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House of Commons Hansard
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Oral Answers to Questions
24 July 2018
Volume 645

Health and Social Care

The Secretary of State was asked—

NHS Services: Online Access

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1. What recent progress has been made on providing patients with online access to NHS services. [906605]

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It is a great honour to be here, Mr Speaker.

There is good progress in patients using online services in the NHS—about a quarter of patients are now registered to access general practitioner online services, up from about a fifth a year ago—but there is much more to be done to use technology in the NHS for the benefit of patients and clinicians alike.

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I congratulate my right hon. Friend on his appointment. Healthcare delivered by app is increasingly popular with patients in Havant and across the country. Will my right hon. Friend reconfirm his Department’s commitment to the first ever NHS patient app, and update the House on the timetable for its roll-out?

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The roll-out of technology right across the NHS and, indeed, social care is good for patients and good for clinicians. I have seen countless examples of that in just my first two weeks in this job. I pay tribute to the Centre for Policy Studies report, which was launched by my predecessor and authored by my hon. Friend, which demonstrates how apps can be useful for making healthcare easier to access for patients. Apps are popular with patients, and I cannot wait to drive that forward.

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22. May I congratulate the Secretary of State on his new appointment? Another new technology that really matters is MRI scanners. We have had a big fundraising campaign in Bishop Auckland for ours, but the problem with such fundraising campaigns is that they are of course easier in wealthy areas than in poor areas. Will the Secretary of State pay attention to evening out this uneven distribution of resources? [906629]

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Yes, of course I will. I pay tribute to the hon. Lady for her work to raise funds for the MRI scanner in Bishop Auckland, which benefits from great levels of philanthropy in some areas. The whole purpose of having a national health service is that, wherever people live in the country, they can get high-quality healthcare, free at the point of delivery, according to need. I stand by that principle, and I honour it.

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I welcome the Secretary of State to his post. He will know that no regulator is prospectively examining the safety and effectiveness of diagnostic apps in use in the NHS. I wrote to his predecessor recently following concerns that were raised with me about Babylon’s apps, which could be missing symptoms of meningitis and heart attack, for example. What steps will the Secretary of State take to ensure that, as these technologies are rolled out, patients have can have absolute confidence that they have been properly evaluated for safety and effectiveness? Will he set out how he will take that forward?

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The Chair of the Health and Social Care Committee makes a really important point. There is no greater enthusiast for technology than me—as you well know, Mr Speaker—but the thing about new technology is that the rules sometimes need to be updated to take changes in technology into account. The response when there are challenges such as the one my hon. Friend raises is not to reject the technology, but the opposite: to keep improving the technology so that it gets better and better, and to make sure that the rules keep up to pace. I spoke to Simon Stevens at NHS England about this only this morning—we have had a series of conversations in the past couple of weeks since I have been in post—and he is reviewing this exact question. I am absolutely sure that we will get to the right answer.

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Is the Secretary of State familiar with the “GP at hand” online service? It is a partnership between a private company and a Fulham GP surgery, and it has poached thousands of profitable patients from GPs all over London, to the alarm of the British Medical Association and of GPs generally. My clinical commissioning group is investigating it, and in the meantime CCGs have blocked Babylon’s expansion to Birmingham on safety grounds. This is creating a two-tier system for GPs, so will the Secretary of State investigate it?

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I am acutely aware of the question that the hon. Gentleman raises, not least because I am a user of the Babylon service myself—it is my GP. The important thing is to ensure that the rules are kept up to date so that we can get the benefits of the new technology, but make sure that it works in a way that ensures everybody gets high-quality primary care.

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Warm congratulations to the Secretary of State.

Whether it is online consultations or more traditional, face-to-face ones, will the Secretary of State join me in thanking all the NHS staff who do fantastic work in taking care of my constituents in Chipping Barnet?

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I certainly will. I pay tribute to the NHS workforce and the social care workforce who, every day of their working lives, give up their time to serve their community, to serve their fellow man and woman, and to ensure that we have the healthiest nation we possibly can. I love the NHS, as does everybody in the House. Almost everyone is touched by the NHS at some of the most difficult times in their lives. I pay tribute to the workforce.

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I, too, welcome the Secretary of State to his new position. I note his intention to extend online NHS services, but I hope that he will provide more detail about how he intends to guarantee patient safety, given that the Care Quality Commission reported this year that 43% of online GP and pharmacy services are currently unsafe. Will he reverse the cuts to capital funding so that safe technology can be installed? Furthermore, what steps will he take to ensure that elderly and vulnerable patients, who find it difficult to access online services, will still have the certainty of sustainable community surgeries?

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Those are really important questions. On funding, I announced only last week £487 million to improve technology and technology services to ensure that they can be as high quality as possible. On patient safety, the key is to keep improving technology so that it gets better and better. On universal access, we must use technology in such a way that patients who want to access services through technology can do so, as that frees up resources so that more can be done for those who do not want to use technology, meaning that we preserve universal access.

Drug-related Harm

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2. What recent discussions he has had with the Home Secretary on policies to tackle drug-related harm. [906606]

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I attended the most recent cross-Government board meeting, which was held in June and chaired by the Home Secretary, to discuss the implementation of the drugs strategy. We know that drugs can devastate lives and damage our communities. The Government’s approach remains clear: we must do everything that we can to prevent drug use and support people through successful treatment and recovery.

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Given the recent statistics showing that drug-related deaths in Portugal are three per million, compared with the UK figure of 64 deaths per million, does the Minister agree that the UK Government should follow Portugal’s example and make drug policy reform a matter primarily for Health and Social Care, rather than the Home Office?

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The truth is that we work together. In July 2017, the Government published a comprehensive new drugs strategy, setting out what we think is a balanced approach that brings together the police, health, and community and global partners to tackle the illicit drugs trade, and to protect the most vulnerable in our societies who are struggling with drug dependency and help them to recover and turn their lives around. I know the hon. Gentleman takes a very different view, but that is our approach.

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My nine-year-old constituent is currently having up to 400 epileptic seizures every week, and his family believe that medicinal cannabis may be beneficial. Will my hon. Friend update the House on what progress is being made regarding the use of medicinal cannabis for epilepsy sufferers?

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Obviously, our thoughts are with my hon. Friend’s constituent. A two-part review is going on. In the first part, the chief medical adviser considered the evidence available for the medicinal and therapeutic benefits of cannabis-based medicinal products, and found conclusive evidence of the benefits of those products. Part 2, which will be led by the Advisory Council on the Misuse of Drugs, will provide an assessment, based on the balance of harm and public need, of whether we need to do anything regarding the misuse of drugs regulations. While the review is under way, we have established, as an interim measure, the expert panel of clinicians to advise Ministers on any licence applications from senior clinicians, which helped Alfie Dingley, for example.

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What action is the Minister taking with colleagues in the Home Office in respect of the drug Xanax, which is reputedly freely available at very low prices, and is more addictive than heroin? What action is he taking to raise awareness and deal with rehabilitation?

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We are very aware of this drug and its dangers. A few months ago, I responded to an Adjournment debate on the matter that was secured by the hon. Member for Enfield, Southgate (Bambos Charalambous). We are watching the issue very closely. I will find out some more details and write to the right hon. Gentleman. I know that he takes a close interest in this, and we will speak about it.

Maternity Care

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3. What steps he is taking to improve safety in maternity care. [906607]

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Our national ambition is to halve the rates of stillbirths, neonatal and maternal deaths, and serious birth-related brain injuries by 2015. We are working with our partners to implement the maternity safety strategy, and new data shows that the stillbirth rate in 2017 was the lowest since records began in 1927.

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Our three children were all born in periods of extremely hot weather. I ask the House to think of the families of Banbury who have to travel for up to an hour and a half or even two hours, if they are lucky enough to have their own car, to Oxford to give birth in a full obstetric unit. May I encourage the Minister, in her drive to ensure that maternity care is safe, kind and close to home, to ask the new Secretary of State to visit us in Banbury soon so that he can assess the situation for himself?

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I completely understand my hon. Friend’s concerns. She has been an incredibly strong advocate and campaigner on this very issue. As she knows, no permanent changes will be made until the work is carried out by the independent review panel, which is looking at attempts to recruit obstetric staff for her local services. I thank her very much for the offer of a visit; I am sure the Secretary of State will look at it very closely.

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Dr Neal Russell volunteered to help in the fight against Ebola. Today he has returned his Ebola medal in protest at the healthcare hostile environment for migrants caused by a new charging regime, which has led to vulnerable pregnant women here in the UK being too afraid to get maternity healthcare. Will the Minister suspend her Department’s charging regime, pending the completion of a thorough and independent public health assessment?

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That is incredibly sad news. We hate to hear of anybody who has done such incredible service in the pursuit of great healthcare around the world taking such drastic steps. We have an incredibly strong departmental ambition for NHS maternity to provide the safest, highest quality care in the world. That is something we will continue to aspire towards.

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The maternity unit at Harrogate Hospital is award winning due to the skills and compassion of its fantastic team. What action is my hon. Friend taking to encourage more people into maternity care and midwifery careers?

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The Department’s maternity safety ambition plans are to train more than 3,000 extra midwives over the next four years. As part of that, we will be working with our partners to develop new training routes to become registered midwives so that, along with other roles in the NHS, maternity and midwifery can attract the best and retain the most talented staff.

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According to the Royal College of Midwives, the national shortage of midwives is running at nearly 4,000 and is particularly acute in areas like mine in east London, with its very high property prices and rising birth rates. How does the Minister intend to address that?

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There are in fact 2,300 more midwives in the NHS than there were in 2010, but the hon. Gentleman makes a very good point. We want to continue to attract the best people into midwifery, which is why we are providing an extra £500,000 to the NHS to cover the clinical placement costs for 650 additional students in 2019-20.

Childhood Obesity

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4. What steps he is taking to reduce rates of childhood obesity. [906608]

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14. What steps he is taking to reduce rates of childhood obesity. [906620]

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We published the second chapter of our world-leading childhood obesity plan on 25 June. It builds on the progress we made since the publication of chapter 1 in 2016, particularly on the reformulation of products that our children eat and drink most. We will continue to take an approach that is based on evidence and we are determined to act.

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I warmly welcome the Secretary of State to his post. I am sure that he was as alarmed as I was to learn that the proportion of 11-year-old children who are obese is now greater in the UK than the US. What more can we do to educate children and their parents about the benefit of a balanced diet and healthy life start?

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I pay tribute to my hon. Friend’s work at the Department for Digital, Culture, Media and Sport on this matter. It is critical that we have a cross-Government approach. The obesity plan is led by the Department of Health and Social Care, but it is a cross-Government plan. There is a whole range of actions we need to take—from education through to culture and broadcasting—to make sure we get it right.

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One of the reasons why tackling obesity in children is so important is the fact that it has such long-term detrimental effects on health. Now that the Government have published chapter 2 of their childhood obesity strategy, will the Secretary of State outline how it will have a long-term impact on children’s health and tackle issues such as diabetes and heart disease?

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My hon. Friend is absolutely right that obesity, especially in children, is one of the underlying conditions that often leads to much worse long-term health conditions. Some 22% of children aged four and five in reception are overweight or obese; that number is too high and we have to act.

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I welcome the Secretary of State to his new post, which is one of the toughest jobs in Parliament. Having worked with him on other things in the past, I am sure that his energy will come through in the Department.

I have a vested interest in the welfare of young children as we are expecting our 11th grandchild in October. Will the Secretary of State look closely at the relationship between obesity in later childhood and the diet of mothers during pregnancy? Early research shows that there is a link, so will he look at it carefully?

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A veritable football team of Sheermans.

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I am sure that they will grow into that, Mr Speaker.

I pay tribute to the work that the hon. Gentleman has done, which I have watched with admiration from elsewhere. I will certainly look at the point that he raises, which is very important, and we will take a fully evidence-based approach.

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I, too, welcome the Secretary of State to his new job. Today’s figures show that levels of severe obesity in children are at a record high, so will the Government speed up their childhood obesity strategy to tackle this urgent public health challenge?

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We published chapter 2 less than a month ago. There is further work to do, because that sets out a whole series of areas in which we are going to take action, and I am already working on pushing it faster.

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I know that the Secretary of State has a track record of evidence-free, nanny-state policies from his time in DCMS. Can we expect more of the same in his new Department, or is he going to try out some Conservative principles, such as individual freedom, and individual and parental responsibility?

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I am delighted to see that the teamwork between my hon. Friend and I is going to continue. You might be surprised to know, Mr Speaker, that there are some things on which my hon. Friend and I agree. One is the importance of individuals taking responsibility—a critical part of public health and tackling obesity—supported by an enabling state.

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The Secretary of State is working extremely hard. I hope that he will take it in the right spirit if I say that I do not think he has yet quite secured the Shipley vote.

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Sarah, who runs the Devonport Live café in Devonport, one of the poorest parts of the country, used to provide cookery classes for local young mums, but she cannot do that anymore because of a lack of funding to provide the support, facilities and food to help young mums—especially those on low incomes—to get the skills that they need to cook healthy meals for their children. What support can the Secretary of State give to young mums and to people such as Sarah who want to provide cookery lessons to support tackling childhood obesity?

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The hon. Gentleman makes an important point. Funding is available from lots of sources, not just taxpayers. Nevertheless, he will have noted that I have already started talking about the importance of getting funding out into the community, whether that is through social prescribing or wider public health efforts, to make sure that we try to tackle health problems at source and keep people out of hospital as much as possible, rather than spending all the money on sorting things out later in hospital.

HPV Vaccine

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5. What assessment he has made of the potential merits of extending the provision of the HPV vaccine to boys. [906609]

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Our expert group, the Joint Committee on Vaccination and Immunisation, issued its final advice on HPV vaccination for boys on 18 July. I have carefully considered its advice, and I wanted to tell the House first that the Government will introduce a nationwide HPV vaccination programme for adolescent boys. This will bring clear health benefits for boys, providing them with direct protection against HPV infection and associated disease, including a number of cancers.

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I declare an interest as a very, very part-time dentist.

I am delighted by the response, but given the importance of head and neck cancer prevention for both sexes, but especially for males, who are twice as susceptible, will the Minister supplement this programme with a catch-up programme, as was done for girls in 2008, to make the vaccine available for 14 to 18-year-old boys?

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I thank my hon. Friend for welcoming this. The British Dental Association has been key in lobbying on this issue, as has—I give credit where it is due—The Mail on Sunday, which has campaigned on it for a long time. I have asked NHS England and Public Health England to work together to advise me on the implementation of the programme, including with regard to the issue that he raises, which makes a lot of sense and for which there is precedent from the girls’ programme. I will of course consider the advice and confirm the implementation plan as soon as possible.

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I congratulate the Minister on that announcement. The vaccine also plays its part in protecting against sexually transmitted disease. Will he saying something about the fact that syphilis is now at its highest rate since the second world war and that there are strains of gonorrhoea resistant to treatment? What are the Government going to do about this?

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They are linked but separate issues. Yes, the HPV vaccine is very important for adolescent boys, for men who have sex with men and for people before their sexual debut. Sexual health is of course a huge challenge. We work closely with local authorities—top-tier local authorities are all public health authorities—and, through the ring-fenced public health grant, which is £16 billion during this spending review period, we are providing those services.

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Cancer survival rates are now at an all-time high thanks to the brilliant and dedicated work of clinicians, including at Cheltenham General Hospital, but prevention is better than cure. Will the Secretary of State direct his customary energy towards prevention work, including vaccinations, but also tackling risk factors such as obesity?

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Yes, he will. I am pleased to say that prevention is one of the Secretary of State’s three key priorities. The HPV vaccine is a key prevention measure, while one of the drivers behind the child obesity plan was Cancer Research UK’s very clear advice that being overweight was one of the big risk factors, alongside diabetes, in cancer. Yes, prevention is always better than cure.

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I welcome the Government’s acceptance of the JCVI’s recommendation to extend the vaccination programme to adolescent boys, but the Minister will know that there are huge regional differences in the take-up of the vaccination among girls. What steps will he take to tackle these regional differences before and during the roll-out to boys?

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The shadow Minister is absolutely right to raise this issue, which she also raised with me in the Westminster Hall debate on the same subject introduced by my hon. Friend the Member for North Thanet (Sir Roger Gale), who has done a lot in this area. I have already spoken to Public Health England about this in respect of the girls’ programme, and I will be speaking to it again now that we have announced the boys’ programme, because the equality of doing the dual programme must be matched by the equality of its taking place in her constituency as much as in mine in Hampshire.

BAME Blood, Stem Cell and Organ Donors

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6. What steps his Department is taking to increase the number of BAME blood, stem cell and organ donors throughout England. [906610]

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We urgently need more black, Asian and minority ethnic donors to save lives through the gift of organ donation. That is a priority for the Government. Last week, I launched a national campaign to address myths and barriers and bring attention to the life-saving power of organ donation. It is crucial that these messages be properly tailored to enable everyone to participate.

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In 2017-18, only 1 33 people from the BAME community in this country donated an organ. While they are still living, BAME people make up a third of the people on transplant waiting lists and have to wait over a year longer than white patients. I know that the Government announced a new campaign, following NHS Blood and Transplant’s annual report on organ donation, within the BAME community, but it fails to address many of the recommendations in my report “Ending the Silent Crisis”, published in June. I sent a copy to the Minister, along with a request for a meeting, but I have yet to receive a response. Will she agree to meet me after the recess to discuss the recommendations in my review?

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I am sorry the hon. Lady has not received a response, because I instructed my office to say I would agree to meet her. I commend her work in this area, because it is very important that we tackle this injustice. Central to that is reaching out to those communities and engaging with them in a way that inspires them. We have found in our work over the last year that there is a sense of distrust among some minority ethnic communities towards health providers. I will be bringing out some tools in the autumn and would encourage all Members to reach out to their minority ethnic communities to tackle the fact that, as she says, a third of people on transplant waiting lists are from black and Asian communities and that we need more donors.

Adult Eating Disorders

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7. What steps he is taking to improve access to NHS adult eating disorder services. [906612]

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The Government are committed to improving eating disorder services for adults. The National Institute for Health and Care Excellence has updated its guidelines, and NHS England recently completed a national review of provision and is considering next steps. We will also be ensuring that people remain properly served as they transfer between children’s and adults’ services.

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Two thirds of adults wait more than four weeks and one third wait 11 weeks for treatment. What are the Government going to do about it, in the light of the review that the Minister has just mentioned?

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As I have said, NICE has published its new clinical guideline on the recognition and treatment of eating disorders in people over the age of eight, including adults, and we will make clear to NHS organisations what we expect of them. We are ensuring that we meet the waiting times for eating disorder treatment, and we are delivering against those standards.

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Data from NHS Digital show that the number of beds for people with serious mental health conditions, such as eating disorders, has fallen by nearly 30% since 2009. The Government say that they are committed to ensuring that everyone with an eating disorder has access to timely treatment, but according to the hon. Member for Central Suffolk and North Ipswich (Dr Poulter)—who I believe is also an NHS doctor—there is often a long wait for patients with eating disorders who need beds for urgent in-patient care. Does the Minister agree with him?

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The hon. Lady’s starting point was “since 2009”. It is certainly true that there was a decline then, for a number of reasons, not least the fact that we are improving treatment in community settings rather than acute in-patient beds. Our Five Year Forward View began in 2014, and we have been delivering improvements in the number of beds and staff since that date.

Leaving the EU

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8. What recent assessment he has made of the effect on the health and social care sector of the UK leaving the EU. [906613]

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The Government are undertaking a wide range of analysis in support of our EU exit negotiations and preparations. Our overall programme of work is comprehensive, thorough and continuously updated.

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Brexit poses major challenges for the NHS and, in particular, the beleaguered and neglected hospitals of East Kent. Can the Minister reassure me—and the Royal College of Midwives and other bodies—that we will be able to recruit much needed migrant worker staff to the health and social care sector and will encourage them to stay after March 2019?

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We will remain committed to attracting the brightest and best. The hon. Lady says that her area is “beleaguered”; I remind her that the Kent and Medway sustainability and transformation partnership received £101.2 million more than it received in the previous year.

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Nearly 10,000 EU citizens work in the social care sector, caring for some of the most vulnerable people in society. What steps is my hon. Friend taking to ensure that there will be no shortage of people working in that sector once we have left the EU?

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My hon. Friend has raised an extremely important point. The Home Secretary recently announced a settlement scheme to enable those staff from the European economic area to remain. However, it is also important for us not to scare EU nationals, and to point out that there are now 4,500 more non-UK EU nationals working in the NHS than there were two years ago, at the time of the referendum. There is often a sense that there are fewer, but that is not the case.

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20. The number of vulnerable adults in Newcastle is rising by 20% each year. The over-85 population is set to rise by 60% in the next decade, and additional cost pressures will mean £30 million in extra costs over the next three years. How is Newcastle City Council supposed to meet the adult social care budget, given the cuts that have been made in it? I ask the Minister please not to mention the adult social care precept, because it does not even begin to cover those costs. [906627]

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I would have expected the hon. Lady to welcome the additional funds that have been announced—not just the £2 billion for social care, but the extra £20.5 billion a year, in real terms, that will be delivered through the long-term funding settlement. Instead of criticising that funding, the hon. Lady should welcome the Government’s commitment to increasing funds for the NHS and ensuring that it remains fit for the future.

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Does my hon. Friend agree that one of the big benefits of our leaving the European Union is that we will not be sending billions of pounds a year to Brussels, and can instead spend that money on our health service, as per the new funding settlement?

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My hon. Friend is right to draw the House’s attention to the fact that there are a number of benefits from leaving the EU, not just in terms of the dividend to which he refers, but in terms of flexibility, for example in—[Interruption.] Labour Members do not seem to want to hear about the opportunities: opportunities on life sciences for example, in terms of getting medicines through in shorter timescales; opportunities on immigration; opportunities on professional qualifications; opportunities even on food labelling. It is important that we take those opportunities, as my hon. Friend says.

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I too welcome the Secretary of State to his place. Membership of the European Medicines Agency has enabled early access to new drugs for UK patients through a single Europe-wide licensing system for a population of 500 million. Can the Minister clarify whether it is still the Government’s intention to remain a member of the EMA, and perhaps explain why on earth they voted against the EMA amendment last Tuesday?

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As the hon. Lady will be aware, we accepted the amendment, and it is our intention to work as closely as possible on that as part of taking that forward—[Interruption.] To correct the—[Interruption.]

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Order. To be fair, it is a speedy correction.

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This is a near instantaneous correction, Mr Speaker, to recognise that what I should have clarified is that, following the vote in the House, it is our intention to work as closely as possible with that, and we recognise the point the hon. Lady makes.

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It is still rather hard to understand why the Government voted against it in the first place. There is no current associate membership of the EMA for the UK to re-join as a third country, so if it is not possible to stay in the EMA what is the plan to avoid delays of up to a year in the licensing of new drugs for UK patients?

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There are a number of things that can be taken advantage of. We can use the flexibilities we have in terms of assessments with shorter timescales so that we can prioritise UK drugs that are bespoke to the UK market. There will be opportunities as part of this, as well as our working closely with European colleagues.

NHS Workforce

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9. What steps he is taking to tackle workforce shortages in the NHS. [906614]

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17. What steps he is taking to tackle workforce shortages in the NHS. [906623]

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We now have more professionally qualified clinical staff working in the NHS: over 41,000 more since 2010, including over 14,000 more doctors and over 13,000 more nurses on our wards.

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The majority of NHS staff in Scotland will benefit from a 9% pay rise over the next three years; their equivalents in England will get a much lower increase, and we do not even know if the funding for that is secured. Does the Minister have any concerns that nurses in England may choose to relocate to Scotland where they could be paid almost £1,000 more and work for a health service whose Government actually value its work?

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It is interesting that the hon. Gentleman asks that question, because it is worth looking at some of the facts. Over the five years to 2017 health spending increased by 20% in England but by only 14% in Scotland. As a consequence, people are 30% more likely to wait 18 weeks for treatment in Scotland than in England, and the increase in the number of nurses and doctors in England has been higher than in Scotland. Perhaps the SNP should look at how we have been performing in the NHS in England and learn from that.

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In that case, perhaps the Secretary of State will join the Royal College of Nursing in welcoming the action by the Scottish Government to enshrine safe staffing levels and ratios in law. Given that there are over 36,000 vacant nursing posts in the NHS in England, when will he follow the Scottish Government’s lead and bring forward legislation on safe staffing levels?

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I have seen what has happened, and maybe the reason why the SNP has had to do that is that in England we have increased the medical workforce faster than in Scotland. When the performances improve in the Scottish NHS, we in England will start to take lessons, but until then I will concentrate on making sure we get the very best NHS right across the country.

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Barely two years after the shock closure of Deer Park medical centre in Witney, the people of Witney are now deeply concerned over the future of Cogges medical centre. Please will Ministers explain what they are doing to help with recruitment and retention of GPs in rural areas, and will the Secretary of State meet me to discuss the provision of GP services in our market towns?

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I or the Minister of State would be delighted to meet my hon. Friend. Making sure that our GP services are of high quality and can respond to the health needs in the local community is absolutely mission-critical to getting prevention right, and I hope that my hon. Friend’s insights will feed into the long-term plan to guarantee the future of the NHS.

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I congratulate the Secretary of State and remind him that when he tours the high streets of Britain he will find an increasing number of acupuncturists, herbal medicine practitioners, reflexologists, yoga practitioners and many more, and they all have one thing in common: none of them is available on the health service. Will he introduce a review that takes into account patient experience and practitioner experience?

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I pay tribute to my hon. Friend’s long campaign in this area, and I very much look forward to working with him on it to ensure that we get the right evidence-based approach to using all kinds of medicines and technologies for the benefit of patients.

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I welcome the new Secretary of State to his post. He has said that the whole workforce of the NHS and social care should have the chance to fulfil their potential, but the care workforce has an annual turnover of 27% and a vacancy rate of 7%, and, sadly, care staff learned last week that they would not even be paid the national minimum wage for sleep-in shifts, which will potentially drive even more people away from working in social care. Will the Secretary of State demonstrate the leadership that this Government have lacked on this issue and ask the Chancellor to change the regulations on the national minimum wage for sleep-in shifts, to show care staff that they matter?

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I value every person who works in the NHS and in social care, because everybody plays a part in improving the wellbeing and the health of the nation. I care deeply about that. On the question of sleep-in shifts, I saw the decision by the court and I have already had conversations with the Department for Business, Energy and Industrial Strategy, which leads on this regulation, to ensure that we can get the rules right for the future.

Alcohol Dependency

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10. What plans the Government have to improve support for the children of alcohol-dependent parents. [906615]

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Alcohol addiction has a devastating impact on individuals and their families, and it is unacceptable that children bear the brunt of their parents’ condition. That is why we are investing £6 million over three years to support vulnerable children living with alcohol-dependent parents. I pay tribute to the former Secretary of State and to the shadow Secretary of State for their leadership in making this happen.

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I thank the Minister for his answer, but this is obviously a much wider problem, affecting more than just the children of alcohol-dependent parents. Will he tell the House what more can be done to ensure that people in the wider community can access that kind of help?

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We are working on an alcohol strategy, which is being led by the Home Office, and I have spoken to a number of stakeholders in the last two weeks at the various roundtables I have been holding. On the question of alcohol-dependent parents with children, we are working through local authorities, which is important, but as part of the investment that I have mentioned, there is also £500,000 going into expanding the helpline provision for children who find themselves in this position. I have heard time and again when talking to children affected by this that being able to say that they are not alone in this is often a great place to start. The helpline will be very important in that regard.

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I welcome the comments made by the Public Health Minister today. I also welcome how open he has been to cross-party lobbying on this issue, including from my hon. Friend the Member for Leicester South (Jonathan Ashworth), the shadow Secretary of State. The £6 million is welcome news. Just to put it in perspective, more than 4,000 children phone Childline each year about alcohol use—it is the biggest concern that children have about their parents when they ring that service. We have something in Doncaster called the Family MOT—Moving On Together—and I hope the Minister will take the opportunity to see some of the good practice that is going on around the country. Will he tell us more about how that £6 million is likely to be spread around the country?

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I probably cannot do all of that without trying Mr Speaker’s patience, but I should like to thank the right hon. Lady, who is one of my predecessors, for the work that she does through the all-party parliamentary group on children of alcoholics, and with the charity Adfam. Charities and other third sector organisations will play a key part in putting in bids to work with local authorities, as part of the £6 million. Public Health England is leading on that, and I look forward to having ongoing discussions with her and with other Members who I know have a deeply held personal interest in this matter.

Pregnancy: Smoking Rates

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11. What steps he is taking to help reduce the rates of smoking during pregnancy. [906616]

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Smoking rates are at their lowest ever, but we need to make more progress on tackling smoking in pregnancy, as I outlined in the general debate last Thursday. We are determined to redouble our efforts in this area, because smoking is still the biggest preventable killer in our country today.

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I thank my hon. Friend for his answer. Smoking rates among pregnant women are still stubbornly high. What steps can he take to encourage the partners of pregnant women to give up smoking so that both partners play a part in preventing damage to the unborn child?

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My hon. Friend makes a good point, which he made in last week’s debate. Public Health England and NHS England will continue to work with local areas in our constituencies to promote evidence-based ways of identifying and supporting pregnant smokers to quit. The overall ambitions in the tobacco control plan, which I published a year ago last week, will touch the general population, which of course includes the partners of pregnant women.

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Has the Department carried out investigations into the effects of vaping during pregnancy? If so, what are the results?

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Vaping and e-cigarettes were part of the Stoptober campaign that we ran last October through Public Health England. I am often criticised for not promoting vaping enough, and I am sometimes criticised for promoting it too much, which possibly gives me a steer. The advice is clear that the best thing to do, whether someone is pregnant or otherwise, is not to smoke.

Mistakes in Healthcare

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12. What steps his Department is taking to support families and patients affected by mistakes made in the healthcare system. [906618]

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Families and patients are at the heart of our work to improve patient safety, which is why all NHS organisations are subject to a statutory duty of candour and should be open and transparent with patients and families when things go wrong. Last week, the National Quality Board published new guidance for NHS trusts to help them better support, communicate and engage with bereaved families and carers.

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I thank the Minister for that response, but since I was elected three years ago I have come across several examples of families who have lost loved ones who went to hospital for repeat interventions from the health service, yet died from undiagnosed conditions, many of which could have been avoided. The problem is that those families have found getting answers and finding anyone to accept responsibility fruitless, so what more can the Department do to help them?

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My hon. Friend is right to raise that issue. Those who have lost loved ones in that way need answers when things go wrong. The recent bereavement guidance is clear that, when notified of a death, families and carers should be told that they can comment on the care of the person who has died and raise any concerns. From next year, medical examiners will offer greater scrutiny for the bereaved, increasing transparency and offering them the opportunity to raise concerns.

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In a recent report, Healthwatch Greenwich drew attention to the fact that many local GP practices are still wrongly refusing to register patients, often vulnerable ones, unless they have ID or proof of address. What more can the Minister do to ensure that each and every GP practice is following the Department’s guidance?

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I am grateful to the hon. Gentleman for that question, and I will certainly look more closely at the issue.

Draft Human Fertilisation and Embryology Act 2008 (Remedial) Order

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13. What assessment he has made of the extent to which the draft Human Fertilisation and Embryology Act 2008 (Remedial) Order 2018 meets his Department’s policy objectives on equality. [906619]

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The revised remedial order laid last week addresses the potential inequalities that were identified by the Joint Committee on Human Rights, but it also goes further, ensuring that a sole applicant biologically related to the child will always be able to apply for a parental order regardless of their relationship status. That is a step forward for equality.

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On behalf of the all-party parliamentary group on surrogacy, I thank the Minister for meeting us recently and for laying the order, which removes an inequality. Surrogacy helps to build families, be they heterosexual, same-sex or individuals, so what more can she do to promote it?

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My hon. Friend is right. There has been considerable growth in surrogacy arrangements in recent years, but I am unsure whether the law has kept pace with the changing practice. We have been revising the guidance to ensure that everyone can approach the matter with greater certainty but, more specifically, I have commissioned the Law Commission to have a good look at the law in the area so that we can ensure good practice in this country without driving people overseas.

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What action is the Minister taking to ensure that the National Institute for Health and Care Excellence guidelines on equal access to IVF are adhered to, so that people such as my constituent Rebekah Hambling, who sadly lost her IVF baby to group B strep, are not denied further rounds of IVF in North East Lincolnshire because they would still have been eligible in other CCG areas?

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I agree with the hon. Lady. It is unacceptable that seven CCGs offer no IVF treatment at all, which is establishing a postcode lottery. We keep reminding NHS England and CCGs of the NICE guidelines and we expect them to follow them.

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I call Bim Afolami. Not here. This is a rum state of affairs. I hope the fellow is all right. He was here earlier, but he has beetled out of the Chamber at a most inopportune moment. Well, there is nothing to be done, and the grouping breaks down, but I hope Bim’s okay. Reports would be welcome.

Cancer Strategy

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16. What steps the Government are taking to ensure that the recommendations of the cancer strategy will be implemented by 2020. [906622]

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I, too, hope my hon. Friend the Member for Hitchin and Harpenden (Bim Afolami) is okay.

Saying that gave me a crucial few seconds. [Interruption.]

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It is very good of the hon. Member for Hitchin and Harpenden to drop back in on us. Unfortunately, he beetled out of the Chamber at a most inopportune moment, just before his question was reached. If he sits there, and if he is a good boy, we might get to him in due course. We have moved on now, which is most unfortunate.

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We are very clear that achieving the 62-day standard is not a prerequisite for transformation funding, but the better the performance against the standard, the more funding alliances will receive. Most have now received 75% to 100% of the funding requested. This is taxpayers’ money, so we must ensure alliances are operationally strong and ready to achieve transformation.

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I welcome the new Secretary of State to his post.

There remains the inconvenient truth that, despite all Governments bombarding the NHS with process targets in recent decades, cancer survival rates are not catching up with international averages. The last Government’s estimates suggested that that needlessly costs 10,000 lives a year as a result. Will the Minister work with the new Secretary of State, in drawing up the next cancer strategy, to put outcome indicators at the very heart of the process? For example, holding the local NHS accountable for its one-year figures would encourage initiatives to promote earlier diagnosis, cancer’s magic key.

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I thank my hon. Friend for his work chairing the all-party group on cancer over many years, as I know he is about to step down. He has two answers in one here. Yes is the answer. Improving cancer patient outcomes will be the seam that runs through the centre of the NHS’s long-term plan, like the proverbial stick of rock.

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Only 5% of the NHS cancer budget, about £385 million a year, is spent on radiotherapy, and that underinvestment is affecting patient access to advanced modern radiotherapy and outcomes. Is it not time to make the cancer drugs fund a cancer treatment fund and extend those opportunities?

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We are looking at the future of the cancer drugs fund as part of the new 10-year plan. There is a radiotherapy review at the moment, as the hon. Gentleman will be aware. Knowing him, he will be engaging with the review in his area. He talks about the latest radiotherapy and, of course, we have the new proton beam therapy treatment coming online in London and Manchester, for which children and patients are currently sent overseas. That is a great step forward, but there is an awful lot more to do, which is why the 10-year plan will have cancer at its heart.

Artificial Intelligence

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18. What assessment he has made of the opportunity for artificial intelligence tools to improve the provision of healthcare. [906624]

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The Government believe that artificial intelligence and other digital technologies have the potential to transform health and care services. Our work on that includes investing over £400 million in tech transformation, which I announced last week. There is much more to do.

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I also welcome my right hon. Friend to his new role. He will bring tremendous energy and enthusiasm, particularly into the information advantage that we know is needed to transform the NHS. Does he share my view that not only will this transform patient outcomes but we can use artificial intelligence to improve patient treatments? What are his initial views of the obstacles standing in the way of rapid uptake of such technologies?

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There are huge opportunities for AI to improve patient outcomes and to make life easier for staff. In answer to the second part of my hon. Friend’s question, it is all about getting interoperable data rules and standards in place so that different systems can talk to each other in a secure, safe and innovative way.

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rose—

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When we were at university together there was nothing, in my judgment, about the hon. Gentleman’s intelligence that was artificial.

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Thank you, Mr Speaker. It is not just artificial intelligence. The development of other life sciences and new technologies can have a massive effect on improving people’s healthcare, such as the development of treatments like Orkambi for people with cystic fibrosis. Will the Secretary of State make it an important priority to cut through the impasse between NHS England and the manufacturer, Vertex, so that people with cystic fibrosis can finally get access to the drugs they need?

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As the Clerk advises—his is the intellectual copyright—the hon. Gentleman has used his intelligence artificially to shoehorn his preoccupation into a question to which it has no other relation. But he has got away with it on this occasion, as it is the last day and we are all in a summer mood.

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I welcome the power of new technologies to bring new drugs to the table. NHS England has made a very generous final offer to the manufacturer of Orkambi. Having spoken to those involved again over the past couple of days, I understand that a meeting has been offered to the company but not taken up. The company can break this impasse by accepting the very generous offer on the table.

Children's Mental Health: Social Media

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19. What steps his Department is taking to help protect children’s mental health from the harmful effects of social media. [906625]

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Our chief medical officer is leading a systematic review of international research to improve our understanding of social media use and children’s mental health. We are also working with the Department for Digital, Culture, Media and Sport to consider what more can be done to reduce potential harm to children’s mental health from social media. This is being done through the Government’s upcoming internet harms White Paper, which is due later this year.

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The longer people spend online, the more likely they are to experience cyber-bullying. Research by Childline, a service of the National Society for the Prevention of Cruelty to Children, shows that the number of young people seeking counselling as a result of online bullying has increased by 88% in just five years. What are the Government doing to improve research on this issue and to better understand the potential harms?

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My hon. Friend is right to highlight this, but it is worth bearing in mind that there are also positive effects from engagement on social media. The relationship between social media use and its impact on mental health is not conclusive. That is why the chief medical officer is carrying out a review of all the evidence in this area, so that we can understand and shape future policy. That report will be due next year.

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The Government acknowledge that we are seeing an increase in the number of children suffering with their mental health. We have only to look at the figures on the number of children turning up at accident and emergency in a crisis to know that that is the case. This is a serious state of affairs. Why then are the Government releasing their response to the consultation on the Green Paper on young people’s mental health later this week, when we are in recess, and thus avoiding scrutiny in this House?

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Respectfully, I say to the hon. Lady that this is a response to the consultation on the Green Paper, which has had considerable debate in this House. The suggestion that we have avoided scrutiny really does not pass.

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Thank you for calling me, Mr Speaker; news of my death has been greatly exaggerated, Sir.

I thank the Minister for her previous reply. She will be aware that there is considerable concern about certain images on social media, particularly those relating to self-harming, and the effect they have on young people’s mental health. Will she set out the Government’s response in dealing with this issue?

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I know the hon. Gentleman, who has returned to the Chamber in rude health, is in fact deeply grateful to me for my generosity in accommodating him, notwithstanding his rather eccentric disappearance, and the fact that he did not mention it was a mere oversight.

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I can confirm that the Government will be publishing their online harm White Paper by the end of this year to address the very subject my hon. Friend mentions.

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I have asked the previous Secretary of State whether he would agree to engage in my all-party group inquiry on social media and the impact on young people’s mental health. May I ask this Minister to go a step further and engage in our oral evidence sessions, which are starting when the House returns in September, about how we can find solutions to the problems that the impact of social media causes to young people’s mental health?

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I would be more than happy to engage with the hon. Gentleman and the all-party group on this issue, because it is important we do as much as we can to learn and to get as much evidence as possible in this area.

South Tees CCG

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21. If he will ensure that funding for services commissioned by South Tees clinical commissioning group will not be reduced as a result of that group being placed in special measures. [906628]

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I reassure the hon. Lady that the level of funding allocated to South Tees CCG will not change as a result of the group being placed in special measures.

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I appreciate the Minister’s reply, but does she agree that, instead of dismissing this as a failure of bookkeeping, as her colleague in the Tees Valley has done, she should look carefully again at the rising demand in our area and at the unique challenges we face as a result of high levels of deprivation, ageing demographics and the economic shock we suffered three years ago? Will she look again at a fairer funding allocation to make sure that we can serve everyone’s needs in the Tees Valley?

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The hon. Lady is absolutely right to raise this issue. Prevention is a key aspect of the new Secretary of State’s focus as the Department moves forward. NHS England will support all CCGs that are in special measures to return to financial balance. It also provides a bespoke package of support, along with a higher level of monitoring and oversight, to ensure that the money is always spent wisely.

Topical Questions

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T2. If he will make a statement on his departmental responsibilities. [906632]

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We have proposed £20 billion more funding for the NHS to guarantee its future, and I am looking forward to working with everyone in the NHS and the social care system on a long-term plan to ensure that that money is well spent. Today, we have published for the House the 2018-19 pay settlement for doctors and dentists. It represents the highest pay settlement since 2008. I regard it as a first step and look forward to a wider conversation on pay and improvements to help to make the NHS the best employer in the world.

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Will the Secretary of State update the House on the progress of Baroness Cumberlege’s review of the use of mesh implants? Will he confirm whether the inquiry will liaise with the Scottish Government and whether it will hold any evidence sessions in Scotland? There are plenty of women, including some in my constituency, who had operations in England but now live in Scotland. Their voices must be heard in the inquiry.

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Yes, the hon. Gentleman is absolutely right. We published information on this issue just last week. We absolutely will consult the Scottish Government and all interested stakeholders. It is a very important matter to get right.

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T5. Last year, 7.3 million people were prescribed antidepressants, including more than 70,000 children. That is an increase of more than 500% in the past 20 years. In welcoming the Secretary of State’s announcement on social prescribing, may I, as co-chair of the all-party group on mindfulness, ask him what part mindfulness and other evidence-based non-drug options will play in the strategy? Would he like to undertake a mindfulness course, and in doing so join the now more than 150 other MPs and Lords who have done so at Westminster? [906636]

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I would be absolutely thrilled to. I have previously participated in mindfulness training. In fact, the former chairman of my local Conservative association became a mindfulness instructor, which shows how much we take it seriously locally. I pay tribute to my hon. Friend’s work on this issue. He will have seen that, even in my first two weeks in this role I have already spoken out in favour of moves towards social prescribing and the broader prescribing of less intervention and less medicinal methods, where possible, because medicines do of course have their place. The work that he has done on this issue over many years is to be applauded.

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I welcome the Secretary of State to his post. May I take a moment to thank all the NHS and social care staff who are caring for vulnerable patients in this intense summer heat?

The new Secretary of State inherits waiting lists at 4.3 million, with more than 3,000 patients waiting more than a year for an operation. He inherits a situation in which 1,700 patient requests for hip and knee operations have been refused, and in which patients in Sussex are now expected to endure “Uncontrolled, intense, persistent pain” for six months before they receive hip or knee treatment. Does he consider such increased rationing to be fair?

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I am grateful to the hon. Gentleman for his welcome. Like him, I pay tribute to the work of NHS and social care staff in this summer heat. There are of course pressures on the NHS—I fully acknowledge that—and he raises a couple that I have already raised with NHS England. What he did not mention was that since 2010 there are 6,000 more operations every day and 1,800 more emergency admissions every day.

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Since 2010, the NHS has suffered the biggest financial squeeze in its history, and the rationing that I referred to is a consequence of that squeeze.

Let me ask the Secretary of State about general practice, which he will know is facing a severe workforce crisis, with GP numbers down by 1,000 and many GPs worried about the patient safety implications of the Babylon app, which we have already discussed this morning, and its funding implications for their model of practice. When Babylon itself admits that it is still testing it out, when Hammersmith and Fulham CCG says that

“there is evidence of concern regarding the risk to patient safety”

of expanding the service, and when Birmingham and Solihull CCG questions whether Babylon can operate in an effective and safe manner, why does the Secretary of State dismiss concerns about patient safety and say that the rules simply need to be updated? Will he tell us what specific rules will be updated to allay concerns about patient safety?

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It is almost as if it was not just my hon. Friend the Member for Hitchin and Harpenden (Bim Afolami) who popped out, but the shadow Secretary of State, who obviously was not here for the earlier discussion. Getting more resources and increased resources into primary care and to GPs in particular is absolutely mission critical to the long-term sustainability of the NHS. I am delighted that there is record GP recruitment at the moment and that the work that has been done to increase GP training is bearing fruit. On the question of new technology, as we discussed over a series of questions earlier, yes, it is important to make sure that it works well and that the rules are right but, if we turn our backs on new technology, we are turning our backs on better care.

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I congratulate my right hon. Friend on his new position. Despite having incredible NHS staff, our hospital in Harlow, the Princess Alexandra Hospital, is not fit for purpose in terms of its building. We desperately need a new hospital. Will he visit Princess Alexandra Hospital as Secretary of State and will he please make sure that we get the new hospital that we urgently need in the constituency of Harlow?

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I pay tribute to the work that my right hon. Friend has done over many years making the case for his hospital, which I have heard loud and clear. I always enjoy visiting Harlow, especially when I am his guest. I hear the case that he puts and look forward to visiting soon.

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T3. Last month, a constituent contacted me about the care of her adult son who needed to be admitted to hospital under the Mental Health Act 2007. She was told that no beds were available anywhere in the country. The following day, a bed was identified but when, after three hours’ wait, the ambulance had not arrived, the bed was filled by another patient. Three days later, he was finally admitted to hospital. The head of mental health at Nottingham City Council told me that this is not an infrequent occurrence. Secretary of State, how is this an acceptable standard of mental healthcare? [906633]

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Clearly, the sequence of events that the hon. Lady has outlined is completely unacceptable. We have obviously set out clear expectations on NHS England to commission sufficient beds to enable local placements where possible and specialist care where a more acute service is required. It is up to NHS England to ensure that sufficient services are commissioned and I will readily take up that case with NHS England.

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I welcome my right hon. Friend to his new position.

On Friday, a retired NHS consultant visited my surgery to talk about carpal tunnel syndrome. It appears that some of the operations are not going to happen now, and he said that they can happen at general practice level for about a third of the cost that they happen at hospital level. Is there an opportunity, yes, to save money but also to do things better by moving surgery out to community facilities? Can we explore such opportunities before these decisions are taken?

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My right hon. Friend raises an important point about ensuring that procedures are done in the right place at the right cost, but primarily in a way that is best for the patient. I am happy to meet her to discuss the specifics of that and to see whether a change can be made.

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T4. Despite previous reassurances from Health Ministers, I continue to receive reports from constituents of waiting times for referrals to child and adolescent mental health services in excess of nine months and, with an extremely high threshold for support, many are turned away. The Government spend less than 1% of the NHS budget on children’s mental health. When will the Department stop failing our children and gives CAMHS the investment that it desperately needs? [906634]

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The hon. Lady will be aware of the proposals that we have in the children and young people’s mental health Green Paper. We have very ambitious plans to roll out a whole new workforce to work in schools to support children at an earlier stage of mental ill health. Why we have these proposals is that we readily admit that an insufficient number of children are able to access services at present, and that is why we are making this investment.

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My constituent, Aaron Winstanley, from Barton-upon-Humber is currently in Germany receiving immunotherapy treatment for a rare form of cancer. The local community has reacted magnificently, raising around half of the £300,000 that this treatment costs. Could the Minister outline what is being done to introduce this treatment into England?

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I wish my hon. Friend’s constituent well and pay tribute to the money that the local community has raised. I will connect my hon. Friend to the office of Cally Palmer, the national cancer director. As we write the new long-term plan for the NHS—to which the cancer stream is so central—we will ensure that innovative new technologies and treatments that were not thought of even a few years ago are also at its centre.

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T6. Three times more people die by suicide each year than in road accidents. Today, Samaritans volunteers across the UK are taking part in its awareness campaign, “The Big Listen”. What action is the Secretary of State taking to ensure that local agencies are encouraged and resourced to carry out awareness-raising work to get out the message that suicide is preventable, not inevitable, in line with NICE’s draft guidelines? [906638]

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I thank the hon. Lady for her dedicated work on this issue. She is right to pay tribute to the work of the Samaritans, and the Department is pleased to do everything that we can to support the Samaritans in this area. Our real tool for tackling suicide is to ensure that the local suicide prevention plans are up to spec to deliver a reduction in suicides. We will be taking steps properly to interrogate the quality of the plans so that we can deliver against the guidelines.

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I welcome the Secretary of State to his position, especially given his background in data and digital. What is he going to do to improve NHS data management to enable its use to develop the next generation of drugs and medical technologies to deliver better health outcomes?

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That is a great question. Not only can technology improve in health settings; there are even greater opportunities on the research side. Getting the data structures right is mission critical, but there is so much more that we can do.

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T7. To help to reduce childhood obesity, 76% of people support a ban on junk food adverts before 9 o’clock, but the consultation on this is going into the middle distance. Critics would say that the Government are dragging their feet. By when will we see this ban finally put into place? [906639]

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We announced that we will be consulting less than a month ago. I have been closely involved in this in my previous role, as well as in this one. We will ensure that we take an evidence-based approach, but I am determined that we proceed.

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Will the Secretary of State come down to East Sussex to view the Better Together partnership, which puts health and social care together?

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How could I say no? The integration of health and social care is vital and long awaited, and there is so much to do.

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As someone who is about to have a knee operation, may I tell the Secretary of State that it is a painful thing to wait for and that people should not have to stay on waiting lists for long periods of time? My question is about hospital medical staff. Western Mail carried out a survey to look at the effect of EU nationals leaving the national health service because of Brexit. It found one health board saying that there were 1,200 more nurses than there were four years ago, and another saying that there were 1,400 fewer. No one seems to be able to tell us with absolute certainty the numbers of these staff in the health service.

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I listened carefully to the right hon. Lady because she has long been a campaigner on health issues, and I very much take her point about knee operations. Of course, the number of EU nationals working in the NHS in England has risen by over 4,000 since the referendum. I know that there are concerns in specific areas, but I hope that we can all take reassurance from the fact that that number has continued to rise. We are determined to ensure that the NHS has the workforce that it needs.

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I welcome the Secretary of State to his place. I encourage him to visit the most rural part of England, up in Northumberland, to see for himself the challenges to healthcare provision due to the lack of a real rural financial formula. Will he update my constituents and the Save Rothbury Hospital campaign on how the review for that community hospital is going? That sort of low-level care is what makes the difference.

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I am happy to discuss with my hon. Friend how we provide support. Addressing the fact that 43% of patients in acutes do not actually clinically need to be in hospital is a key objective of the long-term plan to ensure that we get the right community services and relieve pressure from acutes.

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I am sorry, but as in the national health service—under Governments of whichever colour—demand massively outstrips supply. I have tried to extend the envelope, but we must now move on. [Interruption.] I heard the shadow Chancellor’s observation from a sedentary position, which may well be recorded in the Official Report. We now move on to the urgent question.