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Oral Answers to Questions

Volume 609: debated on Tuesday 10 May 2016


The Secretary of State was asked—

NHS Bursary

1. What assessment he has made of the potential effect of his proposals to reform the NHS bursary on future levels of recruitment into the medical professions. (904937)

7. What assessment he has made of the potential effect of his proposals to reform the NHS bursary on future levels of recruitment into the medical professions. (904943)

10. What assessment he has made of the potential effect of his proposals to reform the NHS bursary on future levels of recruitment into the medical professions. (904946)

The reform to the NHS bursary will lift the cap currently placed on university places for nurses, midwives and allied health professions. Universities will be able to train up to 10,000 extra students by the end of this Parliament. This increase in UK graduates will reduce NHS reliance on expensive agency staff and staff from overseas.

I am certain that the Minister will want to congratulate the SNP on sweeping spectacularly to a historic third successive term, all on a manifesto pledge to protect rather than abolish the nursing bursary in Scotland. The serious question is this: how does the Secretary of State plan to monitor the impact that the removal of the bursary might have on students from poorer backgrounds who are training as nurses in England?

I would like to congratulate my friend the leader of the Scottish Conservative party, who has led the extraordinary resurgence of Conservatism and Unionism north of the border.

I regret very much that the SNP is not endorsing our plan to give opportunity to thousands more people who want to become nurses, especially those from under-privileged backgrounds. We will of course monitor the reform, not only as we continue our process towards making a decision, taking account of all the equalities analysis that will be done in the interim, but after the final decision has been made.

It is recognised that there is a high proportion of mature students of nursing and other health professions. How does the Secretary of State plan to mitigate the effects of the removal of the bursary and provide support to students who have family commitments or who already have a student loan from a previous degree?

The NHS benefits enormously from mature students entering the service, and that is why we have already said that we will be looking at offering second-degree bursaries in the scheme. The consultation is clear: it asks a number of open questions, inviting responses from nurses and nurse trainees about how best to support mature students. We will be looking at those carefully as we formulate our conclusions.

With the increased cost of training as a nurse and a 1% pay freeze throughout this Parliament, how does the Secretary of State plan to recruit and retain sufficient nurses in permanent posts in the short term, so that patient care and staff wellbeing are not negatively affected?

South of the border we have been able over the past six years to increase the number of nurses, both in training and in the service, which has been made possible by the stronger economy and the stewardship of the NHS, in such contrast to the developing picture in Scotland. We are able to expand the numbers in training by up to 10,000 between now and 2020 as a result of that innovative policy, and that is why it should also be adopted in Scotland.

What lessons has the Minister learned from the experience in higher education, where bursaries or grants were removed and replaced with student loans, and we have seen an increased number of students from all backgrounds?

We have indeed, and it is remarkable that south of the border we have seen a university that would equate to the fourth largest in the country filled every year as a result of the reforms to higher education funding, and a university the size of the University of Leicester filled with those who would not previously have gone to university as a result of the reforms that we introduced in 2011. I want to see those benefits extended across the range including to those who have not so far had them—namely, student nurses.

Considering the importance and the central role of nurses in the medical profession and in helping people when they are ill, how long does the Minister expect it will take on average for a nurse working in the NHS to pay back the total debt that would be accrued under the Government’s proposed replacement for the bursary scheme?

It depends of course on the career progression of that particular nurse, but the repayment terms will be precisely those for students of other degrees. Newly qualified nurses will not pay any more than they do currently, and the exact rates at which they will pay back—9% above £21,000—are outlined carefully in the consultation document. I recommend that the hon. Lady looks at it and sees the benefits that will come from the reform that, were it to be adopted in Scotland, would provide an enormous benefit to the service north of the border.

I start by congratulating the Secretary of State on becoming the longest serving Health Secretary in history. It is an important-landmark, not least because it is the first target that he has managed to hit.

On NHS bursaries, last week the Minister said that

“more mature students are applying now than in 2010.”—[Official Report, 4 May 2016; Vol. 609, c. 197.]

However, a written answer given to me yesterday by the Minister for Universities and Science appears to contradict this. Indeed, it shows that numbers of mature students have fallen in the past five years by almost 200,000. Given that the average age of a student nurse is 28, and in the light of the clear evidence from his own Government, will the Minister correct the record and commit to looking again at the impact of these proposals on mature students, who form a significant part of the student nurse intake?

I, too, as I know will all my ministerial colleagues, congratulate my right hon. Friend the Secretary of State on a remarkable tenure in his post.

It is clear that mature student numbers dropped immediately after the higher education reforms, but they then started rising and have now exceeded the rate before the reforms. I am happy to give the hon. Gentleman the details of that. We are also clear that we need to nurture mature students, which is why the consultation asked the specific question that it did. We want to invite answers from the service about how best we can do that because we are clear that the current system is not working as well as it should.

Specialist Nurses: Disabled People

2. What recent assessment he has made of the effectiveness of specialist nurses in supporting disabled people. (904938)

Specialist nurses make a valuable contribution to the care of disabled people. They have specialist post-registration qualifications, which are attained through additional training. There are now 3,000 more nurses working in the NHS than in May 2010, ensuring that disabled people continue to receive the highest possible quality care.

In May 2010 there were 5,360 learning disability nurses. In January 2016 there were 3,619. The Government promised to protect the NHS frontline. Why does this protection not extend to people with learning disabilities?

It is true that the skills mix and the way in which specialist nurses have changed over the past six years may well account for the variation that the hon. Lady has noticed—I am willing to write to her with the detail—but the total number of nurses has increased, and we are giving better and more varied training to nurses across the board so that they can deal with the specialist problems that are increasingly the core part of their work.

I thank the Minister for his response. Specialist nurses are vital for the care and support that they provide for patients and families, not just for the elderly but for the disabled. What is his Department doing to ensure that funding for specialist nurses is maintained and that we do not end up in the situation that we have in Northern Ireland with Four Seasons, which is responsible for 62 homes in Northern Ireland and 450 across the whole of the United Kingdom of Great Britain and Northern Ireland?

Funding for nurses has increased over the past six years. It is because of the sixth largest increase in the NHS budget that we can guarantee that nursing numbers will remain in that strong position for the remainder of this Parliament. That will include specialist nurses. My role is to make sure that as many nurses as possible get additional training so that we have a wider and richer skills mix, specifically so that nurses can develop their careers—something that I am afraid was often made more difficult rather than easier under the previous career structure.

Biosimilar Medicines

The biosimilars—the generic versions of biologic products—represent part of the extraordinary range of new drugs that are becoming available for the benefit of our patients. The Government are committed to ensuring access to drugs for UK patients at the highest level of quality and safety, and to ensuring that effective biosimilar medicines are available. That is why we are leading, not just here but in Europe, the regulatory regime through the Medicines and Healthcare Products Regulatory Agency as the lead assessor and rapporteur. In the NHS, the chief pharmaceutical officer, Keith Ridge, and the commercial medicines unit in my directorate have put together a framework agreement for biosimilars, and through the medicines optimisation programme we are looking specifically at biosimilars, and we have set up a national biosimilars medicines group.

I thank my hon. Friend for that answer. May I ask also that where NHS pharmacists are involved in oncology clinics, there is a higher prescribing of biosimilars? What steps are in place to encourage more oncology clinics to involve NHS pharmacists at the start of the patient’s treatment journey?

Not surprisingly, my hon. and, in this field, learned Friend makes a very important point. We have set up a number of initiatives to that very end: to make sure that our pharmacologists and pharmacists in the system are alert and have all the information they need to increase the prescription of biologics and the generic versions, biosimilars. I will happily write to her, describing a range of initiatives that are in place which we are pursuing to that end.

One of the issues around the adoption of biosimilars and, indeed, driving down the NHS drugs budget generally is the lack of local analysis of patterns of prescribing against efficacy and cost. I wonder whether the Minister would consider encouraging clinical commissioning groups to appoint analytical pharmacists, who could look at this equation and recommend different prescribing decisions on a local basis.

My hon. Friend makes a really interesting point. It goes to the heart of the work that we are doing at the moment with CCGs, in terms of use of data to map and track prescribing practice across the system. I will happily pick up the point about ensuring that biosimilars are incorporated in that.

Lyme Disease

Lyme disease is a complex infection, so we recognise that there are real challenges in diagnosis and treatment. In the light of this, I am pleased to say that the Department plans to commission three reviews on the diagnosis, treatment and transmission of Lyme disease to inform future decision making.

A constituent in Earby was struck down with a debilitating illness several years ago, which has totally destroyed her quality of life. Since then, I have been visiting her regularly at home every few months, as she has fought to get a diagnosis. Over recent months, all the evidence has started to point towards Lyme disease, but there seems to be precious little support out there for people with this condition. What more can my hon. Friend do to support constituents like mine?

In addition to the reviews that the chief scientific adviser is overseeing, we have commissioned the National Institute for Health and Care Excellence to develop a new evidence-based guideline for care, specifically to respond to the sort of situation that my hon. Friend describes with his constituent. That is for publication in 2018 and it is being prioritised because of the interest in this area.

Agency Staffing Expenditure

We have taken tough measures to control unsustainable spending on agency staff, which cost the NHS more than £3 billion last year. Overall agency spend is now falling and we expect to save the NHS at least £1 billion this year as a result.

I thank the Secretary of State for his answer. I do not share his optimism. Is not the real problem the shortage of permanent staff and the budgetary constraints on the acute sector? Most of them are now below establishment.

I think the hon. Gentleman is right that we have historically not trained enough staff to work in the NHS and been over-optimistic about the staff needs. That is why, in this Parliament, we will be training over 11,000 more doctors as a result of the spending review, and 40,000 more nurses.

In the Public Accounts Committee, which I sit on with the hon. Member for Southport (John Pugh), we have repeatedly come to this question about agency staffing. The key thing is, as he says, that the establishment level for acute hospitals is always under par, because the budget set from the centre is never enough to meet it. Will the Secretary of State go and take a serious look at this issue, and stop this myth that it is just down to the rates paid? That is part of the problem, but it is not the main problem.

Perhaps I can give the hon. Lady some comfort. I recognise that there is a big mountain to move, but the changes we made last year were not just about changing the rates paid to agencies. They were also about capping the amounts agencies can pay their own staff, because we think it is incredibly divisive inside hospitals to have two nurses doing exactly the same work, but one being paid dramatically more than the other. We are also capping the total amount hospitals can spend on agency staff. The result is that the monthly spend on agency staff is now falling and we are on track to reduce the agency bill by about £1 billion in this Parliament.

Spending on agency staff has gone through the roof under this Health Secretary, and the Secretary of State’s attempt to deal with the symptoms of the problem but not the cause has left hospitals struggling to get staff at rates they are allowed to pay. In the past few weeks we have seen reports of emergency surgery suspended in Doncaster, an A&E department downgraded in Chorley and two critical care units closed in Leeds, all because of staff shortages. The Health Secretary has admitted that this will be his last big job in politics. May I urge him before he goes to get a grip on the cause of the staffing crisis? Otherwise, it will be patients who will be facing the consequences long after he has gone.

May I start by thanking the hon. Member for Ellesmere Port and Neston (Justin Madders) for his generous congratulations earlier, and indeed for making history himself by being the first Opposition Member I can remember to congratulate the Government on hitting a target?

I say to the hon. Lady that, as a result of the measures we have taken to deal with the agency staff issue, we think we have saved £290 million compared with what we would have spent since last October, two thirds of trusts are reporting savings and the price paid for agency nurses is 10% lower than it was in October. The root cause of the problem is, as the hon. Member for Southport (John Pugh) said, our failure in the past to recruit enough staff. One of the reasons for that is that successive Governments failed to understand the needs of nursing in wards, which is why we had the problem at Mid Staffs. Because we are addressing that, we are now able to make sure that we do not pay excessive rates for agency staff.

If I may turn to another part of the staffing crisis, all Opposition Members welcome the resumption of talks on the junior doctors contract. It is in no one’s interest—not the Government’s, not junior doctors’ and certainly not patients’—for this dispute to drag on any longer. May I implore the Health Secretary to do all he can to find a reasonable compromise this week that will keep doctors in the NHS and ensure that we have a motivated, well trained and fairly rewarded workforce to continue to deliver the excellent care we all want?

I thank the hon. Lady for her reasonable tone and absolutely give her that assurance. We have always wanted a negotiated outcome to this dispute. That is why we paused the introduction of the new contracts last November to give talks a chance to succeed, and it is why this week I have said we will further pause the introduction of the new contracts to see whether we can get a negotiated outcome. We want a motivated workforce and we are highly cognisant of the fact that hospitals that offer seven-day care and higher standards of care for patients are the very hospitals that have some of the highest levels of morale in the NHS. It takes two to tango, and I very much hope that the British Medical Association will play ball and its part this week in helping us to deliver a safer seven-day NHS.

Rarer Cancers

The extraordinary pace of progress in biomedical science, not least in genomics and data, is transforming our understanding of cancer. It is leading to greater identification of more rare cancers, and indeed to more diseases becoming rare diseases. That is why we have invested so heavily in Genomics England and set up the 13 genomic medicine centres around the UK, leading in cancer and rare disease diagnosis. I am delighted that we are now setting up a Northern Ireland General Medical Council, which will collect 17,000 samples. We will implement the recommendations of the independent cancer taskforce on diagnosis and we are setting up a series of regional genetic laboratories and infrastructure. I believe the hon. Gentleman will be able to see that we are investing heavily in making sure we lead not only in the science but in the adoption of genomic medicine in the NHS.

I thank the Minister for all that, but remind him that there is concern about the implications of the cancer drugs fund details, as they will affect people with rare cancers. Is he prepared to promote progress on rare and less-common cancers as part of the new work programme for the British-Irish Council? The challenges of small patient numbers, thinner investment in research, and symptoms being less well known are not confined to his jurisdiction.

The hon. Gentleman makes an important point. In both Northern Ireland and the Republic, I have seen some great leadership in this field, and as the UK Parliamentary Under-Secretary of State for Life Sciences, I would be delighted to pick this up through that council, and suggest that our nations, working together, can collaborate better, not least in implementing the accelerated access reforms that I am putting in place. Those reforms, aligned with the cancer drugs fund in its revised format, should see us able to accelerate the adoption of drugs for rarer cancers for patients’ benefit.

In part because they are the hidden majority, people with rarer cancers are often diagnosed later, often through an emergency presentation. That can make for more aggressive treatments, which can have a longer-term impact on health. Will the Minister update the House on tailored recovery packages, and the plan to roll those out that was outlined by the Government back in September last year—a Government who have, I must say, been a great friend to the cancer community?

I am very grateful for that acknowledgment. We have put £1 billion into the cancer drugs fund, and we are completely committed to increasing the pace at which we bring cancer drugs through. It is true that cancer outcomes have improved quickly since 2010; in 2014-15, over 645,000 more patients with suspected cancers were seen. That is an increase of 71%. Almost 40,000 more patients were treated for cancer—an increase of 17%. We have announced funding of up to £300 million a year by 2020 to increase diagnostic capacity, so that we can meet the new target, which is that patients will be given a definitive cancer diagnosis or the all-clear within 28 days of being referred by a GP.

We are very grateful for all the work that is going on, and for how we are pulling together and working as a United Kingdom, but is there any way of helping those people who cannot afford to travel to the specialists to get the treatment? That is a huge chunk out of a devolved budget, and it is something that we should be working on together.

I will happily look at that as part of the discussions with the council that I just touched on. We are determined to make sure that this life science revolution is not just in the Oxford-Cambridge-London triangle, but goes out across all the devolved areas, which of course are leading on much of the science. That is why we are committed, through the National Institute for Health Research and the NHS, to creating hubs across the country, so that everybody can benefit.

Is my hon. Friend aware that about a third of people, including those with rare cancers, will, on their cancer journey, use some form of complementary or alternative medicine? Is he further aware that there is a range of new treatments out there that are being used in the private sector, including virotherapy and hyperbaric oxygen therapy? The second particularly can help people who have serious effects from chemotherapy and radiotherapy. Will he look at some of these treatments and write to me about them?

I am not against people taking whatever they feel helps, but my hon. Friend will understand that in this field, in allocating every pound, we need to be guided by the very best science and evidence. Internationally, we are applauded for the quality of our assessment, and I intend to do everything to make sure that that continues.

Outcomes in cancer are not just about survival. Does the Minister agree that nowhere is the case for a seven-day NHS stronger than in palliative medicine, and will he say what can be done, in rolling out the 7/7 NHS, to address the scandal whereby only one in five hospitals has specialist palliative care cover on a Saturday and Sunday?

My hon. Friend makes a really important and specific point. He is absolutely right, and that is one reason why we are committed to our seven-day NHS. It is improving—I can share the data with him—but he makes a good point, and that is one reason why we need to continue.

Social Care Budgets

8. What assessment he has made of the effect of changes to local authority social care budgets on demand for health services. (904944)

Good morning, Mr Speaker—[Interruption]and everyone.

There is a link between adult social care funding and demand for NHS services. More recent analysis shows no definitive relationship, but Forder’s 2009 study showed a £1 reduction in social care spend increasing NHS demand by 35p. That is why Government have driven the integration of health and social care, and given councils up to £3.5 billion of new support by 2019-20.

The Royal College of Surgeons has said that

“the new council tax precept will not raise enough funds for the areas of the country”

with the greatest need. In Newcastle, it will raise £1.7 million this year, but the funding gap is £15 million. Why is the Minister’s Government making my constituents pay more for worse social care, increasing the pressure on the NHS and causing misery for millions?

The better care fund has been adjusted to recognise that not all councils can raise a similar amount of money through the social care precept, so the issue that the hon. Lady raises has been noted and recognised. The only way in which the NHS can achieve better outcomes and meet the challenges of rising demand is through an increased focus on preventive community health and social care, and closer working with local authorities. That is what the pooled budget is designed to deliver, and that is what it will do.

Indeed, good morning, Mr Speaker.

A big challenge for local authorities and adult social care is how to fund the increases in the minimum wage that care providers have to pay. As my hon. Friend the Member for Newcastle upon Tyne Central (Chi Onwurah) just detailed, the 2% social care precept does not cover all the increased costs and, indeed, in some areas, it is not even being passed on to care providers. The Local Government Association asked Ministers for £700 million from the better care fund to help with that increased cost this year and next year—not in 2019. When will Ministers listen to local councils and agree to bring forward that much needed funding to support what is effectively their own policy in the care sector?

I do not think that anyone fails to recognise that the next couple of years in social care will be very tight, but that is why the better care fund is there. Work has been done to increase the amount of money available to meet the challenges that the hon. Lady raises. I have to repeat that to fund this properly there has to be a sufficiently strong economy. There has to be the commitment to funding that the Government have been able to make almost uniquely in the House. I sometimes think it would help if she recognised the strength of the economy that has been able to do that by assisting local authorities, rather than complain about the amount of money available.

Accident and Emergency Services

Although we are not currently hitting the national A&E target, hospital A&E departments continue to perform well under great pressure. Overall they are coping with 1.9 million more attendances annually compared with 2009-10, and the average wait to see a doctor remains just 38 minutes.

I thank my right hon. Friend for his answer. Many of my constituents are concerned about the temporary closure of the Chorley A&E department, which now only operates as an urgent care service. What assurance can he give my constituents on A&E cover in and around the Bolton West constituency?

May I reassure my hon. Friend that I am very aware of this issue, and I have had a number of meetings with hon. Members to discuss it? Patient safety has to be the utmost priority. We are working with the local trust, and we have been given an assurance that neighbouring hospitals will be able to absorb any extra activity, and that it is working hard to try to reopen the A&E department.

The temporary closure of A&E services at Chorley hospital has had a knock-on effect on hospitals across Lancashire, and anecdotally I hear of many more people turning up at Preston Royal. What reassurances can the right hon. Gentleman give my constituents and residents across Lancashire that he is doing everything he can to make sure that the staffing issues at Chorley are fixed and that Chorley A&E is open again?

I can reassure the hon. Lady that we have been monitoring the situation closely and have provided extra capacity at the Royal Preston hospital. Her own Royal Lancaster infirmary has recently come out of special measures and done a really good job in turning round the quality of care after protracted difficulties. We continue to monitor the situation, and patient safety is our No. 1 priority.

Following centralisation and specialisation processes to drive up the quality of clinical care, we now have patients presenting at minor injuries units and urgent care centres with conditions that need to be treated elsewhere. Will my right hon. Friend take steps to ensure that those centres own the patients’ experience once they have presented, so that we never again have a patient with a serious illness being sent out to make their own way to A&E?

As ever on health matters, my hon. Friend speaks wisely. The fundamental issue is a high level of confusion about what happens to patients when they are faced with a bewildering choice about what to do when they have an urgent health need that needs resolving. They can call 111, try to get an urgent GP appointment, go to a walk-in centre, go to A&E and many other alternatives. We need to resolve that and make it simpler for patients so that they go to the right place first time. Urgent work is happening to ensure that we do that.

The closure of the A&E unit at Chorley and South Ribble district general hospital has ramifications across the north-west. I am informed that North West Ambulance Service has taken on three private ambulances at a cost of £70,000 each a month to provide the extra cover that is required. Does the Secretary of State accept that it is a false economy when he allows A&E units to close on his watch? He simply passes on the costs to other parts of the fractured NHS over which he presides.

I recognise that we have a difficult situation in Chorley and that people in that trust are working very closely together. The chief executive of the trust pointed out that the reason for the closure was that neighbouring trusts were not respecting the caps on agency staff that she was respecting. It is incredibly important that, across the NHS, we have a concerted effort to bring down the prices paid for agency staff, which I think is the root problem here. However, we are monitoring the situation closely.

But how will my right hon. Friend’s powers to ensure good quality accident and emergency provision in hospitals across Greater Manchester be affected by the devolution of health and social care responsibilities to Greater Manchester councils?

I can reassure my hon. Friend that, although we are happy to put the local authorities in Greater Manchester in the driving seat for some major changes, including what I hope will be the first full-scale integration of health and social care across the NHS, we are monitoring the performance against national standards. We will be able to see exactly how well they do on patient safety, waiting times and so on, and whether they live up to the big promises that have been made.

Junior Doctors: Industrial Dispute

Talks are now taking place between NHS employers and the British Medical Association to try to resolve outstanding issues around the junior doctors’ contract.

In his recent letter to the head of the BMA, the Secretary of State offered to discuss improving work-life balance, especially for people with family responsibilities. How exactly does he plan to do that with a contract that the Government’s own quality impact assessment has identified as especially disadvantaging women?

That is not correct. It is worth saying that the reason for the dispute is a manifesto commitment to a seven-day NHS that the Government made to the people of England and that the Scottish National party has not made to the people of Scotland. The weekend effect does not happen just in England. There are studies in Scotland, including the Handel study, which states:

“The excess of admissions ending in deaths at weekends compared with those during weekdays seen elsewhere were also found in Scotland.”

I gently say to the hon. Gentleman that yes, we want to improve the quality of life for junior doctors so that they can live and work in the same city as their partners, and we are looking at the solution to that problem, but that he might think about doing the same thing in Scotland.

Will my right hon. Friend bear it in mind that Secretary of State Dean Rusk always said that jaw-jaw was better than war-war, and that it is welcome that the negotiations have resumed with the BMA on this difficult problem? Does he also accept that everyone wishes the talks well so that we can get a meaningful agreement that ensures a seven-day NHS for the benefit of patients and their safety?

My right hon. Friend speaks very wisely. Indeed, I was thinking about the talks as I spoke on my mobile phone and he was having a cigarette just outside the House yesterday morning. He is absolutely right about jaw-jaw. That is why I think that across the whole House we wish the talks well. However, for them to succeed all sides need to recognise their objective, which is a safer seven-day service for patients. I hope that, on that basis, we will be able to make progress.

I too am glad that the Secretary of State has reopened talks with the junior doctors, but I am a little concerned by the claim that the only issue is Saturday pay, whereas the doctors tell me that they fear the danger of exhaustion. Has he seen the analysis by Cass Business School suggesting that it is impossible to avoid high levels of fatigue under the new contract?

What I have done in the new contract is precisely to try to address those issues by reducing the maximum number of hours that junior doctors can be asked to work every week from 91 to 72 and by stopping junior doctors being asked to work six nights in a row or seven long days in a row. These are important steps forward, and the hon Lady may want to look at Channel 4 FactCheck and other independent analysis of the safety aspects of the new contract which say that this contract is a safer contract.

I would just say that stating it does not make it happen. Junior doctors have looked at the rotas that have been put out as exemplars, and they will not be able to avoid high levels of fatigue. Does the Secretary of State not recognise that, now that we have more data suggesting that the weekend effect may just be statistical, we actually require clinical research because he does not know exactly what the problem is that he is trying to fix?

The new data that the hon. Lady has talked about have been heavily contested this week by some of the most distinguished experts on mortality rates in the country. Academics do sometimes disagree, but Ministers have to decide. The fact is that the overwhelming evidence—whether it is on cancer, cardiac arrests, maternity or emergency surgery, and whether it is in big studies, small studies, UK studies or international studies—is that there is a weekend effect. This Government are determined to do something about it, and I gently say to the hon. Lady that she might consider whether something similar should be done in Scotland.

18. I am fully signed up to the national health service, and that is why I want to see the reopening of Chorley A&E as soon as possible. Many of my constituents use it.In his compromising mood, will my right hon. Friend ensure that, as he talks to the junior doctors, whom I value greatly, the one thing that he will not compromise on is delivering a full service seven days a week? (904954)

My hon. Friend is absolutely right. In the end, the British people’s passion for, and commitment to, the NHS is based upon its offering the highest standard of care for patients. It is sometimes difficult to take these decisions and sometimes we have arguments around them. I want to reassure him that my compromising mood is not a temporary thing. We have always wanted a negotiated solution, but there is one bit that we will not compromise on: the moment that the Government start doing things that mean that we are not delivering safe care for patients is the moment that we will fundamentally shake confidence in the NHS. This Government will not allow that to happen.

Healthcare Costs (EU and UK Citizens)

12. How much was (a) collected in payment for NHS care received in the UK by EU citizens and (b) paid for healthcare received by UK citizens in other EU countries in the last 12 months. (904948)

For 2014-15, it is estimated that the UK owes other European economic area countries and Switzerland £674 million and is owed £49.5 million by other EEA countries and Switzerland for healthcare activity received in that year.

My constituents in Kettering are increasingly fed up with our national health service paying for the healthcare of foreigners who come to this country to freeload on our system. What more can be done to make sure that hospitals and other healthcare providers bill foreign citizens for the NHS services that they use in this country?

The Government take extremely seriously the issue of making sure that only those who should have access to NHS services do access them. Let me make an important point about the figures that I have just given. Some 80% of that imbalanced statistic represents our pensioners who choose to retire to Europe, typically for sunnier weather. The figure is 80% because many more UK pensioners retire to Europe than European pensioners retire here, and there will always be an imbalance. I am sure that even the keenest Brexiteer would not claim that Britain would be sunnier outside the EU.

Will the Minister encourage her Back Benchers to study the expert evidence that was given recently to the Select Committee on Health on the issue that the hon. Member for Kettering (Mr Hollobone) has just raised, our access to free healthcare in Europe, and the economic shock that our leaving the European Union would cause to the NHS finances and to major public health measures such as clean air and clean water that benefit us immensely? Every single one of them told our Committee that leaving the European Union would be disastrous for the NHS, disastrous for health and disastrous for public health.

On this, I am happy to say that I very much agree with the right hon. Gentleman. I encourage all colleagues to look at the evidence deposited with the Committee. Just last year, UK European health insurance card holders—5.5 million people—were able to travel to any other EEA country or Switzerland safe in the knowledge that they would be able to receive free healthcare or reduced costs arising from healthcare if they needed it. That offers great peace of mind and shows that Britain is safer in a reformed EU.

Health and Social Care Integration

13. What support his Department is providing for meeting additional costs incurred by NHS providers in the integration of health and social care. (904949)

I concur with the remarks that the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), just made.

The Government recognise that the NHS and adult social care face significant demand pressures, and established the better care fund to join up health and care. In 2016-17, the BCF will be increased to a mandated minimum of £3.9 billion, with additional social care funding of £1.5 billion by 2019-20.

NHS Cornwall has a significant overspend in 2015-16 because of the cost of keeping people in acute hospitals rather than their being cared for in the community. Despite the commitment and enthusiasm in Cornwall to achieve meaningful integration of health and social care, the pressure on NHS Cornwall finances threatens this badly needed integration. Does the Minister agree that investment in this today will lead to significant savings for the future and better outcomes for patients?

I am aware of significant problems in Cornwall that a number of Members have brought to me, and they are very complex. The clinical commissioning group is building on existing work with NHS England to address the financial challenges facing NHS Kernow and the wider local health and care system. Statutory directions were put in place late last year to support the CCG’s work with local partners in ensuring that services are affordable as well as good. An independently led capability and capacity review is being completed and an action plan is being implemented. I encourage the CCG to continue to work closely with NHS England to help to put its finances on a firmer foundation to achieve its integration plans. There is a further meeting planned locally tomorrow.

We recently had a Westminster Hall debate on care workers not even being paid the national minimum wage, and now we have private social care providers saying that they will not be able to afford the new national living wage. How does the Department intend to address this impending crisis?

It is absolutely essential that workers are paid the national minimum wage, and for care workers that includes travel. The Department has been very clear in that regard. Extra money is being provided to local authorities to pay for social care, as we know, but matters are tight—I am well aware of that. We are looking to providers and local authority providers to meet their statutory obligations to ensure that hard-pressed care workers have the financial support they need to do their vital job.

Five Year Forward View

We are making good progress in implementing the five year forward view, including £133 million invested in new models of care and 18 million people benefiting from extended GP access.

It is estimated that a third of patients in acute hospitals could be better treated elsewhere, for instance at home, and in east Kent our vanguard aims to address this with new models of care, but it is early days. Will my right hon. Friend advise us of what he is doing to drive progress on new models of care, bringing together health and social care so that more people are cared for in the right place?

My hon. Friend is absolutely right to draw attention to what is, in a way, the most fundamental point of the five year forward view, which is getting care to people earlier to help them live healthily and happily at home. Perhaps the most significant announcement we have had in the past few weeks has been the extra £2.6 billion a year that will be invested by the end of the Parliament in general practice. That is a 14% increase that will allow us to recruit many more GPs and, I hope, dramatically improve care for her constituents and others.

Yesterday the Health Secretary admitted to the Health Committee that “we didn’t protect the entire health budget” in the last comprehensive spending review. I am pleased that he appears to have adopted a bit of straight-talking, honest politics, so in that spirit will he now admit that the very real cuts to public health budgets over the next few years will make it harder to deliver the “radical upgrade” in public health that his five year forward view called for?

In the spirit of straight talking and honesty, which I think is an excellent thing, perhaps the hon. Gentleman might concede that those cuts and efficiencies that he is talking about would have been a great deal more if we had followed Labour’s spending plans—that is, £5.5 billion less for the NHS than this Government promised, on the back of a strong economy.

Topical Questions

Last week I agreed to pause the introduction of the new junior doctors contract for five days and return to talks with the junior doctors committee. I commend the junior doctors for their decision to return to talks. They have agreed to suspend the threat of further industrial action and those talks are now in their second day. We have always been clear that we want to see a negotiated solution to this dispute, and the resumption of these talks shows that the Government’s door is and always has been open to meaningful talks.

Last Friday I met my constituent Lisa Cass whose son Ben was recently diagnosed with type 1 diabetes. Ben had been showing signs of the four T’s of type 1 diabetes—toilet, thirst, tired and thinner—and Lisa took him to her local GP for an appointment. No test was done on the day at the surgery and a blood test was booked for the following week. The following day Ben was back at his GP’s surgery after a rapid decline which could have been fatal, and the air ambulance was called. Thankfully—credit is due to the excellent medical professionals who treated Ben—he is now doing well and is managing his condition. However, this case shows the need for awareness of type 1 diabetes to be improved right across the country. Will my right hon. Friend meet me and my constituent to see what more we can do to raise awareness of type 1 diabetes and its symptoms among health professionals and the wider public?

Of course I am happy meet my hon. Friend and his constituents. A close friend of mine who wanted to take a place in this House ended up dying tragically early because he had type 1 diabetes and was not able to get the care that he needed, so I am very aware of those issues. What we are doing in England, which is different from Wales, is publishing transparent indicators of the quality of diabetes care CCG by CCG. Those data will be published before the summer recess and will enable us to look at the disparities in care. I am sure there is more we can do.

Research published yesterday by NHS Providers and the Healthcare Financial Management Association showed that half of mental health trusts had not had an increase in their budget in 2015-16 and just a quarter of providers are confident that they will receive a funding increase for this financial year, 2016-17. Will the Secretary of State finally admit that the supposed additional investment in mental health that he talks about so often has not materialised for the patients and services that need it most? What is he going to do about it?

I thank the hon. Lady for her question and for her support for me in the recent London marathon. With reference to her question, it is precisely for the reasons she gives that it is so important for us to make sure that CCGs do transfer the extra money that is available for mental health into mental health services. That is why there will be more transparency and a scorecard for CCGs. She is absolutely correct—it is essential that that money flows through and we are determined to ensure that. Yesterday’s report only shows how right our current actions are to make sure that that happens.

T3. The Havant Men’s Shed movement has created community workspaces across my constituency, helping to boost mental health and wellbeing, especially for older residents. Will the Minister join me in congratulating the movement on its work and come to Havant to open its new building? (904930)

Yes. My family know I am a keen supporter of the shed movement, just as I am a keen supporter of the 5 Live Saturday afternoon movement and the beer in the shed movement. I can assure my hon. Friend that an opportunity to visit the Havant Men’s Shed movement will be an important part of the ministerial diary in the very near future.

T2. During March, at one of my local trusts the A&E ambulance target was missed for 937 patients, and more than 4,000 patients waited for more than four hours in A&E. Staff and management agree that this is a trust in crisis, with many wards staffed to less than half the minimum safe staffing levels. Patient safety is being compromised every day. Will the Secretary of State please stop passing the buck and act to stop the downgrade of Dewsbury and Huddersfield hospitals, because it is clear that our local healthcare is in absolute crisis? (904928)

The hon. Lady mentioned to me yesterday that she would raise this issue today. We are absolutely not passing the buck; the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), had a very productive meeting with her and local representatives to address these issues. She is right to have concerns about some of the safety indicators, but it is also true that summary hospital-level mortality for the trust has improved, and there are encouraging improvements in morale, as recorded through the NHS staff survey. However, there are worrying things, and we will continue to monitor them closely.

T4. Last month, Coperforma took on the patient transport contract for Sussex. Unfortunately, since then there have been unacceptable and serious delays for some very sick and elderly patients. May I have assurances that the Department of Health will follow up this issue? (904931)

Sussex CCGs are responsible for monitoring Coperforma’s performance, and High Weald Lewes Havens CCG acknowledges that, as my hon. Friend said, the early performance of the new non-emergency patient transport service has not been acceptable. For that reason, the CCG, on behalf of all Sussex CCGs, has begun an inquiry, with the aim of making a report available by June, and with interim progress reports. We will of course monitor the issue carefully.

T5. In my corner of Essex, there is a primary care crisis: demand for GP services is rising, the supply of GPs is falling and many surgeries are simply no longer accepting new patients. What assurance can the Minister give me that we will definitely get more GPs, and when will we get them? (904933)

The concerns the hon. Gentleman raises are very real, and they are shared by GPs around the country, which is why we put so much work into analysing them. The recently published “GP Five Year Forward View” addresses a number of concerns brought to us by GPs, but the determination to have 5,000 more doctors working in general practice by 2020 is a reflection of the fact that making sure there are enough doctors physically to work in general practice is an important aim of the Government’s.

T8. My constituent Archie Hill and his parents, Louisa and Gary, were really excited when, on 15 April, the National Institute for Health and Care Excellence recommended that the drug Translarna—a breakthrough drug for children with Duchenne muscular dystrophy —should be funded by NHS England. Hon. Members can imagine what happened when, on 4 May, NICE unexpectedly announced that it required extra time to come to an agreement with NHS England. What is going on? We thought this drug had been cleared. Time is of the essence, because the boys affected are eligible for this drug only if they are still walking. Can we please look into this issue, and can we please go back to the original timetable? After all, these boys have had to wait several years to get to this stage. (904936)

I commend my right hon. Friend, and we have had numerous discussions over the last year on this subject. She can rest assured that I am actively doing everything I can to make sure we expedite this. She will understand that there are important negotiations with NHS England, NICE and the company at the moment, which are key to making sure we can get this drug accelerated quickly.

T6. Other EU countries charge us £650 million a year more for the health treatment of our citizens abroad than we do for the treatment of their citizens here. Is that because we cannot charge them, or because we have not got our act together? (904934)

The answer, regrettably, is that for many years we have not got our act together. That is why I have changed the system of incentives for trusts to make sure that they get a premium for identifying EU nationals they treat and that we can then recharge the treatment to their home countries. We are, as a result, now seeing significant increases in the amount we are reclaiming from other countries.

Community hospitals are immensely valued by the communities they serve. Will the Secretary of State meet me to discuss the proposals for south Devon, which will particularly affect my constituents living in Dartmouth and in Paignton?

Yes, I am happy to do that. I have a number of community hospitals in my own area. It is really important that even as the functions and jobs that community hospitals do inevitably change, we recognise that they have a very important long-term future in the NHS.

T7. Wigan A&E is expected to take a third of the patients turned away from Chorley A&E owing to Chorley’s unplanned closure, yet it has a similar ratio of staffing vacancies. What extra resources are being given to Wrightington, Wigan and Leigh NHS Foundation Trust to help it to cope with this crisis? (904935)

We are making sure that neighbouring hospitals have the resources to deal with the temporary closure of Chorley A&E. The more patients that any hospital sees, the more resources it gets. This is none the less a very worrying situation that we are monitoring very closely.

The success regime review in Devon is causing real concern about the future of acute services at North Devon District Hospital. Does the Minister recognise that the unique geographical circumstances of Barnstaple mean that the reduction of any of those services will, for some of my constituents, mean a round journey of more than 120 miles to access them?

I do recognise the unique geographical circumstances in my hon. Friend’s constituency. That is precisely why the success regime is being led by local clinicians. I hope and expect that in formulating plans they take account of all the views and all the clinical needs of his constituents and his own views.

There is growing concern that the additional investment in children’s mental health services committed last year is not getting through to where it is intended. What will the Secretary of State do to guarantee that that money gets through to help children with mental health needs? It would be scandalous if it did not get through. Transparency is not enough.

I thank the right hon. Gentleman for all the work he did in relation to this. I can assure him that the £1.25 billion committed in the 2015 Budget will be available during the course of this Parliament. As I said to the hon. Member for Liverpool, Wavertree (Luciana Berger), it is absolutely essential to me and to us that we make sure that that money does get through to CCGs. The regime will be more transparent, but there will be a determination to expose it to make sure that the money is spent on child and adolescent mental health services, as it needs to be.

My right hon. Friend will be well aware that the business case for the rebuilding of the Royal National Orthopaedic Hospital has been dragging on within the NHS for more than six years. We now seem to have a decision for the Trust Development Authority to make. Will he put pressure on the TDA to approve this business case so that work can begin this summer?

As my hon. Friend knows, I have done a shift as a porter in that hospital and seen for myself just how much it needs the extra investment to transform its facilities. I will happily look into the matter for him, and I am keen to see it progress as fast as possible.

The Minister will be aware that mortality rates in England and Wales have increased by 5.4% in 2015—the biggest increase in the death rate for decades. She will also be aware that mortality rates have been rising since 2011. Has she done any analysis of what has been behind those trends? Specifically, with the Cridland review starting, what will her Department do to negotiate with Cridland on the increase in the pensionable age to take account of the recent changes taking place?

We welcome the overall trend towards longer life expectancy. There are annual fluctuations, but overall the trend remains positive. The key thing is helping people to live longer, healthier lives. Therefore, tackling health inequalities among people of all ages and in all communities is embedded in policy right across the Department—for example, the investment in nearly doubling the health visitor workforce over the previous Parliament—so that we can really bear down on the things that drive those health inequalities, particularly among poorer communities and poorer children.

I thank the Secretary of State for working so tirelessly to get the BMA back to the negotiating table. Will he confirm that Saturday pay for junior doctors will be at a 30% premium, which is above that for any of the hard-working midwives, nurses, firefighters, paramedics and so on in my constituency?

I thank my hon. Friend for her question. She makes the important point that the proposals on the table in the new contract are incredibly generous compared with the terms of the other people working in hospitals. That is why it is very important that we have some flexibility from the BMA on Saturday pay so that we can deliver the seven-day service that we all want. It is a very good deal for junior doctors, and I think that if they look at it objectively, we should be able to come to an agreement this week, but it will take flexibility on both sides.

Order. I shall call the hon. Member for Nottingham North (Graham Allen) if he guarantees that his grey cells will produce a one-sentence, pithy question.

Will the Minister responsible for dental matters meet me and the hon. Member for Mole Valley (Sir Paul Beresford) to discuss dental ill health in children and how we can change the dentist contract to make it more prevention-friendly? I have got a lot more to say, but I will sit down.

Marvellous. I am sorry to disappoint remaining colleagues, but we must move on. I am most grateful to colleagues for their good humour.