House of Commons
Tuesday 21 March 2017
The House met at half-past Eleven o’clock
[Mr Speaker in the Chair]
Oral Answers to Questions
The Secretary of State was asked—
Domestic Students of Medicine
We are funding 1,500 additional medical school places each year to ensure that the NHS can continue to deliver safe, compassionate and effective care well into the future. Around 500 places will be made available in September 2018, and the remaining 1,000 places by September 2019.
In Taunton Deane, we are desperately short of trained health professionals, from dermatologists to nurses, but one of the worst shortages is of GPs, with some practices not even able to get locums. I know Ministers are working on this, but could my right hon. Friend update me on what the Department is doing to encourage more medical students to become GPs? It is hard to believe they do not want to come to Somerset, but what are we doing to encourage them?
There is no greater champion for Somerset than my hon. Friend. What I would say to her is what I would say to all medical students, which is that general practice is going to be the biggest area of expansion in the NHS over the coming years; in fact, we are planning to have the biggest increase in GPs in the history of the NHS.
It will take many years for the doctors the Secretary of State has just talked about to come on stream, and we have a workforce crisis in the NHS now, partly because of the cuts the Government made in the last Parliament, but also because of their irrational pursuit of the hardest of Brexits. He could do something very simple today to address this crisis in the short term, and that is to announce that all EU nationals who do vital work in our NHS will be able to stay when we leave the European Union.
The one simple thing the Government are not going to do is refuse to listen to what the British people said when they voted on 23 June. We will do what they said—it is the right thing to do. However, the right hon. Gentleman is absolutely right to highlight the vital role that the around 10,000 EU doctors in the NHS play in this country. I can reassure him that the number of doctors joining the NHS from the EU was higher in the four months following the referendum result than in the same four months the previous year.
I can absolutely confirm that the garden of England would be an ideal place for a new medical school—alongside many other parts of the country that are actively competing to start medical schools as a result of the expansion in doctor numbers. It is an independent process run by the General Medical Council, and we will await what it says with great interest.
On this wonderful first day of spring, will the Secretary of State think anew about the training of GPs? We want more GPs, we want them highly trained and we want them to know that someone who suffers from atrial fibrillation should not be neglected and should not be put on aspirin or warfarin, but should be given the new anti-coagulants.
The hon. Gentleman speaks very wisely about this, and he is one of a number of people who say we need to look at the training we give GPs on patient safety, on growing, new areas like mental health, and on things like the identification of cancers. This is something we are having an ongoing discussion with the Royal College of General Practitioners about.
Given the importance of training new doctors and nurses to the future of the health service, will my right hon. Friend welcome the building, which will commence later this summer at the Anglia Ruskin University in Chelmsford, of a new medical school that is solely there to train doctors to meet the needs of people in Essex and beyond its borders?
I absolutely welcome that, and I know my right hon. Friend has personally championed it as a local MP. The historical mistake that those on both sides of the House have made is not to do long-term workforce planning for the NHS, and that is something we want to put right.
Plans to train more UK doctors are absolutely welcome, but the Secretary of State knows that it takes at least 10 years to train a doctor, so what is his response to the surveys by the British Medical Association and the GMC showing that, having been left hanging for nine months, 40% to 60% of EU doctors are thinking of leaving?
My response is the one I give many times in this House, which is to stress to all those doctors how valued they are as critical parts of the NHS. We do not see any evidence of the number of doctors joining from the EU going down. The NHS is one of the best health services in the world, and it is a great place for people from other countries to work and train.
The workforce is one of the biggest challenges right across the nations of the UK, and particularly in rural areas, as we heard earlier. With a 92% drop in the number of EU nurses coming to the UK and a 60% increase in the number who left last year, how does the Secretary of State plan to avoid an NHS staffing crisis immediately post-Brexit, before there is time to train anybody extra?
The hon. Lady needs to be very careful in her use of statistics, because she will know that one reason for the drop in the number of nurses coming from the EU is that prior to the Brexit vote we introduced much stricter language tests, as that is better for the safety of patients and a very important thing that we need to get right. We are very confident that nurses will continue to want to work in the NHS, because it is a great place to work.
A&E Waiting Times
Between February 2016 and January 2017, there were just under 3,500 waits of longer than 12 hours from decision to admit to admission. That is completely unacceptable, which is why the Government took urgent steps to free up NHS bed capacity in this month’s Budget.
Earlier this month, the chair of the Royal College of General Practitioners said that the “best place for GPs” is working within their communities to provide the highest possible general practice quality. What forecast has the Secretary of State made of the reduction in A&E waiting times next winter as a result of the new GP triage units in A&E departments? Does he agree that this is simply a small sticking plaster on the gaping wound that is our drastically underfunded NHS?
Thank you, Mr Speaker. To continue, let me say that in this so-called “drastically underfunded NHS”, the hon. Lady’s local hospital—St George’s in Tooting—now has 36 more doctors working in A&E than there were in 2010. However, we also think that as a lot of people go to A&E departments with minor injuries and things that can be dealt with by GPs, we need to have GPs on site, and this Parliament we are planning to have 5,000 more doctors working in general practice.
In January, more than 1,000 patients at the Countess of Chester’s A&E unit had to wait more than four hours and only 81% of patients had to wait less than four hours. Now that the 95% target has been abandoned, until at least midway through next year, what guarantee can the Secretary of State give my constituents that we will not get a repeat of this next winter?
On the contrary, we have not abandoned the 95% target—we have reiterated its importance. There is, however, one part of the United Kingdom that has said it wants to move away from the 95% target—Wales. The Welsh Health Minister said last week:
“You can go to A&E and be there five hours but have…a good experience.”
That is not looking after patients; it is giving up on them.
On this important issue of A&Es, does the Secretary of State agree that it makes no sense at all for my local clinical commissioning group to be bringing forward a business case to spend an extra £300 million on bulldozing Huddersfield royal infirmary and downgrading our A&E?
I recognise the very strong arguments my hon. Friend makes and the strong campaigning he does on behalf of his constituents. We are waiting for the final recommendations to come from his local CCG, but I agree that too often we have closed beds in the NHS when we do not have alternative capacity in the community, and we need to be very careful not to repeat that mistake.
The cost of presenting with a minor ailment at a pharmacy is only 10% of the cost of presenting at A&E. What more can be done to help persuade those who present themselves to A&E that the pharmacy sector could be a better use of their time?
I entirely agree with my hon. Friend on that. Despite the current debates, the pharmacy sector has a very bright future, and we have set up a £40 million integration fund precisely to help pharmacists to play more of a role in the NHS and, in particular, to reduce pressure on A&Es.
This year, the winter crisis in A&E has been the worst ever. Things have got so bad that, rather than waiting in A&E, record numbers of people are just giving up—I am sure there are many who wish the Secretary of State would do likewise. In January, nearly 1,000 people were stuck on trolleys waiting more than 12 hours to be admitted to A&E. Will the Secretary of State accept that that is far more than just a small number of isolated incidents? After five years in the job, he has to accept responsibility for the crisis he has created.
I accept responsibility for everything that happens in the NHS, including the fact that, compared with 2010, we are seeing 2,500 more patients within four hours every single day. We are also seeing a big increase in demand, which is why there were particular measures in the Budget to make sure that we return to the 95% target, including £2 billion for social care, which is £2 billion more than the Labour party promised for social care at the election.
The urgent care centre at Corby has done much to relieve the pressures on Kettering A&E, and it is a class leader. Given the announcement of £100 million for new triaging projects, would the Secretary of State like to visit the Corby urgent care centre to see this beacon of best practice at first hand?
Cough-assist machines are one of a variety of respiratory treatments that may be appropriate for sufferers of conditions such as motor neurone disease or muscular dystrophy. In the end, it is a matter of clinical judgment.
There are good examples of best practice cough-assist commissioning policies for muscle-wasting conditions that can be followed by health boards and CCGs. Given the hard work being done to extend the lives of those who suffer from muscular dystrophies, what support and assistance can the Department provide to Muscular Dystrophy UK to ensure that such policy is more widely adopted?
It is not for the Government to direct clinicians regarding the efficacy of particular treatments; it is for clinicians to decide, based on guidance from the National Institute for Health and Care Excellence and others. In developing its recent motor neurone disease guidance, NICE found that the evidence base for the routine use of cough-assist machines was weak. However, the matter is kept under review, so that may change as and if new data emerge.
NHS: Export of Procedures
Many NHS bodies work with their international peers, and each makes its own assessment about the effectiveness of intended collaboration, rather than any determination being made at a national level. Trusts should only pursue opportunities that deliver value for money and do not impair their ability to deliver NHS services.
A team of clinicians at Southmead hospital in my constituency, led by Professor Tim Draycott, have developed and are now exporting internationally a system of maternity healthcare that is transforming maternity safety and childbirth. What is the Department doing to provide further support and ensure that the evidence base the team have developed is embedded and incorporated in policy making in this place?
My hon. Friend will be aware that the professor to whom she refers has presented his findings to the Secretary of State. Partly in response to that, we have set up an £8 million innovation fund to help to take such initiatives forward and to spread best practice throughout the country.
May I endorse what the hon. Member for Bristol North West (Charlotte Leslie) said? In the area of diabetes, for example, our country has some of the best clinicians in the world. Will the Minister ensure that the next time the Prime Minister goes on an official delegation she takes one of these professors with her to show the rest of the world what we are able to do for conditions such as diabetes?
The right hon. Gentleman is an acknowledged expert on diabetes. I have visited facilities around the world, including in Abu Dhabi, where Imperial College London has a joint venture with the diabetes centre there. The UK is an acknowledged expert, and we are launching the national diabetes prevention programme, which will roll out across 10 pilot sites for type 2 diabetes prevention work. I shall encourage the Prime Minister to consider the right hon. Gentleman’s proposal that we expand that work on other trade visits, certainly those for health, around the world.
Mental Health Treatment
This Government were the first to set a national ambition to eliminate inappropriate out-of-area placements by 2020-21. By then, no adult, child or young person will be sent away from their local area to be treated for a general mental health condition.
I thank the Secretary of State for his response. My 17-year-old constituent Jess needed an acute mental health bed. The nearest available was in Colchester. She was allowed to go home some weekends, but it meant an 800-mile trip for her mum. We can only imagine the emotional and financial hardship that that caused. The Secretary of State tells us that he is working on this matter, and I believe that he does want to improve things, but what progress has actually been made, as this is really, really not good enough for Jess and others?
I agree with the hon. Lady and she makes her case very powerfully. We need to make progress and we need to make it fast, particularly for young people, as their recovery can be very closely linked with the potential of their parents to come to visit them. Nearby places such as the Sheffield Health and Social Care Foundation Trust, which do not serve her constituents, have eliminated out-of-area placements and saved £2 million in the process. It is about spreading that best practice.
My hon. Friend speaks very wisely on this matter. In the end, schools are a vital place in which to spot mental health conditions early. We know that around half of mental health conditions become established before the age of 14, and this will be a big part of the Green Paper that we publish later this year.
Does the Secretary of State recognise the ways in which poverty, the associated financial strain and deprivation intersect with mental health; understand the need for him to work with the Secretary of State for Work and Pensions to ensure that mental health is properly recognised in personal independence payment assessments; and recognise that the problem is more acutely affected if people have to travel out of their area of residence?
Some innovative and award-winning work is being done by Bradford District NHS Care Trust. It is working alongside excellent voluntary organisations and charitable organisations such as the Cellar Trust in Shipley, which is delivering much improved support for mental health patients. Will the Secretary of State congratulate the work that is being done in Bradford, and would he like to pay a visit so that he can share this best practice with other parts of the UK?
I am happy to congratulate the Cellar Trust, and to pay a visit if I can find the time to do so. My hon. Friend is right to say that voluntary organisations play a vital role. Very often, they can see the whole picture and they treat the whole person, not just the specific NHS or specific housing issue, so he is right to commend its work.
Recent figures show that 18 mental health patients were placed more than 185 miles away from their home for treatment, including five from the northern region—Jess is one such example. Their families will have to travel the equivalent of Manchester to London, or further, to visit them. We have also learned that £800 million was taken out of CCG budgets, which could be funding services such as mental health in-patient beds, just to help NHS England balance the books. Will the Secretary of State tell those patients and families why they should be treated so far from home when their local CCG should be able to fund the in-patient beds they need?
With great respect to the hon. Lady, we are the first Government to count out-of-area placements, and to commit to eradicating them. What she does not tell the House is the context, which is the biggest expansion in mental health provision anywhere in Europe, with 1,400 more people being treated every single day, and an extra £342 million being spent this year on mental health compared with last year.
As part of our plan to improve access to general practice, we are taking steps to ensure that there will be an extra 5,000 doctors by 2020. We are increasing the number of GP training places, recruiting up to 500 doctors from overseas and encouraging doctors who have retired to return to general practice.
I am very happy to meet my hon. Friend. He will know that the surgery got an £80,000 grant this year through NHS England’s general practice resilience scheme, but I am aware that there are lots of pressures on surgeries such as St Luke’s and I am happy to talk about it further.
I am delighted to hear the Secretary of State issue some information about the additional GPs who will be coming on stream in the coming years. How many will be coming to north-east Lincolnshire and when will they be there? We have a critical shortage of GPs and people are struggling to get appointments.
The hon. Lady is absolutely right that areas such as Lincolnshire find it particularly difficult to attract GP recruits, which is why we have set up a fund that gives new GP trainees a financial incentive to move to some of the more remote parts of the country. This is beginning to have some effect, and I am happy to write to her with more details.
I warmly welcome the Secretary of State’s efforts to recruit more GPs, and I know that he wants all GPs and, indeed, doctors to have high levels of job satisfaction. Is he aware of the fact that reasonable numbers of doctors are leaving the UK to work overseas? Given the cost of medical training and the money that taxpayers put into that education, will he look at that issue, perhaps by requiring a certain commitment to the NHS?
My hon. Friend raises an important point. There is currently no evidence of an increase in the number of doctors going to work abroad, but there is an issue of fairness because it costs around £230,000 to train a doctor over five years. In return for that, there should be some commitment to spend some time working in the NHS, and we are consulting on that at the moment.
GPs around the country are facing unprecedented pressures as they work to deliver the highest possible standards of care, despite underinvestment and increasing patient demand. A record number of GP practices closed in 2016. Are the Government really serious about addressing the problem for the sake of GPs and their patients? If so, why has the promised £16 million resilience fund not been delivered in full, when it was promised by October 2016? There is very little evidence to date of the Government delivering on any of their promises in “General Practice Forward View”, no sign of the extra £2.4 billion, no sign of—
Order. We have got the general drift. May I gently say to the hon. Lady that the longer the Opposition Front Benchers take, the less time there is for Back Benchers on both sides? This is becoming a worsening phenomenon. It is not only the fault of the hon. Lady, but it really must stop. It is not fair to Back-Bench Members.
During my time as Health Secretary, the real-terms investment in general practice has gone up by £700 million or 8%, and we are planning to increase it by 14%—£2.4 billion—over this Parliament. A lot of extra money is going in, but I recognise that there are still a lot of pressures.
The Secretary of State’s plans to recruit doctors will be widely welcomed in Leicestershire, but should he not be making greater use of already properly regulated practitioners—those who are regulated by the Professional Standards Authority—of whom there are 20,000, including hypnotherapists?
My hon. Friend’s ingenuity in bringing these issues up in question after question never ceases to amaze me. As he knows, we recognise that the pressure in primary care cannot just be borne by general practice, but we must always follow the science as to where we get our help from.
Only recently, a surgery has been closed down in the borough of Halton. There is a clear shortage of GPs. Despite the efforts of the clinical commissioning group to try to find replacements, that has not happened. How will merging CCGs help, and can the Secretary of State rule out any merger between Warrington and Halton?
The hon. Gentleman says from a sedentary position that we set up the CCGs. I remind him that CCGs came together without central prescription as to what their size should be, but we will always listen to the advice we get on the ground if people want to change their size.
Mental Health: Digital Platforms
The Prime Minister herself announced our commitment to developing and expanding digital mental health services, and we have backed that with an investment of more than £65 million. This work includes improving digital technology for the mental healthcare system, developing digital tools and therapies, and improving mental health information and services provided through nhs.uk and 111 platforms.
The Minister will know that for people with mental health problems, attending accident and emergency or going to see their GP is not always the best point of intervention, so I welcome measures to improve accessibility. Stockport Healthy Minds, which serves my constituency of Cheadle, provides a range of services such as online self-help courses, one-to-one therapy sessions, and group workshops. What is her Department doing to provide projects like Healthy Minds with the support and accessibility they need?
In addition to the funding that we are providing to improve the mental health pathways through nhs.uk and 111, we are providing £500,000 for the development of six digital tools, with a particular focus on children and young people’s mental health. I pay tribute to the work of Healthy Minds in my hon. Friend’s constituency and to her own championing of this issue.
Order. It is always a pleasure to hear the hon. Member for Hyndburn (Graham Jones), but can I just say to him that it is a good idea to bob consistently, and then one knows of the interest of an hon. Member? On this occasion, he looked at me meaningfully but was not bobbing; I am not psychic. But let us hear the voice of Hyndburn: Graham Jones.
I am very grateful, Mr Speaker, for your asking me to ask a question. Mental health is a really serious, and growing, problem. I have been out with my local police force and I appreciate the emphasis on digital technology, but what are we doing on the frontline as well? We cannot just have digital operations. In the Lancashire constabulary, because of the Government’s cuts, we are removing the mental health worker from the frontline force. While we may be doing something around digital, we are removing mental health services, because that post goes on 31 March. Is this not ridiculous? Is it not the case that the Government do not have a coherent policy on mental health?
The hon. Gentleman misrepresents the situation entirely. Not only are we investing an extra £1 billion year in mental health services and expanding mental health services at a faster rate than anywhere else in Europe, but we have invested £15 million extra in places of safety for those in crisis and are expanding triage services, precisely to address the problem that he raises of those in mental health crisis who come into contact with the criminal justice service.
While digital platforms can be useful in guiding patients to the right service, does the Minister accept that there are still huge shortages of people who can carry out talking therapies, and long waits for child and adolescent mental health services? When are the Government going to stop talking about improving mental health services and actually ensure that the money is going where it is needed to recruit staff?
We are working extremely hard on increasing staff. We are not only introducing our new mental health workforce strategy, which we will publish shortly, but increasing the number of people who are seeing these services. Four million extra people have seen psychiatry services—talking therapies—and 90% of those patients are being seen within six weeks, which is exceeding our waiting time target.
We have engaged fully with the health and research community to ensure a positive and beneficial application of the GDPR in the UK. My hon. Friend is right that data are vital to the delivery of safe and high-quality care, but we need to ensure that there is a trusted system in place, and that people understand that their information is secure and have confidence in its use.
I thank the Minister for that answer, but I have to tell her that when the EU’s general data protection regulation becomes enforceable next year, it will be more difficult to share data. Cancer charities, including Cancer Research UK, are concerned because the progress of life-saving research, especially into rare and children’s cancers, would not have been possible were it not for data-sharing. Will she do what she can to shield the UK from this harmful regulation, given that it disproportionately affects us because of the wealth of our data?
We have been clear that we are going to introduce the data regulation. We are working on exactly how we will do that in a balanced way that encourages data-sharing for the purposes of research in a sustainable NHS. We have set up a sub-group to examine the impact of the GDPR on research. It is hosted by the Wellcome Trust and includes members of the Health Research Authority’s confidentiality advisory group, the NHS Confederation, the Medical Research Council, the Department of Health, and the PHG Foundation. We will ensure that this works in an effective way to address the concerns that my hon. Friend has raised.
Enriched Culture Medium Test
My right hon. Friend will be aware that Public Health England published a paper in June 2015 precisely on this subject, but it concluded that within the currently accepted clinical guidelines there are no clinical indicators for testing women using enriched culture medium methods. This test is not, therefore, recommended for routine use at present.
My hon. Friend will be aware from his reading of the British Paediatric Surveillance Unit report that the incidence of group B strep has increased by 30% over the last 15 years. Does he agree that this matter has gone on for far too long, and that the Government must come to a conclusion to prevent further tragedies?
As my right hon. Friend will be aware, the UK National Screening Committee is reviewing the evidence for antenatal screening, including the use of enriched culture medium tests for group B streptococcus, following a public consultation. I understand that its recommendation will be published very soon, and I assure him that I will consider the recommendation very carefully and write to him with my view.
“General Practice Forward View”
“General Practice Forward View” announced that investment in general practice will increase from £9.6 billion in 2015-16 to more than £12 billion in 2020-21. This represents an increase of 14% in real terms, which is almost double the increase for the rest of the NHS. Two years into the forward view, we remain on track to deliver that.
I appreciate the Minister’s response, but the reality on the ground in areas such as Redcar and Teesside is that we face a deficit of £281 million by 2020. How can he reassure my constituents, who are already finding it hard to get an appointment with a GP, that already scarce services will not become even more so?
We do recognise that in parts of the country there are shortages of GPs. As Members have heard, we are planning to have 5,000 more doctors working in general practice by 2020, and a proportion of those will be in Teesside. It is important that we meet that goal.
GPs in Wycombe cite long hours, bureaucracy and the declining attractiveness of the partnership model as reasons why people do not want to be in general practice. Will the Minister ensure that funding within the forward view is directed to deal with those key problems?
Yes, and the contract discussions that we have just completed with the British Medical Association addressed a number of the issues that my hon. Friend talks about, in terms of the pressures on doctors working in general practice. We acknowledge that the workload pressures are enormous, and, through the contract, we need to do all that we can to mitigate them.
More than 80% of clinical appointments are carried out by GPs, but they receive a proportionately much lower level of funding. What steps will the Department of Health take to make sure that all sustainability and transformation plans abide by NHS England’s recommended allocation of funding to general practice?
One of the criteria by which STPs are being judged is the extent to which they are making this tilt from secondary into primary care, exactly as the hon. Lady suggests. That is precisely why the extra funding for primary care that I have set out is so important and why it is happening.
“General Practice Forward View” talks about supporting general practice to improve digital technology for patients. Given the recent data challenges, does the Minister agree that putting a national data guardian on a statutory footing to protect patients and professionals is becoming an imperative?
The support that is provided to GP practices in relation to IT, information and so on is absolutely crucial to their effective operation, but problems continue today in my constituency with the service provided by Capita. Capita cannot, for example, now get prescribing certificates for locums and new GPs. When are the Government going to get a grip on this failing contract and, if Capita cannot perform adequately, get someone else to do it?
The hon. Lady is right. There have been issues with the Capita contract, and we have been let down by Capita. We are working hard to get that sorted, and my colleague the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood), meets Capita weekly to get this fixed. We are making progress, and we believe that the issues that the hon. Lady refers to will be fixed in the foreseeable future.
There is a shortage of GPs across Northamptonshire, especially in Kettering, and the age profile of local GPs means that a very large number are about to reach retirement, which will make the problem worse. What can be done to encourage experienced GPs to stay on longer and to encourage those who have retired to come back?
My hon. Friend is absolutely right that one of the things we need to achieve is either to encourage older GPs to work part time or to make it easier for them to step down into more of a mentoring role. With the Royal College of General Practitioners, we have brought forward a scheme called GP Career Plus, which enables GPs in 10 pilot areas—the pilots are being rolled out now—to work as mentors across practice areas, and not to feel as though they have to retire, as GPs too frequently do at the moment.
Heart Disease and Paediatric Services
Standards for paediatric co-location for congenital heart disease services are not currently met by the Royal Brompton, Leicester and Newcastle hospitals. NHS England is consulting on proposals to cease commissioning level 1 surgical services from the Royal Brompton and Leicester. No final decisions have been made on the proposed changes. Public consultation continues until 5 June 2017, and I encourage my hon. Friend to participate in that consultation.
Mr Speaker, you are absolutely correct in your comment.
Does the Minister agree that the standards review found that not all clinicians are in agreement about how essential the co-location of paediatric services is, bearing in mind that a child being treated right now at the Royal Brompton will have 24-hour access to all necessary medical specialties? Will he tell us what improvements co-location at the world-class Royal Brompton hospital would achieve?
My hon. Friend has considerable expertise, but I am advised that having all relevant children’s specialties on the same site is the optimal model of care for the most critically ill children. It promotes closer, more integrated ways of working between specialist teams, and ensures rapid access to key services, such as paediatric surgery, at the most critical times when they are needed.
Mortality rates for the treatment of congenital heart disease fell from 14% in 1991 to 2% last year. The Royal Brompton, where the service is threatened with closure, does better even than this. What evidence is there that the closure programme will produce any further improvement, and if there is none, why is it being pursued?
The hon. Gentleman is right to point out that we have some world-leading patient outcomes for congenital heart disease, and I recognise the statistics that he read out. This is being driven entirely by seeking to improve patient outcomes across the country—improving them even on that very good performance—and to ensure greater resilience of service in some areas where there are relatively low volumes and an over-reliance on locums. I accept that that is not the case at the Royal Brompton, but it is in some of the others.
The Leeds heart unit is performing very well, and is free from the threat that it was facing, unfairly, a few years ago. Will lessons be learned, however, from the disastrous Safe and Sustainable review process, which pitted hospital against hospital and clinician against clinician? Can we find a much better way—I hope the Minister will tell us that this is happening now—to reconfigure such services?
I recognise that when the proposal was put forward back in 2012, it led to a process that we felt was wrong, and we therefore stopped it. This process, we hope, is being conducted in a more rigorous and fairer way, and will lead to outcomes driven, as I say, by improving patient experience.
Labour’s legacy cost from the 103 hospital PFI schemes entered into between 1997 and 2010 was a public sector liability of £77 billion. The estimated total NHS PFI payments for the financial year ending at the end of this month is £1.97 billion, and the totals for the next three financial years are £2.04 billion, £2.11 billion and £2.16 billion.
Those are alarming figures, so what are the Government doing to support the trusts affected by those expensive and inflexible PFI and other deals reached under the previous Labour Government? What assessment has the Minister made of what the funds could be buying in the NHS now if it was not saddled by this Labour debt legacy?
My hon. Friend is right to point out that the Opposition constantly complain about the cost of the PFI programmes that they themselves initiated. The Government are making large efforts to support trusts in dealing with the PFI legacy. We are giving the seven trusts worst affected by PFI schemes access to a £1.5 billion support fund over a 25-year period. In 2014 alone, trusts negotiated savings worth over £250 million on their contracts.
The Department is urgently undertaking work to understand what the impact on the NHS will be. There have been regular meetings with the NHS Litigation Authority since the announcement. The Government will adjust the NHSLA’s budget to meet the additional costs associated with the change in the discount rate.
The hon. Member for Southport (John Pugh) shoehorned Question 21, which we did not reach, into a Question that we did reach. He blurted it out so quickly that it took us a while to notice that it had absolutely nothing whatsoever to do with the private finance initiative. Very naughty boy!
PFI always was idiotic. It carried on under the coalition Government and has left a huge financial hangover. Will the Minister have a word with his colleagues in the Treasury, because the Treasury figures on hospital liabilities are different from the figures that some of the hospitals themselves produce? As there is a discrepancy, we do not even know what the liabilities are.
The hon. Gentleman has been assiduous, as is his wont, in trying to get to the bottom of the costs of the PFI impact on the hospital in his area. If he has a discrepancy, it would be very helpful if he pointed it out to me in writing. I will then respond to him.
Social Care: Unmet Needs
Social care continues to be a key priority for the Government. That is why local authorities in England will receive an uplift in the money available for social care over the next three years of 17% in cash terms. That significant uplift will allow councils to support more people and sustain a diverse care market.
Does the Minister recognise that the figure he has just given—the additional £1 billion in the Budget—is just half of what is needed to fill the shortfall in social care? Will he tell the House what he is doing to ensure that the sector gets the additional money and to stop councils being bankrupted by their social care requirements?
The 17% cash uplift over the next three years exceeds what we have been asked for by a number of stakeholders in the sector. I have conceded at this Dispatch Box many times that the sector is under pressure. The additional moneys that we have come forward with will help to alleviate that and will make a big difference. In Lancashire, the figure is not 17% over three years; it is 18% over three years.
The Minister is quite right that central Government are providing extra money for essential care and allowing local councils to raise a precept on the council tax for social care. How will the Government ensure that councils actually spend that money on social care?
Much of the money will go through the better care fund and there is conditionality on that. We expect councils to spend this money, as they have requested it, on social care and we believe that that will be the case. We understand the pressures and have acted.
But 1.2 million older people are living with unmet care needs. The £1 billion that was announced in the Budget for this year is not enough to prop up the failing care sector, when many councils are suffering contracts being handed back. Given that 1 million people over the age of 65 do not have adult children, will the Minister explain how all those people living with unmet care needs are meant to manage?
The figure on unmet care needs comes from an Age UK analysis. I am meeting Age UK to go through its recent report, but we do not accept that analysis because the Care Act 2014, which had cross-party support, set statutory consistent definitions for what care councils have to provide. It is illegal for that not to be met, and our follow-up work with the Local Government Association has indicated that it is being met. Furthermore, we have put in a 17% increase over the next three years.
Our childhood obesity plan includes a number of measures, such as the soft drinks industry levy, reformulation and school-based interventions, that will help all children, including those in inner-city communities. We will monitor progress carefully, including through the national child measurement programme. We will routinely publish developments on all key measurements for the programme, but it stands to reason that those who are most in need will benefit most from these interventions.
I thank the Minister for that answer, but it remains the case that childhood obesity is twice as high in deprived areas as it is in more affluent areas. In Tower Hamlets, 20% of children are obese and a third are overweight. What will the Government do to reduce childhood obesity and when will the plan be published?
The childhood obesity plan has already been published. I think the hon. Lady may be talking about the reformulation targets and the baseline data, which are coming out imminently. The experts in Public Health England are working feverishly to make sure that the data are exactly as they should be. One measure I think she will be particularly keen to see is the investment in schools committed to by the Chancellor in the Budget, including the voluntary healthy rating scheme, which will be published in June.
As I mentioned, we will be publishing the reformulation baselines against which all future success will be measured. They will include measurement across all industry targets. In addition, we will of course have the voluntary healthy rating scheme for primary schools to recognise and encourage their contribution to preventing obesity.
As part of our ambition to make the NHS the safest healthcare system in the world, I will today be speaking at the largest ever conference on learning from avoidable deaths and what we can do to improve care in the future. As part of that, I can inform the House that the NHS Litigation Authority will radically change its focus from simply defending NHS litigation claims to the early settlement of cases, learning from what goes wrong and the prevention of errors. As part of those changes, it will change its name to NHS Resolution.
My constituent Pauline Cafferkey was cleared of misconduct last September, following a very public case surrounding her return from Sierra Leone and her contraction of Ebola. Will she receive an apology from Public Health England and will it reimburse her legal costs?
With respect to Pauline Cafferkey, who is a very brave lady and who gave very good service to this country and the people of Sierra Leone with her work during the Ebola crisis, the hon. Lady will understand that disciplinary procedures are an independent matter. They are not dealt with by the Government. They have to be done at arm’s length and we have to respect whatever is said or done.
We are firmly committed to improving the UK’s air quality and cutting harmful emissions. We have committed £2 billion since 2011 to increase the uptake of ultra-low emission vehicles, support greener transport schemes and set out how we will improve air quality through a new programme of clean air zones. In addition, in the autumn statement we announced a further £290 million to support electric vehicles, low emission buses, taxis and alternative fuels. I regularly meet the Department for Environment, Food and Rural Affairs to see how we can roll out this work.
The Government have not met the four-hour target for A&E since July 2015. In the NHS mandate, finally published yesterday, the Secretary of State is effectively telling hospitals that they do not need to meet it in 2017 and that it only needs to be met in aggregate across hospitals
“within the course of 2018”.
Is that not the clearest admission that the targets will not be met next year, because in the next 12 months the NHS will be denied the funding it needs and, as a consequence, patients will suffer?
Apart from observing that if the hon. Gentleman cares so much about the 95% target he might want to ask his colleagues in Wales why they are looking at scrapping it, on the money let me be very clear: in the next year, the NHS will be getting about £1.5 billion more than his party were promising at the last election and the social care system will be getting £1.5 billion more than his party were promising at the last election. We are doing our job.
The Secretary of State says he is doing his job, so why does he not take that up with NHS Providers, which is warning that because of the underfunding, it will be “mission impossible” in the next 12 months to deliver standards of care. Returning to the NHS mandate, did you notice, Mr Speaker, that in that mandate there is no mention whatsoever of Brexit, even though the NHS relies on 140,000 NHS and care workers? I know that the Secretary of State is not a member of the Cabinet Brexit committee, but will he use his considerable influence with the Prime Minister to ensure that when she triggers article 50 next week, she will finally give an absolute guarantee of the rights of all those EU workers in our NHS?
First, let me first reassure you, Mr Speaker, that I will be attending the Brexit committee when it is relevant to the NHS; in fact, I shall attend it this week, because issues relating to the NHS are coming up in it. What we are not going to do in that committee, however, is to take steps that would risk the welfare of British citizens living in countries such as Spain, Ireland and France. That is why, although it is a top priority for us to negotiate the rights of EU citizens living in Britain, including those working in the NHS, it has to be part of an agreement that protects the rights of British citizens abroad.
I absolutely agree. What I think my hon. Friend should tell her constituents—I am sure she will—is that general practice is going to be the most exciting, fastest-growing part of the NHS, where care is going to be transformed, making this the right thing to do.
Frist, let me pay tribute to my hon. Friend for his leadership of the APPG on rare diseases. I am sure he will join me in feeling proud that the UK is a recognised leader in research, treatment and care for rare diseases in particular. We are at the forefront of the genomics revolution. He is right that the UK strategy for rare diseases needs to be translated into an implementation plan, and that is one of my personal commitments.
The formula is based on the better care fund formula, which is based on the spending power of local authorities. Let me tell the hon. Lady that, over the next year, that improved better care fund is going up by 35%, and Surrey’s allocation is going up by only 5%.
There is no hitch. The Government remain committed to putting this into place, and the legislation will be brought forward shortly.
The hon. Lady is absolutely right to say that this is a serious issue. I commend the brilliant work done by NHS trauma centres throughout the country, which are world-beating, but, as well as setting up those centres, we have established much closer co-operation with local police forces so that we can work out where the crime hotspots are and help the police to prevent such things from happening.
As my hon. Friend will have heard from the Secretary of State earlier, a number of areas are competing to secure a new medical facility. One of our criteria will involve encouraging doctors to be trained in areas where there are shortages, and I am sure that Lincoln University will take that factor into consideration.
The British Medical Association said recently that the funds for sustainability and transformation plans that were announced in the Budget would be completely inadequate for the task. Health trusts throughout the country are being forced to consider rationing treatment and ending or downgrading local services such as A&E, which will result in even longer waits and journey times to access care. Why do the Government not call STPs what they really are—secret Tory plans to decimate the national health service further?
This is a year in which funding for the NHS has risen by £3.8 billion in real terms. I do not know how the hon. Gentleman can say what he has said, given that in 2015 he stood on a platform to give the NHS £1.3 billion less this year than it is receiving under the Conservatives.
Last week, to the distress of its vulnerable residents, Aldingham House care home in Blackheath became the latest care home in south-east London to close. Do the Government accept that the care home industry is at breaking point, and, if so, what are they doing about it?
The number of care home beds in the country has remained broadly constant at just over half a million over the last 10 years. There is variation and churn between areas, but I believe that the 17% cash-terms increase that we have injected into the social care market in the Budget, and the better care fund that is to come, will make a difference.
I welcome the new nursing associates role that is currently being piloted. Will other areas, such as Portsmouth, be able to offer the same opportunities in the future, and will the new role be open to older people wishing to return to the workplace?
As my hon. Friend knows, we are launching a second wave of nursing associates at the beginning of April. I am pleased to be able to confirm that Southern Health NHS Foundation Trust, which manages Portsmouth Hospitals NHS Trust, is one of the trusts that will receive nursing associates, and that the system is partly designed to give social care workers opportunities to upskill.
The Secretary of State will be aware of a recent High Court case concerning a surrogacy issue that has led to legal limbo. Does he agree that the existing legislation has let children down, and that reform is urgently needed?
I can confirm that the High Court has made a judgment, that the current orders for parental orders are discriminatory, and that the Government will act within a reasonable timescale. We intend to lay an order before the summer recess in an attempt to address some of the challenges.
One of my constituents, Harriet North, has been diagnosed with TRAPS—tumour necrosis factor receptor-associated periodic syndrome. Her consultants say that the drug Anakinra will not only transform her life, but will save her life. Will my hon. Friend meet me to discuss how we can get the best treatment for Harriet, and if it is possible for NHS England to review the decision on this?
My hon. Friend has raised this case with the Department and has been making a number of pleas on behalf of his constituent. It is a very difficult case and I would like to pass on my sympathies to his constituent. Obviously, the National Institute for Health and Care Excellence is independent and this drug is not recommended for TRAPS. I do not know the details of the case because it is confidential, but I will be very happy to meet my hon. Friend and his constituent to see if anything can be done.
I do not know if you spotted the rather topical news story about children’s dentistry this morning, Mr Speaker: there were 1,464 hospital admissions for children for teeth extractions across one clinical commissioning area of Birmingham last year, the highest figure since 2010-11. How does the Minister account for this, and what is he going to do about it?
The figures for child extractions are clearly disappointing and two key actions need to take place: less sugar, which we expect the soft drinks levy to help with; and getting more fluoride on to teeth, particularly through fluoride varnishing. That has increased across the NHS over the last year, and by 12% in Birmingham. We hope that that will make a difference.
The NHS mandate was published yesterday, just days before coming into force. Can the Secretary of State set out the reason for the delay, because it allows very little time for scrutiny of this important document by this House? Will he also set out how he is going to prevent money being leached from mental health services and primary care to prop up provider deficits, so that we can meet objective 6 on improving community services?
My hon. Friend makes very important points. The reason for the delay was because about a month ago we had wind that we might be successful in securing extra money for social care in the Budget, and we needed to wait until the Budget was completed before we concluded discussions on the mandate. Our confidence as a result of what is in the Budget has enabled us to make the commitments we have made in the mandate, including making sure that we continue to invest in the transformation of out-of-hospital care.
The Secretary of State will be aware that many migrants in the UK are not registered with GPs, yet now when they come to Britain they have to pay an NHS fine. What is he doing, with the Home Office, to ensure that migrants are registered with a GP and are aware of community health facilities?
I am not quite sure whether I understand the right hon. Lady’s question, but there is not a fining system for migrants; what we say is that people who come to the UK as visitors should pay for their healthcare, or pay the visa surcharge if they are coming for a longer period. There is an exemption for public health, because it is important for everyone that we make sure that we treat people for things like tuberculosis.
The Secretary of State is aware of the concern that I and the people of Witney have about the future of Deer Park medical centre, which is a vital local resource. I am grateful to him for meeting me and for our correspondence. Please will he confirm that he will press the Independent Review Panel for a response at the earliest opportunity, given that the clinical commissioning group is determined to close this vital practice in three days’ time, and that he will consider the views of the patients of Witney very carefully indeed?
Money Laundering: British Banks
We want our financial institutions to lead the way in the global fight against money laundering. This is not only a question of financial crime, with illicit finance used to fund serious organised crime groups, as well as terrorist organisations; this is about keeping our citizens safe. That is why the Government are going to do what it takes to prevent the practice and pursue anyone who might seek to abuse our financial system.
The Financial Conduct Authority and the National Crime Agency take any such allegations seriously and will investigate closely whether recent information from The Guardian newspaper—or, indeed, any other media source—regarding money laundering from Russia would allow the progression of an investigation. Beyond that, we need to ensure that sophisticated criminal networks cannot exploit our financial services industry.
This Government already do more than any other to tackle the global threat of money laundering. Since 2010, we have seized £1.4 billion in illegal funds and put hundreds of millions more beyond the reach of criminals. We have set up the Panama papers taskforce and we hosted the global anti-corruption summit last year. Now, we are preparing the most significant changes to our anti-money-laundering and terrorist finance regime in over a decade. We are strengthening the rules to put the UK at the forefront of international efforts to crack down on money laundering, with new regulations coming into force by the end of June. We are also bringing in a landmark piece of legislation in the form of the Criminal Finances Bill. That will allow banks to share more information than ever to help to uncover money laundering. It will also give law enforcement agencies new powers to bring criminals to justice.
However, domestic changes alone are not enough in a world of global criminal networks, which is why we are working closely with our international partners to stand up to this threat together. Work continues apace in groups such as the G20 and the Financial Action Task Force, whose membership includes all the world’s leading financial centres. We have led the way in getting more than 90 countries to exchange data on offshore accounts and to uphold the global standard of tax transparency. We are determined to make the UK the most difficult place in the world for international crime networks to channel their finances through, and we will not relent in our efforts to do that.
I hope that the Minister recognises the immense gravity of the situation that we are facing, because I believe that his statement reflects complacency on the part of the Government. Let me go through the allegations, which are of the deepest concern. First, it is alleged that, via an operation referred to as the “global laundromat”, banks based in Britain have been used to launder immense sums of money obtained from criminal activity in Russia linked to the FSB spy agency there. This appears to point to an overwhelming failure of basic management on the part of the banks. One of those banks, HSBC, is an institution that has previously faced money laundering charges in the US and across the globe. The direct intervention of this Government helped to block a 2012 US investigation on the purported grounds of its potential risk to financial stability. Money laundering through London and elsewhere threatens the stability of our financial sector and our economy.
In the case of another bank, RBS, the Government directly own a 72% stake. A third bank, Barclays, has been under investigation for its role in LIBOR rigging. Will the Minister give us specific details of what steps are being taken to address this scandal? Can we have an assurance that there is the potential to open criminal proceedings to break up what is effectively a criminal network? Will the Government also undertake that they will not—as they have in the past with HSBC—attempt to intervene in criminal or other investigations taking place elsewhere in the world? The major risk to financial stability is not from investigations intended to clear out criminal activity from our banking system; it is from inactivity on the part of the Government and others, and from failing to act to ensure that our major banks are clean and fit for purpose.
Secondly, all those banks claim to have strict internal policies to deal with money laundering. The Financial Conduct Authority places great stress on the need for banks to self-police and create appropriate internal procedures to prevent money laundering. It is obvious from today’s revelations, however, that the current arrangements are not working to prevent widespread, organised and sophisticated criminal activity. Will the Government tell the House what steps they will be taking to address this matter with the FCA? Will the Government today commit to opening an inquiry with a view to reporting rapidly on measures to be taken that will strengthen the regulations, including introducing tighter controls on and closer monitoring of the banks themselves?
Finally, when the Government own major stakes in the banks involved—RBS in particular, since they are no longer able to sell off that stake—there is an immediate need for them to reassure taxpayers that publicly owned banks are not indirectly involved in criminal activity. What steps will the Government, as a major shareholder in RBS, take to investigate the allegations against it and to reassure taxpayers? Our banks have been found wanting yet again. Urgent action is needed from the Government to protect the standing of our finance sector and to protect our economy. Complacency and inaction are not good enough.
I assure the right hon. Gentleman that the Government are far from complacent. As I outlined earlier, we have been updating the UK’s money laundering regulations, and I hope that the Criminal Finances Bill, which is currently in the other place, will receive Royal Assent in the near future, creating new powers for enforcement agencies. The FCA takes misconduct seriously and fined Deutsche Bank £163 million only last month. As for whether we should be telling the independent FCA or the NCA what to do, it is worth saying that if the information reveals new findings, the FCA will be able to investigate accordingly. It would not be appropriate for me to comment on potential legal proceedings.
This revelation is shocking, but it is not in the least bit surprising. For over a year, I have been campaigning in this House on associated areas. After the story was released yesterday evening, I undertook research that indicates that at the heart of the issue is the banks’ use of limited partnerships—not only Scottish limited partnerships, but many other forms—that allow the criminals to hide their ownership of companies. It is through that mechanism that these things are happening.
I have several questions for the Minister. First, the Department for Business, Energy and Industrial Strategy closed its review of limited partnerships on Friday. Will the Government allow me and other interested Members to resubmit to the review, although it is formally closed, so that we can raise this important matter and have it considered in the review?
Secondly, when one looks at the outcome and the extent of the situation, it is too much to believe that we are the world leader in money laundering regulation in general, so it is time for another look at that. Thirdly, a key concern of many in the House is that the banks have not had a supportive whistleblowing regime in recent years. We need to encourage, not inhibit, whistleblowing.
In this alleged case, my understanding is that the bodies used were limited companies, not limited partnerships. Last year, BEIS introduced the register of people with significant control, and we will be consulting shortly on UK property-owning foreign companies. That is a step forward.
The hon. Gentleman mentioned the limited partnership consultation; I am sure that any right hon. or hon. Member who wants to write to the Secretary of State for Business, Energy and Industrial Strategy can do so. It is also appropriate to say that we are world leaders in financial regulation. The FCA does a good job, is held in high regard by the rest of the world and strikes the right balance between consumer protection and fairness.
The Economic Secretary has shown real complacency about the huge and building scandal that has been revealed by The Guardian today. Given that our banking sector is very large and that the consequences of its being destabilised by such criminal behaviour are very serious for our economy, does he not realise that his complacent, process-driven answers today are simply not good enough?
I do not recognise that at all. The FCA and the NCA are well placed to investigate this, if appropriate. We have not only world-leading financial regulation but world-leading financial services. More than 1 million people across the country are employed in financial services in all our constituencies, and the vast majority of them work hard, do a good job and represent customers as well as they can. We have outlined the measures that the Government are undertaking—[Interruption.] I have addressed everything that the hon. Member for Wallasey (Ms Eagle) mentioned. This Government are doing more than at any time in the past 10 years to tackle this issue.
Given the overlap between money laundering networks and terrorist financing networks, does my hon. Friend agree that this is also an issue of national security and that, furthermore, the only way we can tackle it is with greater information sharing between the private sector, regulatory bodies and enforcement agencies?
My hon. Friend is absolutely right. Greater information sharing and transparency are the way forward. The register of people with significant control is an important step forward, and I look forward to additional transparency in the future. Ultimately, people with nothing to hide have nothing to fear.
To counter the impression that he has been promoted beyond his competence, can the Minister tell us which British banks have been convicted of money laundering over the past five years? What specific, individual thing has he learned from reading those judgments? [Interruption.]
Order. The question was discourteous, but it was not disorderly—there is a distinction. The hon. Gentleman has been practising that technique in all sorts of different forums in all the 30 years that I have known him. The question was not one of the more extreme variants on the theme.
I can tell the hon. Member for Bassetlaw (John Mann) that the FCA has carried out a number of enforcement actions, both large and small, over a large number of different financial services. It is right and proper that a balance between fairness and responsible behaviour is struck at all times.
If these allegations are proven, particularly against a bank in which the Government own a majority stake, will my hon. Friend commit to using the full powers of the Criminal Finances Bill to clamp down on this type of money laundering, which, if proven, will be a national disgrace and scandal?
Has the Minister discussed the matter with the former Chancellor, the right hon. Member for Tatton (Mr Osborne), who the US House of Representatives found intervened with the American authorities to prevent HSBC from being prosecuted in 2012? What has the FCA specifically done since the “global laundromat” was discovered in 2013?
I have not had that conversation with my right hon. Friend. It is fair to say that the FCA has carried out a number of investigations, and it is right and proper that it does so. The FCA is an independent operational body that we set up as asked, and it would not be appropriate for me to comment.
It seems to me, and to many others, that there is an unwritten deal here: that Russians and others of dubious or illegal means can essentially come to this country, send their kids to our schools, buy our real estate or our sports clubs and get involved in this country on the basis—this is the other side of the deal—that they do no wrong while they are here. That is not an acceptable way forward, if it ever was. Is it not now time to rethink this issue?
My hon. Friend raises an interesting point. This Government are doing more than ever before to tackle this important issue. When it comes to money laundering, the Department for Business, Energy and Industrial Strategy has called for evidence on the use of limited partnerships, which were raised by the hon. Member for Kirkcaldy and Cowdenbeath (Roger Mullin), and will in due course consider any action needed to address those concerns.
To a long list of misdemeanours committed by the banks for which directors have not been held responsible, we now have this allegation of extensive laundering of funds that were either stolen or of criminal origin. One of the explanations that has been given is that directors of banks see compliance as an expense with no return. Can the Minister assure us that the allegations will be properly investigated by criminal investigators and that, if it is found that directors have encouraged slack compliance for the profit of their bank, they will feel the full weight of the law and realise that slack compliance has a cost in their personal lives?
The hon. Gentleman is absolutely right that in this country we have not only a world-regarded financial regulation system but a rule of law that is both fair and effective. If there is any wrongdoing or impropriety, it is right and proper that those people face the full weight of the law.
Are the Government or any other public agency in Britain investigating whether laundered Russian money was channelled to any individuals in either the leave campaign or the Trump presidential campaign? Is the Minister aware of any other investigations?
Compliance officers across the banking sector play a key role in stamping out some of the behaviour that has been reported. Will the Minister assure the House that the FCA and other regulators are making sure that compliance officers are properly trained and are proactive on the ground?
Having previously claimed that
“there is little evidence of corporate economic wrongdoing going unpunished”,
the Ministry of Justice is now considering whether it should extend the criminal liability offences to money laundering. Does the Minister now agree that the “global laundromat” allegations clearly highlight that the law needs to be toughened up in this area?