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Volume 596: debated on Tuesday 2 June 2015

The Secretary of State was asked—

Ambulance Waiting Times

As you said, Mr Speaker, we shall have those tributes tomorrow, but I should like very briefly to echo your comments, because I know that the whole House is shocked and deeply saddened by the umtimely passing of Charles Kennedy. He was a giant of his generation, loved and respected in all parts of the House. Our thoughts are particularly with Liberal Democrat Members who knew him well, and to whom he was a very good friend over many years. We shall all miss him as a brave and principled man who had the common touch, and who proved that it is possible to be passionate and committed without ever being bitter or bearing grudges. Our thoughts are with his whole family.

I can tell the hon. Member for South Shields (Mrs Lewell-Buck) that the ambulance service is performing well under a great deal of pressure. Although a number of national targets are not being met, the service is responding to a record number of calls, and is making a record number of journeys involving all categories of patients.

I echo the comments made about the late Member for Ross, Skye and Lochaber. He was one of the kindest Members of the House, and he will be greatly missed by many of us.

As for the Secretary of State’s response to my question, I think that his assessment was a bit off. When my constituent Malcolm Hodgson’s son-in-law broke his leg in a local park, he waited in agony for 50 minutes for an ambulance, and then waited a further five days for an operation. Can the Secretary of State explain how our ambulance and health services were allowed to fall into such a dire state over the past five years, and will he apologise to that young man for the delay and the pain that he suffered on the right hon. Gentleman’s watch?

I take responsibility for everything that happens on my watch. [Interruption.] I think it is a little early to ask the Secretary of State to resign—but maybe not. The ambulance service is under great pressure, but across the country we have 2,000 more paramedics than five years ago, we are recruiting an additional 1,700 over the next few years, and from March this year, compared with March the previous year, the most urgent calls—the category A red 1 calls—went up by 24% and the ambulance service answered nearly 2,000 more calls within the eight-minute period. There is a lot of pressure, we have a plan to deal with it, but we need to give credit to the ambulance service for its hard work.

I stood against Charles Kennedy in 1992 in Ross, Cromarty and Skye and will take the opportunity tomorrow of remembering what a very happy occasion it was and how very glad I was to lose to Charles at that election.

I strongly opposed the creation of the South Western Ambulance Service because I believed the Wiltshire Ambulance Service did a better job on its own. I know the Secretary of State has been monitoring the calls received by the South Western Ambulance Service—one of the two trial areas. Will he tell the House whether response times in the south-west have improved or got worse in recent years?

NHS England will be updating the House on the results of that trial. It was a very important trial because it was designed to stop the dispatch of ambulances to people who did not need one within eight minutes, in order to make sure ambulances were available for people who did need one. South Western was very helpful in taking part in that trial and we will update the House shortly on the results of it.

Yesterday 400 people in my region expected to begin a paramedics course put on by the East of England Ambulance Service only to discover that there is no course and they are now £4,000 out of pocket. That is because the University of East Anglia and Anglia Ruskin University could not get accreditation for the courses. Does the Secretary of State think this event is going to help the ambulance service in the east of England where staff are already overwhelmed? It is a critical service—a vital service. Does he think this will contribute to hitting those targets, which at the moment are being inadequately met?

I welcome the hon. Gentleman to his place. It is important that we train more paramedics. It is one of the most challenging jobs in the NHS and I will take up the issue he raises with the Secretary of State for Business, Innovation and Skills to understand precisely what the problem was and to try to resolve it as quickly as possible.

Will the Secretary of State consider reviewing the protocol, which is unique to the ambulance service in terms of our emergency services, that breaks cannot be broken into even if there is a category A incident in the area? We had the loss of a young man in Berwick recently; the ambulance which was in post in the ambulance station a mere four minutes down the road was not called and the boy died. That is the cause of enormous distress across the rural areas of Northumberland.

I welcome my hon. Friend to her place as someone who campaigned a great deal on health issues while she was a parliamentary candidate; it is wonderful to see her here. That is a tragic case and we need to look at those rules. I will take that up and see what we can do.

Translarna (Duchenne Muscular Dystrophy)

2. When he expects NHS England to reach a decision on access to Translarna for the treatment of Duchenne muscular dystrophy; and if he will make a statement. (900001)

11. When he expects NHS England to reach a decision on access to Translarna for the treatment of Duchenne muscular dystrophy; and if he will make a statement. (900011)

NHS England is considering the interim commissioning position for Translarna as part of its wider prioritisation process for funding in 2015-16 and expects to come to a decision by the end of this month. Translarna has also been referred for evaluation by the National Institute for Health and Care Excellence’s highly specialised technologies programme. Draft NICE guidance will be available later this year, with final guidance expected in February 2016.

I thank the Minister for that response and welcome him to his place. Yesterday my constituent Jules Geary came to see me regarding her son Jagger, who suffers from Duchenne muscular dystrophy. Jagger had been approved for Translarna treatment but then suddenly found that it had been withdrawn at the last moment. Like many other boys, he is now waiting, not knowing when a treatment that will prolong his mobility will be forthcoming. Will my hon. Friend meet me, Jules and Muscular Dystrophy UK to discuss how this process can be streamlined so that other children do not have to wait this long?

Muscular dystrophy is a terrible, debilitating illness and my sympathies go out to Jagger and his family. My hon. Friend will be aware that families and their representatives will be going to Downing Street on 10 June to make their representations on this matter. The Minister for Life Sciences has introduced an accelerated access review precisely because of the concerns that my hon. Friend has raised, and I know that he will welcome representations once it has been completed.

Is the Minister aware of the case of my constituent, little George Pegg? At one time he could not walk, but this drug has made his life 100% better and he can now walk. Why are we dithering? This has been going on for at least a year, so why don’t you get off that backside of yours and get it approved?

Order. May I just exhort Members to have some regard to considerations of taste? This is a new Minister. I call Minister Gummer.

I thank the hon. Gentleman for his question. In relation to posteriors, it is good to see his in its rightful place. I have heard of his constituent’s case, which is as distressing as that of Jagger and of all those suffering from Duchenne muscular dystrophy. It is a terrible disease that causes lasting pain to the sufferers and their families. That is precisely why we are pushing hard for a decision from NHS England by the end of this month—it could not have come as quick as he had hoped—and for interim NICE guidance by the end of this year. I am pushing officials to move as quickly as they can on this.

The reality is that NHS England has failed to respond to letters or to turn up for meetings, and it has behaved in an utterly unaccountable manner in regard not only to Translarna but to Vimizim, which is used to treat Morquio syndrome. We have still not had confirmation that an interim decision will be made on 25 June, but we are now being told that there will be a decision from NICE on 5 June. Will Ministers finally get a grip on this and give the families affected by these various conditions some sense of when they might get the treatment that could improve their quality of life?

I am sorry to hear that the hon. Gentleman has had that experience with NHS England. My hon. Friend the Minister for Life Sciences will want to speak to him about that; if it is the case, it is clearly unacceptable. As the hon. Gentleman will have heard from my previous answer, we are hoping to get quick decisions from NHS England on the interim commissioning guidance this month, and I am pushing hard for a decision from NICE as soon as possible this year, so that we can get interim guidance from it.

Mid Staffordshire NHS Foundation Trust

3. What progress he has made on the implementation of the trust special administrators’ proposals following the dissolution of Mid Staffordshire NHS Foundation Trust. (900003)

We are putting the terrible tragedy of the old Mid Staffs behind us, and I congratulate my hon. Friend and the staff at the hospital on their superb efforts under a great deal of pressure. We are also investing over £300 million in the Staffordshire health economy, and the local trust and commissioners are making good progress on implementing the recommendations made by the trust special administrators.

I thank my right hon. Friend for his reply. He will have seen the reports over the weekend on the severe pressure on accident and emergency services at the Royal Stoke University hospital, while Stafford’s County hospital A&E often meets the 95% four-hour target. The trust special administrators assured us that the Royal Stoke would have the capacity to cope with additional patients from Stoke and Stafford. Given that that is not the case, will the Secretary of State ensure that A&E in Stafford is reopened to operate 24/7 as soon as is clinically possible?

I share my hon. Friend’s concern about what is happening at the Royal Stoke. Some of the care there was totally unacceptable; there should be no 12-hour trolley waits anywhere in the NHS. I have said that I support a full 24/7 A&E service at County hospital as soon as we can find a way of doing it that is clinically safe, and I will certainly work hard to do everything I can to make that happen.

Will the Secretary of State ensure that other local hospitals, such as the Manor hospital, which have had to take up the slack following the closure of A&E and maternity services also get some support?

We absolutely will take a whole health economy view of that, and look at all hospitals that are affected by the changes.

Administrative Burdens (GPs)

Before I respond, I should like to thank my two predecessors, who have covered most of this portfolio: my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) and the right hon. Member for North Norfolk (Norman Lamb). They have given me a firm foundation on which to build, and I am grateful to them for their work in the Department. Reducing the burden of administration on GPs is important to all of us in the Government. We have already cut the quality and outcomes framework by more than a third to help reduce administration, but we are looking for ways to do more because we recognise that this is a significant problem.

Let me take this opportunity to welcome my right hon. Friend back to the Front Bench. I know that he will want to spend a lot of time in GP surgeries, and we look forward to welcoming him to Lincolnshire in due course.

I want to ask him about the use of information technology and computers during consultations with GPs. I am told by a GP in my constituency that so much time is spent collecting data and inputting them into the computer that there is a loss of focus on the patient, with a possible detriment to patient care. Will my right hon. Friend undertake to look into that and to come to the House in due course to say what can be done to ensure that, during every GP consultation, the focus is always on the patient and not on the computer?

Notwithstanding the importance of recording information collected during a consultation, my hon. and learned Friend’s constituent is absolutely right that it should not get in the way of the relationship between doctor and patient. We have already removed some of the administrative burdens by cutting a third of the quality and outcomes framework indicators that need to be recorded, but plainly more needs to be done. He is right to say that I am looking forward to seeing quite a lot of GP surgeries in the forthcoming months.

I welcome the Minister to the Dispatch Box. Does he think that the community pharmacy could help in great ways with the proper integrated care of patients so that the burden on GP surgeries is shared with other health professionals?

Yes, the whole concept of out-of-hospital care involves an expansion of what is considered to be direct primary care, and it also involves other support services. I am aware of projects in which pharmacies are already connected directly to GP surgeries. We will be expanding some of the pilot work that has already been done. If my Twitter account is anything to go by, pharmacies are very keen to promote themselves and say what they can do for patients, and we will certainly be responding.

Will the Minister pass on my thanks to the Secretary of State for visiting a GP surgery in my constituency in April? Will the Minister assure the House that during his tenure he will continue to visit GPs and to spread examples of good practice to other GPs who may have room for improvement?

I thank my hon. Friend for his question, and the Secretary of State will have picked up his thanks for the visit. Seeing GPs is really important. I will let the House into something that I am likely to say again, which is that my dad is a GP. I pay tribute to him, as he has just passed his 93rd birthday. I thank him and all other GPs for their devotion to practice and to looking after people so well. They are a vital part of the service. I will be keen and rather soft on GPs. I want to see them enjoy their profession as much as my father has enjoyed his.

I welcome the hon. Lady to her place. Briefly, there is a £1 billion fund to improve, over the next five years, GP surgeries and premises and access to GP practices. It is an important part of the process of improving access to GPs, which is good not only for patients but for GPs, who can feel fully engaged in their work without being overburdened. This support should certainly help.

Dementia Diagnosis and Care

Following a sustained effort to improve dementia diagnosis rates in the last Parliament I am pleased to report that in England we now diagnose 61.6% of those with dementia, which we believe is the highest diagnosis rate in the world. But there is much work to be done to make sure that the quality of dementia care post diagnosis is as consistent as it should be.

I thank my right hon. Friend for his answer. A long-standing Weaver Vale constituent, Mrs Gladys Archer, successfully looked after her husband for many, many years at home until he was admitted to hospital for a routine operation. Following a misdiagnosis, he has had to go into a care home with all the personal cost and trials and tribulations that that involves. Will my right hon. Friend look into that case, and highlight what measures are in place and how we can improve matters so that we can stop patients with Alzheimer’s or dementia suffering when they are admitted to hospital?

I thank my hon. Friend for raising that case and I will happily look into it. That is a perfect example of why we need to change the way we look after people with long-term conditions, such as dementia, out of hospital. If we can improve the care that we give them at home and give better support to people such as that man’s wife, we can ensure that the kind of tragedy my hon. Friend talks about does not happen.

Unpaid family carers play a key role in the care of people with dementia, many with heavy caring workloads of 60 hours a week or more. Can the Health Secretary understand how fearful carers now are of talk of cutting their eligibility for carer’s allowance and will he fight any moves within his Government to do that?

I absolutely recognise the vital role that carers play and will continue to play, because we will have 1 million more over-70s by the end of this Parliament, and we need to support them. I hope that she will recognise that we made good progress in the previous Parliament with the Care Act 2014, which gave carers new rights that they did not have before.

18. Two weeks ago, it was dementia friendly care week and I had the pleasure of spending a part of that at a picnic in the village of Corfe Mullen in Mid Dorset and North Poole. Does my right hon. Friend agree that although much progress has been made in diagnosis, there is still a long way to go in terms of care, especially for those individuals in Mid Dorset and North Poole? (900020)

I welcome my hon. Friend warmly to his place; he hits the nail on the head. We had a big problem with diagnosis—less than half of the people who had dementia were getting a diagnosis—and we have made progress on that. It is still the case that in some parts of the country, although I hope not in Mid Dorset, when someone gets a diagnosis not a great deal happens. We need to change that, because getting that support is how we will avoid tragedies such as that in Weaver Vale, which we heard about earlier.

The Secretary of State knows that the availability of social care for vulnerable older people has a big impact on the NHS, especially for people with dementia, yet 300,000 fewer older people are getting help compared with 2010. Given that the Secretary of State has said that he wants to make improving out-of-hospital care his personal priority, can he confirm that there will be no further cuts to adult social care during this Parliament, which would only put the NHS under even more pressure?

I can confirm that we agree with the hon. Gentleman and the Opposition that we must consider adult social care provision alongside NHS provision. The two are very closely linked and have a big impact on each other. I obviously cannot give him the details of the spending settlement now, but we will take full account of that interrelationship and recognise the importance of the integration of health and social care that needs to happen at pace in this Parliament.

Emergency Medicine (Doctor Recruitment)

6. What recent discussions his Department has had with the Royal College of Emergency Medicine on the recruitment of additional middle-grade doctors for NHS hospitals. (900006)

The Secretary of State meets the Royal College of Emergency Medicine on a regular basis. The number of middle-grade emergency medicine doctors has increased by 24% since May 2010. Health Education England is working with the RCEM further to strengthen the workforce to ensure that patients receive high quality care.

I thank the Minister for his response, but I disagree with him. There is a shortage of middle-grade accident and emergency doctors. When will the next recruitment of such doctors take place in the Indian subcontinent and elsewhere and have all the Home Office regulations and impediments been resolved to allow the recruitment to take place?

I should make it clear first that, for the hon. Lady’s constituents, we have no say over the control of the health service in Northern Ireland. We have seen an increase of 24% in middle-grade doctors in the English health service and, as I have said, we have seen an increase in all doctors in emergency medicine of 25%. That is a considerable increase in an area that has been difficult to recruit to for a very long time. The Government made a difference in our previous incarnation and we will continue to do so.

I welcome my hon. Friend to his place and wish him well. Is he aware that when the Select Committee on Health considered emergency care and took evidence from the Royal College of Emergency Medicine in the last Parliament it was clear that there was a perception among doctors that this was not as attractive as other specialties and that that is a serious problem? What is he going to do about it?

I thank my hon. Friend for bringing that to my attention. I was not aware of it and it is certainly something I shall consider. There are several specialties in the NHS where this is a problem and I shall be addressing that as I review the workforce in the years to come.

Of course the Minister knows that his problem is not just recruitment; it is also retention. In that context, is he planning to make greater use of physicians’ assistants?

GP Surgeries

The Government have committed to make sure GPs can be accessed when needed seven days a week, ensuring that people are able to access primary medical care when they need to.

This is already being rolled out through the GP access fund, which will enable 18 million patients to benefit from improved access to their local GP, including extended hours, telephone or Skype consultations.

Does the Secretary of State agree that the news he brings will be of great comfort to elderly people in particular, but in addition the signposting of people towards GPs rather than acute hospitals will be very important and a very useful addition to our policy?

My hon. Friend makes an important point. It is partly the availability of services seven days a week, which we need to provide because illnesses do not happen on only five days a week and we need to respond to changing consumer expectations; but it is also about the signposting. That is absolutely critical, so that people know where to go and do not overburden A&E departments, which should be there for real emergencies.

The right hon. Gentleman talks about access to GPs. Will he wait a moment and think about Islington South, where this month we have three GP surgeries closing because our GPs have all resigned? Given the changes in the funding formula that this Government have overseen, will he meet a group of inner-London MPs to talk about our grave concerns about the change to funding and the lack of resources available to GPs?

I am happy to ensure that inner-London MPs have a meeting with the Minister to discuss those issues. The underfunding of general practice has been an historical problem, because we have had very strong hospital targets, which have tended to suck resources into the acute sector and away from out-of-hospital care. We want to put that right.

The problem in Northamptonshire is that because of rapid population growth, the gap between the appointments required of GP surgeries and the slots available is one of the biggest in the country. There are 333 Northamptonshire GPs at the moment; Healthwatch Northamptonshire estimates that another 183 will be required within the next five years. How are we going to fill that gap?

My hon. Friend is absolutely right to draw attention to that issue. We have plans to train another 5,000 GPs across the country. In the last Parliament, we increased GPs by about 5%. We need to go much further, as part of a real transformation of out-of-hospital care.

How does the Minister intend to find the 5,000 extra GPs when many surgeries throughout the United Kingdom cannot fill the spaces that they have, and how does he plan to fund it? The proposals appear to only fund the setting up of seven-day-a-week, 8 till 8 GP services and not running costs—and these are big running costs.

I welcome the hon. Lady to her place. We do need to find these extra GPs and we will do that by looking at GPs’ terms and conditions. We need to deal with the issue of burnout because many GPs are working very hard. We also need to raise standards in general practice. In the previous Parliament, an Ofsted-style regime was introduced, which is designed to ensure that we encourage the highest standards in general practice. That is good for patients but also, in the long run, good for GPs as well.

Just so that the Secretary of State is aware, it takes 10 years to produce a GP, so that will not be an immediate response. The £8 billion that the Conservatives have suggested they will add by 2020 was just to stand still, not to fund a huge expansion, and as change, which the NHS requires, costs money, can the Secretary of State perhaps give us an indication of what extra we may expect in the next two years?

Well, I can, but may I gently say that under this Government and under the coalition we increased the proportion of money going into the health budget, whereas the Scottish National party decreased the proportion of money going into the NHS in Scotland? The £8 billion is what the NHS asked for to transform services, and that will have an impact, meaning that more money is available for the NHS in Scotland. I hope the SNP will actually spend it on the NHS and not elsewhere.

I thank the Secretary of State for personally intervening to enable the Ilex View medical centre in Rawtenstall to open for longer hours, despite that being precluded under its private finance initiative lease of that building. Will he update the House on what steps can be taken to ensure that where GPs are in a building that is subject to a PFI lease, he will be able to intervene to ensure that they can truly open seven days a week and for extended hours?

This is one of the main reasons why the Chancellor allocated £1 billion to modernise primary care facilities in the autumn statement. We recognise that many GP premises are simply not fit for purpose. If we are going to transform out-of-hospital care, we need to find ways to help GPs move to better premises, to link up with other GP practices, and that will be a major priority for this Parliament.

The 2010 Conservative manifesto promised every patient seven-day GP access from 8 am to 8 pm, but access has got worse and almost half of all patients now say they cannot see a GP in the evenings or at weekends. Five years on, the Conservatives made the exact same promise. Can the Secretary of State tell us why he has failed?

I welcome the hon. Lady back to her place, although I know she hopes it will be for only a brief time, and say to her that we have not failed. We made very good progress delivering seven-day access to GP surgeries for nearly 10 million people during the last Parliament, and we have committed to extending that to everyone during this Parliament. I think the hon. Lady said that what is right is what works, and what works is having a strong economy so we can put funding into the NHS that will mean more GPs.

Keogh Review

8. What effect the implementation of the Keogh urgent and emergency care review will have on type 1 A&E departments in England. (900008)

The Keogh review is all about responding to the long-term challenges facing the NHS, many of which we have already discussed in this Question Time. The implementation of the recommendations of the Keogh review will improve urgent and emergency care services and ensure patients get the right care in the right place.

The “Shaping a healthier future” programme in north-west London, which is seen as a prototype for Keogh in closing or downgrading A&Es, is causing great concern, from the tragic death of Guy Bessant reported yesterday to the more than £20 million spent on external consultants last year. Eleven west London MPs would like to meet the Secretary of State and, I hope, the Under-Secretary, to discuss those concerns. Will they agree to meet us?

I read of the tragic death of that gentleman, who was a Wandsworth resident. Our hearts go out to his family.

As the hon. Gentleman knows, “Shaping a healthier future” is a clinically led programme supported by all eight clinical commissioning groups in the area and all nine medical directors of the trusts involved. There are no plans to make changes to A&E services at Ealing hospital, contrary to what was put about during the election, but I recognise that this is the subject of ongoing concern. All the recommendations of the Keogh review are entirely driven by one thing, which is putting patients and patient safety first, but I am happy to meet him and his colleagues to discuss it.

In implementing the Keogh review, will the Minister also consider the impact on our community hospital minor injuries units, given the difficulties they are facing in staff recruitment? Will she meet me to discuss the difficulties facing Dartmouth community hospital? There are wider implications for the rest of the country.

I think I have some sense of the difficulties my hon. Friend describes from previous meetings, but I am of course happy to talk to her about that. All these things are important, but as I say, the driving principles behind the Keogh review are patient safety and making sure that people get the best and most appropriate urgent and emergency care.

Hospice Funding

Adult voluntary sector hospices in England receive, on average, about a third of their running costs from the NHS. Although this amount varies for individual hospices and it is a locally commissioned service, the level of funding has remained broadly stable.

I delighted that my right hon. Friend is back on the Front Bench. He will know that hospices up and down the country, such as Willen hospice in Milton Keynes, do a marvellous job in caring for terminally ill patients and their families, yet they have an annual struggle to raise money from local communities to support their work. Will he assure me that he will do all he can to maximise the direct funding that hospices receive from the NHS?

I thank my hon. Friend for raising this subject. He is absolutely right: Willen hospice in his constituency, next door to mine, has an excellent reputation, as does St John’s hospice in Moggerhanger in my constituency. We are all indebted to hospices for the invaluable work they do. I am sure that he and the House will be interested to hear that, from April, there will be pilot projects working on a new funding formula for palliative care, with the aim of providing a fair and transparent process and improvements. I expect that there will be a report to the House in due course.

Does the Minister agree that there is a deeper ongoing problem in the financing of hospices? Kirkwood hospice in my constituency faces it all the time. Is it not about time we tackled long term the roots of the problem of funding hospices?

That is probably tied into the whole issue of end-of-life care. A review of that is going on, as the hon. Gentleman may be aware. End-of-life care is important. Choices for people about where they wish to end their days is very important, and the Choice review which reported recently, whose recommendations the Government are considering, will make further progress. Hospice funding is part of that, but we expect local commissioners to take notice of what hospices can provide for those in their area.

Diabetes Treatment

I welcome my hon. Friend to her place. Building on the national diabetes prevention programme, we are developing a comprehensive action plan to improve the outcomes of people with and at risk of diabetes.

I thank my hon. Friend for her excellent response. As she will know, diabetes can often lead to the amputation of a limb. Fareham, my constituency, has one of the highest rates of limb amputations in the country. Can my hon. Friend please explain how the NHS diabetes prevention programme will address this issue?

My hon. Friend raises an extremely important issue. I welcome the fact that she has so quickly got to grips with some of the key local health facts in her area. Hon. Members across the House can look at how their clinical commissioning group is performing in the national context. My hon. Friend is right to say that her CCG performs poorly when it comes to amputations. There is a huge opportunity for improving the outcomes for people if we can get the worst-performing CCGs in that context up to the standard of the best. The national diabetes prevention programme is very much about preventing people getting to the stage where those complications can cause such terrible problems.

13. May I join the Minister in congratulating the hon. Member for Fareham (Suella Fernandes) on her place in this House? She was a worthy opponent of mine in 2005 and I am glad she managed to get elected. On the national diabetes prevention programme, for those of us who have diabetes the issue is what is corporate Britain doing to work with the Government in order to reduce the amount of sugar and fat in food and drink? Unless we do that, we cannot tackle the diabetes crisis that we will face. (900015)

The right hon. Gentleman is quite right. Tackling obesity is one the great public health challenges of our age. Right across the developed world we are looking at all the things that are going on around the world—the new science and the new research. The right hon. Gentleman is right to say that industry has a role to play, as has every part of Government—national Government and local government—as well as families, GPs and the NHS. This will be a whole-nation approach to tackling obesity. We are working on our plans, which I look forward to discussing with him in due course.

Type 2 diabetes is costing our NHS £9 billion a year, and obesity, as we have heard, is the major risk factor. Does the Minister agree with the previous Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), who said the other week that

“Just taking a passive approach to”—


“is not going to work…we have to go further than we’ve gone up to now in the responsibility deal”?

Does the Minister agree and what more is she going to do about it?

I welcome the hon. Lady back to her place. It is good to see her back in that job and not on the Government Benches. It is far from the case that we took a passive approach—far from it. Some important things were learned from the way we have worked with industry and we are looking to build on those, but as I have said, there is no silver bullet. There is not a single academic study in the world that says that the way to respond to obesity in the developed world is through a single mechanism. We have to look at a whole-system approach, and that is what we are doing.

Hospital Trusts (Deficits)

12. What estimate he has made of the anticipated levels of deficits in hospital trusts for the current financial year. (900012)

The NHS faces significant financial challenges this year and beyond. That is why we have now committed £10 billion extra for the NHS—£2 billion for this year and at least £8 billion more by 2020. Individual trust plans for 2015-16 are still being worked up but, with concerted financial control from providers, we expect to deliver financial balance in 2015-16.

But does the Secretary of State accept that in trusts such as mine, which anticipates a £15 million deficit this year, that cannot be done without cuts to staff, beds and services? What happened to the Prime Minister’s pledge on a bare-knuckle fight to protect district general hospitals, when trusts such as mine are facing such circumstances?

I will tell the hon. Lady what has happened to the Prime Minister’s pledge to protect hospitals: an extra £10 billion that we have promised for the NHS, which her party refused to promise. Her local hospital has 88 more doctors since 2010, and it is doing an extra 2,000 operations for her constituents year in, year out. I will tell her what makes the deficit problem a lot worse: the heritage of the private finance initiative, which means £73 billion of debt that her party bequeathed to the NHS.

In 2004 the then Huntingdonshire primary care trust said that it would give Hinchingbrooke hospital a grant of £8 million towards the cost of a new PFI treatment centre. Shortly before the PCT’s demise, it changed without discussion the terms of the grant and made it a loan, which has since been treated in its accounts as a deficit. If I write to my right hon. Friend, will he look into that patently unfair treatment?

Of course. One of my biggest concerns is that many of the hospitals now facing huge deficits are seeing their situation made infinitely worse by PFI debt. We will continue to do everything we can to help hospitals deal with that.

On behalf of everyone on the Opposition Benches, I echo the Secretary of State’s warm tribute to Charles Kennedy. I cannot have been the only person this morning wondering why politics always seems to lose the people it needs most. Charles was warm, generous, genuine and principled. We will miss him greatly. We send our love and deepest sympathy to his family.

I congratulate the Secretary of State on his reappointment, but I commiserate with him on the financial position in the NHS that he inherits from himself. He told The Daily Telegraph today that the NHS has enough money, but that is not true. The deficit in the NHS last year was nearly £1 billion. Can he tell the House what the projected deficit is for the whole of the NHS for this year?

I welcome the right hon. Gentleman to his place. We have seen many feisty disagreements on health policy, and that is just in the shadow Health team. Perhaps he no longer believes his mantra about collaboration, not competition—we know that the shadow care Minister has disagreed with that for some time. To answer his question directly, there is a lot of financial pressure in the NHS, and that is because NHS hospitals took the right decision to respond to the Francis report into Mid Staffs by recruiting more staff to ensure that we ended the scandal of short-staffed wards. As a temporary measure it recruited a lot of agency staff, which has led to deficits, and that is what we are tackling with today’s announcement about banning the use of off-framework agreements for recruiting agency staff.

It is a new Parliament, but there are the same non-answers from the Secretary of State. He did not answer; he never does. I will give him the answer: NHS providers are predicting the deficit to double this year to more than £2 billion. Why has financial discipline been lost on his watch? It is because early in the previous Parliament the Government cut 6,000 nursing posts. They cut nurse training places and, when the Francis report came out, they left hospitals with nowhere to turn other than private staffing agencies. The Bill for agency nurses has gone up by 150% on his watch. He even admitted on the radio this morning that it was a mess of their making. Will he now apologise for this monumental waste of NHS resources and get our hospitals out of the grip of private staffing agencies by recruiting the 20,000 nurses that the NHS needs?

I have here the figures on nurse training placements, which started to go down in 2009-10, by nearly 1,000. Who was Secretary of State at the time? I think it was the right hon. Gentleman. [Interruption.] I have the figures here, and they show that planned nurse training places went down from 21,337 to 20,327. He talks about apologies, but where is the apology for what happened at Mid Staffs, which led to hospitals having to recruit so many staff so quickly? That is the real tragedy, and that is what this Government are sorting out.


May I give my hon. Friend a particularly warm welcome to her place? NHS England routinely commissions eculizumab for the treatment of paroxysmal nocturnal haemoglobinuria, or PNH, and atypical haemolytic uraemic syndrome, or aHUS, as the drug is proven to be safe and effective in treating these conditions.

I very much welcome the statement last week from the Prime Minister in which he requests NHS England to look into the case of my constituent, 12-year-old Abi Longfellow. I am sure that gives great hope to Abi’s family. Abi has a rarer form of DDD—dense deposit disease—involving the alternative complement pathway, and there is evidence that eculizumab helps. Will my hon. Friend ensure that NHS England looks at this rare form and gathers evidence not just from the UK but from countries such as the US, China and Canada which have research and trials in this area?

This is a particularly difficult and tragic case. My hon. Friend is right to champion the case of her young constituent. My right hon. Friend the Prime Minister asked NHS England to make further contact with the Longfellow family to fully explain the decision, and I can confirm that the clinical director for specialised services at NHS England North has spoken to the family twice in the past few days. The National Institute for Health and Care Excellence is reviewing, as a priority, the evidence on the use of eculizumab in treating this condition.

Topical Questions

During the previous Parliament I made it my priority to ensure that NHS hospitals learned from the tragedy of Mid Staffs to transform themselves into the safest hospitals anywhere in the world. That work will continue. Today NHS England has announced measures to ensure that even more funding is available to improve the quality of care. These include restrictions on the use of agency staff and management consultancies, and on senior pay. It is right that the NHS takes every possible measure to direct resources towards improving patient care.

I thank the Secretary of State for supporting the bid by East Lancashire Hospitals NHS Trust for £15.6 million to improve the surgical centre, opthalmology and out-patient services at Burnley General hospital, on which I lobbied him extensively. Thanks to the hard work of the trust’s staff, it has exited special measures. What progress has been made on improving safety in hospitals via the special measures regime?

I thank my hon. Friend for his campaigning for that hospital. The simple answer is that hospitals put into special measures end up recruiting more doctors and nurses and delivering safer care to patients, and his hospital is a shining example of that.

Order. I remind the House at the start of the Parliament—this might be of particular benefit to new Members—that topical questions are supposed to be significantly shorter than substantive questions: the shorter the better, and the more we will get through.

The Secretary of State has said that safe care and good finances go together, but clinical negligence claims are up by 80% since 2010, while trusts are posting huge deficits. Does he think that finances have deteriorated because care quality has deteriorated or that care quality has deteriorated because finances have deteriorated?

The evidence is very clear that safer hospitals end up having lower costs, because one of the most expensive things that can be done in healthcare is to botch an operation, which takes up huge management time as well as being an absolute tragedy for the individual involved. My message to the NHS is this: the best way to reduce your costs and deliver these challenging efficiencies is to improve care for patients. Our best hospitals, like Salford Royal and those run by University Hospitals Birmingham NHS Foundation Trust, do exactly that.

T2. Bringing health and social care together in meaningful integration is a priority for me and my constituents in St Ives. What can the Secretary of State do to help achieve this for the good people of west Cornwall and the Isles of Scilly? Will he accept an invitation to come to west Cornwall to discuss this challenge and see some of the good work that is already being done? (900026)

May I welcome my hon. Friend to his place? Among the many good reasons to go to Cornwall over the next few months will be to visit the Cornwall better care fund, which is part of the Government’s £5.3 billion better care fund, and get the opportunity to see the work of the Cornwall pioneer. Integration of social care and healthcare is extremely important, and it will be great to see it in Cornwall.

T3. For the first time in recent history, many of London’s more prestigious teaching hospitals—King’s College, University College London, Guys and St Thomas’s, and the Royal Free—are all forecasting deficit budgets. Apart from crossing his fingers and hoping the economy picks up to fund investment, what exactly is the Secretary of State going to do to tackle this problem? (900027)

I would not expect the hon. Lady to want to listen to me on the “Today” programme, but I have been talking a lot today about the measures, including in my topical statement. I will tell her exactly what we are doing: this week we are announcing measures to restrict the use of agency staff, which was an important, necessary short-term measure in response to what happened at Mid Staffs. We need to move beyond that. Later in the week we will be helping trusts reduce their procurement costs and taking a number of measures, so a lot is happening. There are a lot of challenges, but I know that NHS trusts can deliver.

T5. Burton hospital trust and the Heart of England foundation trust are discussing how they can make better use of the facilities at the Sir Robert Peel hospital. Will colleagues on the Treasury Bench encourage both trusts to make better use of the facilities, provide new facilities and services at the hospital, and make sure that local people are properly consulted? (900029)

It is a particular pleasure to see my hon. Friend returned to the House. He will be aware that local commissioning decisions are the responsibility of local commissioners, which is something that this Government will continue, as per our reforms in the last Government. I am making it expressly clear to NHS England that I expect consultations to be full and proper and to engage everyone in the local community.

T4. The Secretary of State has admitted this morning that under his watch the NHS and the taxpayer have been ripped off to the tune of somewhere in the region of £1.8 billion for temporary workers and £3.3 billion for agency workers. How many fully qualified NHS nurses could have been employed with that type of finance? (900028)

I will tell the hon. Gentleman what we have done: on my watch, there are 8,000 more nurses in our hospitals to deal with the tragedy of the legacy of poor care left behind by his party. That is what we have done. As part of that, trusts also recruited temporary staff. They have become over-dependent on them, which is why we have taken the measures we announced this morning.

T6. What measures are being taken to improve A and E departments such as that at Broomfield hospital in Chelmsford? (900030)

I am very aware of the problems at Broomfield hospital. The Care Quality Commission has used its enforcement powers to impose an urgent condition on the trust. We will be following it closely, but we need to see urgent change there.

T8. I am very grateful to the right hon. Gentleman for agreeing to meet me and some inner- London MPs to discuss the crisis of GPs in Islington and the surrounding area. In preparation for that meeting, will he look very carefully at the funding formula? It has changed, which means that resources have moved out of inner London to areas such as Bournemouth, where there are more older people. We need to look very carefully at that. Three surgeries have closed in Islington. (900032)

Of course we will look at the funding formula, but it needs to be fair to the whole country. The hon. Lady’s area is not the only one facing pressures in the GP system. Our ambition is to solve the problem everywhere.

T7. The rate of hospital-acquired infections improved dramatically and halved in the last Parliament. Having lost my own father to a hospital-acquired infection, I am fully aware of the challenges we face. Will the Secretary of State look into ensuring that surgical site infections are included in all future statistics? In doing so, we can work on eradicating them, as they are a common way to catch an infection. (900031)

May I, too, welcome my hon. Friend to her seat. I was aware of the tragic death of her father, so she will be pleased to know that we are already collating information on SSIs resulting from orthopaedic surgery. That is done by Public Health England and the information is available from NHS England as a set of statistics. We are looking at what else we can do to include indicators on SSIs for other procedures.

T10. May I invite Ministers to comment on the recent statement by the Academy of Medical Royal Colleges that the Government’s anti-obesity strategy is“failing to have a significant impact”and that there is a“huge crisis waiting to happen”? (900034)

The Government is quite clear, as was the coalition Government, that tackling obesity is one of the great challenges of our time for the whole of the developed world, not just this country. We are looking at a comprehensive strategy right across all aspects of Government, including local government and so on. We will address that and rise to the challenge. Everyone has a part to play, including, as has been said during this Question Time, industry and, of course, families themselves.

T9. My constituent Daniela Tassa has lost her hair while being treated for secondary breast cancer. Sadly, Miss Tassa has been turned down by Solihull clinical commissioning group for a hair replacement treatment called intralace. Is there any guidance that Ministers can offer CCGs when it comes to the sanctioning of such hair replacement treatments? (900033)

I welcome my hon. Friend to his place. I am very sorry to hear of his constituent’s diagnosis of secondary breast cancer. It is of course vital that the NHS supports all patients in the best way possible, but clinical commissioning groups need to make decisions on whether to commission a particular hair-replacement service for patients based on their clinical benefit and cost-effectiveness. I very much hope his CCG will be looking carefully at that.

The planned closure of a GP surgery in my constituency means that more than 1,000 patients will have to go elsewhere to seek basic primary care needs. Local doctors are particularly concerned about the impact this will have on the A&E department at the Royal Free hospital. Will the Minister agree to meet me and local doctors to address those concerns and to ensure that the future of GP surgeries in my constituency is protected?

I welcome the hon. Lady to her place. As has already been covered, the closure of GP surgeries is an issue. They happen from time to time. As my right hon. Friend the Secretary of State said, there will be an opportunity to meet inner-London MPs to discuss this matter.

The all-party group on cancer has long campaigned on the importance of holding clinical commissioning groups accountable for their one-year cancer survival rates as a means of promoting earlier diagnosis. That will be part of the delivery dashboard from April onwards. What steps will the Government take to ensure that underperforming CCGs take corrective action?

My hon. Friend has long championed this issue and I look forward to debating it with him further. He is right to say that the CCG scorecard is currently being developed. Academic experts are looking at a range of indicators, including the one-year cancer survival data which he has brought to the House so often, for inclusion in the scorecard. It is likely to be published this summer. I will of course look carefully at the points he makes ahead of that.

With your permission, Mr Speaker, may I join others in marking the tragic death of Charles Kennedy? He was one of the most able politicians of his generation, and was loved and admired across the political spectrum. He was a brave and principled man, and he will be missed enormously.

May I raise with the Secretary of State my passion for mental health? He will be very much aware of my absolute determination to achieve equality for those who suffer from mental ill health. Will he guarantee that he will do everything to ensure that people with mental ill health get the same timely access to evidence-based treatment as everyone else?

May I start by saying that it was an incredible privilege to work with the right hon. Gentleman on the Government Benches on mental health issues over many years? He was a great inspiration to many people in the mental health world for his championing of that cause. It is my absolute intention to ensure that his legacy is secure and that we continue to make real, tangible progress towards the parity of esteem that we both championed in government.

I welcome the expansion of GP services to seven days a week. Will the Secretary of State remember rural areas such as Ribble Valley when GP services are expanded? Funnily enough, people who live in rural areas also get ill at the weekends.

We will absolutely remember them. That is why it is so important to embrace new technology. Sometimes people who have to travel long distances are able to use such things as Skype or to make a phone call to receive important advice. This is a big priority for us.

With almost 82,000 people living with diabetes in Northern Ireland over the age of 17, does the Minister agree that this ticking time bomb needs more research into better treatments? One way of doing that would be to ensure that there is sufficient funding for Queen’s University in Belfast, in the hope of providing a superior treatment for the many who are affected and living with that disease.

The hon. Gentleman is right to draw attention to the important role of research. We will leave no stone unturned in looking at all aspects of the treatment or prevention of diabetes. The issue of research is something I recently discussed with the chief medical officer. I will draw to her attention the point he makes. As he knows, although health is a devolved matter we always make a point of sharing all research right across our United Kingdom.

May I invite the new Minister with responsibility for GPs to meet me and a couple of excellent GP surgeries that want to expand their services for the local community but are being prevented by the local clinical commissioning group?

Of course I welcome my hon. Friend’s invitation. The innovative work being done by a number of GP practices around the country to expand services is welcomed by all; there is an opportunity to take good practice from one GP practice to another. In addition to my visit to Cornwall, I am clearly on the way to Derbyshire.

With the accident and emergency crisis, over which the Secretary of State has presided, more and more police officers are queuing outside fewer A&E departments in ever-lengthening queues. Last year, there were 1,000 incidents in the Metropolitan police alone. In Liverpool, Patrick McIntosh died after waiting for an ambulance for an hour. Does the Secretary of State accept that after 17,000 police officers have been cut by his Government, this is the worst possible time to ask the police service to do the job of the ambulance service, and that he is guilty of wasting police time?

I think that is harsh. Let me tell the hon. Gentleman some of the progress that was made under the last Government, and that this Government will continue, to reduce the pressure on police, particularly with regard to the holding of people with mental health conditions in police cells. We are in the process of eliminating that; it has seen dramatic falls. We recognise that the NHS needs to work more closely with the police, particularly in such circumstances, and he should recognise the progress that has been made compared with what happened before.

Order. I am genuinely sorry that some colleagues were disappointed today; I ran things on a bit, but we need to move on. In one respect, Health questions is analogous to the national health service, under whichever Government, in that demand always exceeds supply, but I have noticed colleagues who were trying to take part today and I will seek to accommodate them on a subsequent occasion.