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Oral Answers to Questions

Volume 617: debated on Tuesday 15 November 2016


The Secretary of State was asked—

Excess Winter Deaths

Last week, NHS England and Public Health England launched the Stay Well This Winter campaign, which last year reached 98% of the over 65s. This year, for the first time, children in year 3 will be offered free flu vaccine, which means that an additional 600,000 children will be protected this winter, making this the largest children’s flu vaccination programme to date. The Government also provide practical support for those most at risk, including winter fuel payments and the warm home discount scheme. We are also working with the NHS and local authorities to implement our cold weather plan, which is poised to respond to pressures on vital health and social care services this winter.

It is a national disgrace that so many people die needlessly in this country as a result of the cold each year—43,900 people died over the winter of 2014-15. When will somebody in Government accept some responsibility, show some leadership and act decisively to reduce the appalling number of people who die each winter as a result of the cold?

I congratulate the hon. Gentleman on the interest that he takes in this subject. I know that he has a petition currently running in his local area. We do take very seriously the additional pressures placed on the NHS primarily by the winter weather but also by disease prevalence, particularly flu. We started winter planning for this coming winter early in the summer. We have regular updates, which I run, and I report to the Secretary of State on how those plans are going. I can assure him that we are taking as many steps as we can to ensure that we are on top of this issue this winter.

As part of the plans to reduce and prevent deaths during the winter, what changes have been made with regard to the winter fuel payments for those eligible residents living in the Mediterranean?

My right hon. Friend refers to the changes that we introduced under this Government with effect from last year, 2015-16, to reduce the eligibility for those British citizens living in warmer climates around the Mediterranean, which I know caused him considerable concern. I am pleased to be able to tell him that the change in policy last year reduced the amount paid under the winter fuel payments by 70% compared with the previous year to those people living in the European economic area.

One way of preventing excess winter deaths would be to ensure that people can go to their local pharmacy for advice, essential medicines and flu vaccines. Plans to cut pharmacy budgets will hit Dudley hard, with just 1%—one out of Dudley’s 100 pharmacies—getting extra support, compared with 40% in places such as Chesham and Hampshire. Of the thousands of local residents who completed my survey, 97% said that they opposed these cuts. Why will the Minister not listen to the people of Dudley and sort this out?

I wonder whether the hon. Gentleman included in his survey the fact that the reduction in the establishment payment to each pharmacy will be of the order of £200 a week from 1 December, and £400 a week from 1 April. How many of those pharmacies in Dudley will not be able to sustain that reduction in Government subsidy? We use community pharmacies to undertake flu vaccinations for which they will be paid.

What can be done to reduce the effect of winter pressures on the bed state of our acute hospitals and thus reduce the awful phenomenon of bed blocking this winter?

As my hon. Friend knows, we are taking steps, in particular through the sustainable transformation plans, to increase the integration of social care and the health sector. For this winter, we are working hard on delayed transfers of care, to try to ensure that there is more rapid patient flow through our hospitals. That involves closer integration with social care professionals to encourage quicker discharges from the hospitals.

One way of making sure that people do not die in the winter or at any other time is for this Government to concentrate on keeping hospitals open, thereby saving the beds. In that context, why does the Secretary of State refuse to answer the question why hospitals such as Bolsover and another half a dozen in Derbyshire are secretly being closed and Ministers are doing nothing about it?

The question is about flu vaccinations and I strongly encourage the hon. Gentleman to join me in having a flu vaccination, as I believe he is one of the eligible individuals. In relation to Derbyshire, the local health services there are working together to identify the best pattern of provision for a sustainable health service for the future.

The question was about the prevention of excess deaths, so the hon. Member for Bolsover (Mr Skinner) was entirely in order in his interpretation of the question. It was not about flu vaccinations, and nobody should mislead the House, however inadvertently.

Kettering general hospital would be better able to deal with winter pressures were it given permission to develop its urgent care hub. The hospital tells me that its application has been with NHS Improvement for nine months now. Will the Minister prod NHS Improvement to get a move on in approving this application?

My hon. Friend held an Adjournment debate recently which I was pleased to respond to. We discussed the status of Kettering general hospital and the foundation trust that runs it. He is correct that it is discussing with NHS Improvement the development of a business case for an urgent care hub, and this is being considered in the context of the wider sustainability and transformation plan. Mr Speaker, I accept your admonishment in respect of my answer to the previous question. Of course, one of the primary solutions to winter excess deaths is the flu vaccination programme.

Hospitals in Special Measures

In the past four years, 31 trusts have been put into special measures, more than one in 10 of all NHS trusts. Of those, 15 have now come out and I particularly congratulate the staff of Sherwood Forest, Wye Valley, and Norfolk and Suffolk trusts which have come out of special measures in the past month.

Does the Secretary of State agree that the sustainability and transformation plan for Norfolk and Waveney is a vital part of the Queen Elizabeth hospital’s future as it successfully moves out of special measures? Although there is overwhelming support for integrating health and social care, will he confirm that there will be full consultation with different patient groups on the STP?

I can absolutely give that assurance. Through my hon. Friend I congratulate the staff of King’s Lynn hospital who have turned things around there. It was a great privilege for me to visit it and see the work that they have done. My hon. Friend is right—the next step is to integrate the work done in acute hospitals with what happens in the community and the social care system. That is why the open and transparent STP process is so important.

I do listen carefully to the Health Secretary and sometimes I end up wondering what planet he is living on. There are as many trusts in special measures now as there are trusts that have come out of special measures. Just because different people in different places are experiencing poor care does not make the overall picture any better. When will the right hon. Gentleman accept that the overall amount of resource going into the system is simply inadequate if he wishes to provide high quality, timely care for all?

Let me tell the hon. Lady that what is different now is that we have a special measures regime. When Labour was in power, the problems were swept under the carpet and not dealt with. Now they are being dealt with because we want every NHS patient to have confidence that we will not have another Mid Staffs. That is why we are making very good progress. With respect to funding, may I respectfully tell her that had we followed her party’s spending plans, the NHS would have £1.3 billion less this year?

The Secretary of State will know that with depressing regularity the same hospitals come up on that list that he has just referred to. Sustainability and transformation plans provide the opportunity to address some of the unsustainable elements of local health economies, but only, as my hon. Friend the Member for Lewisham East (Heidi Alexander) says, if the money is there. With the health service facing its tightest financial settlement in its history, these plans are just not deliverable.

The right hon. Gentleman understands health extremely well, both from his ministerial position and from being on the Select Committee. If he looks at the hospitals going into special measures, he will see that we are beginning to succeed in moving hospitals out of special measures, but because we have an independent inspection regime, sometimes other ones go in. That is how it should be. That is what works very well in the education sector and is beginning to work well in driving up standards in health care as well.

To go back to my answer to the hon. Member for Lewisham East (Heidi Alexander), £1.3 billion more in the NHS this year compared with what would have been put into the NHS if Labour had won the last election means 30,000 nurses, 13,000 doctors or 200,000 hip replacements that we are able to do because of this Government’s funding of the NHS.

Healthcare Spending

3. How much his Department spent on healthcare as a proportion of GDP in (a) 2009-10 and (b) 2015-16; and what estimate he has made of the amount that will be spent on healthcare as a proportion of GDP in 2020-21. (907199)

Because of the 2008 financial crisis, all political parties committed to reducing the proportion of GDP spent on health in 2010, but because this Government chose to protect the NHS, the proportion fell from 6.4% to 6.2%, a drop of just 0.2% of GDP.

While welcome, that creative response does not answer the question. The fall in GDP spent on health is worrying. To mitigate that fall, when can my constituency expect its share of the Brexit NHS bonus to be injected into its health economy, which would bring in £30 million a year?

No one would be more delighted than the Health Secretary if we had a Brexit bonus for the NHS, which is why we are getting on with negotiating the best possible Brexit deal for this country, including by invoking article 50 as soon as possible.

I thank the Secretary of State for taking time last week to visit the Peterborough City hospital and to praise the magnificent staff there, who are labouring under a £35 million annual private finance initiative millstone. Is the wider context not that we would have a lot more money to spend on front-line care if we did not have to deal with a poisonous legacy from Labour of £64 billion of appalling PFI contracts in the NHS?

My hon. Friend is absolutely right. I was incredibly impressed with the staff I met at Peterborough hospital—there was incredible commitment to patients and some fantastic work going on in the oncology and renal departments, which I visited. He is right: PFI was a disastrous mistake, saddling hospitals up and down the country with huge amounts of debt, which cannot now be put into front-line patient care. We are doing everything we can to sort that out and not repeat those mistakes.

My right hon. Friend will be aware that the NHS spends only about £400 million a year on homeopathic medicine and treatments through the 400 doctors who have trained in homeopathy and are members of the faculty. If he wants to reduce antibiotic prescribing, may I suggest that he increases that budget, because there are very good scientific trials now showing that upper respiratory tract infections can be treated using homeopathic medicine? May I write to him about that?

May I commend my hon. Friend for his great persistence in flying the flag for homeopathic medicine? While we must always follow the science in the way we spend our money on medicines, as I know he agrees, he is right to highlight the threat of antibiotic resistance and the need to be open to every possible way of reducing it.

Today I publish my first annual report as Chair of the Public Accounts Committee, in which I conclude that there is a sustainability crisis in the funding of the NHS. Surely the Secretary of State will agree—he has made some comments in the media that suggest he is becoming aware of this—that he will need to lobby the Chancellor for a better settlement in the autumn statement. Will he update the House on his negotiations?

I am sorry to disappoint the hon. Lady but I do not update the House on Government discussions which happen in the run-up to every Budget and autumn statement. What I would say to the hon. Lady is that I am not someone who believes that the financial pressures that undoubtedly exist in the NHS and social care system threaten the fundamental model of the NHS. What they remind us all of is that what we need in this country is a strong economy that will allow us to continue funding the NHS and social care systems as we cope with the pressures of an elderly population. That, for me, is the most important challenge—the economic challenge that will allow us to fund the NHS.

Will my right hon. Friend confirm that, under his tenure as the Minister, there has been a real-terms increase in spending on the NHS in England, unlike in Wales, where, over the last few years, we have seen real-terms cuts under the Labour party?

As ever, my hon. Friend speaks wisely. Thanks to this Government, health spending in England is up by 10.1% in cash terms—4.6% in real terms—since 2010. That is double the cash increase in Scotland and three times the cash increase in Wales. Other parties talk about funding the NHS, but Conservatives say that actions speak louder than words.

But we have seen public health budgets cut and social care budgets cut, and I can now tell the House that the maintenance budgets have been cut. In fact, the backlog of high-risk maintenance facing the NHS has soared by 69% in the past year. In London alone, the high-risk backlog has grown by £338 million; across the country the figure is nearly £5 billion. NHS finances are so stretched that even the most urgent repairs are being left undone. Is this what the Secretary of State meant when he said that he is giving the NHS the money it asked for?

I know that the hon. Gentleman has only been shadow Health Secretary for a while, but may I ask him to cast his mind back to 2010, when the party that wanted to cut the NHS budget was not the Conservative party but Labour? In 2015, his party turned its back on the five year forward view and said it would increase funding not by £8 billion but by just £2.5 billion. It is not enough to found the NHS—you have got to fund it.

Order. These exchanges, not untypically, are taking far too long, and part of the reason for that is that the Secretary of State keeps dilating on the policies of the Labour party. If he does so again, I will sit him down straight away. [Interruption.] Order. There are a lot of colleagues who want to ask questions. We want to hear about Government policy, not that of the Opposition. I have said it, it is clear— please heed it.

Thank you, Mr Speaker.

If everything is so rosy with the NHS’s finances, why did Simon Stevens say just a couple of weeks ago that

“2018-19 will be the most pressurised year for us, where we will actually have negative per-person NHS funding growth in England”—

in other words, that NHS spending per head will be falling? The number of patients waiting longer than four hours in A&Es has increased. The number of days lost to delayed discharge has increased. The number of people waiting more than 62 days to start cancer treatment following referral has increased. Should not the Secretary of State do his job and make sure that next week’s autumn statement delivers the money that the NHS urgently needs?

Unlike other parties in this House, we have been increasing funding for the NHS. Thanks to that, we are now funding the NHS in England at a 10% higher proportion of GDP than the OECD average, and we are in line with the western European average because of our commitment. These are difficult financial times and there is financial pressure, but this Government have been saying that despite that financial pressure we must make sure that the NHS continues to offer safe, high-quality care—and that is our focus.

Cancer Referral Times

4. What the average time taken is between referral and treatment for patients with (a) ovarian and (b) bowel cancer; and if he will make a statement. (907200)

The figures for times between referral and treatment are published against the standard whereby 85% of patients should begin treatment within 62 days of GP referral. The September 2016 figures were 69% for bowel cancer and 75% for ovarian cancer.

Is it not the case that only skin cancer and breast cancer referrals are meeting that 62-day target? Is it not unsurprising that the survival rate over 10 years is 78% for breast cancer and 89% for skin cancer, whereas it is 35% for ovarian cancer and 57% for bowel cancer? How does the Minister feel about these excess deaths, and what is he going to do to ensure that people with these cancers are treated in time?

There are eight cancer standards for waiting times and we are consistently meeting seven of them, as we did in September. The right hon. Lady is right to say that the 62-day waiting time has been challenging, and that has an impact on bowel cancer and ovarian cancer. It is also true, though, that one-year, five-year and 10-year survival rates for bowel and ovarian cancer are improving significantly. However, we do need to go further. That is why all 96 recommendations of the Cancer Taskforce have been accepted—we are investing up to £300 million to make that happen—and there is going to be a new test whereby all patients will be either diagnosed or given the all-clear within 28 days.

I refer to my entry in the register. Does my hon. Friend agree that research will defeat bowel and gastrointestinal tract cancer, and may I invite him to congratulate Bowel and Cancer Research on its fundraising and support for the cancer research community?

My hon. Friend is quite right: research, in the end, is the way we will beat cancer. This country is ahead of all countries in the world in terms of the number of trials going on, including the US. The voluntary sector, including the charity to which he refers, makes a big impact and I congratulate it.

I lost my mum to ovarian cancer just a few years ago. She received outstanding treatment at the Rosemere centre in Preston. That is the centre that my constituents need to travel to for radiotherapy for all forms of cancer, but an average round trip to receive treatment takes about two hours. Does the Minister agree that that is not acceptable, and will he support the Rosemere centre in setting up a satellite unit at Kendal hospital, so that people in south Cumbria can get treatment quickly?

I certainly agree with the hon. Gentleman that two hours is a long time. His is a large constituency and I am very happy to look at his specific point and to revert to the House.

Like the hon. Member for Westmorland and Lonsdale (Tim Farron), I lost my mother to ovarian cancer. One of the reasons is late diagnosis and it has been suggested that cervical smear results should state that it is not a test for ovarian cancer. Will the excellent Minister update the House on his research on that proposal?

My hon. Friend is right to say that one of the big issues with ovarian cancer—we talked about this earlier—is that early diagnosis does not happen as quickly as it should. It is true that the cervical cancer test could raise awareness of ovarian cancer. We are looking at the issue and will revert to the House.

Ovarian cancer accounts for some 12% of all new cases, and early diagnosis is critical. What discussions has the Minister had with the devolved Assemblies to co-ordinate and make available better treatment options, to provide a truly UK-wide NHS?

This is a reserved matter, but the hon. Gentleman is right to say that early diagnosis is the single most important thing that we need to do better in order to improve our cancer out-turn rates, and that dialogue continues.

Is it not rather unfair to compare outcome rates for skin cancer, with which I was diagnosed, with those for other types of cancer, because it is easier to diagnose skin cancer at an early stage, which means that the outcomes are usually very good?

Yes, because it is easier to diagnose at an early stage—that is the point I am making. Compared with 2010, are we not seeing more than 26,000 extra outpatients a day?

Compared with 2010, we are referring an average of 800,000 more people urgently for cancer treatment. My hon. Friend is also right to say that both skin and lung cancer have more straightforward pathways than ovarian and bowel cancer, but that is not to say that we should not focus on continually improving in relation to the points made by the right hon. Member for Slough (Fiona Mactaggart).

Childhood Obesity Strategy

The Department is working closely with Public Health England, the national health service, local authorities, schools and other partners as we implement the childhood obesity strategy. We have already taken firm action, including consulting on the soft drinks industry levy and launching a broad sugar reduction programme.

Channel 4’s “Dispatches” programme has comprehensively demonstrated how the former Prime Minister’s obesity strategy was drastically watered down by the time of the final publication. Both Public Health England and the Health Committee agree that control of in-store promotions of unhealthy food is absolutely vital. Why was regulation of such promotions ditched from the Government strategy?

We have made no secret of the fact that we considered a range of policies before publishing the childhood obesity strategy, which is a world-leading strategy and one of the most ambitious in the world. It will cut childhood obesity by one fifth in the next 10 years, and I am determined that we do not get lost in a debate about what it could or should have been, but instead get on with implementing it. Our children deserve no less.

A few weeks ago, I hosted a Westminster forum on the implementation of the strategy, at which there was much consternation about why another important recommendation—the creation of a 9 pm watershed to reduce children’s exposure to junk food advertising—was cut. Does the Minister not realise the seriousness of the obesity crisis, and can she explain why that important measure was dumped?

Current restrictions on the advertising of less healthy food and drink in the UK are among the toughest in the world, so I am pleased to reassure the hon. Gentleman and his constituents on that fact.

May I draw the Minister’s attention to some excellent leadership from the private sector? Lucozade Ribena Suntory, which is based in my constituency, announced last week —rather buried in the news from the United States of America, I am afraid—that it was going to take 50% of sugar out of its soft drinks by reformulating all its new and existing products. That demonstrates really good leadership and is an example to other companies.

I welcome my right hon. Friend’s question. He is absolutely right. We very much welcome the actions of not only Lucozade but Tesco in cutting the sugar in their drinks. It is proof that doing so is possible and meets the expectations of many consumers.

Recent data from the national childhood measurement programme shows that obesity rates have risen for the second consecutive year. With that in mind, will the Minister outline what further steps she has taken to make the childhood obesity plan for action into a true strategy?

As I have been saying during this Question Time, I am absolutely determined to focus on implementing the plan that we have. It is one of the most ambitious in the world, and it will deliver a reduction of a fifth in childhood obesity over the next decade. However, we have been clear that this is not the final word; it is just the beginning of the conversation. I would welcome contributions from my hon. Friend, who is a dogged campaigner on this issue.

Yesterday, on World Diabetes Day, the Prime Minister opened the new headquarters of Diabetes UK and said that the number of cases of diabetes increased by 75% in the last decade. The Minister and I attended the launch of the Food Foundation’s declaration on how to tackle obesity. Which of the 10 measures put forward by the foundation has she decided to accept?

The right hon. Gentleman is absolutely right to raise this issue, and we are considering the contributions from the Food Foundation, which are very important. He is right about the role that obesity plays in triggering diabetes. That is why we are focusing on preventing type 2 diabetes through the world’s first national diabetes prevention programme, which aims to deliver at-scale, evidence-based behavioural change to support people to reduce their risk of developing type 2 diabetes.

May I urge the Minister, in tackling childhood obesity, not to go down the line of nanny-state proposal after nanny-state proposal, but instead to look at Active Movement, which is in operation in a number of areas around the country? It builds exercise into the average day of children in schools, and it is already making a great difference to childhood obesity levels.

I very much welcome the hon. Gentleman’s support for a key plank of the childhood obesity strategy, which is helping all children to enjoy an hour of physical activity every day and which will include physical movement as well as specific physical education.

Another target that “Dispatches” uncovered was to be scrapped was the target to halve childhood obesity by 2026. This was compounded by recent national childhood measurement data showing that obesity is on the rise and that obesity rates are more than double in deprived areas compared with more affluent ones. Instead of squandering this opportunity, the Government should be pushing ahead with a comprehensive and preventive strategy. Can the Minister explain, therefore, why this significant target was dropped from the Government’s plans to tackle childhood obesity?

The hon. Lady is right to say that the childhood obesity strategy is one of our key priorities for tackling health inequalities in the UK. Obesity prevalence for children living in the most deprived areas is double that for those living in the least deprived areas, and the gap continues to widen. That is exactly why we will press ahead with the plan, but, as she has said, this is just the beginning of the conversation and we will continue to fight obesity as a government priority.

Sustainability and Transformation Plans

6. What discussions he has had with local government representatives on the sustainability and transformation plan process. (907202)

The STPs are a collaborative local effort, involving providers and commissioners coming together with other stakeholders to produce place-based plans. The vast majority of plans have been developed jointly between the health sector and local authorities. Several plans have been led by local government.

Yesterday, the King’s Fund rightly characterised what is euphemistically called the sustainability and transformation project as being planned in secret, behind the backs of patients and the public. In Merseyside and Wirral, we know from leaks that the Government are going to cut £1 billion from our local national health service, which, despite rising demand, will close hospitals, downgrade many accident and emergency departments and possibly leave the whole of Wirral without an acute hospital. Will the Minister now come clean and publish these plans in full, and will he undertake to visit Wirral so that my constituents in Wallasey can come and have a word with him about his plans for their NHS?

To be clear, every single STP will be published by Christmas. About 12 have been published so far, and the Cheshire and Merseyside STP will be published tomorrow. When the hon. Lady has access to it, she will see that some of the statements she is making are just scaremongering. She mentioned the King’s Fund, so let me quote it:

“The King’s Fund continues to believe that STPs offer the best hope of delivering long term improvements to health and care services.”

That is what the King’s Fund says.

20. Will the Minister ensure that NHS managers undertaking the STP process affecting North Devon are fully aware of my constituents’ concerns, especially in relation to our geographical isolation? In particular, will he ensure that they are aware of their concerns in Ilfracombe, which has suffered from decades of health inequality because of its location? (907218)

It is vital that every STP engages with all stakeholders, and that includes North Devon. The public and, indeed, MPs should engage in the process as critical friends to try to make these plans better.

Despite reassurances, there are still concerns that mental health remains peripheral to STPs in many areas. Will the Minister provide some further reassurance, because unless the Government absolutely insist that mental health is central and that resources are focused on prevention in mental health, these plans will simply fail?

I give the right hon. Gentleman the categorical assurance that better mental health is a fundamental part of what the STPs are trying to achieve, as are better cancer outcomes and better integration of adult social care. If an STP does not include those things, it will have to continue to evolve until it does.

The Mayor of Bedford, Dave Hodgson, and I have a common approach to the STP in Bedford—it is ably led by Pauline Philip, the chief executive officer of Luton and Dunstable hospital—but he is frustrated that he is not being involved and that his voice is not being heard in the process. Will my hon. Friend ensure, when he reviews all the STPs, that he gets a guarantee in every single case that the local authorities have bought into the plan, and, if not, that they will not proceed?

I give my hon. Friend the categorical assurance that if local authorities and the NHS managers doing the planning work have not engaged properly, the plan will not be considered to be complete. That does not mean that every local authority has a veto on its STP.

Following on from that point, the Minister has previously said that STPs will

“not go ahead if councils believe they have been marginalised.”

Given that seven councils in London and west Yorkshire have already rejected their STPs and, as we have heard, that council leaders from both main parties have expressed concerns about the Cheshire and Merseyside proposals, does the Minister have a plan B when it comes to rejected STPs?

In a previous answer, I made the point that every local authority should be engaging with its STP, and the NHS must ensure that that happens. That is not the same as saying that every local authority has a veto on the STP, which was the implication of the hon. Gentleman’s point.

Delayed Hospital Discharges

7. What assessment he has made of the effect of changes to local authority social care budgets on the level of delayed discharges from hospital. (907203)

The Government are giving councils access to a further £3.5 billion for social care by 2019, which will mean a real-terms increase over the lifetime of this Parliament. The causes of delayed transfers of care are complex and, frankly, vary considerably by local council.

The Care Quality Commission has commented that social care is on the verge of collapse. The Government have had six years of warnings in relation to this matter, yet they have cut £4 billion from the social care budget. Will the Secretary of State for Health be talking to his colleague the Chancellor of the Exchequer to ensure that the £4 billion is replaced in the autumn statement?

The system is under pressure but we also know that the best way to achieve the best results is faster integration, and not just money. I will give the hon. Gentleman an example. There is a massive disparity between councils. The best 10% of councils have 20 times fewer delayed transfers of care than the worst 10%. It is not just about money, as the budgets are not 20 times different. Indeed, many councils have been able to increase their budgets, including Middlesbrough.

The Minister is aware of the Health Committee’s concerns about the effect of underfunding of social care on the NHS. He may also be aware that there are particular concerns in my area and in the constituency of my hon. Friend the Member for Torbay (Kevin Foster) because of the recent Care Quality Commission rating of Mears Care as inadequate. Coming on the back of community hospital closures in Paignton, that gives grave concern to all our constituents. Will the Minister meet me and my hon. Friend the Member for Torbay to discuss this further?

My hon. Friend is right that there was an inadequate CQC rating for that care home. It is therefore right that the care home must either improve or go out of business. That is what the CQC regulatory environment will ensure. She makes a point about the issue with the hospital in Paignton; that is out for consultation at the moment, and I would expect the local care situation to be part of that consultation.

The National Audit Office report “Discharging older patients from hospital” said that

“there are…far too many older people in hospitals who do not need to be there”.

Delayed discharges reached a record level in September. The Minister says that this is complex, but I can tell him that the main drivers for that increase were patients waiting for home care or for a nursing home place; those issues are both related to the underfunding of social care. Does he agree with NHS England chief executive Simon Stevens that any extra funding from Government should go into social care?

As I said earlier, we accept that the system is under pressure, but we also make the point that there is a massive disparity between different councils. Some 13% of local authorities cause 50% of the delayed transfers of care—DTOCs. The real point is that those local authorities that go furthest and fastest in integration, with trusted assessors, early discharge planning and discharge to assess, have the most success.

Northern, Eastern and Western Devon clinical commissioning group is already consulting on the possible closure of community beds across Devon. The social care budget in East Devon, an area of elderly people, and the rest of the county is already under severe pressure. That pressure will inevitably increase if community beds are closed. Will the Secretary of State therefore commit to putting those points to the Chancellor of the Exchequer in the run-up to the autumn statement?

The Secretary of State has already made the point that we do not give a running commentary on the status of discussions with the Treasury, but I accept my right hon. Friend’s point about his local issue.

NHS England: A&E

9. What assessment he has made of the performance of NHS England in meeting A&E waiting time targets in the last 12 months. (907205)

Last year, the NHS in England handled 2.4 million more A&E attendances than when this Government took office. There has been a 4.6% increase in attendances, compared with only a 1.2% increase in Scotland. Despite that significant increase in demand the NHS has coped well, with nine out of 10 patients still seen within four hours.

I thank the Minister for that answer, but the truth is it must do better and needs more support. In September, only 86% of patients were treated within the four hour target time in English A&E departments; by contrast, in Scotland it was 95%, for a record consecutive period. Given that winter is coming, what will the Minister do to ensure the service copes?

The hon. Gentleman should know that, according to figures for the most recent month available, 90.6% of A&E attendances were seen within the four hours. We are aware that the system remains under pressure, and are putting efforts into identifying steps through the A&E improvement plan, with five specific measures to improve front-door streaming, back-door discharge and patient pathways through hospitals to improve that performance.

19. Rural areas have high demand for primary and social care that increases the pressure on A&E if it is not met. Given the relationship between primary, secondary, A&E and social care, does the Minister also measure waiting times in primary and social care in the same way? That would give him a fuller picture of the demands on the system that need addressing. (907217)

The short answer is that at present we do not record waiting times in the same way. Tests are being undertaken in relation to waiting times for GPs, but at this point I do not have access to the data.

22. As we are unlikely to reach my question on the Order Paper, perhaps the Minister could now direct his attention to the east midlands where we have problems with A&E, particularly for people in rural areas. For those of us who rely completely on the NHS, this is obviously a matter of vital concern. I just wonder whether we should not have an honest debate about this and recognise that we have an ageing population. Our A&E times are stressed and we may have to either tax people more or even think the unthinkable and charge people for—[Interruption.] See, it is unthinkable, but we have to concentrate on the essentials. Let us have an honest debate about the finances of the NHS. (907220)

My hon. Friend will be aware that the sustainability and transformation plans discussed earlier today are designed to bring closer integration of health providers and commissioners within a health system area, such as the east midlands. The ambition is to integrate better health and social care provision to avoid some of the challenges he identifies.

The A&E target the Minister mentions is actually a measure of the entire acute system. Important in that is the flow of patients from admission through treatment to discharge. In Scotland, delayed discharges have fallen 9% since health and social care were integrated. In England, they have gone up 30%. Does the Minister accept the need to fund social care properly to relieve the back pressure on A&E?

I listen with great interest to what the hon. Lady says, but I gently remind her of two things. First, as the result of the generosity of the Barnett formula, Scotland receives £1,500 per capita more to spend on health than England. Secondly, the Auditor General for Scotland recently reported that NHS Scotland was failing to meet seven out of eight key targets, including waiting times for A&E.

I wonder how many targets are being missed in England. The Royal College of Emergency Medicine report demonstrates that in the 176 emergency departments in England there are only enough consultants to provide the cover of one for 16 hours a day. On top of that, rota gaps among junior doctors are causing safety concerns. What exactly is the Minister going to do this winter and will he agree to lift his ban on locum agency staff to help to keep A&Es functioning?

We recognise that there have been pressures on emergency departments for some years, which is why we have put particular effort into recruiting more consultants. There are, I believe, 50% more consultants working in emergency departments in England than there were in 2010, and 25% more doctors.

Maternity Care

Last month, I launched the safer maternity care action plan, which is part of our ambition to halve the rates of stillbirths, neonatal deaths, maternal deaths and brain injuries by 2030.

I am grateful to my right hon. Friend for that answer. In 2001, the then Labour Government closed the maternity unit at Crawley hospital. Longer journeys to East Surrey hospital have been a safety concern. Will the Department look at reintroducing midwife services to Crawley hospital and GP surgeries in Crawley?

I am happy to talk further with my hon. Friend. He knows that this is a local matter. It was, I think, looked into in 2014, but if the pattern of demand changes it should be kept under review.

Local Authority Social Care Budgets

11. What assessment he has made of the effect of changes to local authority social care budgets on the demand for health services. (907208)

Social care plays a vital role in keeping people healthy and independent, which is why the Government are making a further £3.5 billion available by 2020—a real-terms increase over the lifetime of this Parliament. There is an overlap between care and health, which is why faster integration is our major priority.

The Secretary of State’s Conservative predecessor, Stephen Dorrell, has said this month that we are increasingly using our acute hospitals as “unbelievably expensive care homes”, and he described this as a “grotesque waste of resources”. Is it not the case that the Government have simply outsourced the hardest decisions on social care cuts to the hardest-pressed local authorities to ensure that councils get the blame, not the Government, and that ultimately it is the NHS that suffers?

As I said earlier, we agree that the social care system is under pressure, but we also make the point that there is a massive disparity between the performance of different parts of that system. For example, Manchester, the hon. Gentleman’s own patch, has a DTOC performance seven to eight times worse, per 10,000 patients, than Salford, in spite of the 15% increase in its budget this year.

A small-scale study by Professor Peter Fleming has recently made the press. It links cardiorespiratory compromise in new-borns with sleeping in car seats for prolonged periods—over 30 minutes. Given that for many Eastbourne babies, one of their first life experiences is the journey home from Hastings hospital, which is longer than 30 minutes, will the Department look at these findings, consider whether further study is required and offer reassurance to parents rightly concerned by the research?

This is a very difficult case. The Department will look at the evidence and revert to the House.

That was very dextrous handling of a very broad interpretation of the question on the Order Paper, but I hope that honour has been served.

14. The Cheshire and Merseyside sustainability and transformation plan relies heavily on more care in the community. Does the hon. Gentleman accept that this will not work while local authority social care is being cut to the bone, because it will merely send people back to their own homes, where their health will deteriorate? (907211)

The Cheshire and Merseyside STP will be published tomorrow, and we will all know better then what it says. The hon. Lady is right that there is an interaction between social care and health, but she and I, as Warrington MPs, must both be pleased that Warrington is one of the top performers in terms of delayed transfers of care, and on that we should congratulate our local authorities.

NHS England: A&E

It was this Government who first introduced key tests for service change, giving local people a say. We need an NHS that is ready for the future, and sustainability and transformation plans will help to ensure the best standards of care, with local doctors, hospitals and councils working together in conjunction with local communities for the first time. No decisions about service reconfigurations, including A&E units, will be made without local consultation, as is currently the case.

How can it be right that the disastrous private finance initiative deal at Calderdale is dictating that Huddersfield royal infirmary be bulldozed, leaving Huddersfield as the largest town in England without an A&E unit?

I am familiar with my hon. Friend’s concern for the hospital in Huddersfield. We have discussed it previously. Calderdale royal hospital was an early PFI and is halfway to paying off its liabilities. The present proposal, put forward by the local CCGs, for moving to a full outlined business case would involve an A&E trauma centre on a single site, but there would continue to be emergency care in Huddersfield 24 hours a day, seven days a week, and it would maintain the capability to assess and initiate treatment of all patients, if it were to proceed.

Leaving the EU: Nurse Recruitment

13. What recent assessment his Department has made of the effect of the vote for the UK to leave the EU on future recruitment of nurses to the NHS. (907210)

The NHS currently employs 21,030 nurses from the EU—6.6% of the total number of nurses in the workforce—while a further almost 90,000 EU citizens work in the social care sector across the UK. They all do a fantastic job, and we have been clear that we want them to be able to stay post-Brexit.

My right hon. Friend the Secretary of State has discussions with Cabinet colleagues handling the negotiations, and I am sure that his messages are being well heard across Government.

Topical Questions

I am pleased to report to the House something I was not sure I would ever be able to say: last week, the British Medical Association called off its industrial action and committed to working with the Government on the implementation of new contracts for junior doctors. This will make a significant contribution to our commitment to a safer, seven-day NHS, and the Government will work constructively with junior doctors to address their concerns, because they are a vital and valued part of our NHS.

The South Yorkshire and Bassetlaw STP sets out some very positive ambitions, but it warns that there will be a financial shortfall for health and social care services in our area of £571 million by 2020-21. Those ambitions are unachievable unless the Government address the shortfall. What is the Secretary of State going to do about it?

We are working very carefully with all STP areas to make sure that their plans are balanced so that we can live within the extra funding we are putting into the NHS—an extra £10 billion—by 2020-21. We will look at that plan and do everything we can to help to make sure that it works out.

T3. Will the Secretary of State join me in thanking Dr Ollie O’Toole of the Kirby Road surgery in Dunstable for representing all of the very best in a family doctor? Will he also explain what more we can do to encourage people to go into general practice rather than working for locum companies, which so many seem to want to do at the moment? (907150)

I am happy to do that, and I would like to pass on my congratulations to Dr O’Toole, who obviously does a fantastic job for my hon. Friend’s constituents. We are investing significantly in general practice, with a 14% increase in real terms over this Parliament and our ambition to provide an extra 5,000 doctors working in general practice. This will mean that the need for locums will become much less and we can have much more continuity of care for patients.

The Secretary of State and the Minister will be aware that Capita has wreaked havoc in GP surgeries across the land, placing extra pressures on already overstretched NHS staff, compromising patient safety and breaching confidentiality. Last week, I met a group of practice managers who told me that some patient records have been missing for months, while others have turned up apparently half-eaten by mice. Given that this contract was introduced to save the NHS money, will the Minister tell us how much it is costing to rectify the mess and what steps she is taking to compensate GPs for the expenses they have incurred as a result of ill-conceived and poorly implemented contracts?

The hon. Lady is right that the current delivery of this contract by Capita is unacceptable. I have met NHS England and Capita regularly to make sure that rectification plans are in place. We are assured that these steps are now in place and that the programme will improve.

T4. Across north Northamptonshire there is an enormous appetite for the new urgent care hub to be built at the site of Kettering general hospital, relieving pressure on A&E and improving services for patients. Will the Minister update us on progress? (907151)

As I said to my hon. Friend’s parliamentary neighbour, my hon. Friend the Member for Kettering (Mr Hollobone), we are aware that Kettering hospital has put forward a proposal. The outline business case is due to be discussed with NHS England in the coming weeks. In the meantime, we are looking at an interim solution for relieving pressure on A&E services in the area.

T2. Diabetes is a big problem in my constituency, and the number of unnecessary lower limb amputations due to diabetes is on the rise. Will the Minister ask clinical commissioning groups to provide fully staffed community podiatry foot protection services to avoid amputations, keep people in work and make huge cost savings? (907149)

The hon. Gentleman is absolutely right that diabetes is a major health risk in the UK. That is why we have rolled out the first ever NHS diabetes prevention programme this year on 27 sites, covering nearly half of England and referring nearly 10,000 people. Next year, the second wave of the programme will reach a further 25% of the English population. The aim is for the NDPP to be rolled out across the whole of England by 2020 to support 100,000 people at risk of diabetes each year.

T6. Proper integration of adult social care and health services requires co-operation on both sides. Does the Secretary of State agree that it is really not acceptable that in a borough such as Bromley, the CCG top-sliced only 3.5% of its funding to go into the better care fund—nowhere near enough to make a difference to hard-pressed local services? (907154)

I thank my hon. Friend for bringing up that issue. Everyone recognises, on both sides of the House, that the health and social care sectors need to work together. That happens very well in some parts of the country, but not in others. I think all hon. Members have a job to make sure that people behave responsibly in their constituencies.

T5. Both Public Health England and Food Standards Scotland support restricted advertising of junk food to children, yet this was entirely omitted from the Government’s completely underwhelming obesity strategy. Given that we clearly cannot rely on the UK Government to take this forward, will the Secretary of State support the devolution of broadcasting powers to allow the Scottish Government to tackle the obesity crisis and its devastating impact on society? (907153)

The obesity plan is one of the most ambitious in the world. It will reduce obesity by a fifth by cutting the amount of sugar in our food, helping all children to engage in an hour of physical activity a day, and making it easier for families to make healthy choices. We already have some of the toughest advertising rules in the world, and we have consulted Scotland closely on these arrangements.

T7. The anti-coagulation service at the Furnace Green general practice was recently moved to Crawley hospital, which has caused concern to some local patients. Will a member of the health ministerial team agree to meet me to discuss that further? (907155)

I understand that the clinical commissioning group has provided an alternative which is no more than two miles away, but I should be happy to meet my hon. Friend to discuss the matter.

Climbing obesity rates are expected to lead to increases in type 2 diabetes, cardiovascular disease and the need for joint replacements, which will put even greater pressure on the NHS. Given such threats to health, does the Secretary of State really think that now is the time for timidity and sucking up to business?

As I have made absolutely clear today, I am determined not to allow the House to get lost in a debate about what the plan could or should have been. Our children deserve more from us. We should not politicise this debate; we should get on with delivering the plan that we have before becoming involved in a lengthier conversation about what a long-term obesity programme should be.

T8. General practices in Winsford are being underfunded by 3.6% in terms of the formula that should apply to them because of the slow rate of change, while nearby Merseyside practices are being overfunded by 5%. That is resulting in a £30 million loss to my local surgeries. Will the Minister commit himself to looking into it and introducing a quicker rate of change, so that local residents can benefit from the funds that they should be receiving? (907156)

In 2016, the Government implemented a new formula for allocation, which means a better deal for underfunded areas such as Winsford. As my hon. Friend has noted, however, the extra money is being phased in over a few years to prevent distortions. This year her local CCG received an increase of more than 3%, and the funding will continue to catch up as a result of the new mechanism.

The Minister rightly said that greater integration between health and social care was a prize worth striving for. Why do local government leaders on Merseyside feel that they have been excluded from discussions about the STP process? If we are to make progress, they need to be part of the solution.

As I said earlier, local engagement with all stakeholders is necessary. The STP for Cheshire and Merseyside will be published tomorrow. It is essential for local authorities to engage in it as it evolves, and it is essential for MPs to engage in it—as critical friends—to make the plans better.

T9. According to a report published recently by the British Lung Foundation, 1.2 million people are suffering from and have been diagnosed with chronic obstructive pulmonary disease, while many more sufferers have not been diagnosed. Will the Minister support the establishment of an independent respiratory taskforce to help diagnosis and improve lung health for everyone? (907157)

I know that the British Lung Foundation has called for a taskforce on lung health. Given that a million people have been diagnosed with COPD and a further million remain undiagnosed, the Government and the NHS are keen to work with the NHS and the voluntary sector to find practical and innovative ways of improving outcomes for patients with respiratory disease, and I will consider my hon. Friend’s proposal as part of that process.

The number of nurses working in mental health has fallen by 15% since 2010, from 45,384 to 38,774. Why is that, and does the Secretary of State believe that it will achieve real parity of esteem for mental health in our country?

What I can tell the hon. Lady—who, I know, rightly campaigns hard on mental health—is that we are treating 1,400 more people in our mental health services every day than we did in 2010, and we will be treating a million more people every year when we have implemented the taskforce report. We are investing more, and we are making good progress.

Shared care allows GPs to provide complex prescriptions for drugs such as methotrexate, but in my constituency the Beacon surgery recently withdrew from those arrangements. Can the Secretary of State assure me that the Department will support not only patients who now face potentially longer round trips, but GPs themselves, so that they can continue to provide those vital services?

The arrangement my hon. Friend describes is a special relationship whereby a GP agrees with a hospital consultant to prescribe complex drugs which are normally only hospital-prescribed. This is not part of the standard GP contract and they cannot be required to provide this service. On the specific issue raised, we have asked NHS England to determine whether there are alternatives and I will revert to my hon. Friend on that.

Is the Minister satisfied that the National Institute for Health and Care Excellence procedures for the approval of anti-cancer drugs are sufficiently speedy, because the waiting times for approvals can be months or even years, and there is a widespread feeling that that is too slow?

We have tried to speed this up with the cancer drugs fund, which helped 84,000 people in the last Parliament, but we always keep the NICE procedures under review and I take on board what the hon. Gentleman says.

We recently had an excellent debate in Westminster Hall on the Government’s tobacco control strategy. When will they publish the new strategy, which was promised for publication this summer?

The UK is a world leader in tobacco control and we have a proven record in reducing the harm caused by tobacco. We should be proud of the fact that smoking rates among adults and young people are at the lowest ever level, but my hon. Friend is right to push for the tobacco control plan because there is unacceptable variation. We are working on developing that plan, which we will be publishing shortly.

In Northern Ireland in 2014-15, 870 deaths were due to the cold weather. Will the Minister engage with other Ministers to ensure that fuel poverty is looked at by all Departments, so that the pensioners who raised this in Parliament do not suffer from the health matters that are killing them off?

I thank the hon. Gentleman for making that point. We do of course have the cold weather payment system in force across the UK, and later this week I will attend a meeting with other Government Ministers to look at winter preparedness across the board.

The Minister will be aware of the concerns in Torbay about the impact on accident and emergency services from the potential loss of the minor injuries unit at Paignton hospital. Does he agree that it is vital that MIU services are kept within Paignton given that it is the second biggest town in Devon?

My hon. Friend is aware that a consultation is going on regarding services in south Devon. The point he makes has been well made and I am sure it will be taken into account by the clinical commissioning group and the local community hospital trust.

Order. I am sorry but we must move on. Demand at Question Time tends to exceed supply. I recognise the intense interest in these matters, but it would help if questions and answers were shorter—or maybe the Government want to propose a larger allocation of time for Health questions. But there is much interest and only limited time in which to accommodate it.