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Oral Answers to Questions

Volume 643: debated on Tuesday 19 June 2018

Health and Social Care

The Secretary of State was asked—

NHS Workforce

NHS England, NHS Improvement and Health Education England are working with trusts on a range of recruitment, retention and return-to-practice programmes to ensure that the required workforce are in place to deliver safe and effective services.

The nursing vacancy rate in England is more than double that in Scotland, with one in 10 positions unfilled. The Royal College of Nursing has welcomed the Scottish Government’s Health And Care (Staffing) (Scotland) Bill, which will enshrine safe staffing levels in law. Will the Minister now follow the Scottish Government’s example and bring such a provision into law for NHS England?

I fear that the hon. Gentleman wrote his question before yesterday’s announcement. I thought that he might have started by welcoming the additional £2 billion of investment that Scotland’s NHS will be receiving. We are making historic investment in recruitment, which is why we are opening five new medical schools in England, training 1,500 new medical doctors, taking initiatives such as on apprenticeships and opening new pathways into clinical roles.

While I welcome yesterday’s announcement and the workforce strategy that is coming out in the autumn, will the Minister comment on the Home Office’s new proposals to allow greater flexibility for professional clinicians coming to work in the UK, and on what impact that might have on filling vacancies?

My hon. Friend is right to draw attention both to the Home Office’s welcome announcement on tier 2 visas and to the work on the workforce strategy, in which he played a key role. It will ensure that we have the right workforce for the NHS for the next 10 years.

But the Royal College of Nursing and the Nursing and Midwifery Council are both now so worried about Brexit’s impact on the staffing crisis that they have called for a people’s vote on a deal. Given their on-the-ground experience and the demolition of the myth of a Brexit dividend for the NHS, is it not becoming ever more clear that the dogmatic hard Brexit being pursued by the Government is already doing untold damage to our NHS?

The right hon. Gentleman, as a former Minister of State, will not want to choose selectively from the data on European economic area recruitment into the NHS. He will know full well that there are 3,200 more NHS staff from the EU since the referendum, which shows that people are still coming. If he has an issue with the Brexit dividend, perhaps, as my right hon. Friend the Secretary of State pointed out yesterday, he will raise that with his party leader, who sees that there is a Brexit dividend.

Kettering General is a wonderful hospital with amazing staff, but one of its big financial problems is caused by its over-reliance on agency staff. What can be done to reduce the reliance of so many hospitals, including Kettering, on agency staff to populate their wards?

My hon. Friend rightly points to the key issue of how we bring down the £2.5 billion of agency spend. That goes to the heart of the Prime Minister’s announcement yesterday. Up-front investment in our workforce will allow us to reduce that agency cost.

21. Does the Secretary of State agree that the recent High Court decision on universal credit, which determined that one of my constituents with severe mental health issues was discriminated against financially for moving from one area to another, was correct? Does he agree that people with disabilities should not be penalised in such a way? Will he commit to increasing mental health budgets to ensure that such people get the support that they need in their communities post-Winterbourne? (905933)

Order. The question should relate to the workforce, which is the matter we are dealing with now, but never mind. I am sure that the hon. Gentleman is interested in hearing about the workforce situation.

The two do go together because the mental health workforce is a key component of the NHS workforce. I am sure that the hon. Gentleman will welcome the extra £1 billion by 2020 that the Prime Minister announced yesterday, as well as the Government’s prioritisation of mental health, which for too long has been seen as a Cinderella service within the NHS.

In 2015, the Secretary of State suggested that junior doctor rotas contributed to avoidable hospital deaths, but research shows that the most important factor is the number of patients under the care of each registered nurse. A 7% increase in mortality for every patient means that 36,000 nursing vacancies in England pose a real threat to patient safety. So with no announcement, and a 33% drop in applications since the removal of the nursing bursary, will the Government follow the Scottish Government’s policy and reintroduce the bursary?

The hon. Lady will be well aware that there are 14,000 more nurses in the NHS than five years ago, but she is right to point to the wider issue of long-term workforce planning. That is why she will be aware that Audit Scotland criticised NHS Scotland for its lack of long-term workforce planning.

As the Minister heard, the Scottish Government have just passed a law on staffing. With an ageing population, social care is critical to the function of the NHS, but the charity Independent Age says that we will be short of 700,000 care workers by 2037. With no extra funding for social care announced yesterday, how will the Secretary of State make caring a real profession? Would not it be good to start with a decent wage?

The hon. Lady’s supplementary question really reinforces the answer that I gave a moment ago: the essence of why we need a long-term plan is so that we anticipate these issues. We are addressing that through the Green Paper on social care, and that is part of the investment that the Prime Minister announced yesterday.

Yesterday the Prime Minister said that

“current workloads are not sustainable”—

is that any wonder after eight years of Tory cuts and austerity? The Minister knows that the number of health visitors in the workforce is falling, and that health visitors are vital to improving child health and wellbeing outcomes. No new public health money was announced yesterday; new money will come in 2020. Can the Minister guarantee that health visitor numbers will not continue to fall and that the public health budget will be ring-fenced?

I am grateful that the shadow Secretary of State has drawn attention to public health because the Government have been making significant progress in that area. We have the lowest ever number of teenagers smoking and the lowest ever teenage pregnancy rate. Binge drinking is down and we are addressing child obesity with the sugar tax, which is among a number of measures that the Government have been bringing forward. We are making progress on public health and the hon. Gentleman is right to draw that to the attention of the House.

This Government are breaking the Tory manifesto promise and raising taxes, yet they cannot even answer basic questions about health visitor numbers. The NHS workforce deliver the constitutional performance targets, including the 18-week referral-to-treatment target, and targets for accident and emergency and cancer treatment. Will the Minister reassure patients and the taxpayers whose taxes are going up that he will rule out dropping those essential targets?

Once again—as we heard yesterday—there is no welcome for the announcement of additional funding for the NHS. Opposition Front Benchers are playing politics and talking down our NHS. The Prime Minister has set out a long-term vision to improve standards and raise mental health, which Labour Back Benchers highlighted. The hon. Gentleman should come to the House and welcome that investment in our NHS.

Regional Health Inequalities

2. What assessment he has made of the effect of the level of funding for the NHS on regional health inequalities. (905913)

We take a comprehensive approach to reducing health inequalities, underpinned by legal duties. This includes addressing the wider causes of ill health, promoting healthier lifestyles, and tackling differences in health access and outcomes. A formula is used to allocate funding to clinical commissioning groups, and health inequalities form part of this.

Birmingham has some of the worst health outcomes in the country. It is not a surprise, as A&E waits of over four hours are up by more than 127% in recent years, and waits of more than 18 weeks for treatment are up by 65%. Yet, according to freedom of information request responses I have received, our trusts in Birmingham have to make savings of £155 million this year. What are the Government going to do to save the health system in Birmingham, which is currently in a state of collapse?

It is disappointing to hear the right hon. Gentleman making such negative points about his local NHS when 86% of GPs in his area are rated good or outstanding. Everything about yesterday’s announcement will tell Members that we are not complacent about the health challenges facing us, and we will make the necessary resources available. It ill behoves Opposition Members to keep continually talking down our NHS.

Does the Minister agree that the best way in which to reduce health inequalities across the country is to continue to build a strong economy that offers good jobs and prospects to all the people of our country?

I could not have put that better myself—[Laughter.] Opposition Members can laugh, but the Government firmly believe that work is good for people’s health. We are committed to getting 1 million more people with disabilities into work so that we actually treat them as assets, and we are encouraging them to be more independent and to take control of their own lives. The only way to achieve that is by having a strong economy.

When the coalition Government came into office in 2010, life expectancy began to stall for the first time in over a century. This, coupled with eight years of funding cuts, means that there are grossly disproportionate health inequalities across the country. For example, according to Northern Health Science Alliance, people in the north are 20% more likely to die early than people in the south. Is not it a failure of the Government’s funding deal for the NHS that it comes with no public health money to tackle these astonishing regional health inequalities?

No, it is not. Labour Members like to draw attention to north-south divides and so on, but the issues about health inequalities are much more complex than how money is spent and where. Within my constituency, for example, there are differences of 10 years in life expectancy depending on the particular locality. We need a much more multi-layered approach to tackling inequality, and that is what this Government will have.

Tier 2 Visa Cap

3. What discussions he has had with the Home Secretary on the effect of the tier 2 visa cap on recruitment in the NHS and social care sector. (905914)

In Oxfordshire, the situation with social care workers is at least as bad a problem. Of course we all very much welcome the removal of doctors and nurses from the cap, but what about social care workers? Why are we focusing on only half the problem?

Perhaps I can help the hon. Lady by pointing out that tier 2 visa cap is specifically for higher-paid workers. We do need to think about social care workers, but a lot of them are lower paid. That is why we are putting together a 10-year workforce plan for the health and social care sectors, both of which are very important. We will make sure that that goes hand in glove with the NHS plan that we announced yesterday.

The real effect of the cap is that there are not enough staff in the health service, as is shown by “NHS SOS”, a campaign run a few weeks ago in Stoke by The Sentinel that highlighted the lack of doctors and nurses. Realistically, what will the Secretary of State do to remedy that situation in Stoke-on-Trent? Will he meet people from The Sentinel so that they can present the evidence?

Let me tell the hon. Gentleman what we have been doing in the past five years: we have 14,300 more nurses, 10,100 more doctors, and over 40,000 more clinicians across different specialties. He will be very relieved to know that, on top of that, we are promising 50% more than his party did at the last election.

People with Learning Disabilities

4. What assessment he has made of the (a) quality and (b) availability of health and social care services for people with learning disabilities. (905915)

Commissioning high-quality health and social care services is a local responsibility. The Care Quality Commission monitors, inspects and regulates services that people with a learning disability may use. Where quality and safety standards are not met, it will take action.

The Association of Directors of Adult Social Services warned this week that social care services are on the verge of collapse. Despite the announcement of £20 billon yesterday, there was no mention of social care. Cuts of more than £7 billion have left hundreds of thousands of elderly and disabled people without adequate support. What specific measures are the Government taking to ensure that the elderly and disabled are receiving proper care?

Adult social care was mentioned yesterday, specifically in the news that we plan to bring together the way in which health and social care interoperate. We need more collaborative work between health and social care to reduce the amount of pressure that one puts upon the other. We have set out very clearly that we will produce a Green Paper later this year to address how we will tackle the challenges that we face in adult social care, and we will look at how we fund that.

Providers of day care services for people with learning disabilities are not currently subject to an inspection regime. Will the Minister consider bringing such services within the scope of the Care Quality Commission to reassure families about quality and safeguarding issues?

My hon. Friend is absolutely right to draw attention to the fundamental importance of being reassured that all services that are provided are safe and reliable. Since the CQC has been looking at services up and down the country, it has brought to them a level of transparency and, indeed, quality. We keep under review the services that it regulates, and this is certainly something that we can discuss with it.

Will the Government end uncertainty for people with learning difficulties who need social care by funding the historical liabilities associated with the sleep-ins crisis?

We are aware of concerns in the sector with regard to sleep-ins and we are looking very carefully at the options. We have been developing the evidence base very carefully. We have been engaging with the European Commission, the sector and other Government Departments.

Oxford Health NHS Foundation Trust recently won a bid under the Beyond Places of Safety scheme to put in place IT support for users of learning disability services. Is that not a very useful way of taking forward such projects?

My hon. Friend makes an excellent point. It is vital that when we look at how to move forward with both our health and social care services, we are able to capture all the latest technology to ensure that we improve the experience for all our service users.

Much of the health and social care for people with learning disabilities in Plymouth is provided by Livewell Southwest, a social enterprise. The new pay increases for NHS staff will not be mapped over to social enterprise staff, so when they merge back into the NHS, we risk a two-tier workforce. Will the Minister consider extending the pay increases to support those who work with people with learning difficulties in the social enterprise sector so that we ensure that everyone doing the same job is paid the same amount?

The hon. Gentleman makes an excellent point. It would be terrible to see a health and social care sector in which people doing the same work are valued differently, so I will look carefully at the point he raises.

Life Sciences and Medical Research

The life sciences sector is critical to the UK economy, which is why we support it with a £1 billion annual grant through the National Institute for Health Research.

What steps is my right hon. Friend taking to further life sciences in Scotland? Will he meet me to see what the UK Government can do to support the forthcoming International Environment Centre in Clackmannanshire in my constituency?

I am happy to do that. The life sciences industry is critical to Scotland, and Scotland’s role is critical to the UK. We all remember Dolly the sheep being pioneered in Edinburgh University, and last week’s announcement of a new centre in Renfrewshire is another good example of the great things happening in Scotland.

The use of big data and artificial intelligence in medical research has the potential to save hundreds of thousands of lives. Will my right hon. Friend consider setting up data hubs and support the full digitisation of patient records?

My hon. Friend is very knowledgeable about that area. We have announced the creation of a set of digital innovation hubs, and perhaps we can broaden those to turn them into the hubs that he thinks would be a good idea.

Getting new drugs approved more quickly would not just be a big boost for the life sciences and medical research sectors, but would help my constituents and others across the country with cystic fibrosis who desperately need access to Orkambi. They have been waiting for years; it is not good enough. Why can the Secretary of State not sort this out, get a grip, get his officials and Vertex in a room, and force them to come to an agreement? People have waited too long for this.

That is exactly what we have been doing, but we need Vertex to be reasonable regarding the price that it offers the NHS. We need to pay fair prices. We have heard that it will be coming back with a new offer next week—we hope it is a reasonable one—but we urge Vertex to waive commercial confidentiality so that we can all see, in the interests of transparency, the kind of prices it is trying to charge the NHS.

Will the Secretary of State consider West Yorkshire in particular? We have the universities, the science, the technology and the life sciences; all we need is a new teaching hospital in Huddersfield.

We have great teaching hospitals in Yorkshire and we have introduced five new medical schools. When we do the new workforce plan later this year, who knows? We may need more.

Further to the point made by the hon. Member for Dudley North (Ian Austin), we know that the UK is a world leader in research into rare conditions, but that does not always translate into timely access to those treatments. The Secretary of State will know that there are many CFTR—cystic fibrosis transmembrane conductance regulator—treatments in the pipeline that could benefit people who are living with cystic fibrosis. Will he meet me to see how we can ensure that those are available in a timely manner for the people who desperately need them?

Of course I am happy to meet my hon. Friend. I recognise that this is one of the things that we are not good at at the moment. We have fantastic research, with amazing new drugs developed in this country, but our uptake can be painfully slow, and that is of course something that we want to put right.

ME affects approximately a quarter of a million people across the UK, and while there has been substantial psychological research into the condition, there has been very little biomedical research. What funding will the Secretary of State make available specifically for biomedical research into the treatment and diagnosis of ME?

I am grateful to the hon. Lady for raising that issue. She is introducing a debate on it in Westminster Hall on Thursday. I have met a number of families who have suffered very badly as a result of ME, and we would all like better research, so I hope that her campaign is successful.

Sport: Public Health

There is a strong body of evidence on the health benefits of participating in sport— possibly not watching it, if last night is anything to go by. Last year, a review by Sport England brought together evidence to show the association between sport and physical and mental wellbeing.

As the Minister may be aware, I co-chair the all-party parliamentary group for golf—a sport sometimes labelled, rather unfairly, a good walk spoiled. Does he agree that there are many positive health benefits associated with participation in golf, especially for people with long-term conditions?

I certainly would, as someone who used to work in the golf industry before coming to the House. I was at Wentworth last month for the PGA, and a good example of what my hon. Friend refers to is a social enterprise that I met called Golf in Society led by an inspirational chap called Anthony Blackburn. He founded a project at Lincoln Golf Centre that works with people with dementia and Parkinson’s disease to show that golf is one of the best leisure activities out there, and gives people with those long-term conditions a sense that their life is not over and that they can still play golf, and play it rather well—probably better than me.

In 2016, Stoke-on-Trent was the European city of sport, but it faces some of the highest health inequalities in the country. The Stoke newspaper The Sentinel highlighted the power of exercise in its recent NHS SOS campaign. Will the Minister meet the editor Martin Tideswell and my hon. Friend the Member for Stoke-on-Trent Central (Gareth Snell) to receive details of that incredibly important local campaign?

I am aware of that campaign. Something that we want to see in schools across the country, including in Stoke, is the Golden Mile. I see good examples in schools in my constituency and across the country when I travel. We are interested to learn more about what Stoke has done on this subject.


7. What steps he is taking to ensure that homeless people are able to access healthcare and dentistry services. (905919)

NHS England has a legal duty to commission services to meet local need, which includes people who are homeless, and we are very clear that a patient should not be turned away from a GP if they cannot produce any supporting documentation. If they state that they reside within the boundaries for the practice, the GP is expected to accept the registration. The same applies for dentistry, and training is in place to remind people of their obligations.

Mags Drummond is a Walthamstow woman on a mission, to try to help our many rough sleepers get decent quality healthcare, but she, like me, has hit a brick wall with our local dentists and doctors. It is little wonder that one study shows that 15% of homeless people have pulled out their own teeth because they cannot get access to services. Will the Minister meet Mags and me to look at what we can do to change that and make sure that her promises are not toothless?

Very good—I commend the hon. Lady for her wit, and I agree with her. Notwithstanding our expectations of GPs and dentists in this regard, it is quite clear that homeless people do not always have access to the treatment they should have. The hon. Lady will be aware of the work that we are doing to support rough sleepers, and I would be delighted to meet her and Mags Drummond to see what insight they can provide on how we can improve services in this area.

Order. It is of the utmost importance that we are ready for the one-minute silence, so I shall take a brief inquiry from Mr Nic Dakin, and a brief reply.

There are homeless people in the Scunthorpe area who present with mental health problems. What are the Government doing to ensure that proper mental health support is there for people who present as homeless?

The hon. Gentleman is quite right. Mental health is both a symptom and a cause of homelessness, and we will tackle that as part of our work on rough sleepers.

Does anyone else want to come in on this? Apparently not. I do not wish to proceed to the next question because of the unpredictability of the time that it will take. Colleagues will want to prepare themselves for the one-minute silence that we are about to observe. I think I can say with some confidence that everyone who is in the House today will wish to observe that one-minute silence. Perhaps they will think it appropriate to stand. That one-minute silence is going to start very soon. The next question is grouped, so it would be highly inconvenient to take it. Any moment now we shall observe the silence. [Interruption.] There is much merit in repetition in certain circumstances.

Order. We shall now observe silence for one minute to remember those who died or were affected by the attack outside Finsbury Park mosque, I remind colleagues, a year ago today.

The House observed a minute’s silence.

Personal Health and Care Budgets

I know that the thoughts of the whole House are with the families affected by the terrible atrocity a year ago.

Personal health budgets have a transformative effect on people with very complex health needs, and we plan for 50,000 to 100,000 more people to benefit from them by 2021.

I thank the Secretary of State for that reply. Does he agree that a key part of integrating health and social care is giving individuals more say and flexibility in how they use their entitlements? Will he consider extending his pilots to my constituency of North West Norfolk?

Absolutely, and not just to North West Norfolk, but to the whole country. We are currently consulting on giving a right to personal health budgets to people with the most complex health needs. That would be about 350,000 people and would include anyone with a continuing NHS need combined with a mental health need, a learning disability, autism or PTSD. Obviously, it would be hugely significant if we were able to proceed with that.

Will the Minister ensure that the long-term NHS plan puts a major emphasis on empowering patients through the wider availability of personal budgets? May I also join my hon. Friend the Member for North West Norfolk (Sir Henry Bellingham) and make a pitch for my local area of Northampton for one of the next wave of pilots?

Absolutely, and technology will have a big role, because this year we intend all NHS patients to be able to access their health records through an app. That will be extremely empowering, but my hon. Friend is right that giving people with long-term conditions control over their health and care destiny is a potentially huge leap forward.

While I agree with the philosophy and approach behind health and personal care budgets, will the Secretary of State acknowledge that the 21% fall in social care funding between 2010 and 2015-16 has caused a catastrophe in this area? Will he acknowledge that if this approach is to work in future, the funding has to be there?

I congratulate the last Labour Government on introducing direct payments, which were the first step in this process. The hon. Lady talks about cuts in social care, which I acknowledge, but, with respect to her, she never talks about the reason, which was that in 2008 we had the worst financial crisis in our peacetime history, and we had to take measures. It is as a result of creating 3.2 million jobs since then that funding for social care is now going up.

Bearing in mind that the number of bed days lost increased in the second quarter of 2017-18, with most of the patients subject to delays being elderly people, will the Minister outline a dedicated strategy for getting people out of hospital and back home with appropriate care as a matter of urgency, for the good of the patient as well as the public purse?

This is a huge challenge in all parts of the United Kingdom. In England, about 22% of bed days are occupied by people who have been in hospital for more than three weeks, and probably less than 20% of those people should be in hospital. We are taking urgent steps to rectify that, because it is very, very bad for the patients involved.

Mental Health Workforce

The mental health workforce plan published last summer underpins our expansion of mental health services, as set out in the “Five Year Forward View for Mental Health”. We aim to create 21,000 new posts in mental health by 2021.

I thank the Minister for her response. Mental health is one of the many complex drivers of rough sleeping, and can add to the complexity of getting rough sleepers off the street and into accommodation. Will my hon. Friend say how the new mental health employees in the NHS can help us to get rough sleepers off the streets and into accommodation?

I hope the expansion of mental health services will stop people becoming rough sleepers in the first place by bringing forward support earlier in the process. In January, we announced a £1 billion investment in mental health, part of which will be focused on crisis care and helping people who are experiencing crisis to stay out of hospital. The workforce plan backs that commitment by planning 5,200 posts to support those in crisis. We will be working with the Ministry of Housing, Communities and Local Government on a forthcoming strategy to make sure we honour our commitments.

It is not just the size of the mental health workforce that is critical, but the pressures faced within those workforces. We have just learned that there was the highest number of out-of-area placements in January since records were first kept. Mental health doctors and nurses often spend hours hunting for out-of-area beds, taking them away from other patients. When is the Government’s pledge to reduce and eventually ban out-of-area placements actually going to start to become a reality?

The hon. Lady is right to raise this issue. We are determined to end out-of-area placements, but clearly that will require behavioural change on the part of commissioners, as well as making sure that the investment takes place. I know she will continue to hold me to account on this issue, because it is clear that out-of-area placements can cause harm and we must tackle them.

According to data from 48 of 56 NHS mental health trusts, 3,652 patients suffered an injury in 2016-17 through being restrained—the highest number ever. There are concerns that increased use of insufficiently trained agency and bank staff since 2013 is contributing to this increase. Employing 21,000 new staff by 2021 just is not good enough. What is the Minister doing now to ensure that wards are safely staffed and patients are not injured?

I am grateful to the hon. Lady for her question. She will be aware that I have been working with her colleague the hon. Member for Croydon North (Mr Reed) on his Bill to limit the use of restraint, because we on the Government Benches also very firmly believe in that. An essential part of his measure will be to improve training for staff in mental health units. That will be a tool in making sure that restraint is minimised.

Capital Investment Projects

23. What funding his Department has recently allocated to capital investment projects in the NHS. (905935)

Could my right hon. Friend indicate what implications that welcome statement might have for the much needed rebuilding and refurbishment of the A&E unit at the Queen Elizabeth the Queen Mother Hospital in Margate?

I hope it will have a positive impact. We are asking NHS trusts to get their proposals in during July. We are also delighted that there is a new medical school in Canterbury and we hope that this will be the start of a transformation of NHS services.

Earlier this year, Torbay and South Devon NHS Foundation Trust was allocated £13.3 million of capital funding for improved urgent care and a new emergency department at Torbay Hospital. Will my right hon. Friend confirm what progress is being made to get those major construction projects under way?

I think it will be brilliant not just for patients at Torbay Hospital but for patients living in Newton Abbot and Torquay. My understanding is that this project is on track, and my hon. Friend should be very proud, because he campaigned hard.

Warrington desperately needs a new hospital to replace its old, out-of-date buildings, so in allocating future capital funding will the Secretary of State bear in mind the levels of health deprivation that exist in the area, and will he ensure that any new hospital is accessible to those in my constituency, which has areas that are among the most health deprived in the borough?

I visited the hospital not too long ago and was able to see for myself some of the estate issues the hon. Lady talks about. I can assure her that need is a fundamental criterion when we look at allocating capital funding.

The Secretary of State knows that he has presided over a crisis in capital funding, with a £5.5 billion estimated maintenance backlog, £1 billion of which is classified as urgent. Yesterday’s statement hopefully goes some way to addressing that, although it was far from clear whether capital funding was included in that announcement. Can the Secretary of State confirm today whether any cash generated by the sale of NHS property under the Naylor review is in addition to the money announced yesterday?

Highly Specialised Technologies Evaluations

11. What recent discussions his Department has had with representatives of NICE on increasing the capacity of the highly specialised technologies evaluation process. (905923)

My officials have regular discussions with the National Institute for Health and Care Excellence, of course, but we are clear that there is no fixed capacity in NICE’s HST programme. The number of drugs that it evaluates each year is driven by the pipeline of drugs expected to come to market, and we will refer any suitable drugs to it for evaluation.

There is a risk that new treatments for life-limiting conditions, such as Duchenne muscular dystrophy and spinal muscular atrophy, might not be approved by NICE, so will the Minister meet me and Muscular Dystrophy UK to discuss ways to facilitate access to treatments, as highlighted by the charity’s FastTrack campaign?

NICE has recommended the drug Translarna for use in the treatment of Duchenne muscular dystrophy; it is now routinely available on the NHS. It is a disease that I grew up with—the friends that I grew up with did not, and I did, and this is a timely reminder of how terrible this disease can be. I would be really pleased, therefore, to meet the hon. Lady and the charity that she mentioned.

Is the Minister aware of the recent NICE draft review regarding treatment of abdominal aortic aneurysms? Some 1,500 to 2,000 lives are saved yearly by NHS AAA screening. If the draft recommendations are adopted, a patient is likely to have an aneurysm erupt before treatment and 80% of patients are then likely to die. Will the Minister look carefully at this issue to avoid this unintended consequence?

I am not the all-seeing eye, so all I can say is yes, I will look very carefully at the issue that my hon. Friend raises.

Community First Responders

Community first responders play a valuable role in helping ambulance services. Support includes ongoing training, necessary medical equipment and occupational health support.

In just five years, the Neilston and Uplawmoor first responders have responded to over 1,300 calls, saving many lives, and earlier this month they received the Queen’s award for voluntary service. Will the Minister join me in congratulating all the volunteers and paying tribute to community first responder units right across the United Kingdom?

I am very happy to join my hon. Friend in congratulating Stuart McLellan, Ross Nelson and the volunteers that play such a key role. I know that my hon. Friend the Member for Brigg and Goole (Andrew Percy) also performs this service in his constituency. I have spoken to him about it and I know that it plays a very valuable role.

Epilepsy Guidance (Autism)

14. What recent assessment he has made of the potential merits of including autism in NICE guidance on epilepsy. (905926)

NICE is currently in the early stages of updating the clinical guidelines on the diagnosis and management of epilepsies in adults, and plan to go out to consultation on a draft scope in October this year.

The UK’s autism research charity Autistica advises that up to 40% of people with epilepsies are, in fact, autistic, and that epileptic seizures are the leading cause of early death for autistic people with a learning disability. NICE guidance has never mentioned autism when referring to epilepsy, and autistic people have distinctive types of epilepsies that require different clinical approaches. Will the Minister please ensure that NICE includes autism in the guidelines on epilepsy?

At this stage, it is too early in the update process for NICE to say exactly what its guidance will cover. However, my right hon. Friend is chair of the all-party group on autism and vice-chair of the all-party group on epilepsy, and she was the driving force behind the Autism Act 2009. I think that NICE would do very well to heed her advice.

And that advice will be proffered on a very large number of occasions in this Chamber until the right hon. Member for Chesham and Amersham (Dame Cheryl Gillan) gets what she seeks—I think I can say that with not just confidence, but certainty.

Clinical Staff Shortages

15. What steps his Department is taking to support NHS foundation trusts to tackle shortages in clinical staff. (905927)

The workforce strategy we are bringing forward will include investment and an expansion in the number of medical schools— five new medical schools—alongside those 1,500 new doctor places.

I had wanted to ask the Secretary of State to get behind exempting nurses and doctors from the tier 2 visa process, but I do not need to do that; I just have to thank him for his support in doing that. Instead, for his next challenge, will he commit to looking again at the pensions cap, which I fear might be one reason some senior NHS professionals and doctors are retiring sooner than they might otherwise do?

I am grateful for my hon. Friend’s support on tier 2 visas. She will be aware that clinicians who reach the £1 million lifetime allowance limit can expect a pension of about £44,000, payable at age 60, increasing with inflation, plus a tax-free lump sum of about £132,000. Although these are ultimately issues for the Treasury, it is important that we ensure that tax allowances, two thirds of which go to higher-rate taxpayers, are fair to other taxpayers.

Innovative Drugs and Devices

16. What steps his Department is taking to support the use of innovative drugs and devices in the NHS. (905928)

The Government are committed to ensuring that innovative healthcare products reach patients faster than ever before. We have established the Accelerated Access Collaborative to identify transformative innovations and help their route to market, and today we have appointed Lord Darzi as the new chair of the AAC to lead this work.

I welcome the fact that the Prime Minister in her speech yesterday announced much more funding for personalised medicines and new technologies that will transform care. On that basis, will the Minister update the House on when the groundbreaking CAR-T— chimeric antigen receptor T-cell—therapy might be made available to NHS patients suffering from cancer?

Yes, indeed. As the cancer Minister, I consider CAR-T to be one of the most innovative and exciting treatments ever offered on the NHS. NICE is considering the first of the therapies this year and preparations are well under way. We are working closely with NHS England to make these transformative medicines available to cancer patients.

Patients with PKU—phenylketonuria—are awaiting progress on the approval of a drug called Kuvan. In the meantime, their illness is controlled by diet. Will the Secretary of State and other Members join me in Committee Room 21 after this meeting to hear about the “Diet for a day” challenge, which many Members across the House are taking up next Thursday?

Having just dialled into the Secretary of State’s diary, I know that he is going right after these questions.

Does the Minister have proposals for the reform of the Medicines and Healthcare Products Regulatory Agency? I hope so.

We keep all our arm’s length bodies, including the MHRA, under review to provide best value for taxpayers, and we are working closely with Lord O’Shaughnessy, who is the Minister responsible for this area.

Thank you, Mr Speaker. Probably the most important recommendation in the new O’Neill review into antimicrobial resistance was the requirement for diagnostics prior to the prescription of antibiotics by 2020. Will the Minister update the House on progress towards that goal, and will he agree to meet me and colleagues, including Lord O’Neill, to discuss the establishment of an antibiotic diagnostics fund?

Yes, the Government’s response to Lord O’Neill’s review in 2016 set out new ambitions building on existing progress, including ensuring that tests on epidemiological data are used to support clinical decision making and delivering high-quality diagnostics in the NHS in support of our other ambitions. My hon. Friend is right to raise this issue, and I am happy to meet him.

Childhood Obesity

We are delivering the most ambitious childhood obesity plan in the world, and we are already seeing results. We always said that our 2016 plan was the start of the conversation, not the final word. [Interruption.] Yes, it does say that here, but I have also said it everywhere else many, many times.

With one in three primary school children leaving either obese or overweight and more than 77% of children not doing the minimum requirement for physical activity, surely the Government’s priority should be getting children active by opening up school facilities after hours and in the holidays, not faffing around with political gestures on television advertising that children have long since stopped watching.

I do not think that it is a binary choice. We recognise that child obesity is caused by many different factors, and that no one policy will work on its own. Yes, this is about tackling advertising, and yes, it is about tackling children’s activity and working with schools; and, as I said recently, we will present new proposals very shortly.

As the Minister will know, perhaps the two biggest challenges that we currently face in relation to young people’s health are mental health and child obesity. Will he update the House on the progress of chapter 1 of his childhood obesity plan in reducing the amount of sugar in both food and drink?

Since we published the plan, progress has been made on sugar reduction. The amount of sugar in soft drinks has been reduced by 11% in response to the industry levy, and Public Health England has published a detailed assessment of progress against delivery of the 5% reduction for the first year. Progress is good, but it is not good enough, which is why we have said that we will produce chapter 2 shortly.

The Minister says that progress is not good enough, so why does he not introduce a levy on high-sugar food as well as the one on sugary drinks? Manufacturers would then reformulate the food that they produce.

Because we believe that there should be a mixture of carrot and stick. We believe that the soft drinks industry levy has been successful, but we are also working with the industry on reformulation across the board. I recently visited Suntory, which makes Lucozade and Ribena. If we work with industry, we see transformative results for companies and for the people who buy their products.

A few years ago, I initiated a debate on this issue in Westminster Hall. Since then, no progress has been made on childhood obesity. Would the Minister care to outline what he thinks will happen in the lifetime of this Parliament in terms of achieving the objectives that he has set out?

We assess the plan all the time, and we make progress reports on it, as we did last month with the sugar report. However, when I addressed the Health Committee recently, I could not have made it clearer that we think there has been progress.

This is a world-leading plan. When we talk to other people around the world, they are very keen to hear about what we are doing and very interested, and we are interested in learning from them. If we do not take action, one of our biggest public health challenges will get worse and worse, and that will have implications for the health service and for all our constituents.

Topical Questions

When something goes tragically wrong in healthcare, the best apology to grieving families is to guarantee that no one will experience the same heartache again. Last week I accepted the recommendations of the Williams review of gross negligence manslaughter, and we announced a new national clinical improvement programme to provide NHS consultants with confidential data on their clinical outcomes. From next April independent medical examiners will examine every hospital death, and the learning from deaths programme will be extended to primary care.

Will the Secretary of State encourage NHS England to respond to my freedom of information request of 13 March this year regarding Greater Manchester Shared Services and the likely failure of the NHS to correctly enforce guidance on recruiting agency staff in the reappointment of Deborah Hancox after her criminal conviction and two-year prison sentence for defrauding the NHS? How can we employ these people?

The hon. Lady has highlighted what is potentially an extremely serious issue. Obviously the FOI is a matter for NHS England, but let me reassure her that the Minister for Health, my hon. Friend the Member for North East Cambridgeshire (Stephen Barclay)—the hospitals Minister—met the chief executive of the NHS Counter Fraud Authority this morning.

T6. A recent report by the King’s Fund highlighted the potential for a hypothecated source of funding for health and care, with national insurance as a possible starting point. Does my right hon. Friend agree with the report that hypothecation would increase transparency in regard to what our constituents pay for health and care, and will he encourage the Chancellor to look at the report’s implications? (905943)

I thought that the report made powerful reading, and I know that my hon. Friend was associated with it. Yesterday the Prime Minister was straightforward about the fact that, if we are to preserve our NHS and make it one of the best systems in the world, the burden of taxation will need to increase, and she was willing to listen to the views of colleagues about the most appropriate way in which that should be done.

The Association of Directors of Adult Social Services has reported a £7 billion reduction in adult social care funding since 2010, and Age UK has reported there are now “care deserts” in some parts of the country. There are 1.2 million older people living with unmet care needs, and one in five care services has the poorest quality ratings from the Care Quality Commission.

As well as a long-term funding solution for social care, we need the extra £1 billion this year and £8 billion in the current Parliament that Labour pledged before last year’s general election. However, all that the Government offer is a delayed Green Paper. When will the Secretary of State deal with the current crisis in social care?

No, that is not correct. Yesterday we made very clear our support for the social care system and our recognition that reform of the NHS must go hand in glove with the social care system, and we said there would be a new financial settlement for the social care system. It is also time that the Labour party took some responsibility for the financial crisis that made all these cuts necessary.

T7. Prostate cancer survival rates may be at a record high, but it is still among the biggest cancer killers in our country today. What can the Government do to save more lives in this area? (905944)

Survival rates are high, but I am ambitious for more. That is why the Prime Minister recently announced £75 million to support new research into the early diagnosis and treatment of prostate cancer. We will recruit 40,000 patients into more than 60 studies over the next five years, and further to this even more exciting is the rapid pathway that I was discussing yesterday with Cally Palmer, our national cancer director, which we are trialling across three hospital sites in west London as part of its local cancer alliance.

T2. Given the challenges the Secretary of State and his Government face in recruiting and retaining health and social care staff, will he follow the example of the Scottish Government, who pay their social care assistants and care assistants the real living wage, meaning they earn £1,100 a year more than their counterparts in England? (905938)

May I gently remind the hon. Lady that it was this Conservative Government who introduced the national living wage, and we did that on the basis of transforming the economy, championing policies that were by and large opposed every step of the way by the Scottish National party?

The Minister of State visited my hospital trust last month. Is he in a position to support its requests, and will he say whether he is satisfied with the progress it is making to remove itself from special measures?

I very much enjoyed visiting the trust with my hon. Friend. As he will be aware from our discussion during that visit a process for capital bids is under way. As my right hon. Friend the Secretary of State set out, the date for that is mid-July and I look forward to seeing the bid from my hon. Friend’s trust.

T3. NICE guide- lines on IVF seem to be largely honoured in the breach, leading to a postcode lottery across the country. Is it acceptable that women in North Lincolnshire who cannot conceive are being refused IVF if their partner has had children in another relationship? (905940)

I recently met the hon. Gentleman’s party colleague, the hon. Member for Birmingham, Selly Oak (Steve McCabe), to discuss this matter with the facility. We are very clear: we expect all clinical commissioning groups to honour the NICE guidelines. I am very cross that CCGs tend to view IVF services as low-hanging fruit with which to make cuts. That is totally unacceptable and I will be taking steps to remind them of that.

My hon. Friend has visited Princess Alexandra Hospital in Harlow and has acknowledged that it is not fit for purpose. Will he use the excellent £20 billion of extra NHS funding to ensure we get the Harlow hospital health campus we need?

My right hon. Friend is right to champion this, as he did through the recent Adjournment debate, when he set out the case in more detail. We recognise, as we did at the last Health questions and in the Adjournment debate, that there are significant issues with the local hospital, and that is why it is working very actively on its bid for capital funding.

T4. Four months ago, a damning report exposed the extent of abuse inflicted on children for decades sent overseas by this Department. It said that compensation must be paid, and urgently, because people have died and others are dying. It took a month for the Prime Minister to work out which Department was responsible, and another month for the Health Minister, the hon. Member for Thurrock (Jackie Doyle-Price), to tell me she was formulating a response. Has she got a response today, or is she honestly going to stand at that Dispatch Box and tell me and all those survivors that the Prime Minister has spent £64 million of public money on a report that the Minister is now trying to bury? (905941)

I reject that accusation; we are far from burying it. The Prime Minister is looking at responding to the interim report. I will repeat what I said to the hon. Lady when she last asked this question. We are quite clear that the child migrant policy was wrong. We have apologised for that policy, and we have established a £7 million family restoration fund. The response from the Government to that report will be laid in due course.

Can the Minister provide an update on the work being undertaken by the policy research unit on obesity to consider the relationship between the many streams of marketing and obesity, and can he tell us whether the unit is looking specifically at childhood obesity?

The National Institute for Health Research—the policy research unit—is specifically looking at the impact of the marketing of products with a high sugar, fat or salt content on children’s food and drink preferences and consumption. The unit has already published a report on children’s exposure to television advertising, and it will be publishing further findings from other projects later this year.

T5. The Institute for Fiscal Studies says that there is no such thing as a Brexit dividend, so the Secretary of State will need to put up taxes to fund our NHS. Will he be transparent and promise NHS workers in Portsmouth, to whom he has only just given a pay rise, that the burden will not fall on hard-working families like them—or is he robbing Peter to pay Boris? (905942)

Will the hon. Gentleman be transparent, if he disagrees with the Brexit dividend, and challenge his own party leader, who supports it?

I am delighted that our NHS will be getting an extra £20 billion. This has long been at the top of my agenda, and the agenda of my constituents. Does my right hon. Friend agree that, to ensure that that money is always spent on the NHS, we need to consider a hypothecated tax as part of the funding plan?

As I say, there are compelling arguments in favour of hypothecated taxes, but there are also strong reasons why we have to be cautious—namely, the fact that tax revenues go up and down, year on year, while the NHS needs stable funding. Important arguments and discussions need to happen between now and the Budget, when the Chancellor will make that decision.

T8. In the light of the additional funding announced by the Secretary of State yesterday, will he tell me how much additional funding will be provided for palliative care, which I highlighted in my Terminal Illness (Provision of Palliative Care and Support for Carers) Bill? (905945)

I thank the hon. Gentleman for his private Member’s Bill. Palliative care is something that we do well in the UK—thanks, a lot, to the brilliant hospice movement—but we can do a lot better. I know that this will be an important part of the NHS plan.

Stroke is the fourth largest single cause of death in Britain. What action are the Government taking to prevent stroke and to raise awareness? And will the Minister meet me to discuss my GP surgery at Sutherland Lodge?

Two for the price of one. Up to 70% of strokes are preventable if hypertension, atrial fibrillation, diabetes, cholesterol and other lifestyle factors are detected and managed earlier. The current national stroke strategy came to an end last year, so we are working closely with NHS England and the Stroke Association on a new national plan, which I hope to publish this summer.

T9. One of the biggest causes of regional health inequalities is the broken social care system, yet yesterday’s announcement postponed social care reforms again until the autumn. There is no end in sight for the overstretched and underfunded social care system, and without reforms to care, the extra money for the NHS will be wasted. Will the Minister bring up the timetable for those reforms before the care system collapses? (905946)

The fundamental issue here is that we need a social care system that works hand in hand with our health services—the two are umbilically linked. The key plank of the new NHS 10-year plan must be the full integration of health and care services. It does not make sense to publish the Green Paper before the NHS plan has even been drafted. We will bring forward a Green Paper, but in the meantime, spending on adult social care has gone up by 8% this year.

Like many others, I welcome the announcement yesterday of the £20 billion investment in the NHS. Will my right hon. Friend join me in seeking assurances that the £2 billion extra for the Scottish Government shall be allocated to spending on the NHS in Scotland?

I sincerely hope so, because Scottish NHS patients are currently 30% more likely to wait too long for their elective care.

What comparison has the Minister made of the cost of preventing children and young people’s mental health issues by tackling adverse childhood experience in the first few years of life, rather than letting them develop into much costlier issues for school-age children?

The hon. Lady will be aware that there is much work going on in this area. We are clear that we need to tackle these issues in schools, which is in the Green Paper, but more support also needs to be given in the early years. We are looking at how we can do that.

Northern Devon Healthcare Trust recently announced that it is to share the chairman and chief executive of the Royal Devon and Exeter NHS Foundation Trust. Will the Minister meet me to ensure that the new arrangements will help to secure services in North Devon?

Last November, the Health Secretary committed to ending out-of-area mental health placements by 2020, but the number of people placed more than 100 km from their home rose by 65% over the past year. The earlier response from the Under-Secretary of State for Health and Social Care, the hon. Member for Thurrock (Jackie Doyle-Price), was no answer, so what are the Government actually going to do to turn the situation around?

There are record numbers of tier 4 beds, and we are putting record amounts of money into mental health.

Mr Speaker, you will recall recently granting me a Westminster Hall debate on the HPV vaccine for boys. Will the Department update me on progress?

I remember that debate. The matter was on the Joint Committee on Vaccination and Immunisation’s June agenda, and I am awaiting its advice with bated breath. As I said in the debate, I will turn that advice around as soon as I get it and get a decision. I know a lot of people are waiting on that.

Order. I am sorry, but we have run out of time. However, the person whom I think has been standing the longest is Rachael Maskell.

Thank you, Mr Speaker. NHS Property Services intends to sell the Bootham Park Hospital site, but reinvesting in that site would make such a difference to the health needs of our city. Will the Minister ensure that that happens?

I have met the hon. Lady, and she made her case in a characteristically powerful fashion. The matter is being looked at actively.

As I understand that the point of order flows from Health questions, I will take it if it is brief.

Very brief, Mr Speaker. Yesterday, the Secretary of State for Health and Social Care said that he would place the details of the funding settlement in the Library, but the paper has not yet been deposited. Mr Speaker, given the implications for higher tax and spending, will you use your good offices to ensure that that paper is deposited as soon as possible?

I dare say that it will be, but the Secretary of State has heard the hon. Gentleman and is nodding enthusiastically from his sedentary position, and I take the nod as an indication of good intent.

Forthwith. Splendid. The hon. Gentleman looks satisfied—at least for now.

We have an urgent question in a moment from Alison Thewliss. I advise the House that it is on an extremely important matter that warrants urgent treatment on the Floor of the House, but it does not warrant treatment at length. I do not intend to run it for any longer than 20 minutes, because there is other business to protect.