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Volume 602: debated on Tuesday 17 November 2015

The Secretary of State was asked—

Learning Disabilities and Autism

1. What steps his Department is taking to improve care and support for people with learning disabilities and autism. (902107)

We are determined to ensure that people with learning disabilities live independent lives, with better care and improved outcomes. Taken together, the Government’s recent response to the “No Voice Unheard, No Right Ignored” consultation and the newly published “Transforming care” consultation set out the steps we will take to protect rights, strengthen choice, meet physical and mental health needs and end institutional care by default.

I thank my right hon. Friend for his answer. South Gloucestershire and Stroud college, based in my constituency, is making an application to open a free school for autistic children. How does he feel that such schools can improve the support and education for children with autism?

I thank my hon. Friend for the question. Autism is certainly a growing area of identified special educational need across the country that requires an increasing range of provision to meet the diverse needs of the population. Although it would be inappropriate for me to comment on a particular free school application, where it is needed, a special free school can add to the local continuum of provision, by providing specialist places and specialist expertise that can be shared more widely.

The all-party group on foetal alcohol spectrum disorders took evidence last week about the link between alcohol consumed by mothers during pregnancy and the growing incidence of learning disability and autism. In Canada, this has been widely known for many years, and the Canadian Government at national and federal levels have invested heavily in raising awareness. When can we expect the same in this country?

The syndrome to which the hon. Gentleman rightly draws attention is well known here as well. I understand from the public health Minister, my hon. Friend the Member for Battersea (Jane Ellison), that a consultation in relation to this will be announced shortly, and of course there will be new guidelines in response. The all-party group is right to draw attention to this, and anything that can protect women during pregnancy and, of course, their children is of benefit to all.

In one family in my constituency, three of the four youngsters have autism. Will the Minister look at the work of local authorities? In this specific case, Lancashire is clearly not working closely enough with the mother, who has one idea about how she wants her youngsters to be educated. The local authority, for cost reasons alone, is simply not working with the parents. It would prefer to see her prosecuted, rather than working with her.

I fairly regularly meet families and others who have had young people and older people in the system and where there is a difference of opinion about what might be done. Some of the stories are very distressing. Families will sometimes feel that people have not listened to them. There can be quite difficult clashes of opinion on occasion. Of course, any case that my hon. Friend wants to bring me I would be happy to see, but this is a perpetual issue. The important thing is always to listen to those who are closest to a problem. That is likely to be the best way forward. Even if there is a difference of opinion, if people feel that they have been listened to, there is a proper opportunity to explore what can be done.

The autism numbers in Northern Ireland are growing. I understand that it is a devolved matter, but it is clear to me that three Departments have a responsibility: Health, No. 1; Education, No. 2; and Employment, No. 3. We need to ensure that the health of autistic children is looked after and that they have an education that prepares them for employment. Does the Minister have a strategy that takes all three Departments on board, and if so, is it shared among all the regions of the United Kingdom of Great Britain and Northern Ireland?

Yes. I could not have put it better myself. We have an autism programme board, on which sit representatives of the families of those with autism, which provides an opportunity to look overall at the Government strategy. The hon. Gentleman is right to say that it contains many different elements. For example, in relation to work, we have set out a challenge to halve the disability employment gap, because more people with disabilities want to take the chance of working. That must be done in the right way; we are working closely with the Department for Work and Pensions in relation to that, but things such as the autism programme board give a chance for families to be involved right across the areas where they might expect help and assistance.

Full Hospital Services

2. What steps he plans to take to ensure that full services in hospitals are available seven days a week by 2020. (902109)

By 2020, all patients admitted to hospital in an emergency will have access to the same level of consultant assessment and diagnostic tests, whichever day of the week they are admitted.

With mortality rates at weekends suggesting that there is an increased risk of dying, does the Secretary of State recognise the importance for Dorset of getting right the proposal for a new emergency hospital in the Poole and Bournemouth area and ensuring that there are specialist consultants 24/7?

I thank my hon. Friend for raising that issue, which is incredibly important for his constituents and for Dorset as a whole. I know that the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), who has responsibility for hospitals, will be going there very soon. The clinical standard says that anyone admitted to hospital in an emergency should be assessed by a consultant within 14 hours. Across every day of the week and all specialties, that happens in only one in eight of our hospitals. That is why it is so important to get this right.

Bootham Park mental health hospital and York’s place of safety shut with four working days’ notice, so York no longer has a seven-day service, nor even a one-day service in our hospital. That would have been totally avoidable if one NHS body had overarching responsibility for patient safety. Will the Secretary of State agree to meet me and to have an independent inquiry so that mental health patients are not put at serious risk again and we can have a full seven-day service before 2020?

Obviously, I am very concerned to hear what the hon. Lady says. I know that my right hon. Friend the Minister of State has been looking at this issue and is very willing to talk to her about it. Alternative provision has been made, but she is right to make sure that her constituents have access to urgent and emergency care seven days a week.

Does my right hon. Friend agree that full hospital services does not mean full services in every hospital, and that if we are to achieve our ambition of driving down excess weekend deaths, we will have to look again at concentrating services in regional and sub-regional centres, and, in addition, make sure that we network properly among smaller hospitals, where they exist?

My hon. Friend speaks very wisely on this issue. Yes, this is not about making sure that every hospital is providing every service seven days a week. It is about making sure that in an urgent or emergency situation, people can access the care they need and that, for example, high dependency patients are reviewed twice a day, even at the weekends, by consultants. That happens across all specialties in one in 20 of our hospitals, which is why it is so important to get this right.

What assessment has the Department made of the impact of reduced accident and emergency hours, and what effect will that have on the implementation of a seven-day work plan?

I am not quite sure I understand what the hon. Lady is referring to. We are not reducing A and E hours; we are investing. We have nearly 2,000 more consultants in our A and E departments than five years ago and we need to support strong A and E departments as much as possible.

Over the weekend we learned of the close links between the leadership of the British Medical Association and the Labour party. It seems that the BMA is more interested in pushing its own political agenda than in securing the best deal for its members. Can my right hon. Friend assure me that he will hold his nerve and deliver the seven-day NHS that will make the NHS safer for our patients?

I can absolutely give my hon. Friend that assurance. This is essential for the constituents of all hon. Members, whichever side of the House they sit on, and this Government will always stand on the side of patients. The weekend mortality rates are not acceptable. That is why we are doing something about them.

Given the acute pressures on the national health service, we are a long way from the vision that the Secretary of State wants to achieve. I met the Indian Workers Association this morning. Thousands and thousands of care workers of Indian origin are trained nurses and could be in our NHS, but the bar for the language test has been set so high that they are excluded. Will the Secretary of State look again at the test?

I commend the extraordinary contribution made by NHS front-line workers of Indian origin. I have met the Indian doctors association, the British Association of Physicians of Indian Origin, and have had many discussions on that front. It is very important, however, that people speak good English if they are providing care in the NHS. There are real issues for clinical safety when the standard of English is not high enough. We have a lot of fantastic support from immigrants who do a great job on the NHS frontline, but good English is an absolute pre-requisite.

Diagnostic Testing (Primary Care)

The Government are determined to improve and invest in diagnostic testing in primary care. Diagnostics and breakthroughs in innovative diagnostics are key to a 21st-century NHS. That is why we have set up the medical technology strategy group, which I chair, to look at accelerating diagnostics into the system; the cancer strategy taskforce; the Prime Minister’s GP access fund; the new models of care programme; and the accelerated access review, which is looking to accelerate those diagnostics with particular value to patients and the system. We have also introduced the new guidelines for the National Institute for Health and Care Excellence, and, through the genomics programme, we are investing in 21st-century molecular diagnostics, which will come to shape the future.

C-reactive protein point-of-care testing could reduce the number of prescriptions for antibiotics, contribute to the UK’s anti-microbial resistance strategy, and save the NHS millions of pounds each year. Ahead of my Adjournment debate on this issue next Monday, will the Minister agree to look at this type of testing as a way of saving the NHS money and providing appropriate patient treatments?

My hon. Friend makes an excellent point. We are completely committed to tackling anti-microbial resistance, and reducing the volume of antibiotics prescribing is vital to that. We are a world leader in this field in tackling AMR. We have an expert group looking at how to improve diagnostic services in relation to AMR, and it has already identified what diagnostics are currently in use and what new technologies are on the horizon, including C-reactive protein point-of-care testing. The group is currently formulating conclusions. The public health Minister, my hon. Friend the Member for Battersea (Jane Ellison), is looking forward to responding to my hon. Friend’s debate on Monday to set out more of the detail.

The Government have done a very good job in getting one-year cancer survival rates into the DNA of the NHS as a means of encouraging clinical commissioning groups to promote earlier diagnosis—cancer’s magic key. Does the Minister agree that we all need to ensure that we keep the CCGs’ feet close to the fire as regards these one-year figures so that we do not just improve diagnostic testing in primary care, but improve screening rates, GP referral rates and awareness campaigns as a means of ensuring that we save the thousands of lives that are needlessly lost through late diagnosis?

My hon. Friend is absolutely right. I pay tribute to his work on this through the independent cancer taskforce. The aim is to save 30,000 more lives a year by 2020. We are working with Harpal Kumar and Cancer Research UK on implementing its recommendations. NICE has set out new guidelines on clear ambitions and standards on how quickly patients should be referred for diagnostics. There is good news in that in 2014-15, compared with 2009-10, over 4.3 million more imaging and endoscopy tests were commonly used to diagnose cancers, but I agree that we have much more still to do.

Suicide Rates

Every person lost to suicide is a tragedy. We continue to deliver the national suicide prevention strategy to reduce suicide rates by working across Government and with the NHS, community, voluntary and charitable sectors. But above all, we must challenge the inevitability of suicide, and I want us to be more ambitious about suicide prevention.

In Rochdale, suicides have gone up by 25% since 2010. The rate is 11.8% against an average of 8.9% in England. We have a much higher rate of male suicide. If the Government continue to get their approach to this wrong, there will be more and more needless deaths. Are they going to fund mental health services properly?

Looking at mental health services is just part of what we intend to do, and more money is going into mental health. The hon. Gentleman is absolutely right about male suicide. Men are three times more likely to commit suicide than women. It is also a particular cause for concern among young men. Overall, our national suicide rates remain relatively low in comparison with others, but they have been rising, and I am worried. I am interested in the theory of zero suicide, with more work to try to ensure that suicide is not seen as inevitable and more work in detail with particularly affected communities. The work that we are doing with people at a younger age, using child and adolescent mental health services more effectively to deal with depression and similar issues before suicide becomes a greater risk, will also be important. I am really interested in this area, and I think we are going to have a debate on it later this week.

As my right hon. Friend says, we will indeed be having a debate on this matter later this week, on Thursday in Westminster Hall. It will be the first time that we have been able to mark international men’s day and consider the whole issue of male suicide in more detail, and it will give us the opportunity to look at why the proportion of male deaths to female deaths has increased steadily since 1981.

I am grateful to my hon. Friend for raising the subject and for mentioning the forthcoming debate. The subject deserves to be looked at extremely carefully. As I have said, there should be neither complacency nor a sense of inevitability about suicide, and I am very interested in what more can be done. I have met one or two of the families who have experienced these tragedies and I am deeply impressed with their commitment to doing something for those age groups particularly affected. This afternoon I will meet a gentleman who is well known for having been involved in a suicide prevention incident. We are doing work to reduce stigma and to find places for people to talk about their concerns, and the more people are prepared to talk about things that might cause suicide, the better. This is an issue that we can give a higher profile to and do more work on, because every time there is a suicide it leaves a trail of damage for families and friends that is truly distressing to behold.

Last week, yet another report—this one from the King’s Fund—warned of a mental health system that is under huge pressure. On this Government’s watch, just 14% of patients feel that they have received appropriate care in a crisis. The number of mental health nurses has dropped, and increasing numbers of people are having to travel hundreds of miles for a bed. What action will the Minister take to turn his rhetoric into reality?

This is a cross-party matter and it is very important. We believe we have made strides during both the previous and this Government. We are investing more money in mental health services—it was increased to £11.7 billion last year—and this was the first Government to introduce standards for access and waiting times with regard to mental health, to try to put it on a par with other conditions. That was not how it was done before. We will now try to ensure that the money that goes in nationally is used to provide assistance locally, and that the money that is put in for local use is used locally.

There are areas to celebrate. We are world leaders with the improving access to psychological therapies service, which has treated 3 million people since 2009. We want to build on that. We know that the service has lagged behind others in the past, which is why we are determined to do much more about it. I think it is the view of the whole House that we should do more about it, and we will.

I listened very carefully to the Minister’s response, but I reinforce the point that the suicide rate in this country is going up, not down. It is a national scandal that we need to address.

The Minister mentioned prevention. The Government have confirmed that they will make an in-year £200 million cut to local public health grants. That is a political decision. It is not going to save money and, apart from the devastating human price, it is going to cost our NHS and our local authorities more as they deal with both physical and mental ill health that could have been prevented. How can the Minister justify that?

First, £1.25 billion is going into creating new services for children and young people’s mental health services during the course of this Parliament. The hon. Lady’s party did not make that commitment before the general election. More work is being done in schools to provide a better base for mental health. We have, for the first time, appointed in the Department for Education a Minister with responsibility for mental health in schools.

The pressures on public health budgets are the same as those on every other budget. Those pressures on the national health service were met by my colleagues during the general election, with a commitment to provide an extra £8 billion—the figure is now £10 billion—by the end of this Parliament. That commitment was not made by the hon. Lady or her party. She asks for more money to be spent, but we have committed to do that and we are finding it. It is very important that we take the position that we have to do as much as we can with what we have got. Mental health services are moving forward and we should take the opportunity to say that and welcome what has been done. We have provided the resources in a way that I am afraid the hon. Lady’s party did not.

Car Parking Costs

5. If he will take steps to assist hospital trusts to mitigate the cost of car parking on NHS sites for out-patients and visitors. (902112)

It is for NHS organisations locally to set the cost of car parking, but they should be informed by the principles and guidance set by the Department of Health.

My local trust of Mid Yorks has just increased parking charges at Dewsbury and district hospital and has introduced charges for drivers with disabilities. The trust is clear that that is due to the financial settlement from Government. Does the Minister think it is acceptable that people who are ill or in need of medical attention, and their loved ones, are being penalised in this way?

The financial settlement from the Government is more generous than the one promised by the hon. Lady’s party at the last election. We are committing £10 billion over the next few years. I would ask her trust to look at the savings suggested by Lord Carter, who has identified considerable savings that can be made within hospitals. If it feels that it needs to increase car parking charges, it should refer to the Department of Health guidance, which makes it clear that there should be concessions for blue badge holders.

Hospital car parking charges are clearly too high in the UK. I am sure that my hon. Friend agrees that the Minister without Portfolio, my right hon. Friend the Member for Harlow (Robert Halfon), led an amazing campaign during the previous Parliament to reduce the charges. Will my hon. Friend confirm that he is pursuing his commitment to reduce hospital car parking charges and explain how that will help patients and visitors to the Royal United hospital in my constituency?

The principles that the Department publishes are clear that charges, if they are set, should be proportionate and fair and should be set at a level that assures people of a car parking space. One of the problems of free car parking is that it often means there are no spaces for carers and for the sick when they turn up. Clearly, hospitals should exercise judgment in making sure that carers and people making frequent visits get a heavily discounted rate so that such charges do not become an impediment to free access to healthcare.

Mid Yorkshire Hospitals NHS Trust has recent imposed charges for blue badge holders. Many constituents have told me that, as a result, they will struggle to attend their appointments. The trust admitted to me that it had not considered the impact on the DNA—did not attend—rate. Does the Minister agree that not only does this place an extra financial burden on the vulnerable, but could lead to their being denied access to the healthcare that they desperately need?

The hon. Lady raises the surprising point that the hospitals did not consider the impact on their operations, which they should have done. The principles make it quite clear that disabled drivers should get concessionary rates, although charges sometimes need to be applied so that there are spaces for disabled drivers. The hospitals should have thought that through, and should look for savings elsewhere in their operations before they look at car parking charges.

Clinical Outcomes

On a number of fronts, the Department is looking at how it can improve clinical outcomes. Indeed, that is the entire focus of the Department. With reference to hospitals, we can improve clinical outcomes across the service through introducing a seven-day NHS, by increasing transparency and by looking at the cover provided by consultants and doctors.

I welcome the Government’s commitments to improving outcomes for patients admitted at weekends, but seven-day services are needed not just in hospitals but in primary care, community care, social care and mental health services. What steps are the Government taking to make sure that seven-day services are available in all settings where patients need care urgently?

My hon. Friend makes her point extremely well. A seven-day NHS will operate only if it works across all areas of care. That is why the local integration of care and health services is part of our wider vision for the NHS. I urge her to look, when it is published, at Professor Sir Bruce Keogh’s report on urgent and emergency care, which envisages precisely the sort of joined-up care that will ensure people receive the correct attention at the correct level and do not therefore go to hospital when they can be dealt with in primary care settings.

On the Friday before last, a Minister stood at the Dispatch Box and talked out my private Member’s Bill, the Off-patent Drugs Bill, which would have provided a mechanism for improved clinical outcomes by making repurposed drugs more consistently available across the country. The Minister for Community and Social Care said that the Government would consider an alternative pathway. What is that pathway and when will it be implemented?

As I am sure the hon. Gentleman knows, my hon. Friend the Under-Secretary of State for Life Sciences is fully committed to the ambition expressed in the hon. Gentleman’s Bill. My hon. Friend feels that the mechanisms do not work, but has set up a working party to ensure that that ambition can be taken forward. I know that he would welcome full engagement with the hon. Gentleman to make sure that that happens.

If we are to improve patients’ clinical outcomes, surely we need to look more at patient experiences. According to The BMJ, only 11% of the 3,000 treatments looked at in clinical trials proved to be beneficial, with 50% being of unknown effectiveness. Now that the Society of Homeopaths is regulated by the Professional Standards Authority, should we not spend more than a paltry £100,000 a year on homeopathic medicine in the health service?

The Department’s position, despite repeated questioning from my hon. Friend, is consistent on this matter and remains the same.

As I have often had cause to observe, repetition is not a novel phenomenon in the House of Commons.

In Northamptonshire, 80% of end-of-life patients die in hospital, whereas 80% of end-of-life patients want to die at home, assisted by the hospice movement. I have discovered that GPs are ticking the end-of-life box on the quality outcomes framework form, but that that information is not being passed automatically to local hospices. What can the Department do about that?

My hon. Friend raises a terribly important matter. Clinical outcomes can be assessed in a complete sense only if they include end-of-life care for those for whom there is no clinical outcome in the commonly received understanding of the term. If that is what is happening in his clinical commissioning group area, it is unacceptable. I point him to the work that the Government are doing on a paperless NHS to ensure that the kind of bureaucratic muddle he has identified no longer occurs.

Genomics England

7. What progress has been made by Genomics England in making the UK the world leader in genomic medicine. (902114)

The Genomics England project, which was launched by my right hon. Friend the Prime Minister, has electrified the global life and health science community. We are the first nation on earth to commit to sequencing 100,000 entire genomes of NHS patients, which will be combined with patient records to unlock NHS and UK leadership in the fast-emerging field of genomic medicine, focusing initially on rare diseases and cancer. I am delighted to report that we have the genomes of 5,000 patients fully sequenced and that 11 genomic medicine centres have been set up. We have identified first diagnostics and treatments for some rare diseases; 2,500 researchers are involved in the project; the cost of sequencing a genome has fallen from £5,000 to £1,000; and, importantly, NHS England is setting the international standard on ethics and patient consent in genomic medicine.

Does the Minister agree that the world-leading Genomics England will deliver a personalised and patient-centred revolution in modern healthcare by combining the talent of global companies such as AstraZeneca with that of UK-based companies such as Congenica in my region, to the benefit of patients with cancer and other rare diseases, the vitality of our NHS and, through jobs and innovation, the strength of our economy?

My hon. Friend makes a great point. I pay tribute to Congenica, a small company in Cambridge that is doing extraordinary work. I recently went to open Illumina’s global research and development headquarters, which is a £160-million commitment. As well as the significant investment in technology and research in the UK, NHS England is leading genomic medicine across the UK, not just in the Oxford-Cambridge-London triangle, but through 11 genomic medicine centres across the country, which are bringing genomic diagnostics to the benefit of us all.

The Minister will know of the case of one-year-old Layla Richards, who was saved from leukaemia by genome editing at Great Ormond Street hospital. What specific help does he give for such hands-on pioneering work?

The hon. Gentleman makes an excellent point. Genome editing is the latest in a suite of technologies that is rapidly emerging in genomics. Through the Genomics England programme, we are actively supporting those tools and intermediate technologies, and through the accelerated access review that I have launched, we are looking to harness those breakthroughs to support new treatments and new flexibilities for the National Institute for Health and Care Excellence and NHS England on targeted treatments.

Junior Doctors (New Contract)

8. What progress he has made on implementing a new contract for junior doctors; and if he will make a statement. (902115)

Junior doctors are the backbone of the NHS. It is highly regrettable that their union has let them down by refusing to negotiate a new contract that will be fairer for doctors and safer for patients, and deliver the truly seven-day services we all want.

I thank my right hon. Friend for that answer, but has he had an opportunity to speak to medical schools about the new contract for junior doctors, especially the Peninsula medical school in my Plymouth, Sutton and Devonport constituency?

NHS Employers has regular discussions with the Medical Schools Council, which represents the Peninsula medical school. Although the training of doctors is not the specific contractual dispute that is in the headlines, it is something on which we could make significant improvements. We want to use this opportunity to work with medical schools and the royal colleges to see whether we can bring back some of the continuity of training that used to be such an important feature of junior doctors’ training.

The person who has let down junior doctors is none other than the Secretary of State. Does he recognise how insulting it is to those doctors to imply that they are not already working seven days? Crucially, will he listen to the professionals—junior doctors and their senior counterparts who support them—and drop his threat to impose the contract so that meaningful talks can take place?

What exactly would the hon. Lady say to her constituents who are not receiving the standard of care that they need seven days a week, and will she stand side-by-side with them, or with a union that has misrepresented the Government’s position? We have been clear that there are no preconditions to any talks, except that if we fail to make progress on the crucial issue of seven-day reform, we of course reserve the right to implement a manifesto commitment. That must be the way forward, and I urge the British Medical Association to come and negotiate rather than grandstand, so that we get the right answer for everyone.

I am deeply concerned about the impact on patient care caused by the proposed three days of industrial action, including two days of a full walk-out. Will the Secretary of State say what advance preparations are taking place to ensure patient safety? Will he reassure the House that there are no preconditions that will act as barriers and to which the BMA has to agree before negotiations can take place?

I absolutely give my hon. Friend that reassurance. There are no preconditions, and this morning I wrote again to the BMA to reiterate that point. Of course, if we fail to make progress we have to implement our manifesto commitments, but we are willing to talk about absolutely everything. I agree strongly with my hon. Friend that it will be difficult to avoid harm to patients during those three days of industrial action. Delaying a cancer clinic might mean that someone gets a later diagnosis than they should get, and a hip operation might be delayed when someone is in a great deal of pain. It will be hard to avoid such things impacting on patients, and I urge the BMA to listen to the royal colleges—and many others—and call off the strike.

It is 40 years since the last junior doctor strike—before I even started medical school. Given the ballot tomorrow, does the Secretary of State regret the antagonistic approach that he took before the summer towards senior and junior doctors? Should he instead have worked with them and not threatened to impose a contract so as to reach a stronger emergency seven-day service?

I do not know what the hon. Lady thinks is antagonistic about holding reasonable discussions with doctors for three years to try to solve the problem of seven-day care. Those discussions ended with the BMA, after two and a half years, walking away from negotiations last October. We made a manifesto commitment to have a seven-day NHS and to do the right thing for patients, and we simply asked the BMA to sit round the table and talk to us about it. I am confident that we can find a solution.

Claiming in July that senior doctors do not work outside 9 to 5 was perhaps felt to be antagonistic. Contrary to the figures quoted by the hon. Member for Dudley North (Ian Austin) last Monday, A&E figures for NHS England are 5% below those in Scotland. With such disappointing figures before we even get into winter or face a work-to-rule, and in the presence of eye-watering deficits, how does the Secretary of State plan to support hospital trusts through the winter?

I urge the hon. Lady to correct for the record her wholly untrue statement that I ever said that doctors do not work outside 9 to 5. That is exactly the kind of inflammatory comment that makes the current situation a whole lot worse than it needs to be. I have always recognised the work that doctors do at weekends, but I also recognise that we have three times less medical cover at weekends, which means that mortality rates are higher than they should be. On A&E performance, we are taking extensive measures to ensure that the NHS is prepared for winter. It will be a tough winter, but unnecessary and wholly avoidable industrial action by the BMA will make it worse.

17. Does my right hon. Friend agree that the failed attempt by the BMA to get an injunction against the General Medical Council to stop it issuing guidance on how doctors should behave responsibly towards patients if there were to be a strike undermines the BMA’s claim that it is putting patient safety first? Will he assure the House that the BMA will have no veto on a seven-day NHS? That was a Conservative party manifesto commitment and it is what the vast majority of people in this country want. (902129)

My right hon. Friend championed the cause of patients when he was a Health Minister, and we must continue to do the right thing for patients, which is also the right thing for doctors. It is wholly inexplicable that the BMA should try to gag the GMC and stop it issuing guidance to doctors about their professional responsibilities. Whatever the disagreements over the contract, the most important thing is to keep patients safe.

I am sure that both sides of the House genuinely appreciate the excellent work done by all staff in our NHS, which at a time of unprecedented strain relies more than ever on the goodwill of its employees to keep going. We have to support and value our staff, not criticise them and provoke them when there is disagreement. Calling junior doctors militant is not the way to end a dispute, and we have heard more of the same rhetoric this morning. Industrial action is always a last resort when negotiations have failed. Does the Secretary of State accept any responsibility for that failure?

I accept total responsibility for doing the right thing to save patients’ lives. I have to say that I think that any holder of this office would be doing wholly the wrong thing if they were to try to brush under the carpet six academic studies that we have had in the last five years that say we have higher mortality rates at weekends than we should expect. This Government are on the side of patients and we will do something about that.

Genetic Problems (Children)

10. If he will take steps to reduce the number of children born with genetic problems due to marriages between first cousins. (902119)

I am aware that there is an increased risk of recessive genetic conditions in births that occur as a result of first cousin marriages. It is a complex issue, and other factors are also significant, but experienced health professionals use some well-established tools and materials. Specialist clinicians in my hon. Friend’s area are looking at this important issue.

I am grateful to my hon. Friend for that reply, but given the severe medical conditions that are caused by first cousin marriages, is it not time that the Government considered the only proper solution—outlawing first cousin marriages in this country?

Such a change in the law would not be for the Department of Health. Let me respond to my hon. Friend’s specific point about the particular localised challenges. He might be interested to know that in May 2012 a major conference was held at Leeds town hall, with groups drawn from across the area he represents and from the wider West Yorkshire area to look at these issues. As he knows, I have already written to the public health director in Bradford asking what is being done locally to address this issue, and I suggest that it would be useful if my hon. Friend followed up on that. I would be happy to hear how that conversation goes.

Psychological Therapies

11. What steps his Department is taking to ensure that the NHS recruits, trains and retains adequate numbers of therapists, clinicians and other staff to improve access to psychological therapies. (902123)

Health Education England, working with NHS England, is charged with ensuring that there are sufficient staff with the right skill mix to support the delivery of the improving access to psychological therapies programme, and that is monitored by an annual workforce census. For example, HEE’s plans for 2015-16 are to train 946 additional individuals—a 25% increase on last year.

As well as providing adequate numbers of high quality specialised staff, given the prevalence of mental health issues in our society, is it not also important that general awareness is raised of mental health issues and the available treatments among all medical professionals, especially GPs? What future steps can the Government take to improve that training?

There are two particular ways to do that. The first is to enhance GP training, and work is already going on to do that. The second is through continuing professional development, and the Royal College of General Practitioners and HEE are combining to ensure that a good range of materials is available for clinicians and others to improve their skills in that area. My hon. Friend is right to raise the issue.

Health Problems (Poverty)

Across Government we are working to improve the life chances of children, and that is at the heart of our efforts to tackle the real causes of child poverty and improve the prospects for the next generation. That involves taking a broad approach to improving poor health and tackling health inequalities which the last Government embedded in the law. The wider causes of ill health, such as worklessness and unhealthy lifestyles, are all being addressed at the moment. I welcome the fact that we have record numbers of people in work and a dramatic drop in the number of children living in workless households. That goes to the heart of some of the broader drivers of ill health and poverty.

I am pleased that the Government accept that there is a causal link between poverty and poor health outcomes. They will also know of the widespread concern that the proposed changes to the tax credits regime will result in greater poverty, which will in itself cause poorer health outcomes and may put great pressure on the NHS. Will the Department consider putting in place mechanisms to monitor the effect of the tax credit changes on demands on the national health service?

We do far more than monitor health inequalities; we are taking action to deal with them. The heart of my portfolio is comprised entirely of tackling health inequalities in our nation. Let me give just a couple of examples: the expanded troubled families programme, on which the Department of Health is working closely with other Departments; and the family nurse partnership, where we support some of the most vulnerable young parents in the earliest years of their children’s lives. Those programmes have the greatest impact on our most disadvantaged communities. The matters that the hon. Gentleman raises are for other Departments, but I assure the House that improving the life chances of all our children is core business for the Government.

Interesting answer, but unfortunately it was not the answer to the question that was asked. No doubt my hon. Friend will follow that up later. Is the Minister aware of work produced by, for example, Sir Harry Burns, the former chief medical officer of Scotland, which clearly indicates that although there is a very strong link between poverty and poor health, that link is not inevitable and should not be allowed to become inevitable? What are the Government doing to change policy, so that that link can be broken?

I have already given some examples of the work the Government are doing to tackle health inequalities in our nation. Let me give the hon. Gentleman another practical example. The burden of disease that tobacco brings falls disproportionately on poor communities. As well as the action that we have taken on standardised packaging and on smoking in cars with children, we are committed to a new tobacco strategy. I have said publicly that at the heart of the strategy there must be effective action to look at the areas in which the effect of tobacco falls most heavily—disadvantaged communities. We are taking practical action to close gaps in health outcomes in a range of ways.

Hepatitis C Infection (Winter Fuel Payments)

13. If he will discuss with the Secretary of State for Work and Pensions provision of winter fuel payments to people infected with hepatitis C by NHS blood transfusions. (902125)

Those affected by the contaminated blood tragedy are entitled to receive Department for Work and Pensions winter fuel payments if they meet its eligibility criteria. For the benefit of the House, if not the hon. Gentleman, it is worth explaining that there are separate programmes of support. The bodies that put support in place for affected individuals also provide some winter payments. If somebody is eligible for both, receiving something from one body does not preclude them receiving a DWP winter fuel payment if they meet the criteria, but they are two different schemes.

With the UK Government dragging their feet on the £25 million transitional compensation payments for those in receipt of infected blood products, will they now make a firm commitment to supporting patients through this winter, and then get on with the business of getting a just and lasting settlement?

I have had conversations with my opposite numbers in Scotland about this issue and, as the hon. Gentleman knows, Shona Robison wrote to me about it. We are looking at her proposals in the context of wider scheme reform. I have also ensured that my officials are talking to the other devolved Administrations as we move forward to a better solution to this tragedy.

Non-hospital Care

The Government are committed to transforming out-of-hospital care for everyone, in every community, by 2020. We have seen excellent progress in areas led by integration pioneers, such as South Devon and Torbay. My hon. Friend’s own area also has in place a number of initiatives, such as the community treatment team and intensive rehabilitation service, which is rated very highly in her local community.

My right hon. Friend will be aware that elderly people deteriorate rapidly and lose their independence skills when they are admitted to hospital. What discussions have been held with local authorities to ensure that there is an adequate supply of carers to enable older people to remain in their homes whenever possible?

I meet regularly, as does the Department, with our partners in the provision of social care. A new recruitment and retention strategy has been launched by the Department of Health and Skills for Care on how to ensure more care is provided by more skilled and more valued workers in the home environment. My hon. Friend is right to raise this issue.

The ResPublica report, “The Care Collapse”, states that our residential care sector is in crisis. It says:

“Providers are being faced with an unsustainable combination of declining real terms funding, rising demand for their services, and increasing financial liabilities.”

It also states that a £1 billion funding gap in older people’s residential care would result in the loss of 37,000 care beds, which is more than in the Southern Cross collapse. No private sector provider has the capacity to take in residents and cover the lost beds, so those older people will most likely end up in hospital. What is the Minister doing to protect the care sector from catastrophic collapse?

As the House is aware, social care is a matter of great importance as we head towards the spending review round. We are aware of pressures in the system, and there is always contingency planning to identify particular problems. We are working hard with the National Care Association to improve the quality of care provided by the sector, and my right hon. Friend the Secretary of State has commissioned Paul Johnson, of the Institute for Fiscal Studies, to look at pressures in the care home sector and how to ensure that we can meet the challenges. If challenges require more money, which they always seem to do according to the hon. Lady, she needs to come up with ideas for how to provide that money, but she never does. It is the Government’s responsibility to meet those challenges within the context of the overall economic position.

Topical Questions

On Friday, I announced an ambitious plan to halve the rates of maternal deaths, neonatal harm and injury and still births by 2030 by learning from best practice in this and other countries. Following the tragic events in Paris, I know the House would also like my reassurance that we regularly review and stress test the NHS’s preparedness for responding rapidly to terrorist attacks. I have written to Madame Marisol Touraine, my French counterpart, to offer our solidarity and support. Vive la France!

Just after the election, the Health Secretary called childhood obesity a national scandal and made tackling health inequalities one of his key priorities. How will a flat-rate cut in the public health grant across all authorities, regardless of specific health challenges, as well as a further projected cut, under the reformulation, of £3 million in my constituency, help him to achieve his mission?

I gently say to the hon. Lady that we have to find efficiencies in every part of the NHS, and we are asking the public health world to find the same efficiencies as hospitals, GP surgeries and other parts of the NHS, but that should not be at the expense of services. I completely agree with her about childhood obesity, on which we will announce some important plans shortly.

Forgive me colleagues, but what we need at Topical Questions is short inquiries, without preamble, if we are to make progress. Let us be led in this exercise by Fiona Bruce.

T3. This is alcohol awareness week. In Scotland, the number of drink-driving offences dropped by 17% in the first three months after the introduction of a lower drink-driving limit. In the light of this encouraging evidence, is the Minister’s Department looking at the public health implications of reviewing the drink-driving limit in England and Wales as part of its alcohol review? (902174)

Obviously, tackling drink-driving remains a priority for the Government. We will be interested to see a robust and comprehensive evaluation of the change to the Scottish drink-driving limit, and I can confirm that Public Health England’s review of the public health impacts of alcohol will include drink-driving. Obviously, some of the issues my hon. Friend raises are for the Department for Transport, but I can confirm that we will be looking at this issue, and I will be interested to see the evidence.

On Sunday, independent experts, the King’s Fund, the Nuffield Trust and the Health Foundation, had this to say about the coming winter:

“Expect the inevitable: more people dying on lengthening waiting lists; more older people living unwell, unsupported and in misery; and a crisis in Accident and Emergency.”

Are they all wrong?

They are right about the pressures on the NHS, which is why we are investing £5.5 billion more into it than Labour promised. Those pressures will be made a lot worse by the forthcoming strike, so will the hon. Lady clear something up once and for all: does she condemn the strike—yes or no?

Let us be clear: if junior doctors vote for industrial action, one person will be to blame, and that person is the Health Secretary.

The Health Secretary does not want to admit that NHS funding is not keeping pace with demand and that over the last five years, his Government’s deep cuts to social care have left the NHS bleeding. Will he guarantee that every penny of the money his Department had set aside for implementing the now-postponed cap on care costs will go directly into funding social care?

That is the difference: the hon. Lady follows the unions; I lead the NHS. When Labour had a big choice whether to support vulnerable patients who desperately need better weekend care, they chose political expediency—and the whole country noticed.

T6. St Catherine’s hospice provides outstanding end-of-life care, but receives only 26% funding compared with 34% nationally. Will the Minister confirm whether he has any plans to encourage clinical commissioning groups to pay their fair share for hospice care?


I thank my hon. Friend, who is right to raise the issue of end-of-life care, which is central to our plans to provide better care across the NHS. Indeed, it was a manifesto commitment of ours at the general election. NHS England is looking at a more transparent, fairer and clearer funding advice formulae for CCGs. I encourage her CCG to look very carefully at that and to copy the example of some CCGs such as Airedale, which have put this at the centre of the work they do looking after local patients.

T2. I strongly associate myself and my colleagues with the remarks of the Secretary of State about the atrocities in France this weekend. What assessment has the right hon. Gentleman made of the impact of housing problems on the difficult task of recruiting and retaining clinical staff, particularly nurses in London and London’s NHS? (902173)

I do think it is a serious problem. People find it hard to live near to the hospital at which they work, particularly where housing is very expensive. This is an issue that we are looking at closely.

T8. Can the Secretary of State assure me that the NHS funding review that is currently under way will deliver a fairer formula for my constituents and many others across York and North Yorkshire by putting age and rurality—some of the biggest drivers of health costs—at the heart of this long overdue review?


Clinical commissioning group formulae are based on advice provided by the Advisory Committee on Resource Allocation. I can assure my hon. Friend that an adjustment per head is made for morbidity over and above age and gender, but as to whether or not one area is fairer than another, I am afraid that that is always a matter for local decision and discretion.

T4. Can the Health Secretary explain how cutting £200 million from public health budgets is consistent with the emphasis on prevention and public health as set out in the five-year forward view? (902175)

I have already explained that, but I hope the hon. Lady will understand that we also need the Labour party to explain why it is committed to £5.5 billion less for the NHS over this Parliament than this Conservative Government, on the back of a strong economy that her party has never been able to deliver.

T9. Some of our GP surgeries are finding it difficult to attract new GPs. What plans do the Government have to train new GPs and encourage them to work in areas where it is difficult to recruit? (902180)

We are very conscious of the pressure on general practice and of the pressure of ensuring that enough GPs are available. The Government’s plans are for 5,000 more doctors to be working in primary care by 2020, and that is supported by our recruitment, retention and returning campaign, as well as by efforts to ensure that medical schools do everything they can to ensure that general practice is made more attractive. This work will continue right through this Parliament.

T5. According to Public Health England, life expectancy in the most deprived areas of Bradford is 9.6 years lower for men and eight years lower for women, demonstrating that there are clear health inequalities in urban areas in Bradford. The Government’s attack on the poor makes this issue worse, so will the Minister tell me what they are doing to tackle these inequalities and give people in Bradford the quality of life that they deserve? (902176)

The hon. Gentleman will be aware of my earlier answers to other questions. A wide range of aspects of the public health work that this Government are taking forward attack that very issue—the inequality of outcomes for some communities. I gave examples earlier, including the family nurse partnership and the troubled families programme, which has a health aspect to it. More widely, the universal health visiting programme, which has just moved into commissioning by local government, contains significant elements that were designed exactly to support poorer families and disadvantaged communities.

For the avoidance of doubt, will the Secretary of State please repeat again that he will enter into completely open-minded, non-preconditional negotiations with the British Medical Association? The public need to see that we are approaching this matter with an open mind.

I am happy to confirm that we are willing to talk about absolutely anything with the BMA to avoid a dispute that would be very damaging to patients. We do, of course, reserve the right to implement our manifesto commitment to seven-day reforms if we fail to make progress in the negotiations, but at this time, in the interests of patients, the right thing to do is sit round the table and talk rather than refusing to negotiate and going ahead with the strikes.

T7. Rochdale infirmary now has fantastic dementia provision which really meets the needs of local people. Will the Secretary of State observe the good practice there, and look into how it could be shared more widely? (902178)

I shall be happy to do that. We have made great progress in tackling dementia, and there are some very good examples all over the country, but we can still do a lot better. We now need to concentrate not just on dementia diagnosis, but on the quality of the care that we give people when they have been given such a diagnosis.

What support will be available to hospitals over the winter? Norfolk and Norwich University hospital declared a black alert last week.

We are preparing for the winter on an unprecedented scale, having learnt from the experience of last winter. Specific support has already been provided for Norfolk and Norwich University hospital, and support will be provided consistently throughout the winter to enable us to deal with the additional challenges that are, I am afraid, being thrown in the way of hospitals throughout the country by the junior doctors and their industrial action.

Is the Secretary of State doing everything he can to ensure that we secure extra dedicated investment in mental health in the spending review? He will know that introducing the access rights that everyone else already enjoys requires hard cash. I am sure he will agree that we must end the outrageous discrimination against those who suffer from mental ill health.

I congratulate the right hon. Gentleman on his timing, given that the Prime Minister is now present. I assure him that we are committed to putting extra resources into the NHS, and to ensuring that we increase the proportion of those resources that go into mental health. I also congratulate the right hon. Gentleman on the mental health award that he received last week, which was extremely well deserved.