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Health

Volume 633: debated on Tuesday 19 December 2017

The Secretary of State was asked—

Organ Donation

1. What the evidential basis is for his Department’s proposals on presumed consent for organ donation. (903013)

An impact assessment has been published as part of the Government’s public consultation, and it suggests that moving towards an opt-out system for organ donation, as part of a wider communication and logistical package, can be associated with higher donation rates. The Government have invited submissions of further evidence, which we will consider carefully before responding. We have already received in excess of 2,000 responses since the consultation started last week.

As someone with a long-standing passion to increase the number of organs available for donation, I am encouraged by the Minister’s response. Does she think that the shift from the current voluntary system to one where the state makes decisions based on presumed consent had an impact on the reduction in the number of live donors over the past three years?

I part with my hon. Friend on his point about the state taking control through presumed consent. We are talking about a register from which people could physically opt out, rather than opt in. The issues about end-of-life consent will continue to be the same, and the next of kin will be a full consultee. As for live donation, the issues are complex, but one reason why we are seeing a decline is that the waiting lists for receiving an organ are coming down, which is reducing the need for live donors. We should keep a watching brief on that.

Part of the evidence base relates to the fact that hundreds of people die each year because we do not have enough organ donors, so I thank the Minister for her work in bringing forward this consultation. What more can be done to widen public participation?

I thank the hon. Gentleman for his support and for his hard work in this space. Through him, I can perhaps thank the Daily Mirror for its public displays of education through the Max’s law campaign, but we all need to make an effort. There is no doubt that the public are hugely in favour of donation and want to be able to support it as best they can, but the matter has rather fallen from public consciousness. Everyone in the House has an opportunity to raise public awareness, get involved in the consultation and have a real debate, because we need to ensure that people are willing to donate their organs so that we can save more lives.

There are already 24 million people on the voluntary organ donation register, which is a significant proportion of Great Britain’s population. None the less, three people a day die because appropriate organs are not available for transplant, and it is vital to do something about that. Is my hon. Friend aware of a particular difficulty with members of black and minority ethnic populations being more reluctant to join the register than others? Is there a way to encourage them to take part in the voluntary scheme?

My hon. Friend highlights one of the biggest challenges we face. There is no doubt that the rate of organ donation is much lower among black and minority ethnic populations, and yet they are more likely to suffer from diseases that require a donated organ, so we are keen to work on that. Only this week, I met organisations connected with the black and Asian community to discuss how we can communicate, getting the right messages through the right messengers, to encourage people to join the register.

I fully support the organ donation opt-out, because it will increase the pool of organ donors. Will the Minister comment on whether the recent statistics from the Welsh Health Department show an increase in the provision of organs due to presumed consent? In other words, has it been a success so far?

I thank the hon. Gentleman for his support. The figures from Wales come at an early stage, but the system that we are looking to introduce has much in common with that in Spain. The issue is not so much about the register moving towards an opt-out system, but the wraparound care that goes with it, such as the specialist nurses who speak with relatives when they are going through the trauma of losing a loved one, and the public debate that raises awareness. Taken together, they are what will lead to more organs becoming available.

Group B Streptococcus

2. What steps he is taking to ensure that information on group B streptococcus is available to NHS patients. (903014)

As the Secretary of State has set out, our ambition is for the NHS to be the safest place in the world to give birth. Information on prevention and the implications of a group B streptococcus infection is available on the NHS Choices website. Just today, the Royal College of Obstetricians and Gynaecologists published a new patient information leaflet that, from the new year, will be given to all pregnant women for the first time. Because it is Christmas, I have a copy here for the hon. Lady. [Interruption.] I see she has one, too.

I thank the Minister—he has anticipated my question. I reassert that, on average, two babies die each month from complications relating to group B strep. Awareness of the effects of that infection is incredibly low. Will the Minister meet me and Group B Strep Support to discuss how we can get this leaflet to mums-to-be at the earliest possible stage?

I know this is a subject about which the hon. Lady cares greatly. I would be very happy to meet her and to bring together the people I work with from Public Health England to see how we can make the best of this new leaflet and ensure it is the best and most important Christmas present.

I welcome the Government’s focus on reducing stillbirths, and I welcome the maternity safety strategy. I particularly welcome this focus on group B strep. Will the Minister outline how he is working locally with hospitals such as Southampton to make sure they are aware of this new focus?

I thank my parliamentary neighbour for that question. Public Health England is one of the most effective arm’s length bodies with which we work in government, and it will be working with commissioners and trusts across our country to make sure that this new information is out there with pregnant mums and the most at-risk groups. Members of Parliament have an important role to play with local commissioners and trusts, and I know my hon. Friend will play her part in that.

GP Services

General practice remains under sustained pressure, which is why we remain committed to increasing the number of doctors working in general practice by 5,000, however challenging that might be.

Does my right hon. Friend not think it is unfortunate that, at a time when GP services are being sustained, local hospital services in some areas are being reduced? Does he share my concern that some NHS trust managers and clinical commissioning groups seem hellbent on removing valued local services from our smaller hospitals, such as at Driffield and at Bridlington in my constituency?

My right hon. Friend has talked to me extensively about this in private, and I fully understand his concerns. The Government are increasing funding to the NHS, which involves extra money going both to out-of-hospital services, such as general practice, and to hospital services. We expect all areas of the country to find sensible ways for those two sectors to work together.

I refer Members to my entry in the Register of Members’ Financial Interests.

Has the Secretary of State seen the recent report of the Royal College of General Practitioners, “Destination GP,” on how to inspire medical students to pursue a career in general practice? Will he consider the report’s recommendations to help to better support medical student placements in general practice?

I will absolutely consider the sensible recommendations of that report. People on both sides of the House, such as the hon. Gentleman, who were GPs before being elected do a fantastic job of flying the flag for general practice. We are making some progress. Some 3,157 medical school students have gone into general practice as a specialty—the most ever—but there is lots more work to do.

I very much welcome the additional funding this Government have put into the NHS, but constituents tell me that they can better manage chronic conditions and illnesses if they have consistent care from general practitioners, which is something they find difficult to access in some surgeries in my constituency because of problems with recruitment and retention. What is the Secretary of State doing with his team to make sure we can lessen that problem in future?

I totally agree with my right hon. Friend. One of the best things about the NHS is that people have a GP who knows them and their family. There is a lot of evidence that that is the best way to manage people with long-term conditions, as she rightly says. The truth is that, for a very long time, successive Governments have not invested as much as they should in general practice. We are trying to put that right, and part of that is flying the flag for what an exciting career general practice is. It is the one part of medicine where doctors have an ongoing relationship with patients and their families over their whole lives, which is very motivating.

The capacity and availability of at least one GP surgery in my constituency are both profoundly affected by the relationship with NHS Property Services—incomplete maintenance jobs and vastly increased rent are problems. Will the Secretary of State meet me and the practice manager of that GP surgery to discuss this?

I understand the concerns that the hon. Lady raises; they have been raised by a number of Members. There are historical issues on the levels of rent charged by NHS Property Services, which frankly are not fair given the variation in charges to different GP practices across the country. I will be happy to look carefully into the issues she raises.

The NHS has lost 1,300 full-time GP equivalents in the past two years and 200 GP partners during the same period. Given that 20% of the GP workforce is aged over 60, there is clearly a retirement time-bomb looming. What steps does the Secretary of State intend to take to address the growing workforce crisis in general practice? His efforts so far have failed and patients are waiting longer than ever for a surgery appointment.

I would respectfully say that the figures the hon. Lady has pointed out do not take account of locum doctors. None the less, there is a big problem and she is right to draw it to the attention of the House. What are we doing? I think there are two things. First, we need to encourage more medical school graduates to go into general practice as a specialty, and our objective is that half of all medical school graduates should choose general practice as their specialty. We are making good progress on that. [Interruption.] As she is saying to me, rightly, retention is also extremely important. That is why we are putting in place a number of programmes that will make it easier for GPs who want to work for a limited period of time to work flexibly, and potentially for people who have family responsibilities to work from home. We hope that those programmes will also make a difference.

NHS Funding Trends

4. What recent discussions he has had with the Chancellor of the Exchequer on trends in the level of funding for the NHS. (903016)

We had productive discussions with the Chancellor of the Exchequer ahead of the Budget, which led to a £2.8 billion increase in NHS revenue funding and a £3.5 billion increase in NHS capital funding.

Given that NHS trusts in England are facing a cumulative budget shortfall of more than £1 billion and yet one in six patients who attend accident and emergency in England will still wait for more than four hours to be treated, what will the Secretary of State be telling health service managers to prioritise this winter? Have they to concentrate on cutting the deficit or cutting the waiting times?

I am slightly bemused to hear that question from the hon. Gentleman, given that over the past four years NHS funding in England has increased by 10%, whereas in Scotland it has increased by only 5%. Indeed, Scotland now has the longest waiting times on record for elective surgery. What are we saying to NHS managers? We are saying, “We understand how tough it is. You and your teams are doing a brilliant job, and we want to do everything we can to support you through what will be a challenging winter.”

As it is Christmas time, may I congratulate my right hon. Friend on securing the extra funding and making sure that it is spent effectively in his Department? Does he agree that one important thing to think about at this time of year is winter pressures? In an area such as mine, it is important that there should be some extra funding at the hospital at this time of year. Is he able to say anything about that today in respect of the Lister Hospital in Hertfordshire?

In the spirit of Christmas, I am happy to tell my right hon. and learned Friend that Lister Hospital received an extra £2.5 million to help it with winter pressures as a result of the Chancellor’s Budget announcement, and it was told that on Friday.

With patients in Exeter now waiting more than a year, in pain, for vital surgery—well beyond the 18-week maximum guaranteed in the NHS constitution—can the Secretary of State explain the contradictory statements of the Chancellor, who said at the time of the Budget that he expected significant “inroads” to be made into growing waiting time lists, and the NHS England board, which met the following week and said that NHS waiting time standards

“will not be fully funded and met next year”?

I have been waiting for the right hon. Gentleman to issue the press release welcoming the £1.4 million of extra funding that the Royal Devon and Exeter got in the Chancellor’s Budget, but for some extraordinary reason it has not been forthcoming. Let me tell him that, as many people have commented, the NHS got a lot more money than it was expecting in the winter announcement—

This is money that will, to answer the right hon. Gentleman’s question, make a big difference in helping the NHS get back to meeting its constitutional waiting time targets.

I very much welcome the £2 million winter allocation for the hospitals in my area. Funding is clearly important, but given the improvements in the hospitals in my area that are down to the leadership of the chief executives, the leadership team and the staff, does the Secretary of State agree that leadership is as important as funding?

My hon. Friend is absolutely right. Of course, both things matter, and hospitals do need the right level of funding, but one of the highlights of the year for me was visiting my hon. Friend’s local trust in Carlisle and seeing the total transformation in leadership there. It was one of the most troubled trusts in the NHS but, thanks to the incredible dedication of the doctors, nurses and everyone working in the trust, it has really turned things around.

The Scottish Government already pay nurses and care assistants the highest rate in the UK, have maintained the nursing bursary, and have now committed to a 3% pay rise for those earning £30,000 or less. Does the Secretary of State recognise that his failure similarly to value NHS staff in England is one reason why England’s nursing vacancy rate is more than double that of Scotland?

What I recognise is that life expectancy continues to rise in England but has ground to a halt in Scotland. One reason why is that the Scottish National party has consistently not taken the extra resources it could take and put them into the NHS, but has instead chosen other priorities.

At the previous Health questions, the Secretary of State said that funding from the Chancellor to remove the pay cap would be based on productivity improvements. Will he elaborate on what productivity improvements are expected and when NHS England staff will get the pay rise that they deserve?

We are having fruitful and productive discussions about productivity with the “Agenda for Change” unions, including the Royal College of Nursing. We are looking at all sorts of things, including how the increments system works. I am hopeful that we will have a win-win: a modern contract that is fit for the future for “Agenda for Change” staff and that also allows us to go beyond the 1% cap, as the Chancellor has authorised me to do.

Of course, this is not just about funding. The Secretary of State recently wrote to East Sussex Healthcare NHS Trust to recognise the fact that its A&E department was the most improved in the past six months. When I spoke to the chief executive, he said that the management focus on targets and delivery against them was the reason why that turnaround has occurred.

I met the chief executive in person last week and was able to congratulate him on several important changes that are happening. He will be pleased that we were able to find £1.9 million more for East Sussex in the Budget. My hon. Friend is absolutely right that it is not just about money. The difference between the Government and the Opposition is that they say it is all about money whereas we know that quality of leadership makes a critical difference in turning around our hospitals to make them the best in the world.

In the past few weeks, Simon Stevens, Sir Bob Kerslake, Sir Bruce Keogh, Jim Mackey, Chris Hopson and a number of other senior public servants have all told the Government that the NHS does not have the funding that it needs. It is patently obvious that, with most performance targets being missed, treatments being rationed and hard-working staff completely demoralised after seven years of pay restraint, funding levels are not sufficient. Arguing with celebrities on Twitter is not going to change that. Even though the Secretary of State has a new-found enthusiasm for 280-character statements, all I ask from him today is one word. Is the NHS getting the funding it says it needs—yes or no?

Order. We must observe the terms of debate. It is not for the Secretary of State to ask questions. He has been in the House long enough to know that. Please do not play games with the traditional and established procedures of the House, Secretary of State. You can do better than that.

Yes, I am delighted that the local hospital of the hon. Member for Ellesmere Port and Neston (Justin Madders) got £2.8 million in the Budget, but I am disappointed that he did not feel able to issue a press release to his local press. I have much enjoyed debating with the hon. Gentleman over the years, but the difference between me and him is that although we both want to find extra money for the NHS, he would do so by hiking corporation tax, which would destroy jobs, whereas Government Members want to get money into the NHS by creating jobs, which is what we are doing.

Social Care

Councils in England will receive an additional £2 billion for social care over the next three years, as announced in March 2017. The Government have given councils access to up to £9.25 billion more dedicated funding for social care over the next three years as a result of measures introduced since 2015. This means that, overall, councils are able to increase spending on adult social care in real terms in each of the next three years.

Last week’s Health Survey for England revealed that older people in more deprived areas, such as my own constituency of Liverpool, Walton, are twice as likely to have unmet social care needs and our NHS is left picking up the pieces. When will this Government stop passing the buck and bring forward concrete plans on proper investment and reform to end the national scandal that is our care system?

The entitlement to care is completely enshrined in the Care Act 2014, so if needs are not being met, there is a statutory obligation that can be enforced. On the long-term solutions, obviously, we have put in additional money to sort out the short-term funding pressures, but we need to have a long-term and more sustainable deal with which to meet our obligations for social care, which is why we are bringing forward a Green Paper next year. I hope that the hon. Gentleman will participate in that debate.

Following Four Seasons’ temporary reprieve from administration, what plans are in place to help councils to deliver their statutory care duties in the event of the failure of this major provider?

I am grateful to the hon. Gentleman for raising this with me today, because I hope to reassure the House, and anxious people with loved ones in care with Four Seasons, that there is no immediate threat to continuity of care. I and my officials are keeping a very close eye on the situation, so that, with the Care Quality Commission, we ensure that there is a stable transition and that the commercial issues are dealt with in an appropriate way. That is leading to some very challenging conversations, but I can assure him that I and my officials are on it.

Given that health and social care are intrinsically linked, even more so now as sustainability and transformation plans are rolled out, does the Minister agree that now is the time to put health and social care under one roof in a combined department?

I have always thought that a silo culture was the enemy of good public policy, which means that integrating policy making across Government will tend to lead to better outcomes. I can assure my hon. Friend that I have regular conversations with the Department for Communities and Local Government and, as we approach the long-term funding pressures, we will be very much working in tandem.

The recent Health Survey showed not only that unmet needs were most concentrated among people who are the most deprived, as we have just heard, but that 2.3 million older people, aged 65 and over, now have unmet care needs—2.3 million. Neither the care Minister in her recent statement nor the Chancellor in his Budget said anything about closing the funding gap for social care. Given that the Green Paper is only scheduled for next summer, what is the Health Secretary doing about the crisis in funding social care and meeting staggering levels of unmet needs?

The hon. Lady will be aware that, immediately following these questions, we will be having a statement on funding from the Secretary of State for Communities and Local Government. I remind her again that we have made an additional £9.25 billion available for social care over three years, but she is right that the long-term sustainability will be addressed by reform, which is why we are bringing forward the Green Paper. As to the figures on unmet needs, I simply do not recognise them. The entitlement to care is enshrined in the Care Act, and those rights are protected.

NHS Funding (Autumn Budget)

The autumn Budget committed to backing the NHS, so that by 2019-20, it will have received an additional £2.8 billion of revenue funding for frontline services, including £337 million for winter allocated last Friday and £3.5 billion of new capital investment by 2022-23 to transform the estate.

I welcome the recent Budget announcement of billions more funding for the NHS, particularly the extra support to prepare for the winter. Will the Minister tell me what share of funding my local hospital will attain this winter?

My hon. Friend needs to be congratulated in this House on being a champion of the University Hospitals of Morecambe Bay NHS Foundation Trust. The trust has been through some difficulty, and he has stuck with it and supported it. I can confirm that the trust was allocated up to £2 million of funding last Friday; I congratulate it on that. I am sure that he would also join me in congratulating the trust on recently being awarded the title of the eighth most inclusive employer in the UK.

Does my hon. Friend share my delight at the £41 million capital allocation that was announced in the recent Budget? Does he agree that that huge sum will enable us not only to maintain the present excellent services at Southend hospital, but to enhance and develop them further for the benefit of all local residents?

My hon. Friend has worked tirelessly with his neighbouring colleagues in Essex to secure not only the £41 million to which he refers. In fact, that figure is a component of the £118 million capital allocation made to the Mid and South Essex Sustainability and Transformation Partnership area in the Budget. This will provide significant investment not only in his local hospital in Southend, as he as mentioned, but in Basildon and in Broomfield Hospital in Chelmsford. I am sure that he and his colleagues in Essex welcome that.

My local clinical commissioning group in north Derbyshire has been placed in special measures by NHS England. It has been forced to cut £16 million over just six months and to bring forward the closure of the Spencer ward in Buxton before any proper alternative is in place due to a lack of funding. Does the Minister not agree that the Budget funding is too little, too late?

The hon. Lady will be aware that the special measures regime was introduced to help trusts that are having difficulty in meeting quality performance standards to improve their quality. They receive support from NHS Improvement in order to do that. If she would like to write to me with the specific details of her trust’s situation, I would be happy to take up the case. But as far as I am concerned, her trust is on an improvement journey.

Given that about a quarter of the additional funding goes to patients with neurological conditions—from strokes to Parkinson’s —what steps is the Minister taking to reduce the often appalling delays between the onset of disease and access to occupational and physical therapy? Will he agree to meet a charity from my constituency of Twickenham called Integrated Neurological Services, which is saving lives and money by drastically reducing that timeline?

The right hon. Gentleman will be aware that centralising cardiac services in particular into acute cardiac hospitals is having a significant impact on improving access to treatment by reducing the time it takes to get diagnostic tests and initial treatment, and is therefore saving lives. Specialisation is working in London and in other parts of the country where it is being applied. I am sure that he would welcome the recent allocation to Kingston Hospital of up to £1.3 million to help with winter pressures.

The Minister visited Kettering General Hospital earlier this year and saw for himself that a record number of patients are being treated with increasingly world-class treatments. Will he confirm that the hospital will get £2.6 million to cope with winter pressures this year?

My hon. Friend never fails to highlight the success of Kettering General Hospital. I am delighted to confirm that £2.6 million will be available for that hospital this winter. We are working hard with the hospital management, through the special measures regime, to improve performance in that trust.

Bed occupancy rates across London last winter were running very near to 100%, including at Whipps Cross University Hospital in my constituency. With the much-vaunted extra funding, what will the bed occupancy rate have been by the end of this winter?

Bed occupancy rates are high at this time, not least following the recent cold snap, which has put additional pressure on hospital trusts. We have used some of the funding provided in the March Budget to increase the rates of delayed transfers of care to improve patient flow throughout all hospitals, and that has led to a slight reduction in bed occupancy in the run-up to winter.

Mental Health Workforce

In order to increase the number of mental health patients we treat by 1 million every year by 2020-21, we are increasing the number of mental health posts in the NHS by 21,000.

I certainly welcome that increase, but does my right hon. Friend agree that there is a particular need to address mental health issues in schools? Could he set out what plans he has to give extra support there?

My hon. Friend is absolutely right, for the simple reason that prevention is better than cure, and about half of all mental health conditions become established before the age of 14. That is why it was so significant that, following the Budget, we announced the allocation of an extra £300 million through the mental health Green Paper, precisely to improve the service we offer students in schools.

The Secretary of State has, on numerous occasions, to both the media and this House, referred to an increase of 4,300 staff working in mental health trusts since 2010. In response to my written parliamentary question, he was unable to clarify whether this 4,300 figure includes the 1,478 people who were rebadged as mental health trust staff following a trust merger in Manchester last year. Nor would he confirm whether this figure includes the 858 people NHS Digital says were already working in the sector, who transferred from primary care trusts to mental health trusts when primary care trusts closed back in 2013. Would the Secretary of State offer the House some festive cheer and take this opportunity to set the record straight?

I am very happy to offer the hon. Lady festive cheer and to explain to her that, even if her suspicion is right—and I do not believe it is—there has still been a significant increase in the number of staff employed in mental health trusts. The other suspicion she has constantly raised in the media and in this House is that mental health funding is being cut. She will know that the best news of this year is that, last year, funding actually went up by £575 million.

Given that the NHS owns a great deal of land and buildings, and that mental health workers and other health workers face high accommodation costs, will the Secretary of State meet me so that I can explain how the benefits of the Self-build and Custom Housebuilding Act 2015 could be used as a powerful retention and recruitment tool for mental health workers?

I commend my hon. Friend for his work and thinking on this through the Public Accounts Committee, and he is absolutely right. I am more than happy to talk to him about this, but we actually have it as a priority to make sure that when NHS land is disposed of, NHS workers get the first opportunity to buy or rent the houses that are built.

There are still not enough staff trained in autism diagnosis across the NHS. Would the Secretary of State consider training a specialist in each community child and adolescent mental health service right across the country to ensure that there is no longer a postcode lottery?

I would always listen to the hon. Lady on those matters, because she has huge professional experience. I do not think we do well enough for families with autism, and we are looking at what we can do better, but I have a lot of sympathy for the case the hon. Lady is making.

Malnutrition: Hospital Admissions

Ensuring all our constituents—particularly the vulnerable and the elderly—are getting an adequate diet is critically important. That is why, for instance, we have given half a million pounds in funding to a special Age UK taskforce to reduce malnutrition among older people, and we will continue to train NHS staff so that early action can be taken.

A merry Christmas to you, Mr Speaker, and to the Ministers on the Front Bench—maybe they will answer my letter soon.

In the world’s sixth largest economy, it is damning that, under this Government, we have seen a 122% increase in the overall numbers admitted to hospital with malnutrition. It is clear that more action is needed to ensure that we eradicate malnutrition in our society. The Department for Work and Pensions and the Health Department must work together so that, rather than introducing measures such as universal credit eligibility criteria, which will see at least 1 million children lose free school meals, we commit as a country to tackling this issue head on. Will the Minister use his power and influence to ensure that this issue is addressed immediately and that we see an end to this failure to axe malnutrition in the 21st century?

Happy Christmas to St Helens as well. I agree that we need to work together. The Healthy Start programme, for which I am responsible, provides a nutritional safety net to hundreds of thousands of pregnant women and families with children under four. There is a slight increase in cases being reported in recent years. In part, that is due to much better diagnosis and detection. Some 1.1 million children get free school meals in England, and the Government are investing £26 million in breakfast clubs. Only last week, Kellogg’s was here with its breakfast club awards—an excellent innovation.

That being said, it is disgraceful that under this Government’s watch we have seen a 54% increase in children admitted to hospital with malnutrition. Instead of seeing malnutrition rising, we really should be eradicating it. As the festive period is upon us and it is the season for good will and giving, will the Minister give this House an assurance that he will seriously address this matter to ensure that no child in this country ever experiences malnutrition?

Of course we want no child in our country to experience malnutrition. I mentioned the Healthy Start scheme and the breakfast clubs. Healthy Start is an excellent programme run by Public Health England that encourages a healthy diet among hundreds of thousands of families with children under four. It is exactly that which is helping us to tackle this issue.

Life Sciences

10. What steps he is taking to support investment in life sciences for the development of new medical treatments. (903022)

The recently announced life sciences sector deal draws significant investment into the sector from across the world, ensuring that the next wave of breakthrough treatments, innovative medical research and technologies—and highly skilled jobs, of course—are created right here in Great Britain.

In Scotland today there are over 600 life sciences organisations employing more than 30,000 people, making Scotland one of the largest life sciences clusters in Europe, so they too will welcome the announcement the Minister mentions. Will he give the House some more detail on the sector deal and industry investments that could give even more strength to this world-leading industry across the United Kingdom?

The sector’s commercial activity is very broadly spread across the whole of the UK—my hon. Friend’s concern. There are a number of strong emerging life sciences clusters. The deal highlights successes around the UK in Manchester, Leeds, Sheffield, Glasgow, south Wales, and the south-east, so it is a very broad spread.

Medical research charities play a key role in developing new medical treatments, yet the Charity Research Support Fund, which enables universities to unlock investment from the sector, has been frozen since 2010. Will the Minister heed the call from the Association of Medical Research Charities to enhance CRSF in real terms, in line with inflation and with charity investment?

I can come back to the hon. Gentleman in more detail on that. As part of the life sciences sector deal, there is just over £210 million of industrial strategy challenge funding for early diagnosis. This includes funding to build on the UK’s leadership in genomics, where we are very strong, and to establish programmes in digital diagnostics and artificial intelligence in healthcare.

Mental Health Workforce

Although we cannot meaningfully compare between 2010 and today, I can advise that the number of NHS staff working in mental health and learning disability trusts was 162,611 in July 2013 and 166,905 in July 2017—an increase of 4,334.

That did not actually answer my question. Earlier, my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) read out a long list of concerned professionals, so let me add one more—Professor Wendy Burn, the president of the Royal College of Psychiatry, who said after the Budget:

“There is a real and imminent danger that the promises made to improve mental health services for the millions of people who need them are about to be betrayed.”

Is she wrong? Is it not true that without proper funding for more staff, the Prime Minister’s pledge to transform mental health services will not be met?

As the hon. Gentleman knows, we have published a workforce strategy to deliver exactly on the commitments that the Prime Minister has made. I can report that we have had a significant increase in the workforce. For example, in IAPT—improving access to psychological therapies—the number is up by 2,728 since 2012, a 47% increase. The number of psychiatry consultants is up from 4,026 in 2010 to 4,292. The number of community psychiatry nurses is up from 15,500 in 2010 to 16,658 in August 2017. We are delivering the workforce to implement the Prime Minister’s commitments. The most important thing is that rather than trade numbers, we should look at outcomes for patients and improving patient care.

Only a quarter of GPs have training in mental health, and it is usually in psychiatric conditions that they are unlikely to encounter routinely. How can we make better use of GPs in mental health?

As my right hon. Friend identifies, training is key, and another central point is GPs’ ability to signpost people to appropriate treatments and therapies, which is exactly why we are investing in specialist care.

23. If we are talking about concerned professionals and outcomes, can we add headteachers and teachers into the mix? One from my area has written to me about a child whom she referred to CAMHS last summer term only to be told that they were 63rd on the list and faced a 14-month wait for help. That is much longer than the month-long waiting time target that the Government have set. With a shortage of child psychologists, just how are the Government going to keep kids in my constituency safe? (903037)

The hon. Lady raises exactly the point that we are trying to address through the Green Paper. We are committed to delivering on the four-week waiting time by 2020, which will make sure that we treat over 70,000 more children with mental health issues that need to be addressed. I will be quite honest: this is not where I want us to be, but that is exactly why the Government have made it a priority and we will deliver by 2020.

A&E Departments

I am grateful to the Secretary of State for that answer, and I welcome the additional £2.6 million for Kettering General Hospital. As he knows, the Corby urgent care centre is a vital service that helps to relieve pressure on Kettering General’s A&E all year round. What role does he see such facilities playing in relieving pressures, particularly during the winter period?

I thank my hon. Friend for his campaigning, and I am delighted that the Budget allocated an extra £2.4 million to help Kettering General Hospital. He is absolutely right that urgent care centres play a vital role in keeping people away from busy A&E departments. We need to be better at signposting the public so that they know when to go to a GP surgery, when to go to an urgent care centre and when to go to a hospital.

One of the causes of pressure in my part of London is the continuing threat of impending closure to King George Hospital’s A&E. Will the Secretary of State today confirm that the consultation that is now being engaged in will result in the A&E at King George Hospital being saved?

I am afraid that the hon. Gentleman will have to wait until the result of that consultation is published. I visited the trust last week, although I went to the Romford end of it, and I think that it is making great strides in improving the quality of care. I congratulate all the staff at the trust on what they are achieving.

Suicide Rates

We remain committed to reducing the national suicide rate by 10% by 2020, and our record investment in mental health will ensure that we can achieve that ambition. Local suicide prevention plans now cover 98% of the country, and we updated the cross-government suicide prevention strategy in January to strengthen key areas for action, including by focusing on self-harm as an area in its own right.

My constituent Justin Bartholomew, a young man of just 25, recently committed suicide by hanging himself. His family are convinced that the high-energy drinks that he was taking—more than 15 cans a day—increased his anxiety and contributed to his suicide. As there is growing concern about the safety of such energy drinks, may I ask the Minister what assessment of that the Department is undertaking?

I thank my hon. Friend for sharing that very moving case. We have no evidence at this stage that those drinks cause such outcomes, but we know that all stimulants, whether alcohol or caffeine, have consequences that can affect people’s mental health. That is something that bears examination.

What discussions is the Minister having across the United Kingdom to ensure that best practice in dealing with suicide rates, and in particular the escalating rates in the regions of the UK, can be replicated across the United Kingdom as a whole?

I am always keen to learn from areas of the United Kingdom where things are going well. As the hon. Gentleman will be aware, our suicide prevention strategy is very much rooted in local prevention plans. Although 98% of the country is covered by those plans, we really want to do a proper audit of how good they are. That will enable us to share best practice across the nations.

Order. I want to take one last grouping. We are out of time, but I want to accommodate the Questions on mental health services—brief questions, brief answers.

Mental Health Services: Children and Young People

15. What assessment he has made of the adequacy of access to mental health services for children and young people. (903028)

17. What steps he is taking to improve the provision of mental health services for children and young people. (903030)

We have assessed children and young people’s mental health as part of our ongoing work to improve services, and the results of our assessments have led to £1.4 billion of extra funding to support locally led transformation plans. The recent Green Paper aims to improve the provision of services in schools, bolster links between schools and the NHS, and pilot a four-week waiting time target.

Many young people with mental ill health report that crisis care is not good enough. Of course, the pressures on them can get even worse over Christmas, so will the Government back the call by the charity YoungMinds to set up a crisis hotline for children and young people that would be available through the existing 111 service?

We are approaching Christmas, and the hon. Gentleman is quite right to highlight the fact that it can often be the moment of greatest crisis for people with mental health issues. I was with the Samaritans yesterday to commend it for all its work—it is obviously a good pathway to help—but, absolutely, we will speak with YoungMinds.

“Jesse Evans—Autism Adventures” highlights the daily challenges faced by families living with autism, who are supported by self-sustaining groups such as Autism around the Combe. Will the Minister explain how the recent announcement of a multimillion pound development at West Cumberland Hospital will help those families?

My hon. Friend highlights the great synergy between those health services that the Government can provide, on which people obviously rely, and self-help, which is very important, as well as the help that people can give each other when they share their experiences. I commend the work of Jesse Evans and his “Autism Adventures” blog, which is extremely positive and educational.

My clinical commissioning group delivers better-than-average waiting times for mental health talking therapies and follows up 99% of all vulnerable people within a week of their first appointment. It does all that and more on significantly less than the average budget nationally, so will my hon. Friend look at south-east Staffordshire as a case study for delivering a good service with value for money?

How can I say no to such a proposition? My hon. Friend illustrates the importance of good leadership in all local communities. Where good leaders make something a priority, they will deliver good outcomes at reasonable value for money.

Topical Questions

Next week, many NHS and social care staff will give up their family Christmas to keep NHS patients safe. I know that the whole House would like to thank them for their dedication and commitment over the festive period.

Is my right hon. Friend aware that, due to the difficulties in recruiting general practitioners, neither of the two GP surgeries in Maldon are taking on any new patients, despite the significant development taking place in the town? May I therefore welcome the 1,500 extra medical training places that the Government have funded, and ask for his support for some of those to go to the excellent Anglia Ruskin medical school in Chelmsford?

I have a great deal of sympathy with what my right hon. Friend says, and he is right that the recruitment and retention of GPs is a big issue. I have a constituency interest, in that I have a university that is also very keen to host more medical school places, so I am recusing myself from the decision. However, I wish all universities good luck, because this is a historic expansion of medical school places for the NHS.

Order. I am sure that the shadow Secretary of State will be brief, in recognition of the enormous demand from Members wishing to contribute in this session.

May I join the Secretary of State in wishing all our NHS and social care staff a very merry Christmas, and in thanking them for their commitment this winter?

Virgin Care recently won a £100 million contract for children’s health services in Lancashire, but in the Secretary of State’s own backyard of Surrey, Virgin Care recently took legal action against the NHS, forcing it to settle out of court. This money should be going to patient care, not the coffers of Virgin Care, so why will he not step in and fix this scandal so that his Surrey constituents and the NHS do not lose out?

I, too, am very disappointed about the action taken by Virgin Care, but I gently point out to the hon. Gentleman that, contrary to the narrative that he and his colleagues put out, the reason why it took action was that the NHS stripped it of its contract and gave that back to the traditional NHS sector—hardly the mass privatisation that he is always talking about.

The Secretary of State’s Surrey constituents will have heard that he will not be taking action against Virgin Care.

Our research has revealed that there are vacancies for 100,000 staff across the NHS, and there is a “national crisis in workforce”—not my words, but those of the Royal Surrey County Hospital NHS Foundation Trust in the Secretary of State’s constituency. With bed occupancy at the Royal Surrey hitting a peak of 98.7% this winter already, and 94.5% across the NHS on average, can he tell us how he expects the NHS to cope this winter when it is understaffed, overstretched and underfunded?

If we decide that we want more nurses following Mid Staffs, that creates vacancies. If we want to transform mental health provision, that creates vacancies. That is why we announced a workforce plan, which I notice the Welsh Government have not had time to do yet. But I will finish by wishing the hon. Gentleman a merry Christmas. If he wants to take a bit longer off and stay away for January, we are happy to hold the fort.

T2. Research shows that breast density is a strong predictor of developing breast cancer, yet many women remain unaware of the risk. Will the Minister confirm what steps are being taken to educate women with this potentially life-saving information? (903039)

My hon. Friend asks an important question. We have just commissioned Warwick University to investigate the links between breast density and breast cancer. If the findings suggest that there should be any changes to the national breast screening programme, the UK national screening committee will of course consider that, as it does with any new evidence that helps it to target screening appropriately and make women aware of any increased risk of breast cancer. I will be watching this like a hawk.

T3. What assessment has the Secretary of State made of NHS funding for the 2018-19 financial year? Will it be sufficient to deliver the standards set out in the NHS constitution? (903040)

The NHS mandate is very clear that we expect the NHS to move towards hitting those constitution standards which we consider to be vital for patients.

T5. The Secretary of State will be aware of the decision by my Northumberland CCG to close in-patient beds at Rothbury Community Hospital last year. It was done on the premise of underuse, but local sources continue to indicate that it was due to a shortage of nurses at our excellent Northumbria A&E hospital. Following a passionate campaign led by Katie Scott and the Save Rothbury Community Hospital supporters, Northumberland County Council has referred the decision to the Secretary of State for review. I would be grateful if he could update the House on the timescale for a decision. (903042)

I can confirm that the health and wellbeing overview and scrutiny committee has submitted a request for a review by the Independent Reconfiguration Panel. I understand that officials have reverted to the committee to clarify the terms of the referral. Once that has come through to the Department, I am sure that the review will take place.

T4. Last week the Brexit Secretary stated that UK membership of EU agencies is unlikely to continue beyond March 2019, so what provision has the Secretary of State for Health made to replace the European Chemicals Agency, which regulates the raw chemicals required by the pharmaceutical industry to produce drugs in the UK? (903041)

That area will obviously be very important in the negotiations, but we have made our preference clear: a deep and special partnership with the EU in which the benefits of co-operation that we currently have can continue.

T6. Public Health England has stated that e-cigarettes are at least 95% safer than tobacco products and are now the most popular way to stop smoking. What is being done to encourage smokers to quit using this method, and what steps are being taken to ensure that e-cigarette users are not forced to share their space with people who continue to smoke? (903043)

The truth is that we do not yet know enough about e-cigarettes. I welcome the Science and Technology Committee’s investigation into them. We have asked Public Health England to include messages about the relative safety of e-cigarettes in its Quit Smoking campaign next month, but it is for local organisations and businesses to implement their own policies on e-cigarette use in the workplace.

T8. Seriously unwell individuals continue to be placed in immigration detention, despite the “adults at risk” policy, which states that that should not happen. Will the Secretary of State update the House on what discussions are taking place with Home Office colleagues to ensure that assessment, treatment and screening processes, and the application of rule 35, are properly followed so that vulnerable individuals are not held in detention in that way? (903045)

I always listen to what the hon. Lady says on these issues. I have had discussions with the Immigration Minister, but if she would like to write to me in detail I am happy to take the matter up further.

T7. Progress on cancer survival overall is hugely welcome, but what more can be done to improve outcomes for oral cancers? The main causes of oral cancer are smoking, drinking and the human papilloma virus, and men are twice as likely as women to suffer from it. Will the Minister inform the House what steps the Government are taking to address this issue? (903044)

As the House knows, cancer is a huge priority for me and for the Government. Survival rates are at a record high, but we know there is much more work to do. Early diagnosis is key, and that is never more true than with oral cancers. We are supporting dentists to play a vital role in spotting mouth cancers early. I was discussing this very point just last week with the British Dental Association, which shares our passion on this issue.

T9. One of my local hospitals, Sandwell, has a problem with the high number of nurses leaving the profession. But this problem is not confined to Sandwell; it goes across the NHS. What analysis has the Minister done of the reasons for nurses leaving and what will he do to address them? (903046)

We have not been very good at making it easy for people to work flexibility in the NHS. Contracts are too rigid and we are looking to change them. We recognise that for many nurses their commitment to the NHS runs very deep, but that they have to juggle that commitment with family responsibilities. We want to do better.

There are many very committed individuals working in health and social care services in Somerset, but one challenge is getting enough registered nurses into the system to allow them to integrate. What can the Minister do to help to get more registered nurses?

My hon. Friend will be aware that last week we published the workforce strategy. One major focus was on meeting the Secretary of State’s commitment to increase the number of registered nurses by 25% and to broaden the routes into nursing. There is a commitment to expand the nursing associate role, which is helping to provide opportunities, through an alternative route, for healthcare support workers to become registered nurses.

T10. Possibly as many as 20,000 babies have been born with birth defects as a consequence of their mothers having used sodium valproate during pregnancy. When will mandatory warnings be given to pregnant women about the risks associated with valproate, and when will we see independent analysis of how we got to this dreadful situation? (903047)

There is huge interest in this subject in the House. Over the past three years, there has been extensive work to communicate advice on the risks of valproate in pregnancy, through a huge number of channels, to help professionals and patients. It is evident from monitoring activities that providing health professionals with information, even when repeated constantly through multiple sources, is not changing prescribing behaviour sufficiently to minimise harm to children exposed to valproate in pregnancy. The expert working group of the Commission on Human Medicines is informing the UK position in European negotiations and advising on the national action required within the UK health system. [Interruption.] Sorry, Mr Speaker.

Forgive me. I did not mean to be unkind to the Minister who was attending closely to his answer. It is just that we want the whole House to get the benefit of it.

Will the Minister provide an update on efforts to move Worcestershire Acute Hospitals NHS Trust out of special measures, and on the status of the promised £29 million for much needed capital improvement programmes?

As my hon. Friend is aware, I visited all three hospitals in the trust. I am pleased to be able to announce to him today that the Department of Health has concluded its analysis of the outline business case for the £29 million allocated in July and that it has been approved.

On admissions to hospital for malnutrition, will the Minister tell me what has been happening at Wirral University Teaching Hospital? Admissions for malnutrition went up from 21 in 2009-10 to 707 in 2014-15. They went up again to 728 and this year currently stand at 586. That seems very, very high. Can anyone tell me what is going on? If not, will Ministers write to me to explain these huge figures?

There is £2.8 million in extra winter funding, but I will write to the hon. Lady with the details she asks for.

I would like to thank the Minister for listening very sensitively to the victims of Paterson, the rogue surgeon, many of whom are constituents of mine. Does he agree that the evidence from the Hillsborough inquiry is that a bishop-led inquiry can indeed get justice and closure for victims? Will he join me in wishing the Bishop of Norwich great success in getting a good outcome from this inquiry?

I pay tribute to my right hon. Friend for her role in helping to support the victims, many of whom, as she said, are constituents of hers. We are pleased that Bishop James has agreed to take on this inquiry. Bishops provide the ability to empathise with victims and their families, which might not always be the case with judge-led inquiries. As she rightly points out, the Hillsborough inquiry was led by a bishop, but so too is the current Gosport inquiry, while the Morecombe Bay inquiry was led by Bill Kirkup, rather than a judge.

Those with erythropoietic protoporphyria cannot be exposed to sunlight or even some artificial light without extremely painful and violent skin reactions. Trials of the drug Scenesse have proved life-changing for constituents such as James Rawnsley, who, for the first time, can now take his kids to school and go on holiday. The decision to make it available on the NHS will be taken soon. Please will the Minister look at it?

EPP has a devastating impact on a person’s health and quality of life, and is something that the hon. Lady has discussed with me before. We will of course take the matter seriously, and I am very happy to talk to her more about it.

Given that my own brother’s funeral will be held later today, may I ask the Secretary of State what help and support he is giving to the families of drug and alcohol abusers?

The whole House will want to express its condolences to my hon. Friend on what is happening this afternoon. He, alongside many people on both sides of the House, including the shadow Health Secretary, has raised this issue, and we are looking closely at what more support we can give to children in one of the most vulnerable situations imaginable. I thank him for raising the issue.

The NHS patient declaration form for free dental care and prescriptions requires patients to determine the difference between contribution and income-related employment and support allowance. Getting it wrong attracts really hefty fines. Will the Minister ensure that patients first get the opportunity to make the right choice before fines are applied?

Yes, of course. The NHS Business Services Authority issues the penalty charge notices for incorrect claims for exemption from NHS dental care and prescription charges. We have recently increased the number of checks, however, because ultimately this is taxpayers’ money, and we need to ensure that it is spent properly and legally.

I warmly welcome the extra £1.1 million to help with winter pressures at Luton and Dunstable Hospital, and I can tell the ministerial team that the merger with Bedford Hospital is proceeding well, but it needs £150 million of capital. May I ask that favourable consideration be given to that in the allocation of the £3.5 billion announced in the Budget?

My hon. Friend will be aware that the Chancellor provided a package of £10 billion in the Budget last month to be invested in the NHS, of which £3.9 billion will come from the Treasury. All bids for capital are being assessed through the STP prism. The proposal that his area will be making will be assessed against others. As far as I am aware, no such proposal has yet been made to NHS England, but it will obviously be looked at in due course.

You may recall, Mr Speaker, that I raised earlier in the year the issue of a private mental health hospital in my constituency where a young woman had MRSA and was infecting staff and patients. Since then, there have been numerous inspections in relation to children having access to ligatures and medicines in order to overdose. Will the Secretary of State commit to a policy to ensure that no child or young person is placed in a mental health facility that is deemed unsafe?

I commend the hon. Lady for raising this issue, which she and I have met to discuss before. She is right to highlight the ongoing inspections and issues, and I have written to her to offer to discuss the matter with her again. It is absolutely unacceptable that anybody is placed in a facility that is deemed unsafe.

May I thank the ministerial team on behalf of my constituent Susan Bradley for finally laying the remedial order for single-parent surrogates, and can they assure me that they will do everything they can to get it through Parliament as quickly as possible?

An all-party parliamentary group has been established this week, I believe, to take this issue forward, and I look forward to speaking to that group, if invited, next month. The remedial order will follow due parliamentary process, which involves its being laid for 60 days and then, after an interval, for a further 60 days.

There have been 15,000 violent assaults on mental health workers in the west midlands over the last five years. What is the Government’s response to the Care Quality Commission’s opposition to routine searches of all mental health service users for weapons on admission or return to acute in-patient units?

I have a great deal of sympathy with what the hon. Gentleman has said. We are putting a lot of effort into patient safety and staff safety in mental health trusts, and we are discovering that there is a wide variation between practices. The hon. Gentleman has made an important point, and, if I may, I will write to him to inform him of our progress.

The patient transport service in northern Lincolnshire is contracted to Thames Ambulance Service Ltd, which is failing miserably to perform to an adequate standard. Will the Minister meet me, along with my hon. Friend the Member for Brigg and Goole (Andrew Percy) and other neighbouring Members, to discuss what influence the Department can bring to bear?

Order. I appreciate the commitment of colleagues. The session has overrun, but I feel that colleagues will go home for Christmas content only if they have asked their questions and they have been answered. I am extremely grateful to the Front-Bench teams on both sides of the House.

Is the Secretary of State aware that in the course of this hour there have been more questions about hospital closures than about almost anything else, covering East Yorkshire, Berwick on his own side, Warwickshire on our side, and High Peak in Derbyshire, including Bolsover and Bakewell Hospitals? There is a growing suspicion that what this Secretary of State is up to is leaving those hospitals and losing all the beds in them forever so that the private sector can move in and take the lot. That is what is going to happen.

I thank the hon. Gentleman for his Christmas cheer. Let me just say to him that if that were the Government’s intention, we would not have found an extra £2.8 billion for the NHS in the Budget, including £1.95 million for Chesterfield Hospital, which will benefit his own constituents.

Some 50% of young people do not use a condom with a new partner and one in 10 young adults never uses one, which means the chance of an unwanted pregnancy or, indeed, a sexually transmitted disease. Please will the Department do something to ensure that people are aware of the benefits of condoms?

Men may not be very good at wrapping at this time of year, but they need to get this one right. I welcome Public Health England’s “protect against STIs” campaign, which was launched last week and aims to reduce rates among 16 to 24-year-olds, and I encourage young people having fun this Christmas to do so sensibly.

There is an increasing trend for women to share breast milk over the internet with no recourse to the milk banking guidelines from the National Institute for Health and Care Excellence. Will the Minister meet me, and other members of the all-party parliamentary group on infant feeding and inequalities, to discuss the matter further and to ensure that breast milk can be used safely?

As the hon. Lady says, it is important for us to ensure that anything that happens in this space is safe, and I should be very pleased to meet her and other members of the all-party group.

What funds are being made available to our mental health services to meet the additional demands placed on them by changes in the Mental Health Act 1983, which came into force on 11 December this year?

I can reassure the hon. Lady that we are putting a lot of extra funding into mental health— £575 million last year alone—to meet those and other obligations.

NHS Property Services exists on a merry-go-round of taxpayers’ money. Will the Secretary of State give us all a Christmas present by closing it down and returning the control of property to local health communities?

I understand why the hon. Lady has asked that question. I think it fair to say that NHS Property Services has been on a journey and needs to do even better, but we also want to ensure that NHS land is made available for housing for NHS staff.

Will the Secretary of State consider the NHS as a funder of last resort for hospices such as Bury hospice, so that they can operate at full capacity and play their part in the delivery of social care?

We often are a funder of last resort for the hospice movement—and perhaps thanking hospices for the extraordinary work that they will be doing over the festive period and beyond is the right note on which to end today.