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Oral Answers to Questions

Volume 618: debated on Tuesday 20 December 2016

Health

The Secretary of State was asked—

Clinical Leadership

As we wish each other a merry Christmas, the whole House will also this morning remember the people of Berlin as they face up to yesterday’s horrific suspected terrorist attack. Germany and its capital Berlin have been beacons of freedom and tolerance in modern times, and all our thoughts and prayers are with them today.

Evidence from all over the world suggests that higher standards of care for patients relate directly to the quality of clinical leadership, which was why last month I announced a number of measures to increase the number of doctors and nurses in leadership roles in the NHS.

I thank my right hon. Friend for his response. Clinicians in Telford have been showing real leadership by rejecting a proposal to close a brand new women and children’s unit, and elements of our emergency services. The quango responsible for this idea has spent £3 million and taken three years to come up with the proposal, which has been rejected by local people and clinicians. Will my right hon. Friend meet me and my local colleagues to bring an end to this farce, and to ensure that we do not continue in limbo any longer?

I recognise the extent of my hon. Friend’s campaigning on this issue in Telford, and that she expresses the concerns of many of her constituents. As she knows, service changes must be driven locally and must have the support of local GP commissioners. She will also know that the actual situation, very frustratingly, has not led to consensus between clinicians in different parts of Telford and Shropshire. I agree that the process has taken much too long, and I am more than happy to meet her and to try to bring this situation to a close as quickly as possible.

In a year when the Health Secretary has spent quite a lot of time knocking clinicians, it is good to hear him speak so positively about them. After four years in the job, what responsibility does he accept for the lack of suitably qualified individuals—not just clinicians—who are prepared to take on the top jobs in the NHS on a permanent basis?

I will tell the hon. Lady what I take responsibility for: more doctors, more nurses and more funding than ever before in the history of the NHS. We know that the highest standards are often achieved when there is strong clinical leadership. Only 54% of managers in this country are clinicians, compared with 74% in Canada and 94% in Sweden. That is why it is right that we do everything we can to encourage more clinicians into leadership roles.

Does the Secretary of State agree that the clinical leadership involved in the Getting It Right First Time initiative is important, not only because it will save £1.5 billion, which could be put back into patient care, but because patients will be in less pain and will end up having fewer revision operations, and some will even survive treatment that they would not otherwise have survived?

My hon. Friend is absolutely right. I thank him for bringing Professor Tim Briggs to see me to explain just how superb this programme is. Infection rates for orthopaedic surgery vary between one in 20 patients in some trusts to one in 500 in others. Getting this right can transform care for patients and save money at the same time.

I associate myself with the Secretary of State’s comments about Berlin, my one-time home.

Does the Secretary of State accept that we have the best clinical leaders anywhere in the world? The challenge facing the NHS is not one of clinical leadership, or the dedication or skill of staff, but one of chronic underfunding by this Conservative Government.

We do indeed have superb clinical leaders, such as Marianne Griffiths at Worthing, which was recently given an outstanding rating. We also have superb non-clinical leaders, such as David Dalton at Salford Royal. I would gently say to the right hon. Gentleman that if he is worried about funding, why did he stand in the election on a platform that would have seen the NHS have £1.3 billion less this year?

Will the Secretary of State ensure that clinical leaders are able to apply important techniques from other disciplines, such as lean production, which can drive up productivity?

My hon. Friend is absolutely right. Clinical leadership is important, but so is openness to the skills of other industries—particularly engineering skills, with which he is very familiar—that can help us to get processes right so that we improve care and safety for patients.

Does the Secretary of State agree that if the board of Doncaster and Bassetlaw Hospitals NHS Foundation Trust agrees to establish a teaching hospital today, that will enable the trust to train its doctors of tomorrow so that they are more able to move into clinical leadership roles as quickly as possible?

I thank the right hon. Lady for her question and welcome Doncaster hospital’s aspirations and ambitions. Any final decision will obviously be a matter for the NHS and Health Education England, but it is very encouraging that it is reaching for the stars in this way. Yes, we do need to train more doctors, and I hope that the hospital can make a good contribution.

The constituency of the hon. Member for Bassetlaw (John Mann) was just mentioned and he came in on cue. Unfortunately, he was not within the curtilage of the Chamber at the material time. No doubt we will hear from him at a later date, to which we look forward with eager anticipation.

Evidence-based Medicine

2. What his Department’s definition is of evidence-based medicine; and if he will make a statement. (907973)

Evidence-based medicine is about using high-quality research to guide clinical practice and to achieve optimal results for all patients. The National Institute for Health and Care Excellence plays an important role in supporting evidence-based medicine by translating research into authoritative guidance for healthcare professionals on best practice.

Is the Minister aware that the author of “Evidence-based Medicine” in 1992, Professor David Sackett, said that it is

“about integrating individual clinical experience and the best external evidence, not just internal evidence”?

Is she further aware that in respect of the interpretation of evidence-based medicine, I have reported the so-called Good Thinking Society to the Charity Commission for the abuse of its charitable status through its use of legal threats to force the Department and health providers to change the law on healthcare?

NICE obviously considers complementary and alternative medicines when developing its guidance, where there is evidence, and it has been able to recommend some therapies, such as acupuncture for tension headaches and a range of complementary medicines for multiple sclerosis. We expect healthcare professionals to take that guidance into account when designing local services, but they must use their best understanding when treating the individual patients in front of them.

The evidence is very clear that eating more sugar increases the risk of diabetes. Apart from introducing the sugar tax, what further evidence-based research can be used by the Government to reduce the risk of diabetes?

The right hon. Gentleman is a great proponent of tackling the risk of diabetes. He knows that the Government take tackling and preventing diabetes extremely seriously. That is why we have introduced the world’s first national diabetes prevention programme, which we have piloted and are rolling out across the country. It includes not only education programmes but testing, and we are making sure that we use the evidence from the programme to bring about improvement and that we are rolling it out effectively.

We are all in favour of evidence-based medicine. We are also in favour of decent resources for the national health service but, in the case of Huddersfield and Calderdale hospitals, what we want is good, high-quality management, rather than GPs being promoted to a managerial position that they cannot handle.

The hon. Gentleman is a great advocate of evidence-based medicine and I am pleased to hear about his support for it. He will be pleased that the national leadership programme is one of the evidence-based programmes that we are rolling out to improve the leadership of the NHS across the country.

Antimicrobial Resistance

The UK is already a global leader in the fight against AMR. This Government’s leadership has secured a UN declaration on AMR and a commitment from the G20 to drive the development of new antimicrobials. We will continue to deliver international programmes to tackle AMR, including the Fleming fund and the Global AMR innovation fund, which represent more than £300 million of investment over the next five years.

One of the 10 key recommendations of the O’Neill review was to improve the data and surveillance underlying antimicrobial resistance. What plans does the Minister have to routinely test all NHS patients for antibiotic resistance?

My hon. Friend is absolutely right that it is essential that we improve diagnostics if we are to tackle this national threat. A routine part of the clinical management of patients showing symptoms of infections is to take a blood sample. When an infection is identified, those samples are indeed tested for resistance. Part of our AMR strategy is to improve diagnostics and to fund innovation in this area.

Will the Government commit themselves to ensuring that their strategy will include discouraging the use of intensive farming, given its overuse of antibiotics which contributes to antimicrobial-resistant problems?

I agree that we must focus on that as well, but we are currently focusing on reducing the need for antibiotics by minimising disease risk in animals through good animal husbandry and on-farm biosecurity. At present, antibiotics provide the only effective means of treatment for a number of animal diseases, and are therefore essential to ensuring the health and welfare of animals. However, we are also working on the matter in an international context with the World Organisation for Animal Health, and we will continue to drive forward the agenda.

What measures are the Government introducing to support the uptake of point-of-care C-reactive protein testing throughout the United Kingdom, given that it is a proven and cost-effective means of reducing levels of inappropriate antibiotic prescribing in primary care?

As my hon. Friend says, we must focus on innovation and better diagnostic tests, particularly bedside tests. The Government are actively reviewing evidence of the benefits of CRP tests. Pilot studies in the United Kingdom are contributing to that, and will be evaluated so that we can see how best to build on what can be shown to be working well.

20. Given that 480,000 people develop multi-drug-resistant tuberculosis each year and that drug resistance is starting to complicate the fight against HIV and malaria, what steps has the Secretary of State taken to increase awareness in GP surgeries and to provide alternative treatments that can be equally effective, and what co-operation has taken place with devolved Assemblies? (907992)

I am grateful for that immediate promotion from the hon. Gentleman.

We have made considerable progress in establishing the building blocks of our domestic AMR strategy, including better data, guidance for primary care, and a strengthening of the framework for antimicrobial stewardship, which involves introducing incentives for the NHS to improve the prescribing of antibiotics. That has led, in the last quarter, to the first reduction in such prescribing, which I think we can take as an encouraging sign.

One of the 10 recommendations of the O’Neill review on antimicrobial resistance was for a massive global public awareness campaign. Given that 700,000 people die each year as a result of AMR, and given the review’s estimate that that figure will rise to 10 million a year by 2050, what assurances can the Minister give that she is behind that awareness campaign?

The hon. Lady is right to identify the scale of the challenge, which is why we have put AMR on our national risk register, and she is also right to point out that no one country can tackle AMR alone. The United Kingdom has played a global leadership role. We co-sponsored the World Health Organisation’s 2015 global health plan and created the £265 million Fleming fund so that we could specifically help poor countries to tackle drug resistance, and we will continue to play that global leadership role.

The O’Neill report was published some six months ago and included recommendations for national Governments. What practical progress have the Government made so far?

On 19 September we published our comprehensive response to the report, which describes a range of actions that we will take on each of Lord O’Neill’s recommendations. The most practical progress that I can report is the fact that the prescribing of antibiotics has fallen for the first time since records began. I think that we can all be proud of that progress.

Leaving the EU: NHS Workforce

4. What assessment he has made of the potential effect of the UK’s decision to leave the EU on the NHS workforce. (907975)

There are currently 127,000 staff from the EU doing a vital job for patients in the NHS and social care system. In this year of Brexit, we salute their excellent work and remain confident that we will be able to negotiate for them to continue it in the future.

There are more than 50,000 EU nationals working as nurses and doctors throughout the United Kingdom, along with 80,000 in the social care sector. The NHS already faces extensive rota gaps owing to a shortage of senior and junior doctors. Will the Secretary of State join our First Minister in demanding an unequivocal guarantee that EU nationals who are already living here will have the right to remain?

That is exactly what we intend to achieve through negotiations, but we must remember the British citizens, including people from Scotland, who are living in the EU and whose rights we also wish to protect. That is why the Prime Minister has made a big point of saying that she wishes to negotiate the issue at an early stage in order to give certainty to those people.

We are not going to leave the EU for two and a half years, but I want the Secretary of State to grip GP services in Lincolnshire now and to start training more doctors. The Pottergate surgery in Gainsborough is closing, potentially throwing hundreds of people out without a GP, and there is a shortage of 80 GPs against a target of 915 in Lincolnshire, and only six out of 30 training places were taken up recently. Will the Secretary of State now grip the GP services in Lincolnshire for the sake of our people?

Order. The hon. Gentleman has rather cheekily brushed aside the part of the question that does not suit his purposes. Only to focus on half a question is very cheeky; we will allow him to get away with it on this one occasion only.

I hope that I can reassure my hon. Friend about this because the reality is that we increased the number of GPs by 5% in the previous Parliament, and in this Parliament we are planning an increase of another 5,000, which will be the biggest increase in GPs in the history of the NHS, and will go along with considerable extra resources.

I will focus on the half of the question that the hon. Member for Gainsborough (Sir Edward Leigh) missed out. The other day I had a meeting with some constituents who told me that they were so pleased that we were leaving the European Union because it meant that the extra £350 million could be used to reopen the A&E department at Bishop Auckland. Has the Secretary of State found that £350 million yet?

The hon. Lady might have noticed that I personally did not talk very much about that £350 million. Whatever resources we have post-Brexit will have to be set in the overall economic context, but of course the great thing is that, post-Brexit, that will be a decision for this Parliament.

Many members of the NHS workforce across Bedford and Kempston come from the EU, but many others come from Caribbean countries, the Philippines, India and many countries in Africa. Will my right hon. Friend make sure that, in the future, people from those countries are given equal access to work in our NHS as that for EU nationals?

The benefit of Brexit will be that we can take precisely such decisions in this Parliament, because we will get back control of our borders. I am grateful to my hon. Friend for mentioning the very important work done by people from outside the EU in the NHS. Because I happened to meet the Philippines ambassador last week, I want to pay credit particularly to the Filipino workers in the NHS and the social care system, who do a fantastic job.

May I start by extending my party’s sympathies to the victims of the Berlin attack?

Much of what we have heard today is about keeping those who are already here, but BMA Scotland has said that insecurity is stopping EU nationals from taking up posts that really need to be filled. This is an urgent problem, so does the Secretary of State agree that it is time to create some certainty for EU nationals and to avoid a self-made workforce crisis?

I absolutely agree with the hon. Gentleman, which is why it is extremely frustrating that the current signals from the EU are that it is unwilling to bring forward negotiations about the status of EU nationals here, and indeed that of British nationals in the EU. No one from either side of the Brexit debate has ever said that there will be no immigration post-Brexit; they have simply said that we will control that immigration ourselves through this House and through decisions made by the British people at general elections.

On behalf of the official Opposition, may I echo the words of the Secretary of State in relation to the tragic events in Berlin and send our condolences to the people there?

The Institute for Employment Studies has today warned that Brexit could make nursing shortages even worse. That follows The Times reporting that

“applications for nursing, midwifery and allied health courses were down by about 20%”

and that in some institutions applications had halved. The decision to scrap nurse bursaries is having the consequences that every expert predicted it would. With the uncertainty of Brexit looming over our workforce, now is not the time to be taking a massive gamble with our nurses so, in the light of the evidence, will the Secretary of State now agree to scrap that disastrous policy?

I simply say to the hon. Gentleman that the purpose of that policy was to allow us to train more nurses; in fact, we will be training 40,000 more nurses during this Parliament. We have more than 11,000 more nurses in our NHS wards, and at Countess of Chester hospital—the hon. Gentleman’s own hospital—there are 172 more nurses than in 2010.

Hospitals in Special Measures

We want the NHS to offer the safest, highest quality care anywhere in the world, so we are now tackling unacceptable performance. That is in contrast to the Labour party, which ignored failures for so long. Since introducing the rigorous special measures inspection regime, 31 provider trusts have gone into Care Quality Commission special measures, of which 15 have been turned around as a result of significant quality improvements. I congratulate again the staff of Sherwood Forest, Wye Valley, Norfolk, and Suffolk trusts, all of which have come out of special measures in recent months.

Medway Maritime Hospital has made significant improvements since it was put into special measures: mortality rates and length of patient stay are down; leadership is excellent; and there has been extensive investment in the A&E. Does the Minister agree that it is the right time for the hospital to come out of special measures? Will he join me in paying tribute to the excellent work of the hospital’s staff?

I congratulate my hon. Friend on his role in championing Medway Maritime Hospital, which I visited earlier this autumn. The CQC is in the process of re-inspecting Medway and will publish its findings in the new year. I congratulate the trust on its improvements thus far that were highlighted by my hon. Friend, which include reducing its average length of stay on admission wards from 11 days to only 3 days.

A recent damning report on maternity care from the Pennine Acute Hospitals NHS Trust care referred to appalling neglect that lead to the avoidable deaths of mothers and babies. The trust has implemented an improvement plan, but plans for maternity services under the Making It Better scheme were based on a predicted birth rate of 3,500 a year, and the reality is that the trust deals with 10,000 deliveries a year. What action will the Minister take to address that situation?

I am grateful to the hon. Lady for raising some of the issues at the Pennine trust. We are well aware that it needs improvement, which is why we have buddied it up with the outstanding Salford Royal NHS Foundation Trust next door. The Salford trust is led by Sir David Dalton and the Secretary of State referred to it earlier. I will take up the matter raised by the hon. Lady directly with Sir David.

Community Pharmacies

7. What steps his Department is taking to work with community pharmacies to reduce (a) waste and (b) the cost of medicines. (907978)

NHS England has a range of initiatives for waste and medicine cost reduction. We estimate that there is a prize of up £150 million a year to be realised across the system on waste. Community pharmacies have a significant role to play in that, partly through their existing duty to review prescriptions when repeat dispensing and partly through the separately commissioned medicine use reviews.

The Minister is absolutely right to say that community pharmacies have an important role to play. On 17 October, he told the House:

“We do not believe that any community pharmacies will necessarily close as a result of these cuts.”—[Official Report, 17 October 2016; Vol. 615, c. 597.]

However, the impact assessment published by his Department just two days later described a possible scenario in which 1,000 pharmacies close. Will the Minister confirm that nobody in Britain will have to travel further to get to a chemist as a result of his cuts?

The impact assessment set out an upper range, which we do not believe represents an accurate reflection of what will happen. The facts of the matter are that we need our community pharmacy network to move towards services and away from dispensing. Paying every community pharmacy in the country, or 91% of them, £25,000 just for having an establishment does not achieve—[Interruption.]

Order. The hon. Member for West Ham (Lyn Brown) should not chunter from a sedentary position in an attempt to hector the Minister, who should glide seamlessly above the attempted provocation. Minister, continue.

To ensure not only that unnecessary costs are reduced, but that the best community pharmacy services are provided, will the Minister do all that he can to make sure that clinical commissioning groups engage as effectively as possible with pharmacies? Preferably, that would be by getting more people on CCG boards to ensure that the crucial connection between the provision of health services and pharmacy is absolutely at the heart of what we do.

My right hon. Friend is right; CCGs are variable in the extent to which they commission pharmacy services. However, we have set out the minor ailments scheme, it will be rolled out nationally by April 2018 and we expect every CCG to take a part in it.

As chair of the all-party group on pharmacy, I have seen many examples of drugs that have been prescribed and not used, as I am sure we all have. Should we not renegotiate the national contract, which currently pays community pharmacies more than 90% of their income through prescribing? Surely we can do things differently.

The right hon. Gentleman rightly says that we must change the contract to move away from 90% of the income coming from dispensing. Far more must come from services, which are separately commissioned by CCGs and others. The Murray review, which he will be aware of from his work on the all-party group, sets out a road map for that, and NHS England is determined to implement it.

May I pay tribute to the excellent work of pharmacies in my constituency? Last night, “Look East” demonstrated the pressure that urgent care centres in the east are under because of extra patient footfall. Will the Minister give me an undertaking that he will put in place guidelines to CCGs to encourage them to work much more closely with pharmacies to reduce that footfall?

My hon. Friend raises an important point, and he is right to say that we must move the community pharmacy network away from just dispensing and into services, which will include minor ailments and repeat prescriptions. I will be encouraging CCGs to do that.

Community pharmacies, which were developed in Scotland 10 years ago, are there for minor ailment, chronic medication and public health services. Although the Minister has expressed admiration for the Scottish system, does he not recognise the need to work with the pharmacy profession to develop the full potential within community services?

I have mentioned on previous occasions that Scotland has, in some respects, gone further and faster than we have in England so far on community pharmacies. The £300 million that we have set aside in the integration fund for the rest of this Parliament is going to be used to do just the things that the hon. Gentleman has mentioned, in terms of minor ailments and repeat prescriptions. We are determined to make that happen.

Over the festive period, in every town and city in the UK, community pharmacies will be open to dispense emergency prescriptions, and to provide specialist services and professional advice. Does the Minister appreciate that service, which not only helps the public, but takes pressure off other parts of the NHS? Will he join me in thanking community pharmacies and their staff for the work they do? Will he commit to reconsider budget cuts that will lead to a reduction of this valuable service, and instead meet the Royal Pharmaceutical Society and the National Pharmacy Association to discuss extending the role of community pharmacies, to deliver savings for the NHS?

I have met the royal college of pharmacies on a number of occasions, and indeed it has worked with us on the Murray review, which is an essential road map that sets out how we are going to move the community pharmacy network away from a remuneration model based just on dispensing and on to services as well. I agree with the hon. Lady that the 11,000 community pharmacies across the country all provide excellent services, and we expect that to continue.

NHS Services: Winter

Last year, the number of excess winter deaths was 45% lower than in the previous year, and contingency planning for this winter is well under way, with £400 million allocated to local health systems for winter preparedness.

This time last year, St Helens CCG told me it needed to postpone elective operations and referrals in order to get through winter. Six months later, it was £12.5 million in deficit and proposing to cancel all non-urgent surgery indefinitely. What the Health Secretary is proposing does not make the problems go away—it stores them up. When will the Government give local trusts and clinicians the funding they require? Stop passing the buck and start passing the bucks!

With the greatest respect, I do not think it is passing the buck to put £1.3 billion more into the NHS this year than the hon. Gentleman was proposing at the last election. A lot of actions are being taken in Cheshire and Merseyside; a local accident and emergency delivery board was set up, which is doing very important work, and the emergency care improvement programme is working very well at his local trust.

There is great pressure on emergency services throughout Staffordshire at the moment. There would be even more without the accident and emergency centres in Stafford and Burton, yet the sustainability and transformation plan proposes to reduce one of them, so there will only be two left in the county. Will the Secretary of State speak to the authors of the STP to make it clear that this is totally unacceptable given the current situation?

No one fights harder and more eloquently than my hon. Friend for the needs of the people of Stafford. I always look with concern at proposals to change emergency services given the huge pressures that exist, so I shall happily look at the plan as he suggests.

21. The problem is not just winter pressures but pressures all year round. The Secretary of State will no doubt tell me that the Government have now allowed councils to increase the precept to allow councils to fund it better, but the fact is that that is not enough money. There is no strategy. Does anyone outside the Department—those in the Department might not either—believe that the Government has a strategy for social care? (907994)

All I would do is urge the hon. Gentleman to listen to what the Prime Minister said at this Dispatch Box last week. She said that we recognise the short-term pressures—indeed, the Communities Secretary came up with a package of £900 million extra over the next couple of years—but that we also need a long-term sustainable solution, on which the Government are working hard.

Does my right hon. Friend agree that one of the pressures of winter that needs improving is inappropriate admissions to A&E? Does he accept that the proposals by the Essex success regime to ensure that the three hospitals concerned will retain their A&E departments but that there will be a specialist centre for cardiothoracic care and for burns and plastic surgery care are the right way forward to improve and enhance the care for those suffering from accidents and emergencies?

My right hon. Friend understands these matters extremely well from his time as a very distinguished Health Minister. He is absolutely right; the truth is that we want widespread availability of A&Es but we do not serve patients best by offering identical services everywhere. That is why in the past three or four years one of the things we are most proud of is the setting up of a national network of 26 trauma centres, which has had a dramatic impact on mortality rates for the most serious cases.

I have just been advised by a very sagacious source that in supplementary questions and answers to this question some reference to winter is desirable.

I associate myself with the Secretary of State’s remarks about Berlin. I wish everyone in the House a merry Christmas and I extend my best wishes for a very peaceful and joyful Christmas and new year to all NHS staff, especially those working over Christmas.

Pressures on the NHS this winter are such and the underfunding is so severe that hospitals have been ordered to close operating theatres for elective surgery over Christmas. Is this what the Secretary of State means by a seven-day NHS?

Let me wish the shadow Health Secretary a merry Christmas and say that despite his rhetoric I see that Santa has been quite generous to him. His local trust in Leicester has 254 more nurses and 306 more doctors than in 2010. Next year, we will have a new £43 million emergency floor at the Leicester royal infirmary. We need to ensure that there is sufficient bed capacity in our hospitals over winter—that is a very important part of winter planning—but we are also doing 5,000 more elective operations every day than when Labour was in office.

I am delighted that the Secretary of State has done his research on Leicester, but is closing operating theatres for a month this Christmas not, in reality, a short-term fix? The truth is that when the pause ends and hospitals fill up again above the 85% occupancy recommendations, patients will be left with a simple choice: get stuck on a waiting list while hospitals try to reduce occupancy rates to safe levels, or risk going into a hospital when it is at full capacity and potentially unsafe and be exposed to higher infection risks. Which option would the Secretary of State choose?

May I gently urge the hon. Gentleman to be careful with his rhetoric? We are not closing operating theatres for a month over Christmas. We need to be very careful what we say in this place, because people outside are listening. The answer is to ensure that we increase capacity in the NHS, and that is why we have 11,000 more doctors and 11,000 more hospital nurses than we had six years ago. We are training 15,000 more doctors every year from 2018-19 to ensure that we can avoid these problems in the future.

NHS: Financial Recovery

9. What progress the Government are making on recovering money from overseas visitors and other chargeable NHS patients. (907980)

The NHS is a national, not an international, service. This Government were the first to introduce tough measures to clamp down on visitors accessing free NHS care, including introducing the immigration health surcharge. The steps we have taken have meant that income raised from visitors and migrants has risen threefold in three years, from £97 million in 2013-14 to £289 million in 2015-16.

I thank the Minister for that answer, but does he agree that recovering more money from chargeable patients requires a culture change among NHS staff? Does he therefore share my dismay that the leader of the doctors union dismisses the need even to address this issue, while calling for additional investment in our NHS?

I agree with my hon. Friend that we need increased awareness and appropriate participation by all NHS staff in achieving this policy, but I also agree with one thing that Dr Mark Porter said—that sick and vulnerable patients must not be put off seeking necessary treatment, as this may be bad for their health and for that of the public in general. This has always been a clear feature of our policy, so to be clear, this policy does not withhold immediately necessary or urgent treatment, but it makes sure that the NHS is fairly reimbursed by those who are not entitled to free care.

As the Minister will know, the Public Accounts Committee has looked in detail at this issue, and we were rather shocked to discover that the Government themselves are woeful at collecting money from EU citizens who use our hospitals and for whom the Government are then responsible for getting the money from their home Government. When will the Government get their act together to make sure that this money comes into our NHS?

I am always grateful for advice from the Public Accounts Committee, which looks into areas where the Government can recover moneys to which they are entitled. There was an article in today’s Times which referred to outstanding sums, and we are taking steps to try to increase recovery rates in the years ahead.

Sustainability and Transformation Plan: South-west London

10. What assessment he has made of the potential effect of the implementation of the sustainability and transformation plan for south-west London on the provision of health services in that area. (907981)

The sustainability and transformation plan for south-west London sets out how the area will implement the NHS’s five year forward view. The local NHS is looking to strengthen primary care and ensure closer working across NHS bodies, with more sustainable acute services, developing centres of expertise to ensure high-quality service, as well as closer co-ordination with social care providers.

The Epsom and St Helier Trust is a high-performing trust, hitting A&E and cancer treatment referral targets. It is confident that it can deliver sustainable and transformed care services, but will struggle to do so in St Helier hospital, built in the 1930s. The trust has previously secured a commitment from two Governments that funding would be available. Will the Minister give the same undertaking and confirm that once the STP process is complete, funding will be available to the trust to enable it to continue delivering excellent sustainable services from a new hospital?

I am aware of the right hon. Gentleman’s campaign on this matter. It would be wrong for me to pre-empt the work that is being done in reviewing both the STP process and the policy priorities of NHS England. Once those plans have been put forward to Ministers, we will be able to consider which we can prioritise.

The STP for south-west London includes mental health crisis needs, but there is a current crisis of lack of in-patient facilities for mental health patients. Will the Minister look into extra immediate funding to increase the number of in-patient mental health beds?

As my hon. Friend is well aware, given her experience in this area, mental health is a priority of the Government and of the STP process. I will take away what she says in relation to in-patient beds.

Capita

11. If the Government will make a recommendation to NHS England not to renew its primary care support contract with Capita. (907982)

It is too early to speculate on the renewal of this contract, but it will ultimately be for NHS England to determine the selection criteria for the future procurement of services provided by it. My focus right now is on raising the quality of the existing contract, and I have been clear that the standard of Capita’s work under the contract has not been acceptable and it must improve. I continue to meet regularly with Capita and NHS England as they work to improve the performance of the service.

I thank the Minister for that response. Several GP practices in my constituency have reported serious delays in the transfer of medical records. In some cases the records have gone missing altogether, with serious implications for patient safety. I would like a clear response from the Minister about the assurances she can give to my constituents that the Government—not just NHS England, but the Government—take seriously the safe delivery of their confidential medical records.

I take this issue extremely seriously, which is why I am personally meeting NHS England and Capita fortnightly and ensuring that detailed rectification plans are in place for each service delivery programme. The improvements should happen between January and April next year. I shall be happy to write to the hon. Lady in more detail if she would like to be able to reassure her GPs, optometrists and dentists on those issues.

Will the Minister advise GP practices in my constituency, who have been massively inconvenienced by the chaos of the Capita contract, that full compensation will be available for the inconvenience they have been put through?

At the moment, NHS England and Capita are focusing very hard on improving service delivery, which I think must be the top priority, but we are also looking into exactly what inconvenience and costs GPs have suffered, along with dentists and optometrists, and that will be considered and discussed with GPs.

Royal Wolverhampton NHS Trust: Delayed Discharges

13. How many patient days of delayed discharge attributable to the levels of suitable social care available at the Royal Wolverhampton NHS Trust there were in (a) 2010 and (b) 2016. (907985)

Directly comparable figures are not available, but it is clear that in the past two years there has been a substantial increase in delayed discharge figures attributable to social care at the trust, which this year were among the worst currently being recorded across the NHS.

Sadly, those figures are no surprise, despite the well-managed New Cross hospital, because central Government have cut Wolverhampton City Council’s total income by almost 50% in the past six years. The primary care vertical integration pilot in Wolverhampton is a redesign of services so that a single organisation—the hospital trust—deals with patients from initial contact to ongoing management and end-of-life care. What steps is the Department of Health taking to support vertical integration as one potential way to improve care and lessen hospital admissions and delayed discharges?

The hon. Gentleman is right that budgets are part of the issue, which is why last week’s announcement about increased funding is important. However, funding alone does not explain the delayed transfers in Wolverhampton, which are five times worse than those of Telford, which is just down the road; twice as bad as Sandwell, which is very close; and, indeed, 30 times worse than the best performing councils, such as Newcastle, Knowsley and St Helens. With regard to his specific point about the vertically integrated pilot, this is a very exciting project and I commend the people of Wolverhampton for doing it. It is based on a model from Spain that has produced big results. We are watching it carefully and will support it as required.

Unhealthy Food

15. What assessment he has made of the potential effectiveness of introducing (a) a ban on price-cutting promotions on unhealthy food in supermarkets and (b) restrictions on advertising of unhealthy food during family television programmes in reducing childhood obesity. (907987)

In developing the childhood obesity plan, we considered the latest research and evidence on promotions and advertising, including Public Health England’s evidence package “Sugar reduction: the evidence for action”. We have made no secret of the fact that we considered a range of policies before finally settling on those set out in the childhood obesity plan. The plan includes the soft drinks industry levy and taking 20% of sugar out of certain products. We concluded that our plan is the right approach to secure the future health of our children.

I associate myself with the Secretary of State’s words of sympathy for the people of Berlin, and I also add my thoughts for the people of Aleppo, Yemen, Gaza, Mosul and all the forgotten conflicts of the world.

Public health experts have dismissed the Government’s obesity strategy as a weak approach and a wasted opportunity. The Government say that they are committed to evidence-based policy making, but they have failed to acknowledge that relying on voluntary food action without tackling cost and availability is inherently flawed. Will the Minister commit the Government to getting a grip and bringing forward a ban or restrictions on advertising and price-cutting promotions on junk food?

I am happy to reassure the hon. Lady that current restrictions on advertising in the UK are already among the toughest in the world. For example, there is a total ban on the advertising of less healthy food during children’s television programmes. Those have been shown to be very effective. However, we also welcome action that has been taken by forward-thinking retailers on promotions elsewhere. In particular, Sainsbury’s has committed to removing multi-buy promotions across its full range of branded and own-brand soft drinks, confectionery, biscuits and crisps, removing more than 50% of its multi-buy promotions from its grocery business while lowering regular prices for products. It should be congratulated on leading the way.

Advertising agencies and industry bodies can play a key role in ensuring that adverts are appropriate. Will the Minister continue working with the industry to tackle child obesity?

Certain supermarkets persist in placing less healthy foods on promotion near the entrances to their stores, where they are unavoidable. Does the Minister agree that it is not just at checkouts that healthy options should be promoted, and that retailers should exercise more responsibility?

I absolutely agree that putting healthier options near checkouts and helping people to make healthier choices are part of retailers’ responsibilities. What has been notable in my discussions with retailers is that the penny is starting to drop that this is the direction of travel and what the public want, and I think we are going to start seeing a real sea change in the way retailers are advertising.

May I urge the Minister not to go down this ridiculous nanny-state route—which one would not expect from a Conservative Government—of setting up an unhealthy food police to go round telling people what they should be eating and what they should not be eating? No food eaten as part of a balanced diet is in itself particularly unhealthy. If the Government are so concerned about families that are just about managing, why on earth would they even contemplate increasing costs for working families?

My hon. Friend flatters me by saying he thinks I am a nanny—it is really quite a disturbing thought. However, what we have here is an obesity plan that balances the need to cut the sugar in young people’s diets, as a way to make sure they get a healthy diet, and individual choice, which we know is absolutely a Conservative ideal.

Topical Questions

As we enter the challenging winter period, I want, on behalf of the whole country, to thank the 2.7 million people working in the health and care system—particularly those giving up all or part of their own Christmas day to look after patients. We are in their debt, and we wish them a merry Christmas, whenever they get the chance to celebrate it with their families.

Bolton A&E is employing new measures to cope with the staggering demand on its service. What are the Government doing to educate people that A&E is for serious and life-threatening conditions only, so that staff and resources can go where they are needed most?

That is an excellent question. We are doing a number of things. First, we have the Stay Well this Winter campaign, which has a lot of advice to go out to his constituents and all our constituents about how to avoid things that can lead to their having to go to A&E. However, we also urge the public to remember that accident and emergency departments are for precisely that.

There was no new money from the Government for social care in the local government settlement—just a recycling of money from the new homes bonus to social care, and that is for 2017-18 only. Fifty-seven councils will actually lose funding owing to this recycling. Salford, which was recently praised by the Prime Minister for its integration of social care, will lose £2.3 million due to this inept settlement. Is it not time for the Secretary of State to accept that social care is in crisis and that his Government cannot just dump the issue of funding it on councils and council tax payers?

I do listen carefully to what the hon. Lady says, because she has campaigned long and hard for social care. However, with respect, I would say to her that she is ignoring one simple fact: there is more money going into social care now than would have been the case if we had followed her advice at the last election. What the Communities Secretary announced was £900 million of additional help over the next two years.

The Government’s plans for funding social care look inept because they have tied care funding, which is related to need, to council tax and to deductions from the new homes bonus. Last week’s settlement was a pathetic attempt to deal with a funding gap of £2 billion for social care by recycling £240 million within budgets. The chief executive of the British Red Cross has described the social care crisis as

“a humanitarian crisis that needs urgent action.”

When is the Secretary of State going to take that crisis seriously?

The hon. Lady talks about council tax, but she does not call out Labour councils like Hillingdon, Hounslow, Merton and Stoke which complain about pressures in the social care system and then refuse to introduce the social care precept that could make a difference to their residents. We are taking the situation seriously. More was done this week and more will be done in future.

T7. As my hon. Friend is aware, last week the Murray report was published. When is he likely to consider it, and when will he make a statement? (907969)

I thank my hon. Friend for that question and commend him for his work as a pharmacy champion. The Murray review was indeed published last week, and NHS England will respond to it in detail early in the new year. It is a very important document because it sets out in some detail how we intend to transform the community pharmacy network into a service-based profession along the lines that my hon. Friend likes.

T3. Last week, a 76-year-old man with diabetes in my constituency took a fall and had to wait almost two hours for an ambulance. I then wrote to the Health Secretary after it emerged that not a single ambulance trust in England met its response time targets in October, including for the most critical of cases. Will he explain the reasons for these unacceptable ambulance delays and what he intends to do as we approach Christmas? (907964)

I am aware of the case that the hon. Lady refers to. In the week of the incident, the London ambulance service received 40,433 emergency calls—an 8% increase on the previous week. We are trying to do something about this. We have recruited 2,200 more paramedics since 2010 and increased the number of paramedic training places by 60% in this year alone. The London ambulance service has recruited 107 more paramedics since September 2015 to help with this increased demand.

T8. Has the public health Minister had an opportunity to consider the recent report sent to her by the all-party parliamentary group on alcohol harm on the shocking impact of excessive drinking by members of the public on the dedicated people who work in our emergency services? Will she meet the APPG to discuss this? (907970)

I pay tribute to my hon. Friend for her dogged campaigning on this issue, on which she is a true champion. I have not had a chance to read the report in detail, but I have seen a number of its recommendations and we are taking action on some of them, including the publication of the chief medical officer’s low risk guidelines and Public Health England’s One You campaign, which runs over Christmas and the new year. We are embedding alcohol measures into the NHS health check and we have introduced a national CQUIN—Commissioning for Quality and Innovation—because evidence shows that intervention by a health professional is the most effective way of disrupting problem drinking.

T4. Zac from Worksop is three years old, wheelchair-bound, unable to speak and blind, and is regularly admitted on an unplanned basis to Bassetlaw Hospital’s children’s ward. As the people of Bassetlaw are standing with Zac in opposing the proposed overnight closure of the children’s ward, which will create chaos for his small life and that of a number of other very poorly children like him, will democracy prevail, or are the Government going to pick a fight with Zac, me, and the people of Bassetlaw? (907965)

First, I absolutely commend the hon. Gentleman for standing with his constituents and championing individual cases. I will happily look into the proposed changes and how they will affect people like Zac. I assure the hon. Gentleman that when we make these changes it is to improve the services of people and his constituents; that is why we are making them.

Despite some of the obvious challenges in the healthcare service, this is a wonderful time of year when hundreds of thousands of people choose to quit smoking by putting down their cancer stick and picking up an electronic vaping device. Does the Minister share my concern, however, that we must be very cautious in any implementation of the EU tobacco products directive so that it does not act as a barrier to people quitting smoking and taking up vaping?

The Government are very clear that vaping is significantly less harmful than continuing to smoke. Under the current regulatory regime, huge numbers of smokers are successfully using these innovative products as an effective quitting tool. We have already committed to reviewing the TPD and we will fully explore the opportunities that Brexit may provide, but until exit negotiations are concluded we remain a full member of the EU.

T5. On contaminated blood, will the Government confirm that they still plan to use a private profit-making company such as Atos to administer the scheme, and if so, why? (907966)

I absolutely cannot confirm that. The tendering process has not even begun. Therefore, we are not considering any form of company, private or otherwise.

The Health Committee has just published its interim report on preventing suicide. I thank all those who gave evidence to our inquiry and all members of the Department of Health advisory group. We support the strategy, but the clear message that we heard was that implementation needs to be strengthened. Will the Secretary of State meet me to discuss our report’s recommendations, and will he join me in thanking members of the Samaritans and other voluntary groups around the country who will be working tirelessly over Christmas, as they do every day, to support those in crisis?

My hon. Friend speaks wisely. Christmas can be a very lonely time for a number of people, so we all commend the work of voluntary organisations that do so well. I would be delighted to meet her.

More than a third of my male constituents live until they are over 80, and yet next door in Windsor and Maidenhead the same is true of well over half of the residents. In the 10 years before 2010, that gap narrowed. What is the Secretary of State doing to narrow the gap in future?

The best thing we can do to narrow the gap is make sure that we continue to invest properly in the NHS and social care system, and make good progress on public health, which often has the biggest effect on health inequalities. That is why it is good news that we have record low smoking rates.

With acute hospital bed blocking at a record high, do Ministers agree that it is a great pity that so very few of the 40 sustainability and transformation plans now in the public domain deal directly with step-down care and, in particular, with community hospitals?

As my hon. Friend has confirmed, 44 areas are working on their STPs, all of which are charged with looking at improving integration between hospitals and social care in order to improve discharge. In order for STPs to be taken forward, they have to address that issue.

Recent figures from the Royal College of Psychiatrists show that children and adolescent mental health services are still underfunded in many parts of the country—particularly worrying for me is the fact that Bristol seems to be the 13th lowest in the country. What are Ministers doing to ensure that children across England and the rest of the UK get the health services that they need?

The hon. Lady is right to highlight this issue and I agree with her. I am not happy with the service that we provide through CAMHS at the moment. It is a big area of focus for the Government. We are putting a lot of investment in, but there is lots more to be done.

My constituency has been waiting some time for the go-ahead for a new critical treatment hospital providing 24/7 care for the sickest patients, which is very much in line with Government policy. The hospital’s chief executive, Mary Edwards, retires this month after 21 years of exceptional service. Will the Secretary of State give her a retirement present and help me to secure a decision from NHS England?

I join my right hon. Friend in congratulating her chief executive on her commitment to the NHS. As I said in answer to a previous question about the STP for my right hon. Friend’s area, the issue is being reviewed at the moment by NHS England, and I am afraid that I am not in a position to give her any advance notice of the outcome.

The Secretary of State will be aware of the horrifying case of Fiona Hollings, a 19-year-old with anorexia who for the past four months has been nearly 400 miles away from home, in a bed in Glasgow. Her family have travelled 8,000 miles in that time to see her. The Government commit to ending this horrific practice by 2020, but do families really have to put up with it until then? How would he feel if it was his child?

We are taking action and I agree with the right hon. Gentleman that what has happened in that case is completely unacceptable. We are currently commissioning a record number of in-patient mental health beds, and it is a very big priority for us to eliminate the problem entirely by the end of the Parliament.

My constituent Marie Bingham administers a drug at home using pre-filled syringes, but she is unable to dispose of the used needles, partly because they are in 2.5 litre sharps tubs rather than 1 litre sharps tubs. It is a ludicrous situation. Is the Minister aware of the problem, and are there any steps he can take to deal with it?

As my hon. Friend says, pharmacies are commissioned, on such occasions, to dispose of these needles. I was not aware of the particular issue about the 2.5 litre tubs that seems to exist in Rugby. I will investigate that and revert to him.

TB rates are currently higher in bits of Ealing than in Rwanda. Could the Government better the bilateral innovation fund to which they have committed with China and go for the O’Neill report recommendation to work towards a truly global fund, in conjunction with other nations, to fight antimicrobial resistance?

As I have already answered, we are a world leader on AMR. We have not only the bilateral fund with China but the £265 million Fleming fund, through which we will deliver bilateral national action plans with a number of developing nations. We are committed to going further than that through the global action plan with the UN.

A fortnight ago, I visited the pharmacy at the Corby urgent care centre to thank the dedicated staff for all that they do all year round, and to have a flu jab as part of the ongoing campaign. Does the Minister agree that exactly that sort of proactive working is crucial in trying to tackle winter pressures?

I do agree with my hon. Friend. I am particularly pleased that this year, the pharmacy network has done more flu jabs so far than in the entire period last year. I had my flu jab, and it is holding up well.

It is always useful to have a bit of additional information. We are greatly indebted to the Minister.

In the east midlands, the average ambulance arrival time for life-threatening cases has almost doubled in the last three years, and Nottingham’s A&E waiting times are the worst in a decade. Will Ministers apologise to my constituents, including hard-working NHS staff, for their failure to fund health and social care adequately?

I would like to add my tribute to the work of ambulance staff up and down the country, particularly over the busy Christmas period ahead. As I have already said today, we have increased funding for ambulance services. We have increased the number of paramedics, both in training and employed. Earlier this month we announced that we had increased the payments to paramedics to move them from band 5 to band 6, to help to retain and recruit more staff.

Order. We are short of time, but I am in a generous mood. We can manage only one more, so 46 years, six months and two days after his first election to the House, I call Mr Dennis Skinner.

He is a mine of information, isn’t he? He would like to contribute, really.

Does the Secretary of State not think that it is a scandal to be shutting Bolsover hospital, with 16 valuable beds that will go for ever, at a time when people are lined up on trolleys in nearly every hospital in Britain? Why does the Secretary of State not give Bolsover a Christmas present and announce that Bolsover hospital will be saved? Come on!

I add my congratulations to those of the Speaker on the hon. Gentleman’s long service, which has included campaigning for Bolsover hospital. I simply say to him that we will look very carefully at all proposals to change the services offered. I think community hospitals have an important role in the future of the NHS, but the services they provide will change as more people want to be treated at home.