction of energy and attention at crucial times, do not the Government now regret their top-down reorganisation? (907663)

A reorganisation of NHS services that results in administration spending being reduced from 4.27% under the previous Government to 2.77% under this Government, meaning that there is £5 billion more money for front-line patient care, is a good thing. That is something the Opposition should support, because it means that patients are getting a better service.

Can the Minister remind the House of the number of extra specialist A and E doctors working in the NHS in England now compared with 2010?

My hon. Friend is right to raise this important point. As part of our commitment to investing more money in the front line, we have been able to ensure that there are between 800 and 1,000 more doctors now working in A and E than there were under the Labour Government.

Order. May I gently remind the House that the question is not about staff per se in the NHS? The question is about people made redundant and subsequently re-employed. Attention to detail tends to profit a Member.

Those of us on the Public Accounts Committee have heard about the industrial scale of this revolving door of people going out of one job and into another with a fat redundancy payment. Does this not show that the Government have lost their grip on what is truly important in the NHS, which is paying front-line clinicians to serve patients?

That is extraordinary. The Public Accounts Committee will be aware that these redundancy terms were introduced by the previous Labour Government in 2006. We are committed to changing them and I hope that the hon. Lady’s party will support us in exerting pressure on the unions to support the pay deals on the table that will introduce an £80,000 redundancy cap.

21. Yes, Mr Speaker; I am grateful. I want to ask about the number of nurses who have been made redundant. Lots of hospitals in my area are now recruiting from Spain, and I wonder whether an assessment has been made of the cost to the NHS of using nurses from abroad after making other nurses redundant. (907664)

Our NHS has always benefited from overseas staff bringing their skills and coming to work here, and we can all welcome that as long as they have a good standard of spoken English, which is something that we are putting right through the legislation that we are introducing. As I outlined earlier, there are now around 7,500 more nurses, midwives and health visitors working in the NHS than there were under the previous Government.

GP Retirement

2. What contingency plans his Department has formulated to cope with the expected increase in the number of GPs retiring before 2020. (907643)

In addition to the extra 1,000 GPs working in our NHS since 2010, our mandate to Health Education England will ensure that 50% of trainee doctors enter GP training programmes by 2016. This will enable the delivery of 5,000 additional newly qualified GPs by 2020.

I am told that many young doctors are choosing not to go into general practice. That, coupled with the number of retiring GPs, is leading to real shortages in places such as Clacton. What more can be done to make general practice more attractive to young doctors, in order to offset the number of GPs who are retiring?

There have always been parts of our health service where it has been difficult to attract GPs to work; that is a long-standing problem. A new £10 million investment fund has been put in place, and a new 10-point plan is being delivered by NHS England to look at how we can better incentivise younger doctors to work in areas in which it has traditionally been difficult to recruit. I am sure that that will bring benefits to the hon. Gentleman’s constituency and elsewhere in the NHS.

Does my hon. Friend agree that this is not just a matter of the total number of GPs? Quite a lot of GPs now want to work part time, and quite a lot now want to be salaried rather than being partners. Is he confident that the model that was set up in 1948, which effectively means that each GP practice is its own separate, private business, is still suitable in the 21st century?

My right hon. Friend asks an important question. We can of course support the existing model, and the innovation that comes with GPs being small businesses, and that is exactly what we are doing with the £1 billion investment fund for GP infrastructure and technology. We are supporting those GPs as small businesses to develop better patient services.

On what is his last outing, will the Minister tell us how many GPs, in addition to those who have retired, have left the profession and how many have gone to work abroad?

It has always been the case—it was certainly the case among many of my medical contemporaries—that many people from our NHS go and work overseas for some time. They often come back to the NHS, bringing broader experience and skills. As I outlined earlier, there are now 1,000 more GPs working and training in our NHS than there were five years ago.

Following the retirement of a senior partner whom it has been impossible to replace, Dr Hadrian Moss of the Dryland GP surgery in Kettering has followed the advice of the British Medical Association and informally closed his expanded list of 2,500 patients on the ground of patient safety. He has now been taken to task by NHS England for a potential breach of contract. What is the Minister’s opinion on reconciling the views of the BMA on patient safety guidelines and those of NHS England on a potential breach of contract?

I am sure that my hon. Friend will understand that it is difficult for me to comment on an individual case, but I am very happy to look into the matter and get back to him about it.

Given that the needs of patients must come first and that young people are not choosing to pursue GP training as much as they used to, what discussions will the Secretary of State hold directly with the British Medical Association, the Royal Colleges, the training councils and his colleagues in the devolved Administrations throughout the UK to address this issue, to prevent further congestion in accident and emergency departments?

There is a lot of work going on in this area. First, we are encouraging and supporting GPs who have had career breaks, perhaps because they have started a family, to get back into the profession more easily than they have been able to do in the past. Secondly, we also have the commitment that 50% of medical students and doctors leaving foundation training will become GPs in future. That will make sure that we have 5,000 more GPs by 2020.

But the Government’s reorganisation took billions of pounds away from the NHS front line. Figures released last week show that fewer than a quarter of medical students now enter general practice, because they can see the pressure that Ministers have put on it, while GP morale has collapsed. Should the Minister not now admit that the reorganisation was a mistake and instead match Labour’s pledge to invest an extra £2.5 billion a year to recruit 8,000 more GPs and guarantee appointments within 48 hours?

I know that the Labour party is full of professional politicians, but medical students do not just leave medical school and straight away become GPs; they become foundation doctors. As I have outlined, 50% of the people leaving their foundation training will become GPs in future, which will increase the number of GPs by 5,000. Under this Government the number of GPs in education, training and working in the NHS has increased by 1,000, which is a move in the right direction.

Countess of Chester Hospital (Scans)

I am delighted to report to the House that the number of CT scans performed at the Countess of Chester Hospital NHS Foundation Trust increased by 67% between 2010 and 2014. In December 2014, only 0.6% of patients waited more than six weeks from referral to test at the trust—that is rather better than the figure we inherited in 2010 of 4.9%, and I hope that the Opposition will welcome it.

I welcome those fantastic figures at the Countess of Chester hospital. Will the Minister confirm that early and accurate diagnosis is crucial for dealing with many conditions, and that we are seeing the results of that in improved survival rates for conditions such as cancer?

My hon. Friend is absolutely right to say that diagnostics play a key role in our drive to improve cancer survival, which is why we have committed £750 million to deliver our cancer strategy, including £450 million to achieve better diagnosis of cancer, and better awareness and access to diagnostic tests. Projections show that that is working; we are on track to see 12,000 more cancer patients a year surviving for at least five years in 2015, which is more than double the target of 5,000 we set ourselves in January 2011. I hope that the Labour party will agree that these are real benefits for cancer patients in the NHS today.

Cancer scanning services in Cheshire and Staffordshire have recently been subjected to a competitive tendering process, and the contract was awarded to Alliance Medical, despite its bid being £7 million more expensive than the NHS bid. Can the Secretary of State explain why the more expensive private sector bid was chosen over the better value NHS bid to provide these services? Will he commit to investigating the bidding process to ensure that the tender was conducted fairly? [Interruption.] He is chuntering from a sedentary position, but will he today confirm, because this is a matter of profound public interest, that no contact of any sort took place between his Department and the board of Alliance Medical with regard to this decision, including at any point with the current board member, the right hon. and learned Member for Kensington (Sir Malcolm Rifkind)?

Order. That was a considerable essay to which a pithy but comprehensive response is expected. The House seeks it.

I admire the hon. Gentleman’s chutzpah but it ill behoves him to talk to us about privatisation; it was his party that led to the increases and it is this Government who have stopped it, and he needs to acknowledge that. On the facts, in December the NHS in England performed more than 130,000 more diagnostic tests compared with December 2013. I note that he did not talk about Wales, where 24% of patients have waited more than eight weeks for their diagnostic test—the comparative figure is 2% of patients in England.

Order. The question was about Chester, so there was no particular reason to talk about Wales.

Cancer Survival

5. What assessment he has made of the implications for his policies of the most recent rates of cancer survival. (907646)

6. What assessment he has made of the implications for his policies of the most recent rates of cancer survival. (907647)

13. What assessment he has made of the implications for his policies of the most recent rates of cancer survival. (907656)

This Government inherited the worst cancer survival rates in western Europe and, as we have just heard, we have invested a record £450 million in improving early diagnosis, which means that record numbers of people are being tested and record numbers of people are being treated.

I thank the Secretary of State for his response. Last year, I met cancer patients and carers with the aim of looking at how we can improve cancer survival rates so that they are among the best in western Europe. The main observation was that early diagnosis is key. Does my right hon. Friend agree that it is absolutely crucial that we support GPs to find and identify the early signs and symptoms of cancer so that we can improve survival rates?

That is absolutely right. What is said by everyone who has been wrestling with this problem about why our survival rates are not as good as we want them to be is that early diagnosis and access to the latest drugs are the two critical things. My hon. Friend will be pleased that 9,000 people in his region have accessed the cancer drugs fund and that, in his constituency, 300 more people every year are now being treated for cancer than was the case four years ago.

The excellent progress made in cancer survival rates is great news across the UK and in my constituency in Fylde. A lot of that is down to the increase in availability of diagnostic tests. Statistics from Blackpool’s NHS trust show that just under 33,000 more diagnostic tests were carried out in 2014 compared with 2010. With that in mind, will my right hon. Friend commit to increasing the availability of diagnostic tests?

We absolutely can. In fact, we are carrying out about half a million more diagnostic tests for cancer every year than we were four years ago. The result is that, over the course of this Parliament, 700,000 more people are being admitted for cancer treatment in our hospitals than was the case in the previous Parliament, saving 12,000 lives every year.

I welcome the Secretary of State’s answers. Improvements in radiotherapy have been a key factor in improving cancer survival rates and quality of life for patients. This month, Worcestershire is celebrating the delivery of a state-of-the-art radiotherapy centre at Worcestershire Royal hospital. I visited that £25 million oncology centre last week. With some of the most advanced equipment in the country and eight new consultants recently recruited, does my right hon. Friend agree that the centre will be a key asset in taking forward the fight against cancer?

Absolutely. It was a fantastic development for Worcestershire Royal hospital. My hon. Friend campaigned very hard for it, and it is fantastic for his constituents. Cancer treatment is expensive, which is why we can only fund developments in cancer if we have a strong economy. That is what this Government are committed to doing for our NHS.

May I draw the Secretary of State’s attention to an excellent debate we had in the Chamber on 5 February under the auspices of the all-party group on cancer? May I also draw his attention to the uncertainty surrounding the funding of the national cancer peer review group programme? That programme has recently been reviewed and the Minister had indicated that the funding would continue. Will he take the opportunity to give a commitment to funding that peer review group, because there seems to be some doubt among the 17 national cancer charities that support its work.

Let me reassure the hon. Gentleman that we are absolutely committed to furthering and improving peer review as a way of winning the battle against cancer. The NHS is committed to that programme, and it is just looking at how it can be improved. [Interruption.]

The hon. Member for Barrow and Furness (John Woodcock) seems to be enjoying a very close relationship with his mobile phone. I hope that it profits both of them

On the early detection of cancer, will the Secretary of State consider putting more resources into socially deprived areas such as Halton where the incidence of cancer is higher?

We are putting more resources into Halton. In fact, we are putting more resources into the NHS across the country. We are carrying out 21,000 more diagnostic tests, including cancer tests, every year compared with four years ago, and I hope that that is something the hon. Gentleman will welcome.

The all-party group on cancer and the wider cancer community have commended the Government on introducing the one-year survival rates for cancer into the delivery dashboard from April of this year as a means of driving forward earlier diagnosis. But what can the Secretary of State tell us about the work that is being undertaken to ensure that the levers of accountability are in place to push under-performing clinical commissioning groups into raising their standards on behalf of patients?

I congratulate my hon. Friend on his understanding of the importance of transparency. He will welcome the fact that we are now saving 1,000 more lives a month as a result of focusing on the five-year survival rates. But that transparency must apply to CCGs as well, and discussions are ongoing with NHS England as to the best way to do that for lots of things, including cancer.

Last week, we learned that the 62-day target for cancer treatment has been missed for a full 12 months:

“This isn’t just about missed targets–consecutive breaches mean thousands of patients are being failed. These targets exist to ensure swift diagnosis of cancer and access to treatment, which is vital if we’re serious about having the best survival rates in the world.”

Those are not my words; they are an exact quote from Cancer Research UK. Which bit of it does the Secretary of State disagree with?

I do not disagree with it, but I will tell the hon. Lady why we are missing that one target. Incidentally, we are hitting the seven other targets. We are treating and diagnosing so many more people, with 560,000 more diagnoses every year. That means that in this Parliament we are treating 700,000 more people than were treated in Labour’s last Parliament, saving 1,000 more lives a month. If the hon. Lady looks at some of the other things that Cancer Research UK says, she will see that it welcomes that strongly.

Free Social Care

7. What assessment he has made of the implications for his policies of Her Majesty’s Treasury’s costing of free social care at the end of life. (907648)

HM Treasury’s costing demonstrates the limitations of data available nationally in estimating the potential costs of providing free personal care at the end of life. That is why the Department of Health is undertaking further work with stakeholders to develop an evidence base to inform the next spending review.

I thank the Minister for that reply. He will know that most people want to be able to remain at home at the end of their lives, surrounded by the people they love, and I pay tribute to all the carers, volunteers and health professionals, including Rowcroft’s hospice at home, who help to make that possible. Sadly, he will also know that often the situation can break down because of the sheer exhaustion of caring for a loved one at the end of their life. Will he commit that the Government will consider the quality of care as well as the costs when considering introducing free end-of-life social care?

I thank my hon. Friend for that question and join her in paying tribute to the work of so many people: volunteers, loved ones and the professionals working in the community. The whole emphasis should be on ensuring that we respect people’s choice about where they want to be and that they get the best possible care. Later this week, the independent review of choice at the end of life will be published and I hope that it will inform discussions. I am completely with her in trying to ensure that we can achieve this.

One of my constituents recently went through a lengthy, distressing and difficult process to get NHS continuing care for his wife. If we remove the distinction between NHS and social care, many people across this country, including my constituent, will be spared this distress and difficulty at one of the hardest times in their lives. We know that funding should be put where it is needed and we know that that will be more cost-effective in the long run and will be better for patients, so why will the Minister not act?

Actually, we are all agreed on this. We all want free care at the end of life, but whoever is in power after the election in May will have to ensure that we understand fully the costs. There is a lot of evidence, and the evidence is growing. We are having very good discussions with groups involved in care at the end of life and we all want to achieve a solution. Of course, the truth is that very many people are receiving free care at the end of life, but they are in hospital, where they often do not want to be. I am completely with the hon. Lady in trying to achieve this.

Eight out of 10 people say that they would prefer to die at home when their time comes. Since the Government published their White Paper and said that they saw merit in social care being free at the end of life, a succession of reports from Macmillan, Nuffield and others have shown that there are savings to be made and benefits in terms of more dignified deaths and compassion for families. Is it not time to act on the evidence and make social care free at the end of life?

We very much hope that the case will stack up. As I said earlier, we are in active discussions with these groups and I held a round table with them a few months ago to discuss how we can achieve this. Everyone is agreed on the objective, but we need to understand the full costs involved before any Government can make a commitment to it.

Is there not something deceitful about the Government’s promising major changes for the next Parliament when we do not know how they will be paid for? If we want improvements to the NHS and end-of-life care in the next Parliament, Members on both sides of the House need to put before the electorate how we will pay for those important long-term changes.

I am tempted to say that that is a bit rich coming from an Opposition Member. I am sure that he would agree that whatever commitments are made, we need to understand their cost. That work is under way and I hope that as soon as we achieve a full understanding we can proceed.

Genomics Programme

The Government’s £300 million genomics England programme, led and announced by the Prime Minister as part of our life science strategy, has the potential to improve dramatically cancer diagnosis and treatment. By sequencing the entire genetic code of 100,000 NHS patients and volunteers and combining the data with their clinical records, and launching a genomic medicine service—a world first for the NHS—we will be able to understand the genetic triggers of disease, unlock new diagnostics and identify better treatments from existing drugs.

The number of people being treated for cancer successfully and getting appropriate diagnostic treatment in Dudley and Sandwell has increased substantially in the past five years, but does the Minister agree that harnessing genomic medicine is key to the future, and that we need to drive innovation in this field over the next 10, 20 and 30 years?

My hon. Friend makes an excellent point. He is absolutely right: cancer is a genetic disease, and the more we know about genetics, the more we discover about different patients’ predisposition to different diseases and drugs. That is absolutely key, and nowhere more clearly so than in breast cancer, where the HER2-Herceptin breakthrough and the BRCA2 gene are allowing us better to screen, predict and target treatment of breast cancer, freeing women from the choice of mastectomy, which has been far too dominant, and enabling us to treat breast cancer as a preventable disease.

Mental Health

10. What guidance he has given to clinical commissioning groups and mental health trusts on jointly funding not-for-profit voluntary and charitable organisations providing support for people with mental health issues. (907652)

The Government are clear that voluntary organisations and charities make an important contribution to the delivery of local health and social care services, including services that support people’s mental health needs. However, it is the responsibility of local commissioners to commission appropriate services based on their local population’s needs.

The Minister will be aware that although the NHS is one organisation, trusts seem to operate as silos. Will he convene a meeting of all the trusts in the Colchester area to discuss the future of the Haven project?

I visited the Haven last week with my hon. Friend, and I was enormously impressed by everything I heard, including the extraordinary testimonies of people with personality disorders who had benefited so much from the Haven’s service. In my view, it would be incredibly sad and very worrying if that service were to be lost. I am happy to invite the clinical commissioning group and the mental health trust to a meeting in the Department to discuss how it can be saved.

I recently met the five UK Youth Parliament Members from Rotherham, who talked about the lack of facilities for mental health help in education, both further education and state education. May I say to the Minister that it is all right saying that it is up to local commissioning groups, but where is the leadership, when our young people are being left in extremely difficult situations and are seen by some professionals but, sadly, not health professionals?

The local Members of the Youth Parliament the right hon. Gentleman met make an incredibly important point. I refer him to the children and young people’s mental health and well-being taskforce, which will report very soon. I think that the role of schools will be crucial in its conclusions, and I encourage him to look at the report when it emerges.

The latest figures show a huge rise in the number of young people with a mental illness turning up at A and E. Young people not getting the help they need early on and becoming so ill that they need hospital care shows that the system is failing. Does the Minister accept that this Government’s decision to cut children’s mental health services at the same time as wasting £3 billion on a reorganisation has been a key factor in that failure?

This Government have absolutely not made any decision to cut children’s mental health services, and the hon. Lady knows it is misleading to suggest otherwise. These decisions are taken by local commissioners in local authorities and CCGs. Indeed, we have legislated for parity of esteem for mental health. I urge her to look at the outcome of the work of the children and young people’s mental health and well-being taskforce, which I think gives us a real opportunity to improve the way in which services operate.

Nurse Numbers

The full-time equivalent number of nurses, midwives and health visitors working in the hospital and community health services in England per million population from September 2010 to September 2014 inclusive has remained broadly constant at 5,872, 5,768, 5,703, 5,712 and 5,781 respectively.

In response to 11 parliamentary questions that I submitted in the past year, the Minister has admitted that he does not know how many part-time, agency and locum GPs are in the health service, the number of agency and part-time nurses, the number of part-time doctors in our hospitals, or how many working nurses and midwives are also drawing their pensions. Given that he has so little detail on staffing, where did today’s figures come from, and what faith can anyone have in them?

They are in the monthly staff statistics survey. As the hon. Gentleman would like some detailed information, I am sure he will be pleased to hear that in his constituency there are now 386 more nurses than there were in 2010 under the previous Government, and nationally there are 7,500 more nurses, midwives and health visitors working in the NHS.

Does my hon. Friend agree with me and with the nursing profession that if nurse staffing levels on acute hospital wards fall below one registered nurse to seven acutely ill patients, excluding the registered nurse in charge, it will significantly increase the risk to patient care and result in avoidable excess deaths?

My hon. Friend and I have discussed this many times and I do not agree with him, as he knows. What is important is that patients are assessed on their clinical needs. A rehabilitation ward will need a different number of nurses—indeed, it may need physiotherapists and occupational therapists—from intensive care nursing, which often requires one-to-one care, so setting arbitrary staffing ratios is not in the best interests of patients.

Does the Minister accept that the issue is not just broad numbers, but the shortage of specialised nurses in many departments, certainly in Calderdale and Huddersfield, where we are finding it difficult to recruit the right qualified nurses for very specialist tasks, as well as the doctors to go with them?

In many parts of the country we are seeing more specialist nurses working, particularly in areas such as diabetes, and supporting patients with complex care needs. As we need better to support people with those complex care needs at home in their own communities, the Government will continue to invest in specialist nurses not just to provide care in hospital, but to work in the community at the same time.

Russells Hall hospital is being forced to lose one in 10 staff, which could include midwives, to deal with Government efficiency savings of £12 million every year. This morning the hospital’s chief executive has written to me and says that these

“excessive efficiency requirements place care at risk”.

She goes on to say that

“the financial challenge has reached unviable levels”

and that NHS providers

“can no longer guarantee sustainable and safe care”.

What will it take for Ministers to listen not just to us, but to NHS staff, and ensure that hospitals such as Russells Hall have the resources they need to provide care for local people?

I am sure the hon. Gentleman will be pleased that, as part of our winter pressures funding, Dudley received £3.5 million to support the hospital during a difficult winter period. There are now 69 more doctors and 324 more nurses, of whom 29 are extra midwives, working in the area than in 2010.

Personality Disorder Support (North Essex)

12. What discussions he has had with (a) the Haven project in Colchester and (b) NHS bodies in north Essex on the need for continuing funding for support for people with moderate to severe personality disorder. (907654)

My right hon. and noble Friend the Under-Secretary of State with responsibility for quality responded in February 2014 to correspondence from the client chair of the Haven project about its funding. As I said a few minutes ago, decisions on NHS funding are a matter for local commissioners, but I will invite North East Essex clinical commissioning group to meet to discuss the issue in more detail.

I am grateful to my right hon. Friend for taking such a close interest in the matter, and for the visit paid by the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter). Although I understand the huge cost pressures on the CCG, may I invite my right hon. Friend to study the Enable East report, which made a different recommendation on how the unit should be treated? It would be sad to close the leading example among 11 Department of Health pilots, when all the other 10 are being kept open as the lessons learned are so valuable.

I am very much aware of the work that my right hon. Friend and my hon. Friend the Member for Colchester (Sir Bob Russell) have done on this. It is interesting that all the other 10 pilots have continued. They are part of NHS trusts. This is the only one run by a voluntary sector organisation. It is an incredibly valuable service. I was struck by the extent to which people said how much they had reduced their hospital in-patient admissions as a result of the incredibly impressive preventive work that this service provides, and I want to look into it further.

Ehlers-Danlos Syndrome

The Government acknowledge the challenge posed in supporting patients with Ehlers-Danlos syndrome, which encompasses a complex range of conditions with a wide variety of symptoms. Diagnosis and investigation of suspected EDS takes place in dedicated regional genetics clinics, with specialist clinics, as my hon. Friend will know, at Sheffield Children’s NHS Foundation Trust and London North West Healthcare NHS Trust.

People in Burton have raised £130,000 to pay for a life-saving operation that is not available in the UK for Nina Parsons, my constituent, who suffers from EDS. I have another constituent, Sarah Pugh, who is having to pay for vital physiotherapy and an MRI scan. Will my hon. Friend look at what more can be done to help people suffering the misery of EDS, and will she agree to meet some sufferers to discuss the matter further?

I am certainly very happy to talk to my hon. Friend about his particular constituents. I am aware of the work that he has done in his local area. He will be interested to know that in 2013 the Government published “The UK Strategy for Rare Diseases” precisely to address such issues and the complexities around them, and aspects of that strategy speak directly to the challenges that he has just outlined. May I also take this opportunity to mention that there is an event tomorrow in Parliament organised by Rare Disease UK to mark rare disease day, at which the Under-Secretary of State for Women and Equalities, my hon. Friend the Member for East Dunbartonshire (Jo Swinson), will be speaking?

Palliative Care

15. What estimate he has made of the number of admissions to A & E in the last three years for patients with palliative care needs in (a) areas with a 24-hour palliative care helpline or palliative co-ordination centre and (b) areas that do not offer such services; and if he will make a statement. (907658)

We know from local examples that areas that offer 24/7 community palliative care services have been able to reduce the number of A and E attendances and inappropriate hospital admissions, including emergency admissions, for people with palliative care needs. I would encourage all areas to offer these services in line with the NICE quality standard.

A poll conducted by Sue Ryder shows that 82% of people expect advice to be available 24/7, yet only 8% of CCG areas have a dedicated around-the-clock palliative care helpline and co-ordination centre. As I am sure we all agree, carers do wonderful work and need as much support as possible. Will my right hon. Friend’s Department work with Sue Ryder and others to ensure that there is a dedicated 24/7 palliative care service, which would certainly help to take the strain away from A and E, which is already under great pressure?

I pay tribute to the professionals in my hon. Friend’s area, which is one of the leading areas for providing strong support in the community, which prevents unnecessary hospital admissions. I am very happy to work with Sue Ryder and others to try to get the message across that if this can be provided throughout the country we will improve the experience of people at the end of life, but critically also save costs further down the line by stopping inappropriate hospital admissions.

Mental Health

I feel no sense of tedium but almost a state of ecstasy upon calling the right hon. Gentleman. If I gave any other impression, I most heartily apologise to him. I hope that he is now assured of his status in the affections of the Chair, if, possibly, also of the House? There might have to be a Division on that proposition. I do not know.

I am so grateful to be reassured, Mr Speaker.

Mental health is a priority for this Government. We have legislated for parity of esteem between mental and physical health, invested £400 million in talking therapies, significantly reduced the numbers of people who are placed in police cells during mental health crises and are introducing the first waiting times standards for mental health services from April this year.

I recently met a constituent at one of my advice surgeries who had been refused NHS mental health care because she was told that she was entitled to only one batch of free support. Considering how complicated and varied mental health issues can be, is there anything we can do for people who need more support after a relapse of mental ill health?

If that was the advice the hon. Lady’s constituent received, it is complete and utter nonsense. The idea that someone can have only one episode of care under the NHS is so ridiculous that it hardly merits a proper response. I urge her to encourage her constituent, with her support, to go back to those local services and ensure that she gets further support if she needs it, as she is entitled to it.

Community Hospitals

Community hospitals can play a hugely important role in the 21st-century NHS. The NHS “Five Year Forward View” explicitly recognised the role of smaller hospitals, including community hospitals, as part of the new care models towards which we need to evolve. Specific local commissioning decisions are rightly taken by local clinical commissioning groups, reflecting local need.

We have excellent hospitals in Tiverton, Honiton, Axminster and Seaton, and there could be a much greater link between them and the Royal Devon and Exeter NHS Foundation Trust. For example, patients could be moved to the community hospital in Axminster after acute operations, thereby creating space at the RD and E and keeping Axminster hospital open with beds, which the population is keen to see.

I pay tribute to my hon. Friend for his tireless work on this matter. I know that he recently met the Secretary of State to discuss it and that he has been very active locally and here in Parliament. He is right that local community hospitals can play a key role in supporting patient convalescence, providing particularly good care in the community close to home, which is convenient for elderly patients, and relieving pressure on acute hospital beds. You do not have to take it from me, Mr Speaker; take it from Simon Stevens, the chief executive of NHS England. He recently said:

“A number of other countries have found it possible to run viable local hospitals serving smaller communities than sometimes we think are sustainable in the NHS…The NHS needs to abandon a fixation with ‘mass centralisation’”.

I hugely welcome that.

Confidentiality Agreements

18. With reference to the recent Francis report, if he will investigate (a) the case of Meirion Thomas at the Royal Marsden hospital and (b) cases where staff have been disciplined or required to sign confidentiality agreements. (907661)

The Government welcome any individual who has the courage to shine a light on malpractice, wrongdoing or patient safety issues in the NHS, and the House will be well aware that that is something the Secretary of State has very much championed. Professor Thomas has a right to express his views on the health service and on wider issues, and I understand that the trust has confirmed that. The Department is not responsible for investigating cases involving individual members of staff, but I want to be clear that confidentiality agreements cannot be used to prevent individuals from making a protected disclosure in the public interest.

I am glad to hear that, and I note that the Secretary of State has had dealings with Professor Thomas. However, I think it is very important that this is looked at closely in the light of the Francis report. If it is the case, as is said in media reports, that Professor Thomas has been forced to sign a confidentiality agreement—a so-called gagging order—I think that is disgraceful and shows a very dire state in the NHS in the Royal Marsden. Perhaps the Minister would like to comment on that.

I can only reiterate this Government’s complete commitment to openness when it comes to patient safety and say again that confidentiality agreements cannot be used to prevent individuals from making a protected disclosure in the public interest.

NHS (West London)

Clinicians in west London are leading a process that is very much aimed at improving services for people in west London. As the hon. Gentleman is well aware, the local NHS is pressing ahead with the implementation of service improvements as part of the clinically led reconfiguration programme, “Shaping a healthier future”.

The Minister does not sound very convinced by that herself. I wonder whether she saw the comments from the College of Emergency Medicine yesterday, which said that attempts to dissuade people from going to A and E have been a dismal failure and that what we should do is locate primary care services alongside A and E. That is the model we have at Charing Cross hospital and in the rest of west London, and it is succeeding. What is failing is the closure of emergency departments, which is creating an intolerable strain. Will the Government look again at the issue? Will you stop closing A and Es in west London?

I am afraid that the hon. Gentleman has a dismal track record of campaigning on this issue. We have all seen the leaflets being put out in west London. I can only say to his constituents that in the run-up to the election they would glean more from reading their tea leaves than from reading his leaflets if they want to know the truth about the NHS in west London.

Topical Questions

At the end of this Parliament, and before returning, I trust, to the same side of this Chamber in late May, I am pleased to update the House on NHS work force numbers. On the back of a strong economy, our NHS now has more doctors, nurses and midwives than ever before in its history, including 7,500 more nurses and 9,500 more doctors. The result is 9 million more operations during this Parliament than the previous Parliament, fewer people waiting a long time for their operations, and a start in putting right the scandal of short-staffed wards that we inherited and were highlighted by the Francis report. Indeed, last year the Commonwealth Fund said that under this Government the NHS has become the safest, most patient-centred and overall best health care system in any major country.

Let me point out that topical questions and answers should be brief. It is a rank discourtesy—[Interruption.] Order. It is a rank discourtesy to the House to expatiate at length and thereby to deny other Members the chance to put their questions. It will not happen. Simple, short, factual answers are what is required.

In the past couple of days, a number of Devon and Cornwall hospitals have declared black alert status, meaning, essentially, that they are full and cannot cope with any more demand. Do Ministers therefore understand the public concern that the clinical commissioning group is considering closing beds in community hospitals, including Ilfracombe and South Molton in my constituency? Can anything more be done to help rural health economies that are trying to restructure but already struggling to cope with existing demand?

We do understand those concerns. It is absolutely essential that CCGs make sure that they have the right bed capacity to deal with the pressures of winters.

Let me take the Secretary of State back to a subject he likes to avoid—NHS privatisation. He tries to deny that it is happening on his watch, but we heard earlier about the ideological privatisation of cancer scanning in Cheshire and Staffordshire, despite its being more expensive than the NHS bid—and now it could get much worse. On the Friday before the recess, the Government sneaked out the public contracts regulations, which require NHS contracts worth over €750,000 to be opened up to full EU competition. Will the Secretary of State confirm that that is indeed the case in these regulations, and can he explain what mandate he has from the public to open up the NHS to private bidders across Europe?

Since the last time the right hon. Gentleman and I met, the King’s Fund has published its assessment of the NHS reforms over the past few years, and its words were:

“Claims of mass NHS privatisation were and are exaggerated”.

He knows perfectly well that outsourcing grew at double the rate under the previous Labour Government than it has grown under this Government.

The King’s Fund report said that as a result of the Secretary of State’s reforms there is

“greater marketisation of the NHS”.

People will notice that he failed to answer my question. That is because he wants to sneak these plans through under the radar. I serve notice on him today that we will fight him all the way, right to the very last day of this Parliament. If passed, these regulations will mean that almost every NHS contract will be forced to be advertised across Europe, shattering the promise he made to protect the NHS from EU competition law. Is it not now abundantly clear that he has forfeited the public’s trust on the NHS, and that five more years of this Government will lead to huge acceleration in NHS privatisation?

I repeat:

“Claims of mass NHS privatisation were and are exaggerated”.

If the right hon. Gentleman does not like the reforms, let us look at a country that did not have them—Wales. The number of people waiting too long for A and E is nearly double that in England, the number of people waiting too long for urgent ambulances is nearly double that in England, and the number of people waiting for operations is 10 times that in England. That is our record—it is a record of success.

T3. Not enough GPs want to practise in rural Wales. I am told that one of the reasons is that GPs registered in England have to go through a bureaucratic process to be able to work in Wales. Will my hon. Friend the Minister work with the Welsh Government to ensure that we have a common registration process so that GPs can move between England and Wales without having lengthy, time-wasting new bureaucracy? (907720)

I am very happy to look into that issue and to do what we can to support our NHS work force to move as freely as possible between England, Scotland, Wales and Northern Ireland. GP numbers in England have increased because we have protected the NHS budget, unlike in Wales, where it has been cut by the Labour Administration.

T2. A recent Ashcroft poll shows that only 15% of the public think that this Government have the best approach to running the NHS. Will the Secretary of State stand up at the Dispatch Box and apologise for his top-down reorganisation of the NHS and his Tory privatising Health and Social Care Act, and accept that the public will never trust the Tories with the NHS? (907719)

I will tell the hon. Gentleman what the public think about the NHS: last year, under this Government, dissatisfaction was at its lowest ever level and satisfaction jumped the highest among Labour voters. And where did satisfaction go down? In Wales.

T5. I have previously made Ministers aware that there are no beds for females in Dorset who need intensive psychiatric care. Our local newspaper, the Daily Echo, reports that such places will not be provided in Dorset for another three years. Meanwhile, patients are being sent as far away as Bradford. Do Ministers regard that as satisfactory? Are there enough resources coming to Dorset, or is it a local organisational issue? (907723)

No, I do not regard that as satisfactory and I am happy to talk to the local commissioners. We have ensured that there will be real-terms increases in mental health funding for 2015-16, and that should be regarded locally as a matter of urgency.

T6. Bolton’s accident and emergency department has been in crisis recently, partly because the clinical commissioning group closed the town’s walk-in centre. Will the Secretary of State support my petition calling for its reinstatement, or will he say, more predictably, “It’s not me, guv; I’m just the Secretary of State for Health”? (907724)

I am accountable for what happens in the NHS, so let me tell the hon. Gentleman what is actually happening in Bolton: compared with four years ago, 2,756 more people are being seen at A and E within four hours. That is a record of investment and success.

What alternatives do clinical commissioning groups have to a full-scale commercial procurement when their existing contracts for community health services approach the time when they have run their course?

That is a matter for local commissioners. There is no requirement on them to tender competitively if their judgment is that it is right for the local community that services remain with the existing provider. We have been very clear that that is a matter for local commissioners.

T7. My constituent Wilma Ord was prescribed Primodos in the 1970s, an oral hormone pregnancy testing pill that she blames for her daughter’s birth defects. As the Secretary of State is aware, it was announced back in October that an inquiry would be established to look into the whole issue. What progress has been made in setting up the inquiry and what assurances can he give my constituent, and the many other women and families affected throughout the country, that the inquiry will be fully comprehensive, transparent and independent? (907725)

I am delighted to report that I have met colleagues from across the House and patient representatives of that campaign on a number of occasions. We have appointed the chair and made sure that the terms of reference for the inquiry are clear and comprehensive. It is not, I stress, a judicial inquiry; it is a medical inquiry looking at the evidence.[Official Report, 19 March 2015, Vol. 594, c. 1MC.]

A constituent of mine has pointed out that, despite it being a long-term condition, drugs for cystic fibrosis are not subject to an exemption from prescription charges, apparently because, when it was first diagnosed, it was considered to be only a children’s disease. Will Ministers look into this anomaly?

This issue came up in a debate on cystic fibrosis last year and I am very happy to look at it again. I looked at it subsequent to that debate, in response to an inquiry from, I think, the hon. Member for Colchester (Sir Bob Russell), but I am happy to look at it again and get back to my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton).

T8. When I asked the Minister last June what guarantees he would give to GP practices at risk because of the withdrawal of the minimum practice income guarantee, I was told that NHS England would ensure threatened practices “get to the right place.”—[Official Report, 10 June 2014; Vol. 582, c. 400.]Over the past seven months, those discussions have not alleviated the threat to two highly regarded practices in my constituency that face closure. Will the Minister agree to meet me and representatives of the practices to discuss what is really happening, and to consider what can be done to save them? (907726)

I am very happy to meet the hon. Gentleman, but he will be aware that the move away from the historical funding formula towards a per head or capitation formula is a move in the right direction. If there are certain local concerns, I am very happy to meet him to discuss them.

May I commend the Government on raising the priority for dementia in their announcement last week? Will the Secretary of State and the Department of Health put all their resources behind towns such as Newark, which are trying to establish themselves as dementia-friendly towns and are working with shopkeepers, banks and the business community to make it easier for older people with dementia to lead fulfilling lives?

I commend my hon. Friend on his work in that area. People with dementia want to lead as normal a life as possible, and being able to go out to the shops is one very important thing they want to continue to do. We now have 1 million dementia friends in this country. That is a great step forward, and with his help we will do even more.

When does the Secretary of State expect NHS England to confirm a date for the national tariff for the supply of prosthetic services and equipment? The lengthy and, quite frankly, unacceptable delay on his watch is now causing really serious issues for those who need prosthetics, as well as for those who want to deliver the services.

In addition to the work that Monitor does on tariffs for individual pathways, what work has it done to assess the base funding that acute hospitals need to maintain core services, which are so interdependent?

Monitor has done extensive work on this issue, but my hon. Friend is absolutely right to talk about it. If we are to meet the financial challenge that the NHS faces over the next five years, we need to have a very sensible discussion about what realistic efficiency gains need to be made, and I am sure that he will engage in those discussions.

Medway clinical commissioning group is looking at putting GPs at the front of our accident and emergency department to help relieve pressures on emergency doctors. Do Ministers believe that that is a promising way forward?

There is certainly a lot of benefit from having general practice co-located alongside A and E so that people with more minor ailments or concerns can be seen by GPs. That can often take the pressure off A and E services, but more senior expertise is also on hand when required.

I am absolutely happy to do that. Overall, we have 1,000 avoidable deaths every month by some estimates, and a number of those are from sepsis. We have launched a big campaign to prevent those deaths. Indeed, we will shortly have the results of the Morecambe Bay inquiry, from which I think we will hear more about the issue. I want to thank my hon. Friend for her campaigning and her work with the all-party group on sepsis to raise awareness of this very important issue.

GPs across the north-east say that they are facing a work force crisis, with falling numbers of family doctors. Does the Secretary of State not recognise the connection between people being unable to get an appointment to see their GP and the rising and major pressure on our A and E department?

I am sure that the hon. Lady would like to support the plans we have put in place to ensure that we increase the number of GPs by 2020, and to ensure that 50% of doctors leaving foundation training go into careers in general practice.

In order to combat fraud, the previous Government quite rightly introduced five-year prescription charge exemption certificates. Now that the certificates are coming up for renewal, people are finding that they have to pay for their medicines once their certificate has expired, and they have even been fined. Unlike for a TV licence, there is no renewal reminder. Will the Government look at how to ensure that people are told they need to renew their prescription exemption certificates?

As my hon. Friend will be aware, 90% of patients receive free prescriptions either because they are older—over the age of 60—or because of long-standing or other factors. If his constituents are running into difficulties and have problems with renewing their certificate, I am very happy to look into that and to meet him to discuss it further.

Despite assurance from the Prime Minister, it is now clear that the drug Translarna will not be available until after NHS England has concluded its internal consultations. The Secretary of State and others have told me repeatedly that they have no control over the issue, but can the Minister give the House any idea when the drug will be available for young boys suffering from Duchenne muscular dystrophy in this country, in the same way as it is across Europe? The drug is saving young boys from going into wheelchairs earlier. Does the Minister have any idea when it will be available?

I have had a number of meetings with patient groups, campaigners and charities over recent months, and the hon. Gentleman will appreciate that due process is important. NHS England is looking at whether to make an interim ruling on the drug in advance of a decision by the National Institute for Health and Care Excellence, and I have worked with NICE to ensure that its process is accelerated. We should get a decision from NICE this summer, and I hope that NHS England will make a rapid decision based on that judgment.

Order. I am sorry to disappoint remaining colleagues, but as usual demand has exceeded supply.