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Oral Answers to Questions

Volume 604: debated on Tuesday 5 January 2016


The Secretary of State was asked—

Out-of-hospital Care

1. What progress his Department has made on integrating and improving care provided outside hospitals. (902858)

Happy new year, Mr Speaker—and happy new year to the familiar faces opposite in the shadow Cabinet.

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 the integration pioneers such as Torbay and Greenwich. The Government remain fully committed to delivering integration through programmes such as the better care fund and the vanguards.

Seventy per cent. of people would prefer to die in their own homes, yet we still allow 60% of people to die in hospital. This has to change, as it has in the Netherlands owing to the better social care provided outside hospitals. What message would the Minister give to clinical commissioning groups, such as mine, which are trying hard to bring this about and to integrate services?

I am grateful to my hon. Friend for raising this issue. We share his view: we want to see greater choice in end-of-life care so that people are able to be cared for and die in the place they choose and which is appropriate to their needs, whether that is a hospice, a hospital or their own home. The recent Choice review set out a vision of enabling greater choice at the end of life. I am working with NHS England to see how this can be best achieved and the Government expect to comment on that soon.

The Health Secretary recently received a letter from a range of social care organisations and charities panning the spending review offer, saying it

“is not sufficient to resolve the care funding crisis”

and warning of an

“increasing number of older people”

without sufficient support,

“increasing pressure on the NHS.”

Will the Health Secretary finally admit that the offer in the autumn statement is just not good enough?

That social care was an important part of the Chancellor’s spending review was noted by all. Up to £2 billion will be available through the social care precept—that will be added to council tax—and there is a further £1.5 billion available by 2020, so all in all £3.5 billion will be available by 2020. We all know resources for social care are tight; that is why we need best practice everywhere to make the best use of resources, which many leading authorities are already doing.

As my right hon. Friend considers integrating and improving care outside hospitals, will he discuss with the Secretary of State the medical system in the People’s Republic of China, which brings together western medicine, herbal medicine and acupuncture and which is bearing down on the demand for antibiotics? Before he responds to the Report on the Regulation of Herbal Medicines and Practitioners, will he look very carefully at dispensing arrangements for the small-scale assembly of herbal products, something the Government of the People’s Republic of China are very interested in?

Herbal products are slightly beyond my normal portfolio remit, but anything that assists in social care and makes people feel better and can add to their vitality and wellbeing is to be welcomed. I am sure in many local areas they are taken extremely seriously.

I thank the Minister for his response. Integration and improving care outside of hospitals is just one way we can revolutionise the health service. Will he outline any links his Department is exploring between reducing pressure on A&Es and using care provision outside of hospitals to facilitate reducing that pressure?

Absolutely, and a number of the pilots and pioneer programmes are doing just that. Early results from the living well programme in Penwith in Cornwall show a 49% reduction in non-elective admissions to hospital and a 36% reduction in emergency admissions to hospital. So the hon. Gentleman is right: better social care and better integration may have, and should have, an impact on hospital admissions and make sure people are receiving the most appropriate care in the most appropriate place.

I was pleased to hear the Minister’s reference to the integrated care organisation that is being created in my constituency. Given the increasing challenge of providing social care to those in the later stages of life, does he agree that this is a model that needs to be looked at, and will he give it as much support as he can?

Indeed; the ability to see how these pilot projects respond to the different demographics in different areas enables one area to learn from another. Torbay has come up frequently in this context, and I am pleased to be able to praise it again. While I am on my feet, I should also like to point out that many of those involved in adult social care were greatly affected by the recent flooding in the north of England and that they were looking after vulnerable people and working beyond the front line. That work was very important, and I am grateful to Ray James of the Association of Directors of Adult Social Services and to all those working in local authorities in the affected areas who contributed so well to looking after vulnerable people during that period.

The report on the appalling failures at Southern Health NHS Foundation Trust highlighted the fact that more than 1,000 unexpected deaths of mental health and learning disability patients, many of which took place outside hospital, had not been investigated. Given that the Health Secretary did not allow the House an opportunity to scrutinise those findings before Christmas, will he or the Minister respond today to the widely held concern that the experience of that NHS trust is not an isolated one? Does the Minister agree that a national public investigation is now needed?

The hon. Lady is quite right. As my right hon. Friend the Health Secretary said in relation to that urgent question, this is a wider concern. That is why the Care Quality Commission is looking at the picture of what has happened nationally. These deaths have not been investigated appropriately in the past, and that must change. This Government are determined to change a range of things in relation to mental health and learning disabilities, and this is one area that has been forgotten for too long. It has now been brought to light, and work is being done by the Government.

GP Services

Welcome back, Mr Speaker. As part of our commitment to a seven-day NHS, we want all patients to be able to make routine appointments at their GP surgeries in the evenings and at weekends, and 2,500 out of 8,000 surgeries are currently running schemes to make that possible.

Many working people are asked to phone their GP surgeries very early in the morning to book appointments, but that is not always convenient when they are going about their day-to-day work. Will my right hon. Friend tell me whether priority will be given at weekends to people who are working during the week?

My hon. Friend is absolutely right. That system does not work for people who have to go to work, and we want to make it easier for people to book appointments online or using an app on their phone. We also want to make it easier for people living in rural areas such as his constituency of North Cornwall to have telehealth appointments where appropriate, so that they can see someone without actually having to go to the surgery.

Given the increasing difficulty that members of the public are having in getting an appointment with their GP quickly and at a time that is convenient to them, does the Secretary of State believe that his predecessor was wrong when, as one of his first acts, he scrapped Labour’s 48-hour GP access guarantee?

No I do not, because that had perverse consequences. When that target was in place, the number of people waiting to see a GP increased rather than decreased. In the last Parliament, the number of GPs went up by around 1,600—a 5% increase in the workforce—and we have plans to increase it by 13%, which would be one of the biggest-ever increases in the GP workforce in the history of the NHS, on the back of a strong economy.

The Secretary of State will be aware from personal experience of the excellent work being done by GPs in Herefordshire, who won one of the first seven-day-a-week pilots. Can he assure me that this work will continue to be funded, as it is doing an extraordinarily good job in helping my constituents?

We are very pleased with the progress that is being made in Herefordshire and in many other areas, and we are looking at how to maintain funding for those areas. Already, 16 million people are benefiting from enhanced access to GPs in the evenings and at weekends, and we would not want to see the clock being turned back on that.

Today I received a letter from the chair of Slough’s clinical commissioning group, in which he bemoaned the fact that GP practices were making 95% of patient contacts yet receiving only 8% of the NHS’s resources. He also claimed that there had been a 30% reduction in GP partners’ incomes in the past five years, and said that more and more GPs in Slough were turning to private practice. I have noticed that they are also resisting the creation of new GP practices. What is the Secretary of State doing to ensure that under-doctored areas such as mine get more GPs?

First, may I ask the right hon. Lady to congratulate, on my behalf, GPs in Slough, who have benefited from the Prime Minister’s challenge fund? Alongside a number of other schemes, it has had a significant impact on reducing emergency admissions in her area. The answer to the point she makes is that we are investing an extra £8 billion in the NHS over the course of this Parliament—it is £10 billion when we include the money going in this year. We have said that we want more of that money to go into general practice, to reverse the historical underfunding of general practice, which I completely agree needs to be reversed.

Hospital Trusts: Deficits

John Appleby, the chief economist at the independent think tank the King’s Fund, said recently that although the Government claim they will get an increase in funding in the NHS, they have

“in effect, already spent the money”

because of the scale of the hospital deficits. In my South Tees area, the deficit for 2014-15 is nearly £17 million. Will the Minister accept that the Government have totally lost control of NHS finances?

The first point to make is that this Government have provided the money for the NHS that it has asked for—this is money the Opposition refused to say they would pledge at the last election. The second point to make is that Jim Mackey, the new chief executive of NHS Improvement and one of the best chief executives in the NHS, has said that he will help to get hospital trusts in control next year, and that, with the transformation fund announced by my right hon. Friend the Secretary of State, we are confident we will be able to get hospital trusts into balance next year.

Does the Minister agree that clamping down on expensive temporary agency staff is an important step in helping to sort out the NHS and allowing it to balance the books?

My hon. Friend is entirely right, and we are already having an impact. We had to bring in the requirement for safer staffing rotas because of the catastrophe at Mid Staffs and the need to try to staff hospitals better, and that had an immediate consequence which called for agency workers. Unfortunately, some companies have taken advantage of that situation, but we have introduced measures to stop that and are already having an impact across the service.

The University Hospitals of North Midlands NHS Trust faces a deficit of £19 million for 2015-16, but until the NHS’s Staffordshire review is completed it faces uncertain prospects further out, not least as it has taken over Stafford county hospital recently. The hospital wrote to the Minister before Christmas, so will he meet hospital management and local MPs as soon as possible this new year to discuss this uncertain situation and the progress on the whole Staffordshire review?

I would be happy to meet them, I will meet them and I congratulate them on eliminating 12-hour trolley waits for the first time this year. They are doing a great job in difficult circumstances, as are many hospitals across the country. I am confident that they, too, will be able to get their deficit under control next year, with the help of the transformation fund, which is available for high-performing trusts.

Rare Diseases

A rare disease is a life-threatening or chronically debilitating disease that affects five people or fewer in 10,000. Research shows that one in 17 people will suffer from a rare disease at some point. In the UK, that equates to approximately 3.5 million people.

Same But Different, which is based in my constituency, is concerned about a number of the challenges faced by people with rare diseases. One key issue that it has raised with me is the level of support available at the time of diagnosis, particularly for parents of children with rare diseases. Will the Minister examine how we can signpost better help and support to those who have been diagnosed?

I am glad the right hon. Gentleman mentions that point; the House may not be aware that we recently added four new rare diseases to the newborn heel-prick test, which has helped to detect more than 1,400 children with a rare disease. I am disappointed to hear that he feels that some parents had issues with follow-up, and of course we will look into that, but I think he will find that the UK rare diseases strategy, which was published in 2013 and contains 51 commitments from government, covers that. The first report back on that strategy will take place this spring and it is being done by the UK Rare Disease Forum. I am happy to speak to him afterwards about whether the excellent organisation he names is part of that.

One such rare disease is Duchenne muscular dystrophy. I am sure the Minister is aware that we are awaiting what we hope will be a positive decision from NHS England on a drug called Translarna, which could help boys with the disease. We were due to have that announcement yesterday. Does she have any further and better particulars on that? Will she update us on when we can expect an announcement, which we hope will be a positive one?

I know that my colleague, the Under-Secretary of State for Life Sciences, is working very hard on that matter, and is hoping to make an announcement soon. I am sure that, at that point, he will be able to update my right hon. Friend.

With regard to ultra-rare diseases, I will be joining the family of seven-year-old Sam Brown on 23 January to celebrate the funding of Vimizim. I thank all those involved in that decision, including those in the Department. As well as an update on Translarna, can we also have an update on the possibility of funding another drug that we have been campaigning for, which is Everolimus for tuberous sclerosis?

I thank the hon. Gentleman for his words, as does my hon. Friend the Under-Secretary of State for Life Sciences. With regard to the matter that he just mentioned, I know that it is something that NHS England is reviewing and it will come forward with a view in due course.

Will my hon. Friend join me in praising the work of the Institute of Translational Medicine at the University of Birmingham Medical School? It is doing outstanding, world-wide standard work in developing cures and treatments for such rare diseases, and indeed for more common diseases such as cancer.

I absolutely join my hon. Friend in that and agree with his very well-deserved words of congratulation. I know that the Under-Secretary of State for Life Sciences has visited the institute and is—as everyone is—hugely impressed with it. I also join my hon. Friend the Member for Lichfield (Michael Fabricant) and others in congratulating Charlie Craddock on his CBE in the new year honours list.

Patients living with rare cancers often have fewer treatments available to them. Often, the only option is to use off-label treatments. The cancer drugs fund has helped patients gain access to those treatments, but, despite a Conservative party manifesto commitment to continue investing in it, the fund is now under threat because of central Government cuts. What assurances will the Minister provide to people living with rare cancers that off-label drugs will still be funded? Will she apologise for the uncertainty that those cuts are causing to the thousands of people who are affected by cancer in England?

I certainly do not recognise the shadow Minister’s characterisation of the cancer drugs fund. Some £1 billion has been committed to it and it is being reviewed. The fund was introduced by the previous Government, and we are very proud of it. It has made a big difference to the lives of more than 80,000 patients. More widely, the recent cancer taskforce published its report, “Achieving world-class cancer outcomes”, and it made many recommendations, which are particularly relevant to rarer cancers and blood cancers, many of which focus on improving access to diagnostic testing.

Of the 7% of the population that will suffer at some point in their life from a rare disease, 75% are children. Unfortunately, 30% of those will not reach their fifth birthday. What more can be done for Great Ormond Street hospital and for Birmingham children’s hospital, which do such excellent work?

My hon. Friend is quite right to highlight the number of people who will be affected by such diseases. There are between 6,000 and 8,000 rare diseases. Among the things that the Government are doing that will make a really big difference to some of the institutions that he mentioned and others, and particularly to sufferers, is the 100,000 genomes project, in which the Government have invested. The creation of a network of genetic medicine centres will underpin that further development of genetic testing services. As a very large proportion of rare diseases are genetically based, we want to make significant progress with that genomic work.

Social Care Budgets: A&E Attendance

Our health and care system is under extraordinary rising demand from an ageing society. There are a million more pensioners this year than there were at the beginning of the previous Parliament, and there will be another million by the end of this Parliament. The number of adults needing care in the next 10 years will rise from 180,000 to 264,000. That is why integration of health and care is so important, and it is why I am delighted that my right hon. Friend the Chancellor announced in the autumn statement £3.5 billion for social care by 2020 through the new adult precept and extra funding for the NHS five-year forward view.

In any given week at the Countess of Chester hospital, 70-plus elderly patients pitch up and cannot be discharged because care is not available elsewhere. We know that the Government broke their promise before the election to sort out funding for long-term care, and the King’s Fund recently said that the settlement to which the Minister refers will put

“even more pressure on … the NHS to pick up the pieces when there’s a breakdown in … care”.

Will the Minister now accept that that continuing neglect and those broken promises are the key cause of the crisis in our A&E departments?

Well—happy new year! Only Labour could take a £3.5 billion commitment to fund social care as “more pressure”. We are leading the way in integration—not before time, after 14 years in which Labour did nothing. We are leading the way on integration and putting in the extra money. I am delighted to say that, through the £3.8 billion for this coming year and the £10 billion funding for the NHS Five Year Forward View for transformation, it is the Conservative party that is investing in a 21st-century NHS. Labour seems to want to take us back to “Call the Midwife”.

Does my hon. Friend agree that it is an important step to devolve powers to local authorities, as they are best placed to commission care services for local populations?

My hon. Friend makes an excellent point. The key is, of course, more funding and more integration, but crucially more local leadership too, and we are actively making it easier through the devolution programme for local authorities and local health leaders to plan the integrated services that are appropriate for their area. Not all areas are the same.

17. Having listened to what the Minister has to say, people in my constituency will be disbelieving. The number of days that patients are stuck in hospital, not because they are sick but because there is nowhere to move them, has doubled under his Government. He has to acknowledge that that is due to the neglect of local government and adult social care specifically. (902874)

It is true that in different areas there are different pressures. In my own area of Norfolk there are pressures. Let me remind the hon. Lady that A&E spending has gone up dramatically over the past decade, from £900 million in 2001 to £2.4 billion. The early evidence from the better care fund, which we launched only this year to tackle this very issue, is 85,000 fewer delayed transfers, 12,000 more older people at home within three months of discharge, and nearly 3,000 people supported to live independently. Through more funding, greater freedoms and local devolution, we are supporting health leaders and council leaders to bring together health and care.

Despite the pressures, is it not excellent that 95% of patients who present at A&E in England are seen within the target time, unlike in Wales, where the figure is only 81%, as a result of the fact that the NHS is run by members of the Labour party?

My hon. Friend makes an excellent point. We hear very little from the Labour party about Wales, where it is responsible for the health service, and an awful lot of questions about England, where fortunately it is not responsible. If we want to get pressure on A&E down, we need to integrate and invest as we are doing in prevention and in keeping people out of unnecessary A&E admission.

23. The Health Foundation estimates that the gap in social care funding by 2020 will be £6 billion, not taking into account the increase in the minimum wage, so although the spending review narrows the gap, it still leaves an enormous gap which will result in further cuts in social care. How will the Government avoid the totally unacceptable situation in which those with money will still get good care and those without money will get substandard care or no care at all? (902881)

I pay tribute to the right hon. Gentleman. He is a Norfolk colleague and as Minister did a lot of work in this area. He raises an important point that as a society we need to think profoundly about how we integrate health and social care. As I say, the Government have made a £3.5 billion commitment from the new precept and the better care fund is a significant commitment, but he is right—we will have to go further. Through the devolution programme and the integration programme, we will have to develop more powers so that local health leaders and care council leaders can better integrate services to reduce unnecessary pressure.

In Scotland, A&E performance is published weekly, but since June that in England has been published only every month and now after a six-week delay. Since that time, the performance in Scotland has risen and 96% of people were seen within four hours in Christmas week, which is a huge challenge, whereas the last data published for England were for October and show a figure below 90%. Do the Minister and the Secretary of State accept that to improve performance we need to return to more timeous and frequent analysis and publication?

I share the hon. Lady’s interest in data and in proper information. We need to be a little careful about Scottish figures. Over winter, England publishes three times more A&E performance measures than Scotland every week. We publish quality rankings on hospitals, care homes and GP surgeries, which Scotland does not. What we do not hear about in Scotland is A&E closures, A&E diverts, emergency admissions, general and acute beds—I could go on. It is dangerous to compare data that were not prepared on the same basis, but I share the hon. Lady’s enthusiasm, as does the Secretary of State, for information.

I am aware that the renewed strike call from junior doctors has actually been called in order to meet the new rules created by the Government’s own union laws and that negotiations are ongoing. To avoid an impact on hospital waiting times, what will the Secretary of State bring to the negotiating table to try to reassure junior doctors?

I am delighted to be able to announce—the hon. Lady might already have heard this—that the Secretary of State has appointed Sir David Dalton from Salford Royal to lead on that. I repeat the offer that the Secretary of State made this morning: we are very close to an agreement, so the right approach is not to strike, but to come to the table and reach it.

Three hundred thousand fewer older people have publicly funded care packages than in 2010, and nearly half the current record level of hospital delayed discharges are due to waiting for a care package, and that will get worse as winter pressures mount. It is risky that the proposed increases in the better care fund are back-loaded; they do not reach £1.5 billion until 2019-20. The social care precept funding is uncertain because it will raise only £1.6 billion by 2020 if every single council decides to raise the maximum possible. Social care is in crisis now. Can the Minister explain why the Government are proposing risky, uncertain and late funding?

This is the most extraordinary welcome for one of the most important announcements in the autumn statement. Having come under pressure to raise more money for social care, the Chancellor and the Secretary of State announced £3.5 billion extra for social care, from the new adult social care precept and the better care fund. The Opposition say that it is not enough and that it will fail, but the data do not support that. If we look at the early data from the better care fund, which was introduced by this Government early last year, we see 85,000 fewer delayed transfers, 12,500 more older people at home within three months of discharge and 3,000 people supported to live independently. We are making real progress.

Hospital Trusts in Special Measures

6. What progress his Department has made on improving the performance of hospital trusts in special measures. (902863)

Eleven of the 26 hospitals that have been put into special measures have exited that regime because of good clinical progress, the most recent being Morecambe Bay NHS Foundation Trust, which exited in December 2015.

Given that North Cumbria University Hospitals NHS Trust has been in special measures for two and a half years, that there are now serious concerns about the wider health economy in north Cumbria, and that we have the success regime in place, will the Minister now give a commitment that the Government will ensure that the acquisition of the trust will happen?

First, I thank my hon. Friend for the campaigning he does for his local hospital. He knows that I very much support that merger and hope that it will go ahead. It is worth paying tribute to the staff at the trust, who have brought down mortality rates to within the NHS average. The Care Quality Commission says that plans to improve safety are working well. We should celebrate the fact that even the trusts in special measures have hired 700 more doctors and 1,800 more nurses and are making real progress in improving patient safety.

Private finance initiatives are costly and damaging; they always have been and always will be. Can the Secretary of State tell us what percentage of hospitals in special measures have had significant PFI funding?

I can write to the hon. Gentleman with the details, but I can tell him now that the Government inherited £70 billion of PFI debt, which has caused enormous pressure throughout the NHS.

Although Southern Health NHS Foundation Trust is not in special measures, its performance has been criticised in an independent report, particularly in relation to poor investigation of deaths of people with learning disabilities and mental illness. I welcome the Secretary of State’s rapid action and his announcement of a CQC inquiry. Will he update the House on the progress of the inquiry and when it is expected to report?

The inquiry has only just started, but I thank my hon. Friend for her interest in it. The important conclusion that we have drawn from what happened at Southern Health is that this issue is much broader than one trust. We are not as good as we need to be at investigating unexpected mortality in the NHS. Southern Health is perhaps an extreme example, but the problem is much more widespread. A cultural change is needed, and we are determined to do something about it.

Will the Secretary of State undertake to support Morecambe Bay, the other hospital trust in Cumbria, as it moves out of special measures, by confirming the commitment made by the coalition Government to underwrite the capital costs of a radiotherapy unit at Westmorland general hospital and to support the uplift in tariff needed to sustain that unit?

I will happily look into that. I cannot give the hon. Gentleman the answer now, but we would want to do everything we can to support that trust. It has been through a very difficult time and has made huge progress. We want to help it on its way.

Prostate Cancer: Docetaxel

Docetaxel is routinely available in England for the treatment of metastatic prostate cancer, where the disease has not responded to hormone treatment. It is not at the moment licensed for use alongside hormone treatment and has not been appraised by the National Institute for Health and Care Excellence for that indication. In the absence of NICE guidance, NHS commissioners are free to make funding decisions on the best available evidence.

I thank the Minister for stating the current practice. A constituent of mine has prostate cancer. His doctor, consultant and oncologist all say that he would benefit from taking docetaxel, but it is not available in Northamptonshire, although it is available in parts of the rest of the country. He has been told that if he goes down the road to the private hospital, he can have it at £2,700 a cycle. Is that not unacceptable? Should he not get the treatment on the NHS and should he not get refunded the monies paid for private treatment?

I congratulate my hon. Friend on being a diligent advocate for his constituent Mr Vann. I am delighted to tell him that the result of the STAMPEDE clinical trial has now been published. Today NICE is publishing an evidence review. NHS England will shortly be publishing its interim commissioning policy based on that evidence. That is very encouraging.

Wi-fi in Hospitals

9. What assessment his Department has made of the need for wi-fi infrastructure in hospitals to facilitate use of developing healthcare technologies. (902866)

Digitalisation of healthcare is absolutely essential for the 21st-century NHS—for individual care, for system performance and safety, and for research. Wi-fi is an important part of that, with benefits for doctors, nurses, hospital management and patients. That is why I am delighted that my right hon. Friend the Secretary of State secured the necessary funding in the comprehensive spending review to fund fully the NHS’s plans for digitalisation and transformation. We have announced that we are implementing Baroness Martha Lane Fox’s recommendation of free wi-fi in all NHS hospitals.

I am grateful for that answer. The new chief executive of the Royal Shrewsbury hospital informed me that people can receive wi-fi in only half of the hospital area. Can the Minister give me an assurance that everything will be done to ensure that wi-fi is available throughout the Royal Shrewsbury hospital?

That is an important point. It is up to each hospital to implement digitalisation in its own way, but we are putting in place a series of steps to make sure that all parts of the NHS are supported and encouraged in the drive for delivery of a paperless NHS by 2020. In the new year, we are requiring the clinical commissioning group digital index, which will measure the digitalisation of all health economies, and we are launching a review of best practice. We are absolutely committed to driving digitalisation so that the 21st-century NHS is not running on paper and cardboard.

Rural Healthcare Strategy

The “Five Year Forward View” published by NHS England sets out the healthcare strategy for the whole of England, including rural areas. Rural areas have their own health needs, which should be taken into account in planning and developing healthcare systems.

What specific research has the Minister undertaken in order to understand, and what steps has he taken to address, the very different needs and costs of rural communities in the south-west, which has disproportionately high numbers of over 85-year-olds and population distributions that make inflexible multi-speciality community providers and primary and acute care configurations unattainable?

The “Five Year Forward View”, written by Simon Stevens, takes particular account of rural areas, but of course not all rural areas are the same. It is down to clinical commissioning groups to judge the needs of their local areas and make sure that they are reflecting the specific circumstances in which they find themselves.

Non-invasive Pre-natal Treatments

11. What progress his Department has made on expanding access to non-invasive pre-natal treatments in hospitals. (902868)

Non-invasive pre-natal testing is not currently offered routinely for screening women in pregnancy for Down’s syndrome and other trisomy conditions within the NHS. However, it is available to detect genetic changes leading to specific skeletal abnormalities and certain forms of cystic fibrosis. The UK national screening committee has reviewed the case for implementing NIPT as part of the existing foetal anomaly screening programme and will provide its advice shortly.

NIPT is not currently offered for Down’s syndrome routinely within the NHS. Some NHS trusts have piloted the test for screening and a number of maternity units offer NIPT privately. NIPT is available through the NHS to detect genetic changes leading to specific skeletal abnormalities and also to detect certain forms of cystic fibrosis.

The UK national screening committee—UK NSC—which advises Ministers and the NHS in the UK about all aspects of screening policy, has reviewed the case for implementing NIPT as part of the existing NHS foetal anomaly screening programme and will provide its advice in the new year.

At my 12-week scan, I was told that I faced a risk of Down’s syndrome in my child. I was given two options. One was an invasive test available on the NHS—the amniocentesis test, which carried a risk of miscarriage. The second was a non-invasive test, which was not available on the NHS and cost £400. Does the Minister agree that the non-invasive test should be rolled out across the country so that mothers, regardless of wealth, can have equal access to screening and do not have to face the unnecessary risk of miscarriage?

I thank the hon. Lady for bringing her personal experience to the House, and I hope that all is well. She will understand that screening has to be a non-political matter. That is why we have a specific, clinically led committee to look at whether a screening programme should be implemented. It has been looking at NIPTs over the past year and will be making its decision very shortly. On the principle, though, I completely agree with her; it lies at the foundation of the NHS and we support it.

Clinical Commissioning Group Transformation Plans

12. What assessment he has made of the adequacy of clinical commissioning group transformation plans in addressing the needs of (a) all vulnerable children, (b) children in the care system, and (c) children who have been abused. (902869)

NHS England has assured local transformation plans that cover all clinical commissioning groups, ensuring that all the plans address the full spectrum of need for all children and young people, including looked-after children and those who have been sexually abused and/or exploited. Further thematic analysis is being carried out, and the results will be made available in March.

Thank you very much, Mr Speaker—much appreciated.

Children who have suffered the trauma of abuse may benefit from a range of therapeutic services, but there is a lack of consistent data about the number of abused children in need of therapeutic support and the number of services available. Can the Minister assure me that as part of plans to transform children’s mental health, the needs of abused children will be properly monitored and considered at every level?

I am grateful to my hon. Friend not only for his question but for previous questions in relation to this area and his obvious interest and concern about it. He is right. Nationally, the numbers of looked-after and abused children in the new prevalence survey—the first since 2004—would be relatively small. We have therefore asked the statisticians to look at different ways of assessing the data and the numbers so that we can address this issue. I hope to be able to report further on that later in the new year after I have had that meeting.

Nurse Training

I thank my hon. Friend for asking this question. I can tell her that we have made significant steps. In the past two years, there has been an 11% increase in nurse training places, and I anticipate that that increase will continue this year. We are providing over 23,000 full-time-equivalent additional nurses by 2019. We expect there to be an additional 10,000 nurse training places as a result of the announcements made by my right hon. Friend the Chancellor last year.

Speaking as a nurse, I would struggle to undertake my nurse training given the proposed changes to the bursary scheme. I know that the Minister is working very hard on this, but will he outline what additional routes into nursing are planned to help mature students and those on a low income to gain access to nurse training?

My hon. Friend is right to point out that there are different ways into nursing. Just a few weeks ago, we announced a massive expansion in apprenticeships across the NHS, and I anticipate that a significant number will be for those going into nursing. The new post of nursing associate is a vocational route into nursing via an apprenticeship. In addition, our reforms to bursaries will ensure that there is a 25% increase in funding to recipients, bringing it into line with the rest of the student cohort. That cohort has seen a considerable expansion in the number of students coming from disadvantaged backgrounds as a result of the reforms that we undertook in 2011 and 2012.

Does the Minister accept that his Government’s decision to cut nurse training places by 3,000 a year since 2010 has led to the huge shortage of nursing staff in the NHS and an increased reliance on nurses recruited from abroad and expensive agency staff, and that that will get worse with the abolition of bursaries? Is not this a textbook example of a false economy from the Government?

The hon. Lady should look at the facts. March 2015 saw a record number of nurses in the NHS—319,595. We are increasing the number of nurse training places. We are able to increase them by considerably more than we could have done otherwise, as a result of the reforms to student finance that bring nurses into line with teachers and other public sector professionals.

It would be good to hear the Minister concede that it was a bad idea back in 2010 to cut the number of nurse training places. Even today we are still training fewer nurses than we were in 2009. Not only have this Government failed to recruit enough nurses, they have failed to retain them too: last year there was a 12% increase in the number of nurses leaving hospitals. With staff morale already at an all-time low, why does the Minister think it is right that nurses should be burdened with a lifetime of debt to pay for his Government’s mistakes?

The hon. Gentleman raises a reasonable point about attrition rates: they have remained too high for too long. One of the things we are undertaking at the moment is to talk intensively with universities to see how we can reduce attrition rates. We have had some success in some areas, but I want to see far more. It is important that students stay on their courses as much as possible. Of course, many go into community nursing. I would be prepared to write to the hon. Gentleman about further actions we are taking on attrition rates.

Children and Young People’s Mental Health

14. What steps his Department is taking to involve young people in plans for improving children and young people’s mental health. (902871)

Clinical commissioning groups have produced local transformation plans to transform their local offer for children and young people’s mental health. Those plans were decided at local level in collaboration with children, young people and those who care for them. I remember my visit to Derby very well, and I am pleased to say that the NHS in that area has collaborated extremely well with young people to produce those plans.

Last year the Derby youth council ran a consultation on the provision of mental health services in Derby, which highlighted the disparity of services among different trusts. What steps is the Minister taking to ensure that NHS trusts across the UK offer the same level of support for those suffering from mental health issues?

My hon. Friend is absolutely right. I have talked more than once at this Dispatch Box about the variation in performance on different issues around the country. Two or three things will help. On funding and resources, there is a better tracking system to make sure that money that goes into children and young persons’ mental health services will be spent appropriately. More money is going into that. Equally, a children and young persons’ mental health improvement team is working across the national health service to make sure that those variations are evened out so that good practice in the best areas becomes the practice of all.

Topical Questions

Yesterday evening the British Medical Association regrettably decided to walk away from the talks on a new junior doctors’ contract and announced plans for strike action. We had made significant progress in negotiations on 15 of the 16 areas of concern, including doctors’ hours and patient safety, and will now do everything we can to make sure that patients are safe. We promised the British people we would deliver truly seven-day services and, with study after study telling us that hospitals have higher mortality rates than should be expected at weekends, no change is not an option.

I thank the Secretary of State for that response. He will recall the 3 million lives telehealth programme. Since then, it has all gone rather quiet on telehealth. What is the Government’s current strategy on telehealth and what pump-priming funding is there for it?

I thank the hon. Gentleman for his consistent interest in telehealth. The technology landscape has changed significantly since the 3 million lives programme was launched in 2012. We are absolutely committed to it, but we do not want to isolate a few individuals who we think would particularly benefit from it, because we think everyone could benefit from being able to talk to their GP via video conferencing or whatever. The plans we will announce for technology in the next few months will show how we can roll it out to an even wider audience.

T4. Following the assisted dying debate, will the Department set out what steps it is taking to improve end-of-life care, and will Ministers join me in praising local hospices such as Forest Holme hospice in Poole, which serves my constituents?


I will certainly join my hon. Friend in praising the work of hospices. It is a unique contribution in the world of healthcare and we should be proud of their efforts. He will know that I have a commitment to end-of-life care and to improving it. I hope shortly to make announcements in response to last year’s NHS Choices review. I have been talking intensively to people from the sector about what might or might not be possible.

It is a sad state of affairs when a new year starts with the prospect of industrial action in the NHS. Nobody wants strikes, not least the junior doctors, but they feel badly let down by a Health Secretary who seems to think that contract negotiations are a game of brinkmanship. When will he admit that changing the definition of unsocial hours and the associated rates of pay for junior doctors is a forerunner to changing a whole load of other NHS staffing contracts to save on the NHS pay bill? That is what all this is really about, isn’t it?

No, it isn’t. May I start by wishing the hon. Lady every success in retaining her post in the shadow Cabinet? It would be a shame to lose her, having started to get to know her.

This is a difficult issue to solve, but at least the country knows what the Government are trying to do. The hon. Lady, on the other hand, has spent the last six months avoiding telling the country what she would do about these flawed contracts. Now is her chance. Would she change the junior doctors contract to improve seven-day services for patients—yes or no?

Junior doctors do not need warm words from me, stood at the Opposition Dispatch Box; they need action from the Secretary of State to stop the strikes and give patients the care they deserve.

Not content with alienating one group of staff, the Health Secretary now has another target: student nurses. The disastrous decision in the first half of the last Parliament to cut nurse training places has driven the rise in the agency staff bill. We all know that we need more nurses to be trained, but why should a trainee nurse who spends half their degree caring for patients not receive a bursary? If they are on a ward at 3 o’clock in the morning, why should they be expected to pay for the privilege?

The hon. Lady cannot have it both ways. She cannot stand here and criticise cuts in nurse training but oppose the Government’s changes that mean we will be able to train 10,000 more nurses over the course of this Parliament. Let me tell her why there are 8,500 more nurses in our hospital wards since I became Health Secretary. It is because of the Francis inquiry into Mid Staffs. It is this Government that recognise the importance of good nursing in our wards. We did not sweep the problems under the carpet. She should give us credit where it is due.

T7. In Boston in my constituency, as many as one in four children are classified as obese. Will the Minister reassure me that in the forthcoming obesity strategy, the Government will acknowledge that they are allowing families and, indeed, children the opportunity to take the control of their own lifestyles that will fix this problem, rather than seeking to do it for them? (902889)

My hon. Friend is right that there is a really important role for families. More than anything, the Government want to make the healthy choice the easy choice for families. However, young children are not in control of the whole of the food environment around them, as I am sure he would acknowledge. The Government’s forthcoming strategy is focused on children. Obesity is a complex issue and, frankly, everyone needs to play their part—the Government, local government, health professionals, industry and families.

T2. The Health Secretary just tried to tell us why we have 8,500 more nurses in the NHS. Let me tell him why it is. It is because we have record recruitment from abroad. Since the Chancellor announced the scrapping of bursaries for trainee nurses and midwives, there has been a worrying reduction in the number of applications for next year’s training, compared with what we would expect to see at this time of year. That can only have a negative impact on the number of trained nurses from this country and on net migration. Was there any discussion between the Department of Health, the Home Office and the Chancellor before this idiocy was introduced? (902884)

We have record levels of nurses in training and a record number of nurses in practice because of the decision by my right hon. Friend the Health Secretary to increase nurse training by 11% over the past two years. We can expand that significantly due to our reforms to the funding of nurse training. As regards nurses from abroad, part of the reason we are undertaking this change is so that every putative nurse in this country can have the opportunity of having a nursing position. At the moment, we have to limit those positions because of the funding regime that is in place.

T8. Will my right hon. Friend join me in paying tribute to the first responders in Rossendale, who support the ambulance service by attending 999 calls to very serious cases, including one involving a friend of mine over Christmas? Will he in particular pay tribute to Brian Pickup, who is stepping down as team leader of the first responders after 11 years of unpaid public service? (902890)

I am delighted to do so. First responders have been a valued addition to the frontline of allied health professionals whom we can all support, and I am delighted to pay tribute to Brian for the work that he has done. I am sure that I speak for everyone in the House in saying a warm thank you to all those who have been part of the first responder scheme for the effort they have put in.

T3. On too many occasions, children in my constituency who need to be admitted to a psychiatric in-patient bed have to wait for more than a day in accident and emergency before a tier 4 bed is found. Too often, available beds are outside London, and sometimes as far away as Nottingham, Glasgow or Southampton. How long does the Minister believe it is acceptable for a child to wait in A&E for a tier 4 child and adolescent mental health services in-patient bed to become available? Does he consider it acceptable for very unwell children to be sent such a long way from home for the treatment and care that they need? (902885)

In short, no. That is why there has been a drive to find more beds for children and young people who are having a serious crisis, but more support is also going into community services to prevent such crises in the first place. There will always be a need for some specialist beds to be available regionally or nationally, and not everything can be dealt with locally. Where people can be treated locally they should be, and we are working towards that.

T10. The Worcestershire Acute Hospitals NHS Trust now finds itself in special measures, and today its chairman has resigned, largely as a result of an over-extensive and highly complex review of clinical services in the county that has so far failed to reach an agreed conclusion. Given the complexity of the review process, and the apparent impossibility of it reaching an agreed conclusion, what steps can the Government take to untie the Gordian knot that created that situation and help the trust to get back on a stable footing? (902892)

My hon. Friend is right and there is a particularly complex series of circumstances in Worcestershire. I am determined to do something about that, and I want to meet him and his colleagues in the next few days to discuss possible options. I will then discuss those issues in turn with NHS England.

T5. The management at James Cook university hospital in Middlesbrough is seeking to increase nurses’ current 30-minute meal break, which they struggle to take, to a compulsory unpaid 60-minute break that will result in nurses effectively working one shift a month unpaid. In their judgment that will do nothing to address the real issues of staff shortages and patient safety, but will merely disadvantage patients and nurses alike. Will the Secretary of State investigate the matter and write to me? (902887)

I thank the hon. Gentleman for bringing that issue to the attention of the House. All contracts should be governed by the “Agenda for Change” contract, and I would be concerned if there were deviations from that. I would welcome further detail on that so that I can respond to him.

Nobody wants to return to the days of exhausted junior doctors being forced to work excessive hours, and the Secretary of State will know that that is why junior doctors have expressed concern about the potential impact of removing financial penalties from trusts. Will the Secretary of State set out what has happened during the negotiations to reassure the public and doctors about patient safety?

I hope I can reassure my hon. Friend, because we have said that we will not remove financial penalties when doctors are asked to work excessive hours. To quote from the letter that I received from the chief negotiator about our offer to the British Medical Association:

“Any fines will be paid to the Guardian at each Trust, allowing them to spend the money on supporting the working conditions or education of doctors in training in the institution.”

T6. Before Christmas the Chancellor pledged to match the charitable fundraising of Great Ormond Street hospital to a maximum of £1.5 million, using money from outside the health budget. The Secretary of State will know that Great Ormond Street is one of only four specialist children’s hospital trusts in the UK, and one of the other three is in my constituency. Does he agree that the Government’s matched funding should be extended to all four trusts, and will he join me in making that case to the Chancellor? (902888)

I am happy to look charitably on the wishes of the hon. Gentleman, without, of course, making any guarantees.

Nicole, the daughter of a constituent of mine, is currently suffering from mental health issues. She has been held in a transparent police cell overnight after self-harming, with drunks on either side, as there are no other facilities available near York. Clearly, police stations are not appropriate places for secure care. What is the Minister doing to ensure that adequate places are available locally, and that police, should they need to become involved, know how to provide a less traumatic experience for mental health patients?

My hon. Friend is absolutely right. There has been a 54% reduction in the use of police cells for mental health cases in the past three years. This is being improved by work of the local crisis care concordat. My right hon. Friend the Home Secretary will later this year introduce legislation to prevent children and young people from being held in police cells at all, but the use of police cells has gone down dramatically because of the use of the crisis care concordat. We will continue that process.

T9. Yesterday, the Minister’s offer to junior doctors had still not dealt with the important issue of weekend working and appropriate compensation. As a result, doctors in England will be forced to strike and the Minister will have damaged the patient safety he claims to value. Instead of attacking consultants and junior doctors, will he follow the example of the Scottish Government and work with the medical profession to help the NHS face the challenges of increased demands and private finance initiative-induced deficits? (902891)

Project, man, project! We wish to hear the full gist of what the hon. Gentleman has to say to the House.

We absolutely will work with the medical profession to have proper seven-day services throughout the NHS in England. I hope that the hon. Gentleman and Scotland, which has the same issues with weekend mortality rates, will follow the lead of NHS England.

May I thank the Minister for his helpful answer to my hon. Friend the Member for Wyre Forest (Mark Garnier)? Further to that question, having recently met the clinical leadership at Worcester Royal hospital, they are adamant that they want permanent management in place at the hospital. The Care Quality Commission report said that the number of interim directors was one reason why it was put into special measures. Can the Minister reassure me that he will be doing everything he can to put in place permanent long-term management at the Worcestershire Acute Hospitals NHS Trust as quickly as possible?

Mid Yorkshire Hospitals NHS Trust is planning to implement a significant reconfiguration plan 12 months earlier than was agreed by the Secretary of State. Dewsbury hospital will be significantly downgraded before infrastructure is in place to ensure that patients still receive vital care safely. Will the Secretary of State meet me to discuss this premature move, which appears to be purely financially driven and not in the best interests of my constituents?

I thank the hon. Lady for bringing that issue to the notice of the House. The reconfiguration she mentions is the responsibility of local commissioners, but I am very happy to meet her, and anyone she wishes to bring with her, to discuss the planned changes.

My local mental health trust recently reduced its psychiatric liaison cover in A&E and is now considering the level for the coming year. Will my right hon. Friend provide an update on what the Government plan to do to ensure specialist mental health care in A&E?

The mental health taskforce will shortly bring forward its recommendations. It will be looking very carefully at what is provided in A&E. It was the subject of the crisis care concordat review by CQC earlier last year. I am looking specifically at psychiatric liaison, because I saw my hon. Friend’s written question very recently.

What demographic impact assessment has the Secretary of State’s Department made of the potential withdrawal from the European Union on health and social care, and the consequent result it would have on demands for its services?

In the previous Parliament, many people who suffer from a rare disease were pleased with the publication of the Government’s rare diseases strategy. What progress is the Minister making on publishing the ultra-rare diseases strategy?

I am happy to look into that and get back to my hon. Friend. With regard to the 51 recommendations made in the UK rare diseases strategy, he will be pleased to know that the first report on that will be in spring. I will take up the other issue with him after questions.

Health is a devolved matter, but devolved Governments may choose not to spend when it comes to expensive rare diseases and diagnoses. What more can Westminster do to help my constituents?

One example, which I am sure the hon. Gentleman will welcome, is the fact that the four UK Health Departments, along with Cancer Research UK, are jointly funding a network of 18 experimental cancer medicine centres aimed at driving the development and testing of new anti-cancer treatments to deliver benefits for patients, including those with rarer cancers. That is just one example of how we can work together.