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Volume 600: debated on Tuesday 13 October 2015

The Secretary of State was asked—

General Practice/Primary Care

It is a pleasure to be back, Mr Speaker. By 2020, we will increase the primary and community care workforce by at least 10,000, including an estimated 5,000 doctors working in general practice, as well as more practice nurses, district nurses and pharmacists.

Fareham community hospital is an example of Labour’s expensive PFI gone wrong. At a cost of £28 million, it remains underused, half-built and subject to complex governance structures. What will my right hon. Friend do to enable better use of this facility to allow provision for minor injuries, a GP practice and more primary care?

My hon. Friend is right, regrettably, that the PFI projects under the previous Labour Government created a lot of unsustainable debt. I know her local clinical commissioning group is meeting GP practices and working with community health partnerships to see if they can progress the idea she is campaigning for. I hope to visit her in the near future to discuss it myself.

Will my right hon. Friend join me in welcoming the £2.7 million in vanguard funding given to Dudley to provide primary care services out in the community? This will not only improve the level of clinical and social services provided to people in Dudley South, but relieve pressures on Russells Hall hospital.

I welcome my hon. Friend to his post. I am not sure I have had a question from him before. I know quite a bit about the Dudley vanguard programme, because I shared a taxi to Manchester station with the entire Dudley team. They told me, at close quarters, about their exciting plans. What really struck me was how they are talking to different bits of the health and social care system in a way that has never happened before. It is really exciting and I think it really will be in the vanguard of what can happen in the NHS.

Many people in my constituency are struggling to see a GP from Monday to Friday. Warrington has fewer GPs than it had in 2010, despite a rise in population. The number of unfilled GP vacancies quadrupled under the previous Government. How does the Secretary of State expect to produce a seven-day service when he cannot properly staff the service from Monday to Friday?

I shall tell the hon. Lady how I expect to do it. We are, in fact, making very good progress. By March next year, a third of the country will be able to access routine GP appointments at evenings and weekends. We do need more GPs. I agree with her that it takes too long to get a GP appointment, but we are doing something about it. That is why we have announced plans to recruit an estimated 5,000 more GPs. That will be a 15% increase in the number of GPs, the biggest increase in the history of the NHS.

It is widely known that there is a serious lack of doctors who want to go into general practice. At the same time, the Secretary of State is guilty of an abject failure to engage with the British Medical Association in negotiations on junior doctors’ practices. On that basis, how the hell can he promise to increase general practice?

Just look at our track record in the previous Parliament: we increased the number of GPs by 1,700—a 5% increase. We are, on the back of a strong economy, putting in funding that will make it possible to increase that number even more. The hon. Gentleman talks about the BMA. I simply say that the people refusing to negotiate are not the Government, but the BMA.

Order. May I just gently advise the hon. Member for Croydon South (Chris Philp) that he should not stand at this point? He has Question 3. It will be very easily reached, so he should not stand before then. There is no merit in doing that at all.

Unfortunately, every time I open a page of my local newspaper these days I am met with the beaming face of yet another general practitioner in his mid-50s who has decided to throw in his hand after many, many years of serving his community. These doctors are best placed to manage patients in primary care and ensure that they do not have to go to secondary care or A&E. What analysis has my right hon. Friend made of the reasons these experienced professionals are leaving the profession prematurely, and what will his reforms do to stem the tide?

My hon. Friend makes a very important point. We have done extensive analysis, because of our commitment to transform the role of general practice, of the issues. They include too much bureaucracy and form-filling, which means that doctors do not spend enough time with patients, and a sense that successive Governments have not invested in general practice and primary care. That is exactly what we seek to turn around with the “Five Year Forward View”.

What discussions have taken place with the devolved Administrations regarding the introduction of the new GP contract, particularly the junior doctor contract, given the exodus of junior doctors to Australia?

We also have Australian paramedics working in the UK, particularly London, so that traffic goes both ways, but, as the hon. Lady will know, health is a devolved matter, and people follow their own paths. For England, we are determined to eliminate the weekend effect. Every year, there are 11,000 excess deaths as a result of inadequate cover at weekends, and we do not want that to continue.

Mental Health Services (Children and Young People)

2. How much additional investment there will be in children and young people’s mental health services in 2015-16. (901457)

5. How much additional investment there will be in children and young people’s mental health services in 2015-16. (901461)

7. How much additional investment there will be in children and young people’s mental health services in 2015-16. (901463)

We are investing an additional £173 million this year, which includes £30 million specifically for eating disorders. We are taking a targeted and phased approach to the additional investment to develop capacity and capability across health, education and children’s services, from prevention and resilience building to supporting the most vulnerable.

The Government explicitly promised £250 million for children’s mental health in 2015-16, yet the Department of Health has admitted it will be spending only £143 million by next April. Is this £170 million shortfall not further evidence that while Ministers might talk a good talk on mental health, we should judge them by their actions?

No. I take the hon. Lady’s point, but we are committed to spending £1.25 billion over the Parliament. We will not be able to spend the £250 million this year, but it will be included in future years. The reason is that we have to make sure it is effectively and properly spent and it is a phased programme. She will be delighted to know that in her constituency there will be an extra £536,000 for children’s mental health services.

The organisation YoungMinds found that one in five mental health trusts had had to freeze or cut budgets every year in the last Parliament, and at the moment 40,000 young people are being refused mental health treatment. What guarantees can the Minister give that the money promised by the Chancellor recently will actually be made available and that trusts will not continue to cut mental health budgets?

The hon. Lady makes a fair point. While we invest money nationally in services, people complain that locally clinical commissioning groups have not been funnelling the money down. Two things should help: first, for the first time the national access and working time targets, which the Government have introduced, will provide a means of monitoring what CCGs are doing; and, secondly, the new scorecard for CCGs will look explicitly to ensure that a proportion of the increase to a CCG goes into mental health services. The hon. Lady will also be pleased to know that in her own CCG area there will be an extra £521,000 for children’s mental health services.

Some 23% of the adult prison population were in care as children and many of them have poor mental health. Will the Minister ensure that mental health services are in place for children in care to make the greatest contribution possible to improving their life chances, and not least to ensure we reduce the numbers ending up in prison?

Yes, the hon. Gentleman makes a point made by successive Governments: care outcomes are terrible and the earlier the intervention the better. We are encouraging the engagement of early prevention therapies, including for those in care, and for the first time the Government have appointed a dedicated mental health Minister, in the Department for Education, further to promote resilience and work more closely with young children, including those in care.

Infection control in the community is a great way to reduce preventable illness. In November, I will launch a handwashing campaign in Parliament that I hope will have cross-party support. Will the Minister inform the House what his Department is doing to promote infection control outside the hospital setting?

Order. I listened carefully because I wished to hear the development of the question, but it did not appear to relate to mental health services.

Never mind. These things can always be recycled on subsequent occasions. I have been there and I have done it, and the hon. Lady should fear not.

The Minister referred to the additional money for eating disorders in the autumn statement last year, the purpose of which was to introduce a maximum waiting times standard from next April. We all know that early intervention is critical. It is a condition that kills too many people. Will he confirm that he remains committed to introducing a maximum waiting times standard for eating disorders from next April?

I believe we are. I will check to be certain, as I know the right hon. Gentleman knows a great deal about this, but I believe we are. We have £150 million for eating disorders, and £30 million is being spent this year, with additional beds allocated. I will check that the waiting target times remain because they have made a significant difference. The right hon. Gentleman’s work has been of powerful import in what we do.

Yesterday, the National Society for the Prevention of Cruelty to Children revealed that one in five children in need of mental health treatment are being turned away. Is it not appalling that young people are being denied help, only for them to become more seriously ill later on, and that the number of children turning up at A&E because of mental illness has doubled in recent years? Does the Minister accept that children’s mental health needs more money now—this year, as he promised? I can point to many different organisations across the country that would gladly receive that support now. How is he going to put his broken promise right?

May I welcome the hon. Lady to her position, not least her Cabinet position—he said carefully—and welcome the prominence that mental health now has among all parties? Let me say rather gently in response to the tirade that I have just received that under this Government we have for the first time introduced parity of esteem for mental health on waiting times and national access targets. We are spending more money—£1.25 billion over the next five years. We have the highest number of beds for young people in emergency situations; we have the first dedicated education Minister for young people’s health; we have £75 million for perinatal health; and in her own constituency, the hon. Lady will be pleased to welcome from her shadow Cabinet position an extra £1.1 million going to Liverpool for mental health treatment for children and young people. I think that is a significant response.

I do not know who writes a lot of this screed, but sometimes a blue pencil needs to be taken to it. The Minister is immensely capable and experienced, but a distillation or an abridged version rather than a “War and Peace” version would be appreciated.

Seven-day NHS Services

Eighteen million patients will benefit from seven-day GP appointments by March next year, and seven-day hospital services will reach a quarter of the country by then.

In my borough of Croydon, the clinical commissioning group is currently consulting on the possibility of having three seven-day-a-week, 12-hour-a-day combined minor injury and GP centres, with one at Purley hospital in my constituency. Can the Secretary of State confirm whether any additional funding is available from central Government to facilitate this seven-day-a-week service?

Yes, I can. I should have said that seven-day hospital services will be available to a quarter of the country by March 2017. We are putting an extra £10 billion into the NHS in the course of this Parliament, which will help in the roll-out of seven-day services—I hope in Croydon, as well. I commend my hon. Friend for his efforts in that respect.

I met a large group of junior doctors in my constituency on Friday, and we talked a lot about seven-day working. They asked me to put two things straight with the Health Secretary: first, the vast majority of junior doctors are already working seven days a week; and, secondly, on their contract, it was not terms and conditions that they were worried about, as I thought they were, but safety. In respect of those new contracts for junior doctors, what assessment has the Secretary of State’s Government made about patient safety?

I am very happy to do that, and to correct some of the misleading impressions given by the BMA about what the changes are. The changes are about patient safety. They are about the fact that someone is 15% more likely to die if admitted on a Sunday than on a Wednesday because we do not have as many doctors in our hospitals at the weekends as we have mid-week. I want to give better support to the doctors who work weekends by making sure that they have more of their colleagues and more consultants there, as well as proper safeguards, which I do not believe we have at the moment. I will be getting that message out, and I hope that the hon. Lady will, too, when she next meets her junior doctors.

I urge my right hon. Friend to continue on his drive to improve patient safety and to reduce avoidable harm in our NHS because that is crucial for patients and the professions.

I thank my right hon. Friend for his question, and for the interest that he showed in these issues when he was a Minister.

The reality is that about we have about 200 avoidable deaths every week in our hospitals. It is the same in other countries—this is not just an NHS issue—but it is a global scandal in healthcare, and I want England and our NHS to be the first to put it right. I think that that is consistent with NHS values, and consistent with what doctors and nurses all want.

It is good of the Secretary of State to join us today. If he had been here yesterday to discuss the small issue of the £2 billion NHS deficit, he would have heard me say that I hoped we could have a mature and constructive relationship.

As has already been said, junior doctors are key to the delivery of a seven-day NHS. The Secretary of State said recently:

“I don’t want to see any junior doctor have their pay cut.”

Can he now guarantee that no junior doctor will be paid less as a result of his proposed new contract? Yes or no?

I welcome the hon. Lady to her post. I hope that, just occasionally, we might agree on some things, although I suspect that today may not be one of those occasions.

Let me be absolutely clear about the commitment that we have made to junior doctors. We will not cut the junior doctor pay bill, but what we do need to change are the excessive overtime rates that are paid at weekends. They give hospitals a disincentive to roster as many doctors as they need at weekends, and that leads to those 11,000 excessive deaths. Let me gently say that that was a change to the doctors’ contracts made in 2003, so for members of the Labour party to say that this is nothing to do with them is not accurate, and they should help us to sort out the problem.

I think it is fair to say that junior doctors will make up their own minds about that response.

Last week I received an e-mail about a seriously ill woman who had needed to be admitted to hospital over the weekend, but had stayed at home for two days because of recent interviews given by the Department of Health that had made her think

“that the NHS was not staffed at weekends.”

Her doctor went on to say:

“This delayed her operation, put her life in danger and ultimately will have cost the NHS more”.

Does the Secretary of State feel any responsibility for that?

Let me give the hon. Lady the facts. According to an independent study conducted by The BMJ, there are 11,000 excess deaths because we do not staff our hospitals properly at weekends. I think it is my job, and the Government’s job, to deal with that, and to stand up for patients.

The hon. Lady talked about being constructive. There is something constructive that she can do, which is to join the Royal College of Surgeons, the Royal College of Physicians and the Royal College of Nursing, and urge members of the British Medical Association not to strike but to negotiate, which is the sensible, constructive thing to do. Will the hon. Lady tell them to do that?

The question is about the seven-day NHS, but there is no point in our having a seven-day NHS if it is not an NHS across the country. I have a constituent with advanced prostate cancer who, as his oncologist says, needs docetaxel chemotherapy. In fact, all east midlands oncologists say that it is needed, but it is not provided by the NHS in my constituency, although it is provided in Birmingham. If we are to have a seven-day NHS, we need treatment across the board. Will the Secretary of State step in and do something about this?

I will look into the individual case that my hon. Friend has raised, but I think patients recognise that sometimes they need to travel further for the most specialist care, and can receive better care if they do so. However, the way in which what we are doing will help my hon. Friend’s constituents, and other people with cancer, is not just about consultants and junior doctors working at the weekends; it is about seven-day diagnostic tests, which will enable us to get the answers back much more quickly and catch cancers earlier.

Care Costs

We have introduced primary legislation and consulted on draft regulations to introduce the care cap. Following the decision to delay implementation until April 2020, we will use the additional time to improve the policy in the light of feedback from stakeholders.

Let me first declare an interest as a vice-president of the Local Government Association.

May I ask what assistance the Department is offering local authorities which are currently cash-strapped so that they can implement new minimum wage regulation, which is very welcome, in order to provide first-class social care?

It is not possible for me to talk about what may emerge from the spending round and settlement, but I can say to the hon. Lady that local authorities were given extra finance to implement the Care Act 2014. Some £5.3 billion is available to local authorities to work through the new integrated social care and NHS budget. So we are very conscious of the pressures on local authorities, which need the resources to provide the social care we all expect.

The coalition Government agreed a policy of a cap on care costs, and the Conservative manifesto in May said that no one would have to sell their homes to pay for care. Some £100 million has been wasted on this delay, which has betrayed our older people and has simply ducked one of the biggest crises facing this country. Will the Minister and the Department now apologise?

There was a consultation on the coalition proposals, which began at the beginning of this year and ran through the election period. The consultation included a very strong representation from the Local Government Association, which said that it did not want to implement the care cap now and wanted extra time. Therefore, the decision has been taken not to cancel, but to delay. It is of course a change from the position we set out. I fully accept that, but we listened to stakeholders and we are now going to use the extra time, at the request of the LGA and others, to find a way through to implement the policy and to use the time for extra financial products.

Derriford Hospital

8. What assessment his Department has made of progress in implementing the success regime at Derriford hospital in Plymouth. (901464)

I am pleased to refer my hon. Friend to the recent appointments of Ruth Carnall to the role of programme chair and Judith Dean to the role of programme director for the success regime in Northern, Eastern and Western Devon. Together, they will lead an intensive diagnostic exercise within the local health economy, which will develop options for change to be implemented in the new year.

Given the news last week that the Northern, Eastern and Western Devon clinical commissioning group that covers my constituency has appointed a special team to ensure the projected £430 million funding shortfall does not become a reality, what can my hon. Friend do to assure my constituents that an already challenged constituency can retain confidence in its health care provision?

My hon. Friend rightly points out that there are specific challenges in Northern, Eastern and Western Devon and that is precisely why NHS England has instituted the success regime and why it has moved quickly to appoint a programme director and team. I hope that with the engagement that I know he will lead with his colleagues they will come to a resolution that will ensure that the challenges cease.

NHS: Winter Pressures

9. What additional financial support he is making available to the NHS to help it deal with winter pressures. (901465)

17. What additional financial support he is making available to the NHS to help it deal with winter pressures. (901473)

Some £400 million in resilience money has been invested in the NHS for this winter. Learning from previous years, we have put this money into the NHS baseline for 2015-16 so that the NHS can plan effectively at an earlier stage.

I thank the Secretary of State for his response. In my constituency we have an excellent and much-used facility—a walk-in centre in Middleton town centre—which is now threatened with closure. Will he support our campaign to keep it open? Does he agree that its closure would create more A&E attendances and increase winter pressures on our acute services?

I welcome the question and understand the hon. Lady’s concerns about the changes. She will understand that we do not direct these changes centrally and they are decided locally. One of the things we have to try to do is deal with the confusion a lot of people have at a local level as to what they should do when they have, for instance, a child with fever at the weekends and whether they require a GP, an urgent care centre or an A&E department. I would ask all CCGs to be very careful to make sure they sort out that confusion so NHS patients know exactly what they should do.

The Royal Free hospital in my constituency is at the cutting edge of medical research and is currently treating Ebola patient Pauline Cafferkey. I am sure the Secretary of State will join me in wishing her a speedy recovery, yet the hospital faced considerable winter pressures last year. Will the Secretary of State work with the fantastic nurses and doctors at the Royal Free to ensure these winter pressures do not happen again this year?

I thank the hon. Lady for her excellent question. I know that the whole House is thinking of Pauline Cafferkey and her family and that it is proud that, under Dr Mike Jacobs and his team, she is getting the most outstanding care that it is possible to get anywhere in the world. We all wish her a speedy recovery. With respect to winter pressures, I know that the Royal Free had a difficult winter but I also know that it has a very good management team and made heroic efforts. I know that the whole team of doctors and nurses will do an excellent job, and we will want to support them in any way we can.

As part of my right hon. Friend’s plans for dealing with winter pressures, will he look at making greater use of the 63,000 practitioners on the Professional Standards Authority’s 17 accredited registers covering 25 occupations? Has he found time yet to read the authority’s report, “Accredited Registers—Ensuring that health and care practitioners are competent and safe”?

I must confess that I have not yet read that report, but my hon. Friend has reminded me of how important it is that I should do so. I will read it carefully while thinking about whether it could help us to get through the winter pressures this year.

Kettering general hospital, the local clinical commissioning group and the Government are all agreed that the best way to help the NHS in north Northamptonshire to cope with pressures all year round, including in the winter, would be to develop a £30 million urgent care hub at Kettering general hospital. That project is with Monitor. What can the Secretary of State do to encourage Monitor to speed up its deliberations?

Once again, I thank my hon. Friend for his persistent campaigning on behalf of Kettering general hospital. It is a very busy hospital under a great deal of pressure, and I know that people work very hard there. The Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), who has responsibility for hospitals, met campaigners from Kettering recently to discuss this issue, and I will bring the matter up with Monitor as well.

The Department of Health’s own figures show a dramatic change, from a £500 million surplus to a £100 million deficit in 2013, following the introduction of the Health and Social Care Act 2012. That deficit moved to £800 million last year and we have heard in the past week that it stood at more than £900 million from the first quarter of this year. Does the Secretary of State recognise that this situation has been exacerbated by the outsourcing and fragmentation of the NHS, which involves spending money on shareholder profits and tendering bureaucracy, rather than on patients?

I do not. That Act meant that we reduced the number of managers and administrators in the NHS in England by 19,000, saving the NHS £1.5 billion a year. The reason for the deficits that the hon. Lady talks about is that, around the same time, we had the Francis report on Mid Staffs, and hospitals in England were absolutely determined to end the scandal of short-staffing. However, agency staffing is not a sustainable way of doing that, which is why we are taking measures today to change that.

The Francis report recognised the problems of nursing levels. As hospitals will not be able to use agency staff or immigrant staff, how does the Secretary of State suggest they tackle the nursing ratios in hospitals?

If the hon. Lady looks at what has happened with permanent full-time nursing staff, she will see that the numbers have gone up in our hospitals by 8,000 over the past two years, so there are alternatives. We need to do more to help the NHS in this respect, and I will be announcing something about that shortly.

Medical Exemption Certificates

Medical exemption certificates excluding patients with long-term conditions have been in place since the 1960s. The requirement to renew the certificate every five years has been in place since at least 2002 and we have no plans to review it.

The Minister will be aware that, over the summer, there has been media coverage of patients with ongoing and exempt conditions being penalised for not having an up-to-date exemption certificate. Because the renewal period is five years long, the NHS Business Services Authority’s address database gets out of date very quickly and many people have been penalised for inadvertently not renewing their certificate because the database held an out-of-date address for them. What more can be done to assist the authority and the patients, perhaps by introducing a shorter renewal period, and to ensure that this stops occurring?

I pay tribute to my hon. Friend, who has first-hand experience of this matter. It is true that people who are responsible for ensuring that they hold a certificate when claiming the exemption could be subject to genuine mistakes. That is why we responded to the feedback this summer and put measures in place so that if someone submits a valid medical exemption certificate within 60 days of a penalty charge notice, the penalty charge will be cancelled. It is also worth remembering that all patients on benefits or on the NHS low income scheme are exempt anyway, and that patients who require frequent prescriptions can enrol for a pre-payment certificate, which costs no more than £100 a year.

There are 3.3 million diabetics in this country, including myself, who are entitled to these certificates. This is not special pleading, but the issue is that when they come to renew they do need help. As the hon. Member for Blackpool North and Cleveleys (Paul Maynard) has said, it is difficult for them to fill in some of these forms. Will the Minister ensure that local GP practices are able to help people if they need assistance in filling in these forms?

I will happily look into that specific issue, discuss it with the right hon. Gentleman and see whether there is anything we need to do.

Carers: Support

I am not quite sure what the situation is in Wales, but in England I do not think that carers’ invaluable contribution to society has ever been better recognised. We are working very hard to see the implementation of the improved rights for carers enshrined in the Care Act 2014. I am also responsible for developing a new national carers strategy to see what more we can do to support existing and new carers in England.

There are more than 6.5 million unpaid carers in the UK, with nearly 11,000 in my constituency. In total, they save the state more than £119 billion each year, which is more than this Government spend on the NHS . Research by Carers UK has found that nearly 50% of carers are struggling to make ends meet, and that is seriously affecting their health. What plans does the Minister have to work with the Department for Work and Pensions and the Treasury, and across government, to ensure that the improvement of carers’ finances will be a key part of the Government’s care strategy?

The work I am doing on developing the new strategy involves other Departments, and it will look at not only the economics, but what is happening internationally and where we can take the whole concept of caring for a different society in the future. The economics is certainly important; we could not do without the contribution that carers make, but it would be impossible to replace it with total Government finance.

Yesterday, the Public Accounts Committee heard from officials at the Department of Health about the implementation of the Care Act, which is a bold piece of legislation. They admitted that they were very concerned about the unidentified carers, who need to be found in order to be supported. What is the Minister planning to do to make sure that they are identified and supported?

In a way, the self-definition states its own problem: these are unidentified carers. I hope that the new responsibilities in the Care Act will encourage more people to come forward and that the greater work of carer support organisations, such as the one I preside over in Bedfordshire, Carers in Bedfordshire, will be able to identify more carers. We want more young people to come forward because, as the hon. Lady says, people are caring and they do not realise they are. We need a concerted effort all round to try to reveal them, so that more can be done.

I am surprised that the Minister believes he is supporting carers in any way acceptably well. The recent personal social services survey found that 38% of adult carers now care for more than 100 hours a week but only one in five of those carers is getting support to take a break from caring. Government cuts have caused a funding gap in social care, which, it is estimated, will be £4 billion by 2020, piling additional pressure on those family carers, and the better care fund and integration will not, in themselves, fix that gap. When will Health Ministers admit that they have got this wrong and argue for more funding for social care, so that carers can get the support and respite breaks they should get?

Between 2010 and 2015, £400 million extra was found in order to provide respite for those who are caring for others. Any support that goes into local government, or indeed the NHS, is predicated on a decent economy and decent economic principles in order to fund it—I believe from what happened last night that that has been abandoned by the Labour party. We have to have the resources in the first place. That is what we are seeking to ensure and that is what the work is being done for.

A&E Services (Worcester)

Last month, the Department approved a £4 million capital improvement loan for the expansion of the A&E department at Worcestershire Royal hospital and the development of a dedicated discharge lounge. Worcestershire Acute Hospitals NHS Trust and the local health system will also receive practical support via the emergency care improvement programme to help the trust to address the challenges it has faced in meeting the four-hour A&E waiting time standard.

I thank the Minister for his reply. I warmly welcome his recent decision to approve the £4 million interim investment in A&E capacity and a new discharge suite at the Worcestershire Royal. As he knows, demand remains very high, and the number of patients being admitted to hospital is close to record levels. May I urge him and his colleagues to look very carefully and urgently at plans for further upgrades, which could deliver much-needed capacity over the coming years?

I assure my hon. Friend that we will do so, but he will be conscious that capital plans are the responsibility of individual trusts. I urge his trust to take part fully in the Worcestershire acute review and in other reviews of the west midlands health service. There are challenges, and we will fix the problems only if there are locally sourced solutions, which we will then seek to support.

Nurse Training Places

The number of available nurse training places in England in 2015-16 is consistent with those filled in 2010-11. There are 20,033 nurse training places available in England in 2015-16, compared with 20,092 in 2010-11.

Simon Stevens, the head of the NHS in England, has already highlighted the devastating impact that new immigration earnings thresholds will have on nursing numbers—it is estimated that up to 29,755 nurses will be affected, and that the recruitment cost will be more than £178.5 million by 2020. What representations will the Minister be making to the Home Secretary to put a stop to this irresponsible and illogical change in policy that defines ballet dancers but not nurses as a shortage occupation?

The hon. Gentleman will be reassured to know that there are continuing and cordial relations between the Department of Health and the Home Office. Trusts have had three years to prepare for this moment. There is a bigger issue at play here, which is that there are five applicants for every nursing place in the United Kingdom; that is the position for people wishing to train as a nurse. Our first responsibility is to ensure that we are getting as many people who want to be nurses in this country into a nurse training place.

The Mid Yorkshire Hospitals NHS Trust, which covers the Wakefield constituency, has been forced to recruit nurses from both Spain and India. Following on from the previous question, what representations has the Minister made to the Home Office, because these changes could affect nurses who have come to Britain, bought mortgages here and plan to make their lives here? Will they be affected?

The hon. Lady knows that the Immigration Advisory Committee is independent and it makes its recommendations on that basis. There are trusts—I have visited some myself—that had previously relied on agency and migrant labour that have now managed to change the way they are hiring staff so that they can better source sustainable staffing from the domestic staffing pool.

In December 2009, Lord Lansley, as the then shadow Health Secretary, described the amount spent by the NHS on agency staff as “unforgiveable”. Since he made that statement, agency spending has spiralled out of control, rising by 83% in the past three years. Ministers are in denial about the root causes of that increase. The cuts to nursing training places have created a shortage of nurses and forced hospitals to spend vast amounts on expensive agency staff. Will the Minister now come clean and admit that it was the Government’s mismanagement that caused this financial crisis?

The hon. Gentleman should know that the unforgiveable thing was the dereliction of care by a Department of Health under a previous regime. It contributed to short staffing—a significant part of the scandal at Mid Staffs—that we needed to put right in short order. That required an emergency response and agency labour to be employed. We are now putting staffing on a sustainable basis; we were left with short staffing in 2010.

NHS: Consistency in Services and Treatment

14. What steps he is taking to ensure consistency in services and treatment throughout the NHS. (901470)

The mandate for NHS England sets out our national ambitions for the health service across England. NHS England and the clinical commissioning groups are responsible for working with local providers. To ensure quality and consistency, the Care Quality Commission has developed a set of fundamental standards. The National Institute for Health and Care Excellence also provides a range of guidance and quality standards, and the Department of Health has established the MyNHS website to highlight regional variations and use transparency to drive improvement across the system.

I thank the Minister for that answer, but earlier this year figures published by Public Health England showed that more people under the age of 75 die from cancer in Corby than anywhere else in England. What steps are Ministers taking to help to improve those rates? They are stubbornly high, and we need to stop the higher prevalence of cancer in our area.

My hon. Friend makes an important point. The Government are absolutely committed to world-class cancer care, which is why we put £1 billion into the cancer drugs fund. We have seen a huge 71% increase in cancer referrals, with 40,000 more patients treated, and a new cancer strategy has just been set out. It is true that the incidence of cancer in my hon. Friend’s constituency is regrettably high, and Corby CCG has significantly worse cancer outcomes. That has been recognised and the 2015-16 commissioning plan puts in place a series of measures on cancer, including improving earlier diagnosis, providing treatment within 62-day referral targets and implementing the national cancer survivorship programme.

Creswell in my constituency of Bolsover has been trying to get a health service centre, but that small ex-pit village has been unable to get it because NHS Property Services has been arguing with the CCG and others within the national health service. Despite efforts and letters to Ministers, the village is still waiting for the health service that it has been trying to get ever since this Secretary of State got his job under the coalition. If Ministers want some consistency throughout the land, they should give that deprived ex-pit village a new health service: knock some heads together and get it done.

It is a pleasure to take my first question from the hon. Gentleman. I thought I needed my ears cleaning, but I clearly do not. I will happily talk to him about the issue in his constituency, but the truth is that local CCGs are responsible for commissioning local services. I will happily, as a Health Minister, talk to him about what needs to be done.

I think the thrust of the hon. Gentleman’s view is very clear, and he has expressed it with unmistakable force.

Organ Donation

Organ donation rates have increased by about 60% since 2008. The Government give about £60 million a year to NHS Blood and Transplant to support organ donation. NHSBT has a strategy, which it launched in 2013, to take us up to 2020 and increase that figure even further.

Does the Minister agree that one of the most effective ways of increasing organ donation is to ensure that the next of kin of every potential donor is offered a meeting with a specialist nurse in organ donation, irrespective of whether the potential donor carries a card?

My hon. Friend is absolutely right to highlight one of the principal difficulties we face, which is people not having a conversation about donation. Even if people are on the organ donor register, their wishes are sometimes overtaken by those of their families at that very difficult moment. He is right to highlight the brilliant work done by SNODs, as well as initiatives such as the one that will happen this Saturday, when the Daily Mail, together with the organ donor register, will produce a publication that will, we hope, stimulate thousands of conversations across the land. Having a conversation about consent is one of the ways we will crack this problem.

NHS: Transparency

Last year I launched My NHS, where patients can see how safe their local hospital is and many other things. From next May, there will be overall information on the quality of mental health and cancer care.

Does the Secretary of State share my view that driving up standards in the NHS is better achieved through a culture whereby providers can learn from their peers? For example the excellent maternity department at my local Cossham hospital recently received an outstanding rating from the Care Quality Commission. That is better than the old ways of doing things through targets driven by Whitehall.

I agree, and I congratulate the doctors and nurses working in the Cossham maternity unit. Southmead hospital in Bristol has some of the best maternity survival rates in Europe, so there is a lot of very good practice. The way to get the word out is through transparency of outcomes, not endless new targets, so my hon. Friend is absolutely right.

Topical Questions

I would like to make a statement on measures the Government are taking to help NHS organisations tackle the deficits by reducing the cost of agency staff. Building on previously announced controls, from the end of November we will introduce maximum shift rates for all clinical staff employed through agencies, which will gradually decrease over time as the measures take effect and demand for agency staff reduces. In addition, we will work with each trust to limit or reduce the overall agency spend. Exceptional breaches of the limits will require advance agreement. Taken together, these measures are expected to improve patient care and reduce NHS agency staff spend by £1 billion over three years. The chief inspector of hospitals has confirmed that he believes this is the right thing to do.

Like many Members across this House, I have been inundated with letters and emails from junior doctors who feel completely undervalued and undermined by the actions of this Government, so much so that thousands of them are leaving the UK. This weekend over 2,000 medics and students wrote to the Secretary of State, condemning him for his proposed unfair and unsafe changes to the junior doctors contract. What further evidence does he need to see that he has lost the confidence of the future leaders of the NHS, and does he think he can win it back?

Yes, I do. Let us be clear: this is about patient safety, about which every single doctor and nurse in the NHS is passionate. The problem is that the doctors whom the hon. Lady has met have been misled by their own union. This is not about cutting the pay bill for junior doctors, as the BMA has suggested. This is about safer care at weekends, reducing unsafe hours and doing the right thing for patients, and that is the right thing for doctors as well.

T4. It emerged earlier this month that North East Lincolnshire CCG was operating a primary care incentive scheme intended to reduce outpatient referrals. Understandably, this has met with a hostile reception from my constituents, who fear it may affect decisions on their care. Will Ministers look into this scheme and either offer some reassurance or instruct the CCG to reconsider? (901549)

The north Lincolnshire scheme is designed to try to encourage doctors to make sure that there are no inappropriate referrals to secondary care; it is not designed to prevent appropriate ones. Over the past five years we have seen an increase of 600,000 in urgent referrals for cancer care, for example. We want to see that continue. It will not be helped if there are inappropriate referrals, and that is what the scheme is about.

Last week senior officials at Monitor reported being leaned on by the Department of Health to suppress the publication of financial figures ahead of the Conservative party conference. This week the Health Secretary has been accused of vetoing the release of impartial independent reports on measures that could reduce our consumption of sugar. Does he not understand that leadership on transparency must come from the very top? Will he now commit to practising what he preaches on NHS transparency and release this report immediately?

I will take no lessons on transparency from the Opposition. Professor Sir Brian Jarman said that the Department of Health under Labour was a “denial machine” when it came to the problems of Mid Staffs. We have made the NHS more transparent than ever before, and we will continue to practise transparency.

T6. What progress has been made towards the implementation of the Keogh review of urgent and emergency care? (901551)

We are making good progress and we expect to make a substantive announcement on that before the end of the year. That will be about improving the standard and the quality of care in A and E departments, which I know my hon. Friend has a great interest in, and removing the confusion that people feel about what precisely the NHS offer is in their area. It is looking good and I hope to have something to announce to the House before too long.

T3. A recent whistleblower revealed that the 111 helpline is in meltdown and at least two babies have died after staff failed to recommend treatment that may have saved them. Two weeks ago my own three-week-old premature granddaughter was very ill. Her parents called 111 and were promised that the duty doctor would call. He did not. They waited the whole long night and the next morning took her to A and E, and she was diagnosed with meningitis. What exactly is the Minister doing to fix the crisis in the 111 service? (901548)

This is a very serious issue and I will happily look into it personally to make sure that a full investigation is taking place into the incident the hon. Lady mentions, which clearly should not have happened. The 111 service has been an improvement on what we had before. It has taken nearly three times as many calls as the service it replaced, and around a quarter of those are referred to a clinician, but it is clearly not perfect, given the hon. Lady’s story, so I will look into the case that she raised.

T9. Patients in England wait 18 weeks for an operation, but in Wales, where Labour has run the NHS for the past 16 years, they wait 26 weeks. Does that not prove that only the Conservative party can be trusted to run the national health service? (901554)

My hon. Friend is right. A further cause of distress for the people of Wales is the fact they do not have the funding that the NHS requires in their country, just as England would not had a Labour Government been elected in 2015, because we would not have the funding that this Conservative Government have promised to ensure top care for patients.

T5. The all- party spinal cord injury group, which I chair, recently reported that very vulnerable patients are being prejudiced by delayed discharges, taking up lots of public money in hospital expenses that should be used to treat more patients. Will the Secretary of State carry out an urgent service review to address this real problem in England, Wales, Scotland and Northern Ireland? (901550)

Delayed discharge has been a problem across the system for many years. An awful lot of work is going on to ensure that more preventive work is done so that people do not go into hospital, and to ensure that if they do go in they leave quickly. I visited Salford Royal only a couple of months ago and saw the process it has for dealing with discharges more effectively. Learning is going on throughout the system, and more money is in the system for winter in order to cover the problem.

To continue on the same theme—hopefully I am coming in at the right time, Mr Speaker—I chair the all-party group on patient safety, in collaboration with the Patients Association. We are about to look into hospital infections, and in Parliament in November I will launch a hand washing campaign. What is the Department of Health doing to promote infection control outside hospital settings?

I thank my hon. Friend for her great interest in this issue and for the campaigning she did before entering Parliament, which I know stemmed from personal tragedy. This is an incredibly important issue. We face a crisis in global healthcare as a result of anti-microbial resistance, which means the current generation of antibiotics is no longer as effective as it needs to be. Proper hygiene in hospitals is therefore vital, and we have a lot of plans that I will be happy to share with her.

T7. What measures is the Secretary of State putting in place to recruit and retain GPs? Given that he has indicated recruiting 5,000, where does he plan to find them? (901552)

As part of the proposal to see an increase of 5,000 in the number of doctors working in general practice by 2020, work is being done not only to recruit more, but to retain them and to bring back those who have left general practice but want to return. Health Education England is working with the Department on all these plans and proposals. The hon. Gentleman is right to identify that as a key source of those who will come into the service in future.

Delayed publication of evidence is as damaging as non-publication, which is why we rightly expect clinicians, researchers and managers to publish their evidence and data in a timely and transparent manner. It is a matter of great regret to the Health Committee that we started our inquiry today without access to the detailed and impartial review of the evidence that we need to make a contribution to this inquiry. Will the Secretary of State please set out when he will publish it?

I agree with my hon. Friend about the importance of transparency and publishing in a timely manner. I will look again at the planned publication date for the report she wants to see, which will be published so that Parliament can debate it properly. The normal practice is for advice to Ministers to be published at the same time as policy decisions are made, as happened with the Chantler review and the Francis report.

T8. The Royal College of Nursing reports that it is becoming clear that for the first time since the early 2000s there is a critical shortage of registered nurses in the UK. Both the UK and global nursing labour markets are changing, and our increasing reliance on alternative sources is not sustainable. In 2014, 37,645 students across the UK were turned away from nursing courses. Is it not time the Minister admitted that the situation is not good enough and that the Government need drastically to scale up those places to reduce dependency on overseas nursing staff? (901553)

The thrust of the right hon. Lady’s question is correct. That is why we have near-record numbers of nurses in training and a record number of nurses in practice, and we will continue to see growth over the next five years.

Last year the NHS paid £300 million to claimants’ lawyers. Indeed, for small and medium claims, the lawyers made two to three times as much as the claimants themselves. Is there more we can do to stop this abusive behaviour?

There certainly is. We spend £1.3 billion every year on litigation claims—money that could be used to look after patients on the front line. The way to avoid spending that money is to have safer care, and that is why it is so important that we have a seven-day service.

T10. As the Secretary of State will know, the Scottish Government are once again in the vanguard in introducing crucial legislation—the Smoking Prohibition (Children in Motor Vehicles) (Scotland) Bill, which will eradicate more than 60,000 journeys per week where children are exposed to dangerous second-hand smoke. Will he advise on what plans are in place for the rest of the UK to follow Scotland’s example? (901555)

I have to tell the hon. Lady that the law for England and Wales changed on 1 October, so in fact we are in the vanguard, not Scotland.

Given this Government’s continued excellent commitment to investing in our NHS and reducing preventable mortality, does the Minister agree that keeping healthcare provision as local as possible is very important for Moorgreen hospital in my constituency?

The core purpose of the Vanguard programme is to ensure that we get local solutions to local healthcare problems. Only by making sure that we release the potential of local healthcare staff and providers, doctors and nurses, do we get the solutions we require rather than things being determined from Whitehall, as was the wont of previous Administrations that we will not follow.

I can think of few things more frightening than being in labour and being turned away from a maternity unit that someone has visited, become familiar with, and got to know the staff. Over a third of units closed their doors to women in labour last year. What is the Minister going to do about this, and why does he think it has been happening?

The hon. Lady is absolutely right; we need more midwives. We recruited more midwives in the previous Parliament, and we do need to expand maternity provision as we have a growing birth rate. I am happy to look at the problems in her area. However, we also have a maternity review coming up early next year, led by Baroness Cumberlege, that will help us to address this problem sustainably.

What health problems are caused by first-cousin marriages, and how much does dealing with those problems cost the NHS each year?

I cannot give my hon. Friend a specific answer, but I would be very happy to get back to him because I know there has been some local discussion about this in the city that he represents. I know of the issues to which he refers.

Order. As in the health service under any Government, demand on these occasions always tends to outstrip supply. I apologise to colleagues who did not get in, but we must now move on.