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Health and Social Care

Volume 635: debated on Tuesday 6 February 2018

The Secretary of State was asked—

Grenfell Tower: Mental Health

1. What steps he is taking to support the mental health needs of survivors and the wider community affected by the Grenfell Tower fire. (903771)

I am very grateful to have the opportunity to pay tribute to the NHS staff who continue to work tirelessly to support the victims of the fire and their families. So far, more than 4,000 contacts have been made. Over 400 adults are currently in treatment and 96 have completed their treatment.

We have heard the Minister’s words and a litany of numbers. I have two further questions. First, is she considering long-term funding for mental health services around Grenfell, which will be needed, and need to be planned for, for possibly up to five years? Secondly, is she addressing the severe shortage of acute beds for those suffering mental health crises, which was mentioned earlier, particularly as there is an entire ward under lock and key at the Gordon Hospital due to lack of staff funding and a huge need for acute beds there?

The hon. Lady is quite right to press me on these issues. Clearly, there is going to be ongoing trauma, and we need to pay attention to that and make sure that there are adequate resources. I can assure her that this is very high on the list of priorities for the ministerial group. We have committed £23.9 million of national Government funds to address survivors’ needs, with additional expenditure on wider support. The autumn Budget committed a further £28 million to help support victims. I can also assure her that I am in regular contact with Central and North West London NHS Foundation Trust to make sure that we are doing our bit to address this need.

Northern Lincolnshire and Goole NHS Trust

2. If he will make an assessment of trends in the time taken between referral and treatment for patients at hospitals in Northern Lincolnshire and Goole NHS Foundation Trust in the past 12 months. (903772)

In the past 12 months, the average waiting time for patients to start consultant-led treatment at hospitals in northern Lincolnshire and Goole was about nine weeks. We recognise that some trusts face particular challenges with their waiting lists due to rising demand. That is why a package of support, including a system-wide improvement board, has been established within the trust.

The statistics that the Minister has given are very interesting. The Library has said that there is an average wait of 32 weeks—far longer than the nine weeks that he mentioned—and that it is six weeks longer in 2017 than it was in 2016. This is happening on his watch. What is he going to do? My constituents do not accept that it is good enough.

I think the hon. Lady prepared her follow-up before hearing the answer. There is an improvement board established within the trust, chaired by NHS Improvement, that is tasked with reducing waiting times and ensuring that the standard is improved. Currently, the average time waited is 11 weeks for out-patients and seven weeks for in-patients.

Will the Minister give an assurance that the support that NHS Improvement is giving to the trust will continue? He will know that this is the second time that the trust has been in special measures, and clearly we need continuing support. Will he also assure us that he will visit the trust—a promise that was made by his predecessor?

My hon. Friend is right to point out the need to give support to this trust. That is why a wider package of £1.6 billion of funding has been given to the NHS to improve accident and emergency and elective care performance. Alongside that, we have specific work through NHS Improvement to address some of the particular issues that he alluded to in his trust.

Order. We might hear from the hon. Member for Kingswood (Chris Skidmore) later, but I say to him in all friendly courtesy that while Kingswood no doubt has a great deal to be said for it, as does Congleton, both have one thing in common, and that is that they are a very long way from northern Lincolnshire.

Health and Social Care Services

The fact that the Department has been renamed the Department of Health and Social Care reflects both their interdependence and our commitment to achieve co-ordinated care tailored to individual needs. The better care fund is a national integration programme that helps the NHS and local government to deliver better, more joined-up services.

I thank the Minister for that answer and welcome her to her place. The proposal to build a community health centre in Thornbury and Frenchay is an essential part of joining up health and social care in South Gloucestershire. Will the Minister join me in highlighting the importance of Thornbury health centre and in pressing South Gloucestershire clinical commissioning group to make progress with the project as quickly as possible, after years of unnecessary delays?

I thank my hon. Friend for raising that important issue. He is right to do so, and proposals such as those for Thornbury health centre are crucial for ensuring that health and social care are truly integrated and centred around each individual in the community. I am advised that South Gloucestershire CCG remains committed to progressing those plans as soon as possible and that the local NHS expects to be able to provide an update on plans next month.

The Minister will be aware of the situation surrounding pain infusion treatment for patients in Hull and East Riding. Many of the 86 patients who lose that treatment will require increasing levels of social care. Consultants have even written letters to the CCG to say that if that treatment is removed, there is an increased risk of mortality for those patients. Will the Minister meet me urgently to discuss that and write to the CCG to ask it to urgently review its decision in the light of the evidence from consultants?

Of course blanket bans on treatments are unacceptable, and decisions on treatments should always be made locally by doctors, based on clinical assessment. I understand that those patients will be offered an alternative, more rounded service and that the CCGs have arranged for each patient to meet their consultant to discuss their treatment. Where there is evidence of rationing, we expect NHS England to ensure that CCGs are not breaching their duties.

Does my hon. Friend agree that the integration of health and social care is so important to the future success of the NHS that everything needs to be done to speed up the programme to integrate them better? Will she join me in encouraging a speedier approach to that method in Surrey, Sussex and Kent?

My right hon. Friend is absolutely right. The better care fund is already having a fantastic impact in the area. We are developing metrics for assessing progress on integration by local area, particularly at the interface of health and social care. We need to proceed with this as rapidly as possible, and I am sure that with his backing, that will happen in his local area.

It is of course very important that we see integration of the two services, but the fact remains that there is just not enough money. Over a year ago, one of the Minister’s predecessors praised my authority in Halton for the work it was doing in this area, but Halton is now on the brink in terms of the money it has and its ability to deliver its statutory duties. There is simply not enough money, and the Government keep trying to avoid that.

We have provided £2 billion of extra funding over the next three years to help councils commission high-quality services, in addition to giving councils access to up to £9.25 billion of dedicated social care funding by 2019-20.

Will the Minister look at the benefits of independent living schemes such as Priory View, pioneered by Central Bedfordshire Council, which bring reduced hospital admissions and reduced demands on social care through greater socialisation and more use of exercise classes?

Independent living schemes can keep people living healthier, more independent lives for much longer and provide the comradeship and camaraderie that keep people active and healthier. My hon. Friend is right to raise their importance, and the Government very much support them.

With reference to the integration of health and social care, the Minister may be aware that I have two outstanding respite and rehab homes in Eastbourne called Milton Grange and Firwood House. They are both under threat of closure by the county council, which says that central Government are not giving it enough money. Those homes serve a crucial purpose in supporting the local hospital. Will the Minister agree to meet me and representatives from the county council to work out a way to find the funds to keep both those vital homes open?

The hon. Gentleman is absolutely right to stand up for the good-quality respite in his local area. The Care Act 2014 requires local authorities to shape local markets and ensure that they give a sustainable, high-quality local offer. I would be more than happy to meet him to discuss that further.

I welcome the Minister to her place. One model of integration that has aroused considerable concern is the so-called accountable care organisation model. Many are concerned that that means greater private sector involvement, and given legitimate worries about Carillion going bust, Capita not being able to support GPs and Virgin suing the NHS, those concerns are well founded. Can the Minister rule out any private sector involvement in ACOs? Will she also delay laying the relevant regulations to establish an ACO until after the two judicial reviews and the NHS England consultation?

The hon. Gentleman is right to raise this. NHS England is consulting on that at the moment, and I can confirm that no regulations will be laid until that consultation has been completed.

I am extremely grateful to the Minister for offering us that clarification. May I therefore ask her about funding? The integration of health and social care needs more funding, yet the NHS is going through the biggest financial squeeze in its history and social care has been cut by billions since 2010. A few moments ago, the Minister said that the funding is adequate, but if the funding is adequate across health and social care, why are delayed discharges of care up 50%, and why did NHS England say on Friday that for the rest of this year the A&E target has in effect been abandoned?

We recognise that there are pressures on our social care as the population ages. In the short term, we have of course made the extra £2 billion of funding available to local authorities; in the medium term, we need to make sure that best practice is observed across all local authorities and NHS trusts; and in the long term, we will be coming forward with a Green Paper on social care later this year.

Routes into Nursing

The NHS needs more nurses, which is why we are making big changes for new entries into the profession, including the new nurse associate role and new nurse degree apprenticeships.

I am glad to hear that the Secretary of State values the degree apprenticeship as a way to provide further routes into nursing, but will he consider working with the Treasury and across the Government to increase the funding that educational establishments receive from the Institute for Apprenticeships for nursing courses, to further incentivise universities and colleges to offer more places on those courses?

I thank my hon. Friend for his excellent question. It will strengthen my hand with the Department for Education, which decides what levels of funding are made available from the Institute for Apprenticeships. It has actually given us the highest level of funding, at £27,000, but we never say no to more.

But will the Secretary of State admit that he made a basic error by scrapping nurse bursaries, which has led to a 23% fall in the number of people applying to nurse courses? Why does he not look at that if he wants to widen the entrance into nursing?

I am not sure whether the hon. Lady was listening to the answer I just gave, but the truth is—

I am most grateful. That is a very rare compliment, so I shall savour it. I would gently say to her that the point about nurse degree apprenticeships is that it is possible to transition into nursing from being a healthcare assistant without any fees being paid at all. That is why it is a huge and highly significant change.

As the hon. Member for Wallasey (Ms Eagle) is sporting what appears to me to be a very fetching suffragette rosette, it is perhaps timely to record that in the great success our national health service has been under successive Governments, I think I am right in saying, as things stand, that well over 70% of the people who make it great are women.

Following the recent inquiry by the Select Committee on Health into the nursing workforce, we absolutely welcome the new routes into nursing, including the new role of nursing associate. However, one of the issues highlighted strongly was the need to retain our existing nursing workforce as well as to recruit into it. Will the Secretary of State comment on that?

My hon. Friend speaks very wisely—we do need to be better at retaining our existing workforce. I think that is why the Treasury has given me extra latitude in negotiations on the pay rise—those discussions are currently happening—but we also need to be much better at flexible working and at recognising the challenges people have in their ordinary working lives.

Unlike in Scotland, where student nurses receive free tuition and a nursing bursary of over £6,500 a year, nurses in England now face debts of £50,000 on graduation. Owing to that, training applications in England have dropped by a third since 2015, and the new nursing apprenticeship attracted only 30 trainees against a target of 1,000. Will the Secretary of State not accept that he got it wrong, and reinstate the nursing bursary?

I am interested to hear the hon. Gentleman say that, because we have published a draft of a workforce strategy in this country, but I notice that Audit Scotland says that in Scotland there is a lack of a long-term strategic plan for the workforce. I gently say to him that there are workforce pressures across the United Kingdom. We have a plan to dramatically increase the number of nurses that we employ in the NHS, and I am sure many people in Scotland would like to see the same there.

The Secretary of State has claimed that the removal of the bursary would fund 10,000 extra training places, but the first 5,000 will start only this autumn and the nurses will qualify only in 2021. With more than 36,000 nursing vacancies in England, more nurses leaving than joining and a 90% drop in EU nurses coming to the UK because of Brexit, exactly who does he expect to care for patients in the meantime?

As we discussed earlier, we are broadening the routes into nursing from just traditional higher education courses, including nurse apprenticeships and people being able to train on the job over four years in a hospital. We hope that a whole group of healthcare assistants who currently find it difficult to get into nursing can become nurses. I think that would be very welcome in Scotland as well.

Will the Secretary of State update the House on progress made in reducing the cost of agency nurses so that the money can be reinvested in full-time nursing?

I am happy to do that. It is one of the great successes of NHS Improvement, which should be celebrated, that it has brought down the amount spent on agency nursing by £1 billion in the last couple of years. That is a huge achievement. Every penny of that goes back into frontline care.

The Government cut the number of nurse training places in 2010, and when they scrapped bursaries applications from mature students suffered particularly. What is the point of blaming trusts for hiring agency staff when the Government simply do not train enough nurses to fill the vacancies?

Perhaps I should set the record straight for the hon. Lady. We have 52,000 nurses in training—more than was ever the case under the last Labour Government, who were planning to cut nurse training places by 6%. We are planning to increase them by 25%. That shows our commitment to nursing.

Yesterday, the Royal College of Nursing reported on the total failure of Government policies to increase the nursing workforce. As we have just heard, the Government hoped to recruit 1,000 trainees to the nursing apprenticeship, but ended up with just 30. This year, the number applying to university to study nursing has so far fallen by a staggering 33%. We have a workforce crisis exacerbated by badly thought out policies, so is it not time that the Secretary of State admitted that scrapping the bursary was a mistake?

I have a great deal of respect for the hon. Gentleman, but that is not the first time that he has presented a somewhat incomplete picture of what is actually happening. In the last five years, we have 15,700 more nurses, and the reason for those vacancies and for the pressure is that, as he knows very well, under the last Labour Government we had Mid Staffs, which was a crisis of short staffing that this Government are putting right. That is why we want to recruit those extra nurses.

Children and Young People: Mental Health

This week is Children’s Mental Health Week, and still too many children and young people wait too long for their mental health provision in the NHS. That is why, by the end of next year, we will have invested an extra £1.4 billion, meaning that 70,000 extra children and young people are seen every year.

A constituent’s 14-year-old son suffers severe obsessive compulsive disorder, resulting in self-harm. Treatment options have failed and his doctor recommends an intensive residential programme, but as Ministers are aware, places are very limited. He has been waiting seven weeks and counting, with 24-hour parental support and supervision. What more can be done to ensure that that boy and other adolescents who are in desperate need of help get that help before it is too late?

I thank my hon. Friend for raising that issue, and I understand that in that particular case clinicians are meeting this week to resolve those issues. She is right: we need to expand the number of beds available for children and young people. They are at a record level—1,440, and that went up by another 81 last year—but more needs to be done, which is why we published our children and young people’s mental health Green Paper.

I have been approached by a number of my constituents in Leicestershire who are concerned about the wait between a referral to child and adolescent mental health services and the allocation of a named caseworker and formal treatment. Will my right hon. Friend enlarge on how the steps that he is taking, which he has set out, will help to reduce such waits in Leicestershire and across the country?

I am happy to do that. The simple truth is that it is a tragedy for every child who has to wait too long to access mental health care, because half of all mental health conditions become established before the age of 14. If we do not nip them in the bud, they can get a lot worse. What are we doing? We are setting up a whole new service inside schools to spot such problems earlier and we are going to introduce a waiting time target for CAMHS appointments.

In 2016-17, 65% of young people in England with eating disorders started urgent treatment within one week of referral. What has been done to ensure that the target of 95% by 2020 will be reached? Does the Secretary of State share my belief that waiting time targets are a vital tool for improving eating disorder treatment and should be in place in all parts of the United Kingdom?

I absolutely agree with that. I join my hon. Friend in supporting the introduction of waiting time targets in Scotland and other parts of the United Kingdom. How are we doing so far? In terms of the need for urgent treatment for eating disorders, we are hitting 79%, so we are on our way to the 95% target and we want to get there as soon as we can.

I listened very carefully to what the Secretary of State said about the additional funding that is supposed to be reaching the frontline, but the Young Person’s Advisory Service, which is the main service for young people’s mental health in Liverpool, has seen a £757,000 cut—a cut of 43%—in this financial year. There are now 412 children in Liverpool waiting more than 28 weeks for an assessment—not even for treatment. It is absolutely shocking. How can he stand there in young people and children’s mental health week and say that everything is rosy?

I did not; I said the opposite. I said that we need to do a lot more and I told the House what we are doing. If the hon. Lady looks at what is happening in her own clinical commissioning group, she will see that the proportion that is spent on mental health has gone up from 12.3% to 13%. She will see that this Government have done a huge amount on mental health. In 13 years, Labour did not have any waiting time targets for mental health and did not introduce parity of esteem—a whole range of things that are now happening and that she should support.

Will the Government commission more extensive research into the causes of mental ill health among children and young people, both pre and post-natal, with a view to preventing as much ill health as possible?

We are absolutely going to do that. We have a big programme of expansion in perinatal health support, because there is a lot of evidence that pressures on mothers around the time of birth transmit to their children and can leave lasting damage.

Specialist mental health crisis care for young people in south Cumbria is available only between the hours of 9 and 5 from Monday to Friday. Does the Secretary of State agree that in the light of the Care Quality Commission’s recent damning report of the partnership trust, that is not acceptable? Will he join me in asking the Morecambe Bay CCG to ensure that there is out-of-hours and weekend care for all people?

I am happy to look into that issue. The hon. Gentleman’s colleague, the right hon. Member for North Norfolk (Norman Lamb), did a huge amount to set up crisis care provision around the country. We need to build on that for the simple reason that, if we are to have parity of esteem, people need to be able to get help in a mental health crisis, just as they are if something goes wrong with their physical health.

Does my right hon. Friend agree that, as well as improving the treatment of adolescent ill health, everything possible needs to be done to prevent crisis from occurring in the first place? Does he agree that we need more research into why we are seeing a surge in Cheltenham and elsewhere in the world, so that clinicians can best tailor their response?

This is something that my hon. Friend has thought a lot about. A particular area of concern is the growth in mental health problems in young women between the ages of 18 and 24. We are looking carefully at whether that relates to social media use, which is an additional pressure that many of us did not face when we were that age. I thank him for his campaigning on this issue.

19. The figures show that, on average, children and young people have to visit their GP three times before a referral is made for a specialist mental health assessment. Sometimes, they then have to wait six months for treatment. In Lewisham, the CAMHS budget is being cut, which is likely to result in even longer waiting times for treatment. The right hon. Gentleman said that these waiting times are a tragedy, but how bad do things have to get before the Government take action? (903791)

With respect, we are taking action. Last year, spending on mental health went up by £575 million and four out of five CCGs increased their mental health spend by more than their overall spend. This year, all CCGs will do that. That will apply in Lewisham, as it will everywhere else in the country.

Under plans announced by NHS England, child victims of sexual assault in Stoke-on-Trent would have to travel as far as Birmingham to receive the vital support that they need. Will the Secretary of State agree to look urgently into the proposals to remove child sexual assault referral services from the city?

Research by the Children’s Commissioner revealed that the spend on children and young people’s mental health services varied by CCG from 0.2% to 9%, resulting in services in some areas being described as “shockingly poor”. Can the Secretary of State therefore explain the reason for the variation, and will he commit today to matching Labour’s pledge to increase the proportion of the mental health budget spend on CAMHS services?

The hon. Lady is right to shine a light on that variation, and that is why this Government have introduced Ofsted ratings for all CCGs—to make sure that we understand. It is not just in children and young people’s mental health, but in all mental health where we see that variation. Specifically when it comes to children and young people’s mental health, she will be pleased to know that last year overall spending went up by 20%, and the Green Paper that we published announced an additional £300 million in investment.

Children’s Health

This Government want to see all children and young people get the best start in life. We are implementing a wide range of policies to improve child health, including the most ambitious childhood obesity plan in the world, transformation of children’s mental health and maternity services, improving immunisation rates and tackling child sexual abuse.

The Royal College of Paediatrics and Child Health recently praised NHS Scotland’s innovations to improve children’s health. The Scottish initiative Childsmile, which is now 10 years old, has greatly improved children’s dental health, reducing fillings by 24% and cutting annual dental treatment by £5 million. It is good that the UK Government have finally set up trial sites, but with multiple dental extractions under general anaesthetic up by 11%, why is this initiative not being rolled out to all children in England?

The hon. Gentleman is right to highlight that, and we are always keen to respond to any representations made on this very important issue. We are also very keen to learn from the other nations about this area, because it is clear that the more we can do with early intervention in childhood, the better we protect people’s long-term health. I will look more specifically into that.

As a children’s doctor, children’s health is very important to me, and the case of children’s doctor, Dr Bawa-Garba, worries me and doctors up and down the country. In NHS practice, I have seen the adverse effect on reflective practice and the impact that it has on staff morale. Ultimately, that will impact on patient safety. I know that the Secretary of State shares my concerns, and I ask him to tell the House what he is going to do about it.

My right hon. Friend the Secretary of State will be addressing that in a little while. The whole issue of reflective learning is important. We should not, through this case, prevent people from being honest about the experiences that they have had.

20. Energy drinks packed with caffeine have been connected to problems with children’s health. Tesco, Asda and Aldi have banned the sale of these drinks to under-16s, so will the Government do the same? (903793)

We are becoming increasingly conscious of drinks with additional unnatural stimulants and their impact on people’s health generally, but obviously that becomes more acute with children’s health, so we will look more closely at it. I am glad that the hon. Gentleman has highlighted the initiatives that have been taken by individual retailers, because it is up to them to implement good practice.

Does my hon. Friend agree that the best way to achieve strong health and good mental health for children is at the very earliest stages and through forming a strong attachment between that child and their parent in the first 1,001 days from conception? If so, why is there not more in the mental health Green Paper about perinatal mental health?

The Green Paper very much focuses on what we are doing in schools, but my hon. Friend is absolutely right. He highlights the earliest of early intervention, and one reason why we are investing so much more in perinatal mental health is to ensure that the bonds between mother and baby are as strong as they can possibly be.

Following the question from my hon. Friend the Member for Blaenau Gwent (Nick Smith) and the Minister’s answer, may I revisit the issue of energy drinks? She might know that a 500 ml can of energy drink contains 12 teaspoons of sugar and the same amount of caffeine as a double espresso, yet energy drinks are being sold for as little as 25p to children as young as 10, and around one in three young people say they regularly consume them. Given the health risks associated with energy drinks, will she tell me more about what steps she and her Department are taking to reduce energy drink sales to and consumption by children?

The hon. Lady will know that action against sugar is very much part of the childhood obesity plan that the Under-Secretary of State for Health, my hon. Friend the Member for Winchester (Steve Brine), is taking forward, but there is a lot more we can do to address the concerns about caffeine, which I know is high on his “to do” list. We will no doubt have more exchanges on this subject in due course.

Maternity Transformation Programme

Our ambition was to halve the number of maternal deaths, neonatal deaths, neonatal injuries and stillbirths by 2030, but because of the progress we have made with our maternity safety programme, we have brought that forward to 2025.

I am glad to hear that progress is being made. The World Breastfeeding Trends Initiative’s 2016 report highlighted several gaps in access to breastfeeding support, including deficiencies in clinical training and a lack of integration between the NHS and voluntary sector services. What can be done through the maternity transformation programme to ensure that women can access, and health professionals can provide, the best-quality infant feeding advice right across the country?

The hon. Lady is absolutely right to highlight that area. It is one of six high-impact areas we are focusing on throughout the country. We are making progress, but we know we could do a lot better.

NHS Trusts: VAT Status

9. If he will hold discussions with the Chancellor of the Exchequer on the VAT status of NHS trusts. (903781)

I am grateful for that reply, although I suggest it ought to be reconsidered. NHS trusts desperate to avoid financial difficulties appear to have found a new magic money tree: setting up wholly owned subsidiaries to avoid paying substantial amounts of tax to the Treasury. Rather than encouraging this tax dodging and further fragmenting the NHS, why do the Secretary of State and his friend the Chancellor not either ban this practice or agree to let them all have the VAT exemptions?

The Department wrote to all NHS and foundation trusts in September 2017 to remind them that tax avoidance schemes should not be entered into in any circumstances, but the hon. Lady makes a slightly strange point. She seems to be arguing that NHS hospitals are, in essence, paying too much tax to the Treasury, rather than having that money within the NHS. These subsidiaries are 100% owned by trusts themselves.

The Government have already legislated for but not implemented a proposal to introduce a £95,000 limit on exit payments for public servants in the NHS. Would it not be sensible, in the meantime, to charge NHS trusts VAT on any exit payments in excess of £95,000 to deter this waste of public resources?

I admire how the VAT element of the original question was brought into a discussion of exit payments. As my hon. Friend will be well aware, I visited the issue of exit payments frequently as a member of the Public Accounts Committee, and I am happy to discuss it further with him.

National Food Crime Unit

The Food Standards Agency’s national food crime unit is crucial to protecting consumers from serious criminal activity that impacts on the safety of their food and drink. I understand that the FSA is exploring options for the unit’s future funding, and a decision is expected in late spring.

The FSA is answerable to the Department of Health and Social Care for food safety, but there are a lot of assurance schemes that do not really answer to anybody and which the FSA needs to be able to bring together. That is where the crime unit could do a really good job, so anything the Minister can do to get that money and get the crime unit up and running would be very good.

I thank the Chair of the Environment, Food and Rural Affairs Select Committee for his advice. I know that he is keen and astute on this subject. Ensuring that food businesses meet their safety responsibilities is, of course, one of the FSA’s most important roles. It is developing a new regulatory model and actively engaging with third-party assurance scheme owners to determine how information and data can be shared and more effectively used by regulators.

May I send a brief message of congratulation to the Secretary of State for his rapid response to President Trump’s remarks about the values of the NHS?

As chair of the Westminster Commission on Autism, let me now ask the Secretary of State a serious question. We are about to produce a report on the fake medicine that is sold to families with an autistic child. When the report is published, in the next few days, will the Secretary of State act very quickly to stop this dreadful trade?

Possibly. Anyway, it was a worthy effort, and I will give the hon. Gentleman the benefit of the doubt. Let us now hear from the Minister.

As the hon. Gentleman was so very charming to the Secretary of State, we will of course look into the issue.

Hospitals in Special Measures

11. What recent progress he has made on improving the performance of hospitals in special measures. (903783)

It is five years today since the landmark publication of the Francis report on the Mid Staffordshire Foundation NHS Trust. Since then the NHS has made a huge number of changes, not the least being that 34 trusts have gone into special measures and 19 have come out. I particularly congratulate the West Hertfordshire Hospitals NHS Trust on coming out of special measures in January and securing a “good” score for its caring: that was a fantastic achievement by its staff.

Given that York’s local health service is in special measures, the additional funds in the Budget to deal with winter health pressures were very welcome. I am pleased to say that York NHS has already received a tranche of those funds, but the remainder of its share has not been released, although discussions with NHS Improvement are ongoing. Will the Secretary of State undertake to look into the situation, as a matter of urgency?

The Secretary of State will be aware of the importance of King’s College Hospital to my constituents. In 2009, it was rated “excellent” and one of the top hospitals in the country; now it is missing its A&E waiting time targets and a key cancer treatment target, there has been a fourfold increase in the number of cancelled operations, and it is in special measures. The Government must take some responsibility for that. They must not wash their hands of it. Will they step up to the plate and help King’s by, for instance, giving it the resources that it needs?

Let me reassure the right hon. and learned Lady that we do not wash our hands of any trusts that go into special measures. The point of the special measures regime is to highlight where Government intervention is necessary. I know the right hon. and learned Lady will agree that a huge amount of very fine treatment happens at King’s every single day, but it is having profound issues in relation to the management of its finances and some of its waiting times, which is why we are doing everything we can to support it.

With a high delayed-discharge rate of 10%, Kettering General Hospital, which is in special measures, has 60 patients on any one day who have completed their treatment and await their transfer into the community. Northamptonshire County Council has been given millions of pounds, via the better care fund, but it is simply not up to the job. What can be done in those circumstances?

I am well aware of the pressures at Kettering. It is a very busy hospital, and it has undergone a number of changes of management. However, I can reassure my hon. Friend that a big improvement package is there to support it and that we want to take it out of special measures as soon as possible.

The previous chair of King's College Hospital NHS Foundation Trust resigned because he had concluded that the funding provided for King’s had placed the trust in an impossible position. The current interim chair has said that the proportion of GDP spent on health and social care needs to rise to match that in other European countries if our NHS is to be sustainable. When will the Secretary of State heed the warning cries and commit the funding that King’s and, more widely, our NHS need in order to deliver care to our constituents?

We spend 9.9% of our GDP on health. The European Union spends 15%, and the richer EU countries spend 9.6%—slightly less than us, on average. We are able to spend more because this Government put the economy back on its feet.

Pharmacy Services

It is good to be back.

As I have repeatedly said at the Dispatch Box, pharmacies are a vital frontline service for our NHS, with over 1.2 million health-related visits every day. Community pharmacies have again stepped up during this winter period, and I thank them for their hard work. They have vaccinated more than 1 million people against seasonal flu since October. The Government are committed to ensuring that pharmacies and pharmacists are further embedded in the wider health service.

I thank the Minister for that answer. Will he come to Derby to meet a constituent who has pharmacies that are working very hard to keep patients out of hospital, therefore saving the NHS money through their innovative ideas?

Yes, I will do that. I think we have a provisional date in the diary in early March. We continue to promote the Pharmacy First scheme. Next month, we will launch the £2 million Stay Well pharmacy campaign to continue to promote the idea of community pharmacy as the first port of call for many minor health concerns. I am out and about visiting pharmacies—I was at one last week—and I will be very pleased to come to see my hon. Friend.

21. The Minister will be aware that a disproportionate number of GPs are currently heading towards retirement. Therefore, support for primary care services is vital. What practical steps can be taken to increase the use of pharmacies and to seek alternatives to GP services more generally? (903795)

As the hon. Gentleman knows, there are a record number of training places. We know that one of the main reasons why GPs leave general practice is retirement, which is why we have put in place comprehensive measures to ensure that we meet our commitment to deliver an extra 5,000 GPs in the NHS by 2020. GP career plus, the GP retention scheme and the national GP induction and refresher scheme will all help get to valuable experienced GPs back into our NHS, doing the valuable work our constituents so benefit from.

GP Services

We recognise the acute shortages in general practice, which is why we remain, as I said in my previous answer, committed to delivering the additional doctors in general practice by 2020. Millions of patients have already benefited from being able to access evening and weekend GP appointments. We expect everyone in England to have access to this by March 2019.

I am fortunate to work very closely with the GPs in my constituency. It would be appear that, for a variety of reasons, younger GPs are not as likely to buy into the partnership model as their predecessors. Does the Minister agree that we need a mixed model of both private partnership contractor and direct NHS state provision if we are to get GPs to the places where the public need them?

My hon. Friend works very closely with the GPs and commissioning groups in his constituency and they value him greatly as a local MP. We back the partnership model. As the Secretary of State said last month at the Royal College of General Practitioners, we believe in its many benefits as the cornerstone of primary care. That is why we are embarking on a new piece of work to explore other models with the British Medical Association and the RCGP, which have kindly agreed to work with us on this, and to look at the partnership model in the context of primary care at scale.

NHS figures continue to show an alarming decline in the number of family doctors working across the north-east, which is why I am supporting the University of Sunderland bid to establish a new medical school. Does the Minister accept that prioritising training places in areas of greatest need is the best long-term solution to the crisis facing general practice?

There are record numbers in training, and I take note of the hon. Lady’s bid for the training school. One reason the Department and my brief have placed such importance on recruiting new GPs into the NHS in England and on making sure that people can stay working in the NHS in England is that we see general practice, rightly, as the cornerstone of the health service.

Topical Questions

T1. If he will make a statement on his departmental responsibilities. And you wear it well, Mr Speaker. (903796)

I do not know whether the right hon. Lady is referring to my age, a proposition on which I think the House would have to divide, or the rosette. [Interruption.] Yes, I thought she meant the rosette.

On the day that we mark the 100th anniversary of giving a voice to women, I want to update the House on concerns in the medical profession that we may not be giving a voice to doctors and other clinicians who want the freedom to be able to learn from mistakes. The House will know that, as a Government Minister, I cannot comment on a court ruling, but it is fair to say that the recent Dr Bawa-Garba case has caused huge concern, so today I can announce that I have asked Professor Sir Norman Williams, former president of the Royal College of Surgeons and my senior clinical adviser, to conduct a rapid review into the application of gross negligence manslaughter in healthcare.

Working with senior lawyers, Sir Norman will review how we ensure the vital role of reflective learning, openness and transparency is protected so that mistakes are learned from and not covered up, how we ensure that there is clarity about where the line is drawn between gross negligence manslaughter and ordinary human error in medical practice so that doctors and other health professionals know where they stand in respect of criminal liability or professional misconduct, and any lessons that need to be learned by the General Medical Council and other professional regulators. I will engage the devolved Administrations, the Justice Secretary and the Professional Standards Authority for Health and Social Care in this vital review, which will report to me before the end of April 2018.

I thank the Secretary of State for that answer—or rather, for that statement—and also for the robust tweets that he makes on that and many other issues. Would he be amenable to the idea of following on Twitter the Oliver King Foundation? On the foundation’s advice, I have written to all the schools in Broxtowe urging them to install defibrillators. This is an important project. What assistance is the Department of Health giving to such an admirable charity and such an excellent project?

It is a fantastic charity. The boy concerned would have been 19 very shortly. It is a very sad story. I thank my right hon. Friend for her campaigning on this issue. We do indeed need to ensure that we have atrial fibrillators everywhere necessary to prevent these tragedies.

I welcome the review that the Health and Social Care Secretary has just announced. I also welcome the addition of social care to his role and the Government’s belated realisation that social care should be a Cabinet-level role, as Labour recognised with its shadow Cabinet in 2010. Yesterday, the Alzheimer’s Society reported that care homes were turning away people with advanced dementia—or even evicting them, sadly—because care providers do not get enough money from local authorities to cover the cost of their care. Will the Health and Social Care Secretary now be arguing with Treasury colleagues for the funding that is so badly needed to ensure that people with dementia are not evicted from care homes due to a lack of funding?

The hon. Lady always speaks powerfully about the social care system. One of the key parts of the social care Green Paper that we are currently working through is on market stabilisation. We have seen a number of care homes go under, although the number of beds overall has remained broadly stable, but our particular concern is, as she rightly points out, people in the advanced stages of dementia who might not be able to get the care that they want. This is a key focus of our work.

T7. I have had concerns highlighted to me over the national cancer patient experience survey in the light of the introduction of a new national opt-out model. Can the Minister confirm that the survey will continue to deliver the same high-quality data annually and can he tell me when a final decision on its format is likely to be made? (903802)

I have listened carefully to cancer charities, clinicians and patients on the importance of the cancer patient experience survey. I have been clear that, whatever form the CPES takes as a result of the changes to how confidential data is shared, we want the survey to continue with a methodology as close to that of the current survey as possible.

T2. Last week at PMQs, the Prime Minister made an inaccurate statement about the emergency health services in Wales. The chair of the UK Statistics Authority concluded that the Prime Minister’s comparison was not valid. Comparisons on the performance of our NHS are important, so will Government Ministers check their partisan figures in future? (903797)

It is interesting, looking at the comparisons, to see that the NHS in Wales appears to have changed a number of them, to make it more difficult to compare performance between England and Wales. The more scrutiny there is of the performance in Wales—where clinicians say that the best performance often equates to the worst performance in England—the more we will see the need for serious changes in the way in which the NHS delivers its services in Wales.

In Sutton, we have hugely exciting plans for a London cancer hub, working with the Royal Marsden Hospital and the Institute of Cancer Research, on a single campus to provide a global centre for cancer innovation that will in turn provide a huge boost for our local economy, including 13,000 new jobs. Will the Minister join me in Sutton to see the opportunity at first hand? Will he also tell us how such a project can help to deliver on our Government’s life sciences strategy?

I am keen to visit my hon. Friend in Sutton, so let us fix a date as soon as we can. Cancer survival rates are at an all-time high, but I like the idea of a one-stop shop, and the hub that he talks about could be very exciting.

T3. The delivery of sustainability and transformation plans is too dependent on the NHS estates strategy, as discussed in the Naylor review, and there is great concern that our NHS assets will be sold off quickly, cheaply and without transparency to make up for Government underfunding. Will the Minister agree to pause the process to accommodate the urgent need for parliamentary scrutiny? (903798)

The King’s Fund has said that STPs offer the best hope for the NHS and its partners to sustain and transform the delivery of healthcare, so the King’s Fund endorses this recommendation. As the right hon. Lady will know, we announced an additional £325 million of capital funding in the spring Budget to invest in local areas, and in the autumn Budget we committed an additional £10 billion package of capital investment over this Parliament.

Last week, our former colleague Tessa, now Baroness, Jowell gave an inspiring speech about her battle with brain cancer. At this first Health questions after that speech, I am sure that colleagues will join me in paying tribute to her work and will agree that she spoke with courage, grace and the desire to make her suffering prevent others from having to go through the same. Will the Secretary of State assure me that last week’s report from the brain cancer research taskforce, which I set up as a Minister, will be taken seriously in the Department and that everything will be done to ensure that brain cancer, which has been something of a Cinderella for years, receives the support and funding that it deserves so that Tessa’s words were not in vain?

I thank my hon. Friend for his work in this job on this subject. The Secretary of State was in the other place to listen to Baroness Jowell’s speech, and I read it and watched it back. It was a moving and brave piece of work. We take this matter seriously. My colleague Lord O’Shaughnessy has the report, which we are going through line by line, and he and I will jointly chair a roundtable on the subject in the next few weeks.

Will the Secretary of State give an assurance that any accountable care organisations that he establishes will not be able to use commercial confidentiality excuses to evade scrutiny under freedom of information legislation?

Public money is public money, and Members have a right to know how it is being spent, so we will absolutely ensure that those contracts are signed in a fair way.

As the Secretary of State carries out his social care funding review, I urge him to look carefully at whether we should look again at implementing the Dilnot commission’s proposals. Given that we legislated for them, they are the only way that we are going to tackle the issue with the sufficient urgency.

At the heart of the Dilnot proposals was the idea of risk pooling—that there is a randomness in the illnesses that affect us in the later years of our life that we would want, as a society, to do something about. I will confirm what the Prime Minister said in the election campaign: we will consult on a cap on social care costs.

T4. I am shocked that my local hospital, Southport and Ormskirk, has unused bed and theatre capacity despite the huge winter crisis and the pressures on the NHS locally. In that same trust last night, the Virgin-run walk-in centre had a computer glitch and told people, “Either go to A&E or come back tomorrow.” Has the Department made any assessment of the number of beds and theatre hours that could have been sourced to relieve winter pressures and save lives? (903799)

The hon. Lady highlights an important point about the variance in performance between trusts and how we look at some of the lessons from, for example, Lords Carter’s work on efficiency, rotas and how to maximise the value of funding. I am happy to consider her specific point, but she is right that how we manage the patient pathway, in particular the 43% of hospital beds occupied by 5% of patients, is a key challenge.

For the first time ever in Devon and Plymouth, GP practices are struggling to recruit new doctors and new partners in particular and are spending a fortune on locums as a result. The Government have a plan to fix the situation by 2020, but what more can be done in the meantime to ensure that my constituents can access primary care services?

There are two things. First, we have succeeded in increasing the number of medical school graduates who go into general practice—a record 3,157 this year. Secondly—I know this from my conversations with GPs in my hon. Friend’s constituency—we are doing what we can to reinvigorate the partnership model. Since meeting those GPs, I have agreed with the Royal College of General Practitioners and the BMA that we will carry out a formal review of how the partnership model needs to evolve in the modern NHS.

T5. Does the Secretary of State agree that it would be wholly unacceptable if, as a consequence of creating accountable care organisations, private companies gained control of strategic decisions on local health services? (903800)

I point the hon. Gentleman to what the King’s Fund says, which is that accountable care organisations and integrated care systems make a “massive difference” in care to patients. The King’s Fund is not a pro-Government organisation; it regularly holds the Government to account at election time and throughout the year. Not just the King’s Fund but Polly Toynbee and many other people are saying that.

It is very positive that Corby clinical commissioning group has announced that core urgent care services will be protected in Corby, along with the announced new GP access and new primary care facilities, but will the Minister join me in keeping a close eye on the CCG as it designs the new access arrangements? People need to be able to access those urgent care services at the right place, at the right time and without delay.

My hon. Friend is right to draw attention to the funding going into Corby, and it is a tribute to his campaigning as a constituency MP that there is such progress on that measure. I am happy to look at the specific issue. It is important that the CCG continues to consult both Members of Parliament and the public as it takes that work forward.

T6. GP services are in crisis. Practice after practice is closing, and more GPs leave the service every day. When will the Secretary of State finally listen to the chair of the BMA’s GP committee, who says that current GP funding is “nowhere near enough”? (903801)

We have been listening to the Royal College of General Practitioners and the BMA, which is why last year funding for GPs went up by £314 million and why it will be going up by £2.4 billion over the five-year period, which is a 14% real-terms increase.

There really is a magnificent array of rosettes on both sides of the Chamber, which today—today only—I will allow to influence me.

This is a very proud day to be a woman in this House. In mid and south Essex there are plans for a hyper-acute stroke unit at Basildon Hospital. Will the Secretary of State or one of the Ministers confirm that that will be an improvement of services for my constituents in Chelmsford, and not a downgrade?

I am very happy to confirm my hon. Friend’s observation. It is absolutely about improving services. This proposal for a new hyper-acute stroke unit in Basildon will ensure there are specialist nurses and doctors available to manage patients at all times, which very much draws on the lessons from London, where we consolidated stroke services and where health outcomes were improved and lives were saved.

T8. Valerie and Colin Hindmarch in my constituency were prescribed Primodos at eight-weeks pregnant. Their child, Colin, would have been 50 on 12 February. However, he died at five weeks old with multiple congenital abnormalities. Most of Valerie’s medical records are missing. When will the Secretary of State grant a judge-led public inquiry to get justice for this couple and all the other survivors? Crucially, will he acknowledge that the victims’ trust and confidence can only come through this judge-led public inquiry? (903803)

The hon. Lady will know that we are currently implementing the findings of the expert working group, and we are continuing our discussions with the all-party group to see how much further we can go in answering people’s questions and in responding to these moving cases, one of which she has just explained to the House. Obviously I would be happy to have further discussions with any hon. Member who wants to discuss it with me further.

In Shropshire, we have had four years of confusion on the future of our two hospitals. Will the Secretary of State tell the people of Shropshire whether there is Government funding for the proposed reconfiguration of the county’s hospitals?

As my hon. Friend will be aware, we announced further funding in the Budget and the autumn statement. On the specifics of Telford, which she has raised on a number of occasions, I am very happy to have further discussions with her.

T9. In my constituency, Shildon medical centre and half of the Richardson Community Hospital are empty, yet patient services are being cut because the rents charged by NHS Property Services are too high. When will the Secretary of State sort out this waste of resources? (903805)

I am not aware of the specific case the hon. Lady highlights, but I am happy to look at it and to understand why she feels the rents are disproportionately high. This relates to the point I made earlier in response to the hon. Member for West Lancashire (Rosie Cooper), which was about the variance in the system and how we ensure that we obtain best value for money. The reality of the debate on health is that the Labour party simply sees it in terms of how much is put in, whereas Conservative Members recognise that we need to both invest more in the NHS and make sure we get the best outcomes. That is the key dividing line between the parties.

For six years, the people of Redditch have endured a painful consultation on their hospital, the Alex, which has dragged on and on. As a result, they have lost maternity and children’s emergency services, even though nobody wanted that when they were consulted. People have taken the pain, but when will they get the gain? When will they see the urgent care centre? When will the £29 million be spent on the Alex?

There are good plans in place for getting Worcestershire Acute Hospitals NHS Trust and the Alex, specifically, out of special measures. A package of support is in place to enable the trust to improve its quality of care. Delivery of the acute service redesign plan is a key driver to sustaining services in the medium term and £29.6 million of STP funding has been agreed to support that.

At the weekend, NHS England, as my colleagues have pointed out, gave up on the key A&E waiting time target. Does the Minister agree that it is very important that when people go to A&E they do not have to wait longer than four hours, as more than 2.5 million did last year? Whose responsibility is this delivery failure?

I have great respect for the right hon. Gentleman, but he is saying something that is a big exaggeration. What the NHS has committed to is that by the end of the year coming up more than half of the trusts in the country will meet the A&E target and that we will go back to meeting it across the whole country in the following year. So we are absolutely committed to this target. We recognise there are real pressures, which is why it is going to take time to get back to it, but we will get there.

I congratulate the Secretary of State on securing the £10 billion capital commitment in the Budget at the end of the last year to spend on the NHS. May I take advantage of my position on these Benches to urge him for the next allocation of STP funding to adopt the advice of my hon. Friend the Member for Telford (Lucy Allan) and ensure that the Shrewsbury and Telford Hospital NHS Trust gets the Future Fit funding it needs?

May I first pay tribute to my hon. Friend for the work he did in the Department and the high esteem in which he was held by those working in the NHS? On Shrewsbury and Telford, I very much appreciate the importance of the reconfiguration of the trust. We expect a decision shortly on that, although I am not in a position to announce it today.

The Secretary of State will be aware of the huge disruption at the Manchester hospitals this week because of problems with water supplies and a big water leak. He might also be aware that Emmeline Pankhurst’s home is on the site of the Manchester hospitals. What conversations has he had with United Utilities and other water companies to ensure that we have safe, constant supplies of water to our hospitals, so that these disruptions do not happen?

I know that NHS Improvement is aware of that situation and that important conversations are going on to improve the resilience of all our hospitals, including those in Manchester. However, I am happy to write to the hon. Lady on the issue.

I will call the hon. Member for East Worthing and Shoreham (Tim Loughton) if his question is shorter than his tie.

Lipoedema affects 10% of women in this country, many without a diagnosis, so why are an increasing number of my constituents saying they cannot get any therapeutic interventions funded by the CCG? Will the Minister meet a delegation of those people and other hon. Members similarly affected?

We are well over time, but I do not want the hon. Member for Strangford (Jim Shannon) to feel isolated or excluded. Let us hear it.

Child suicide calls to Childline are at a record high among girls—it is at 68%. Despite that, the NHS spends only 11% of its budget on mental health issues. Will the Minister indicate what he is going to do to prevent child suicides?

We are very focused on reducing all suicides. As the hon. Gentleman will know, we have a plan to reduce suicide rates by 10%, and last week we announced a plan to reduce in-patient suicides to zero, which is a big aspiration to which the NHS in England is certainly committed. We are very committed to this agenda.

Order. I think this appertains to the exchanges we have just had and relates to a ministerial answer. If the Secretary of State would be kind enough to wait a moment to hear it, we would be grateful.

I seek your advice, Mr Speaker, on something that is very important to my constituents. In my question earlier, I asked about pain infusions and highlighted a letter from consultants saying that the withdrawal of such treatment would increase the risk of mortality. The Under-Secretary of State for Health, the hon. Member for Winchester (Steve Brine), had previously agreed by email to meet me and said that he would answer my question today, if I was called to speak, yet a different Minister answered my question and there was no promise to meet. My office called the Department of Health and Social Care and was told that my case was labelled as “no further action”. What steps are available to me, Mr Speaker, to ensure that the Minister sticks to his word and agrees to meet me?

I think that the explanation of the situation is innocent and that I can probably reassure the hon. Lady. She came in on a question that was being answered by another Minister. On the whole, it is deprecated if Ministers play musical chairs in answer to the same question, even when supplementaries come. It tends to be expected that one Minister will deal with, to put it bluntly or in the vernacular, the whole caboodle. I think that was why the hon. Lady lost out. However, I just asked the Under-Secretary of State for Health, the hon. Member for Winchester (Steve Brine), who is a very agreeable fellow, whether he stood by his commitment to meet, and he gave a nod of assent. He is very happy to meet the hon. Lady to discuss the matter. They may or may not end up agreeing, but of one thing she can rest assured: there is no conspiracy to exclude her. I hope that the hon. Lady will now go about her business with an additional glint in her eye and spring in her step, confident in the knowledge that she shall shortly meet the hon. Member for Winchester.