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Oral Answers to Questions

Volume 648: debated on Tuesday 23 October 2018

Health and Social Care

The Secretary of State was asked—

NHS Innovation

14. What plans the Government have to improve access to innovative treatments and technologies in the NHS. (907222)

We are bringing a tech revolution to the NHS to improve patient outcomes and reduce waste. Today I am delighted to announce the selection of the first batch of products under the accelerated access collaborative, as well as funding for tech test beds to ensure that more patients get faster access to the most effective innovations.

I am grateful to the Secretary of State for his answer. Will he expand further on the recent announcement of the wave 2 test beds project and how it could deliver better outcomes for my residents down in Cornwall?

The tech test beds programme is about ensuring that we have units around the country that will support local collaborations between the NHS, tech companies and academia to harness new technologies right across the land, including—and no doubt—in Cornwall.

The National Institute for Health and Care Excellence has so far declined to recommend the new drug Spinraza, despite its ability to transform the lives of patients such as my young constituent Matilda Jamieson, who suffers from type 3 spinal muscular atrophy. As NICE meets today to finalise the guidance, will my right hon. Friend assure me that he will work with the manufacturers, NHS England and NICE to ensure that patients such as Matilda can benefit from that drug?

I pay tribute to my hon. Friend for making that case so powerfully. We work very closely with NICE, which is rightly the objective decision maker that makes recommendations for Ministers to follow about what drugs should and should not be accessed through the NHS. He makes the case very strongly.

This question is about innovative technology in the health service. What is the Secretary of State saying today to scientists? For example, 97% of people from the Francis Crick Institute say that our science and our bioscience are in danger because of Brexit. What is he going to do about technology that is suitable for the health service?

The scientists, like me, want a Brexit that is based on a good deal for the UK, and that is what we are seeking to deliver. In any case, we have put more money into the science budget than ever before, so no matter what the outcome of the negotiations, there will be more support for science in Britain.

One of the innovative technologies is the new production and distribution system for flu jabs for the over-65s. Is the Secretary of State aware that this technology is breaking down? In my constituency and elsewhere, there are doctors and pharmacists who simply cannot get hold of stocks, which leads to potential pressures in hospitals. Will the Secretary of State investigate and take action if necessary?

Having a flu jab is incredibly important, and I hope that Members on both sides of the House have taken the opportunity to do so, including the right hon. Gentleman, with whom I enjoyed working for many years. We have a phased roll-out of the flu jab, making sure that we get the best flu jab most appropriately to the people who need it most, and of course we keep that under review.

Digital health tools, including decision-support software, have a great potential to increase the quality, safety and cost-effectiveness of care for patients, and nowhere is that more important than in reducing antimicrobial resistance. Will my right hon. Friend respond to the points that we on the Health and Social Care Committee make in our report about the variation in roll-out, which is wholly unacceptable, and what measures will he take to make sure that it is clear where the responsibility for this lies?

I pay tribute to the Select Committee for the report on AMR that was published yesterday. Of course, digital tools such as the one that my hon. Friend mentions are important in making sure that we make the best use of antibiotics and counter antimicrobial resistance as much as possible.

If we have a “technological revolution”, in the words of the Secretary of State, surely that depends on capital investment, but that has been cut by £1 billion. For example, we have the lowest numbers of CT and MRI scanners on average in the OECD, hospitals are reliant on 1,700 pieces of out-of-date equipment, and the hospital repair bill now stands at £6 billion. If austerity has ended, can he tell us when this maintenance backlog will be cleared?

Unlike with the failed national programme for IT, we are delivering modern technology in the national health service. That is underpinned by a record commitment of £20 billion extra for the NHS over the next five years, accompanied by a long-term plan that will show how we will support the NHS and make sure that it is guaranteed to be there for the long term.

But I asked the Secretary of State about capital budgets, not revenue budgets.

Innovative technology can play a role in prevention, but so do public health budgets. With health inequalities widening, infant mortality rising in the most deprived parts of the population, rates of smoking in pregnancy remaining higher than the EU average and child obesity levels getting worse, will the Secretary of State commit, alongside an investment in technology, to reversing the £700 million of cuts to public health, or is the reality that his promises on prevention are entirely hollow?

I am afraid that the hon. Gentleman has it slightly muddled up, because technology does involve capital investment, but it also includes revenue investment to ensure that the service element of any technology can continue to be delivered. Maybe he should have another look at how technology is delivered these days. Alongside the capital budget, we have record spending on the NHS to ensure that it is there for the long term. Of course public health is an important element of that, and there has been £16 billion for public health over this spending review period because it really matters.

Childhood Obesity

This June we published chapter 2 of the childhood obesity plan, which built on the world-leading measures we introduced in 2016 and included bold plans to halve childhood obesity by 2030. Our consultations on banning energy drinks and on calorie labelling are now open. Later this year we will be consulting on promotion and marketing restrictions, including suggestions of a 9 pm watershed.

The feedback that I receive locally in Waveney is that childhood obesity needs to be tackled by Government Departments, clinical commissioning groups, medical centres and councils working together, whether in schools or by encouraging breastfeeding and the preparation of weaning foods. Can the Minister confirm that he is pursuing such a multi-agency approach?

I can, and the plan covers many Departments, which was why I recently announced the trailblazer programme to support innovative local action with local authorities. That has the commitment of key policy teams across many Departments to support participating councils to harness the potential of what they can do and learn from others.

One in five children in Greater Manchester are classified as overweight or obese, but Prospect Vale Primary School in Heald Green is just one of the schools in my constituency that are getting on and getting moving through the Daily Mile campaign. Will the Minister join me in welcoming that initiative, which brings daily fun and fitness into schools? As more and more adults use wristbands to help them to get fit, what consideration is being given to the use of technology, such as in the UK Fit Kids programme?

Like my hon. Friend, I pay tribute to Prospect Vale. I have many similar examples in Winchester. We absolutely recognise the importance of physical activity in tackling obesity, which is why as part of chapter 2 we are promoting a new national ambition for all primary schools in England to adopt an active mile initiative.

This Government are investing heavily in school sports through the school sport premium. For instance, the money raised from the soft drinks industry levy—the sugar tax—is going directly to supporting schools’ investment in sports, for instance through the Daily Mile campaign, which has just been mentioned.

Scotland’s diet and healthy weight delivery plan contains specific recognition that breastfeeding can be a means of preventing obesity. Will Ministers engage with the all-party group on infant feeding and inequalities to see what more can be done in England through early breastfeeding to prevent children from becoming obese later on in life?

Yes, and I am a big supporter of breastfeeding—I have supported it a lot in my constituency, and we engage regularly with the sector. I will be interested in any proposals that the hon. Lady has.

NHS: Value for Money and Efficiency

Having committed an additional £20 billion in real terms, the Government are asking the NHS to deliver a long-term plan that includes continued improvements in productivity and efficiency, and we are reinvesting the savings in improved patient care.

I congratulate my hon. Friend on his drive to recycle more hospital equipment such as zimmer frames, crutches and wheelchairs, but what steps is his Department taking to encourage more hospitals such as Southport Hospital in my constituency to run recycling programmes to reduce waste in our NHS?

I am keen to work with my hon. Friend to encourage Southport and other trusts to recycle equipment. I know from my family’s experience that it causes significant frustration when people see hospitals not collecting perfectly good medical equipment that could be recycled. I am keen to work with him and with trusts to ensure that we learn from that.

Digitising patient records and removing outdated technologies such as fax machines can improve productivity and patient care across the NHS. What steps is my hon. Friend taking to prepare the NHS for the fourth industrial revolution?

I commend my hon. Friend for his excellent report for the Centre for Policy Studies, which highlights the opportunities provided by technology. I was at a Scan4Safety event last night, looking at how barcodes are being used at six trusts, and at how that could be expanded to deliver 4:1 efficiency savings and improve patient care through the safety it offers.

Does the Minister believe that the practice of cutting funding to hospitals that miss A&E targets helps to improve the patient experience at those hospitals? Will he agree to meet me to discuss how this issue has affected Leighton hospital, which serves my constituents?

The hon. Lady may have missed our recent announcement of significant additional funding, ahead of winter pressure, to assist hospitals. As the Secretary of State announced, the extra £20.5 billion real-terms increase is part of a wider commitment to support our hospitals.

Jack Adcock’s death was a tragedy, but why did the General Medical Council spend £30,000 on getting Dr Hadiza Bawa-Garba struck off, even though she had already faced the consequences of her mistakes in court? Does the Minister think that the GMC needs to sort its act out and that Charlie Massey should resign?

As the right hon. Gentleman will be aware, Professor Norman Williams looked at the circumstances of this case and produced a report on it for the Government. As a part of that, we are looking at a number of factors.

Is the Minister aware that in terms of value for money and efficiency, the Government of India’s integrated health Ministry has half a million ayurvedic doctors and a quarter of a million homeopathic doctors? At a clinic I visited recently in Karnataka province, four fifths of the patients who would have normally gone to see a western doctor were treated by those local doctors. Will he build links with the Indian Ministry of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy?

I pay tribute to my hon. Friend for the longevity and sincerity of his campaigning on these issues. He draws attention to the wider point of how patients presenting with multiple and complex conditions need to be treated in multiple ways, and what he refers to is a part of that wider discussion.

NHS England is being ripped off to the tune of £230 million a year as the price of some off-patent drugs and non-standard preparations, or specials, have been hiked up hundreds of times, for example to over £1,000 for a bottle of pain-relieving mouthwash. In Scotland, specials remain in-house to keep the price down, but a year and a half on from the Health Service Medical Supplies (Costs) Act 2017, why have the Government not used its powers to stop this drug racketeering?

The hon. Lady, very astutely and correctly, identifies the issue, which is how we ensure value for money from specials. Indeed, I commend The Times for highlighting a number of these issues. We are looking at this area. As we commit an extra £20 billion in funding to the NHS, our commitment is to ensure that we derive value for money from that investment. That applies to specials, too.

The healthcare market in NHS England is estimated to cost £5 billion to £10 billion a year and involves 2.5 million nursing hours a week being wasted on non-clinical paperwork. Does the Minister not recognise that this is the biggest inefficiency? Will he commit to reversing the disastrous marketisation of NHS England?

Again, the hon. Lady draws attention to my work on driving productivity improvements within the system, which looks at a range of efficiencies such as sending texts and emails, dealing with missed appointments and the use of green energy. We can implement a whole range of initiatives as a part of that agenda.

As the first port of call for patients with often minor ailments, community pharmacists can really help to improve the efficiency of the NHS by taking pressure off GPs. What plans do the Government have to support and enhance the role of community pharmacists?

My hon. Friend is right to draw attention to the valuable role played by pharmacies. This is part of a wider education campaign within the NHS and increased access to clinicians, such as through 111, is another component of that. We want to ensure that rather than people’s first port of call being a GP, they access the NHS and pharmacies at the appropriate time.

At the end of the last financial year, trusts owed the Department a staggering £11 billion. NHS providers say that this is locking some trusts into

“a vicious circle of inevitable failure”,

and the King’s Fund says that there is no prospect of them ever repaying. Trusts with the biggest debts are forced to pay the highest levels of interest. How can the Minister expect trusts to be efficient when they are paying an interest rate of 6% on debts to his Department?

As it happens, I will be at an event with NHS providers—chief execs—this evening, when I am sure that this will be one of a number of issues that we will discuss. The hon. Gentleman is right to draw attention to the very high private finance initiative costs that many trusts face due to contracts signed under the previous Labour Government. That is a real pressure faced by many trusts.

Global Mental Health Summit

This month, we hosted the world’s first ever global ministerial mental health summit. Over 60 countries were represented, and they were united in the ambition to achieve equality for mental and physical health. The legacy of the summit will continue, with the baton now passed to the Netherlands, which has committed to host next year.

At the summit, I hope that the Government were applauded for appointing a Minister for suicide prevention. Will my right hon. Friend reflect on the fact that many people contemplating taking their life end up in A&E or in police stations, and will he look at James’ Place in Liverpool? That non-clinical centre catches young men in particular, who are very often the victims of this problem, and deals with their mental health issues.

Part of the purpose of having a cross-Government suicide prevention Minister is to bring together all these issues. I pay tribute to the work of James’ Place and its founder, Clare Milford Haven. We are spending £30 million of taxpayers’ money to increase the number of health-based places of safety for people experiencing a crisis, and I look forward to working with my hon. Friend on that.

No, the question has been grouped. The moment is now; the chance is here—let us hear from the hon. Gentleman.

Thank you very much.

It strikes me that every person in this Chamber, every one of our constituents and every household across the country will have been affected by the issue of suicide, whether among family, friends or colleagues. The causes of suicide are multi-faceted—there are so many, including mental health—so I welcome the new ministerial responsibility. Will my right hon. Friend clarify precisely what the role will entail in government?

I very much agree with my hon. Friend. The role will be cross-governmental. It will involve working not only across national Government, convening the policies that need to be pulled together from various Departments’ responses to support people in crisis and to reduce suicide, but with local government, which has responsibilities here.

Suicide prevention plans have to be a key element of any mental health strategy, yet the Government are not monitoring the effectiveness of those plans or ensuring that they are fully funded. Will the Secretary of State commit to ensuring that the plans that are put in place are effective and that local authorities have sufficient funds to implement them properly?

The hon. Lady is right to draw attention to the need to ensure that funding for mental health services has parity with that for physical health services. Getting there is the work of a generation. We did not even measure access to mental health services until this Government brought that in, and we are working towards parity.

The Secretary of State boasted to the global ministerial mental health summit about the Government’s plans to recruit 21,000 more staff to the mental health workforce by 2021, but he did not tell the summit that by the end of May this year, nearly 25,000 mental health staff—one in eight of the workforce—had left the NHS and that fewer than 1,000 extra staff had been recruited by March, equating to just 0.5% of his target. Does he really think that he is in a position to lecture the rest of the world?

I welcome the hon. Lady’s commitment to this area. Clearly it is very important to have the workforce in place. As she said, we are making progress, but we still have more to do. As far as the international approach is concerned, the response to the summit was that many countries came together, because collectively we all face the same sorts of challenges. I am in absolutely no doubt that the leadership shown by some countries, including the UK, is warmly welcomed.

The links between poor mental health, suicide and gambling addiction have been made clear to the Health and Social Care Committee. In that regard, will the Secretary of State make it clear to the Treasury that many across the House want to make sure that action on fixed odds betting terminals is taken forward so that we can have good results in the areas of mental health and suicide prevention?

My hon. Friend knows my personal strength of feeling about tackling the scourge of fixed odds betting terminals. The links between gambling addiction and mental health issues—and indeed, directly to suicide—are clear in the evidence, and we must address them.

My constituent David contacted me after his 18-year-old son became severely mentally unwell and needed emergency treatment. His son spent four days in A&E at the local hospital because no in-patient beds were available. This is not a one-off case: on a daily basis, mentally unwell people are being failed by our health service. When will the Secretary of State take meaningful action to fund mental health services properly and stop this scandal?

I am glad that, like me, the hon. Lady cares so much about getting this right. The long-term plan, which we are writing with the NHS, for how we will spend the £20 billion funding increase is where we can get these details right. Access to mental health services was not even measured before. The first step was to put the measurement in place, and now we can act on that measurement with the huge increase in funding coming to the NHS.


5. If he will ensure that NHS England enables NHS trusts to provide advanced radiotherapy treatment. (907212)

Yes, we are fully committed to ensuring that the most innovative cancer treatments are available to patients on the NHS. Since 2016, the radiotherapy modernisation programme has seen £130 million of new investment to ensure that all new equipment is capable of delivering advanced radiotherapy.

I thank the Minister for that reply. May I point out how effective advanced radiotherapy is against many cancers affecting the soft tissue? I must declare an interest as a beneficiary of the treatment myself. The latest NHS research shows that treating prostate cancer with 20 treatments of advanced radiotherapy is far better for patient outcomes and would save the NHS more than £20 million a year, but the current tariffs system disincentives trusts from saving this money, as their income is based on the number of treatments. Will the Minister meet me and representatives of the all-party group on radiotherapy to discuss how we might address this anomaly and improve treatments?

It is good to see the hon. Gentleman in his place and looking so well—I am glad we looked after him well. He is absolutely right that access to advanced radiotherapy treatments is critical, as is getting them against the key standard. I would be very pleased to meet his all-party group and discuss its manifesto for radiotherapy.

The hon. Lady was standing. She has changed her mind. All right, never mind. We can always have another go later.

A&E: West Midlands

6. What assessment he has made of the effect of the planned closure of Telford Hospital’s A&E department on other A&E departments in the west midlands. (907214)

The planned temporary overnight closure of the Princess Royal Hospital’s A&E in Telford is necessary to ensure that patients continue to receive safe care. The Shrewsbury and Telford Hospital NHS Trust is working closely with colleagues in neighbouring provider trusts and the ambulance service to develop plans for key clinical pathways to minimise the impact.

The proposed closure of Telford A&E would pile even more pressure on New Cross Hospital in my constituency. If the Government will not step in to stop the closure, as it sounds is the case from the Minister’s answer, will they give New Cross the resources it needs to recruit upfront the nurses, doctors and other staff they need so that patients do not have to suffer longer delays?

The current modelling suggests that about 11 ambulances will be diverted from the Shrewsbury and Telford Hospital NHS Trust between the hours of 10 pm and 8 am during closure. Of the patients who go to Wolverhampton, any admitted as in-patients will return to Shrewsbury and Telford and any who are discharged will be discharged from Wolverhampton.

The chief executive of Royal Wolverhampton NHS Trust says that the closure at Telford is the result of bad planning and could have been prevented. Does the Minister agree it is wholly unacceptable that my constituents’ safety should be put at risk by a preventable closure that is the result of bad planning by management, and will he do all he can to ensure that the hospital management have the help they need to properly run our hospital and properly plan for the needs of our community?

First, may I pay tribute to my hon. Friend, who has campaigned assiduously on behalf of her constituents? She has lobbied me and the Secretary of State and made her case very powerfully to NHS leaders. There has been progress: three additional consultants have been hired and attempts made to recruit middle-ranking doctors to the trust, including from neighbouring trusts. We are making a significant capital investment in the Shrewsbury and Telford Hospital NHS Trust, and these changes must be seen in the light of that.

No, no; Yorkshire is the most marvellous place, but it is a considerable distance from the narrow ambit of the question, from which the Minister did not stray. The ingenuity of those Members will be served later in our proceedings.

Health and Social Care Hubs

Health and social care hubs are a great example of health and care systems coming together through sustainability and transformation partnerships and integrated care systems to transform services in local areas. The NHS long-term plan will set out how we will enable and encourage better integration.

The Minister will know that Plymouth is leading the way in developing health and social care wellbeing hubs. She will also know that we have bid for £15 million of funding to create more hubs across the city, especially in our city centre, to bring together NHS dentistry and dental schools, sexual and mental health support, social care and new forms of general practice. Will she do all that she can to look positively on that bid, so that we can help to improve our health outcomes?

I am really pleased that the hon. Gentleman has raised this issue. Plymouth is indeed leading the way in creating hubs and showing how incredibly valuable they are in bringing together all the relevant services in one place, not only to tackle people’s current healthcare needs but to play a vital role in prevention.

Health and social care hubs provide a real opportunity to ensure that patients are cared for in the right place, and it is vital for that to be extended to those who need palliative care. Can the Minister confirm that the NHS 10-year plan will adequately address the need for equal and appropriate access to palliative care across the country?

My hon. Friend is absolutely right to mention this. Palliative care is crucial to the experience not only of patients but of their families and carers. He will be interested to know that we have a new indicator from 2018-19 to measure the proportion of people who have had three or more emergency admissions in their last 90 days of life, which will help us to assess how people can be better supported in the community, and to do that better.

24. Social care hubs could be part of the way forward for social care, but, in response to a recent survey of care providers in my constituency, 71% said that despite the best efforts of staff the quality of care had greatly diminished because of years of chronic underfunding. Does the Minister agree that we need a systemic change in social care funding, given that the extra money provided so far is a drop in the ocean and does not address levels of need? (907232)

The hon. Lady is right. We know that the adult social care system is under pressure, which is why we are setting out a more sustainable future in the Green Paper which will be published later this year. It is, however, important to point out that more than 83% of adult social care providers are rated good or outstanding, and that, thanks to a range of Government actions, County Durham has received an additional £37 million for adult social care in 2018-19 and was allocated £2,822,376 in the recent winter funding announcement.

Cancer: Early Diagnosis

Britain is world leading at treating cancer when it is discovered, but we do not diagnose it early enough, so we will radically overhaul our screening programmes, roll out rapid diagnostic centres for people with early symptoms, and expand mobile lung screening units. Our ambition is to ensure that three quarters of cancers are diagnosed at stage 1 or 2 by 2028, up from half today.

May I first highlight the excellent Guy’s Cancer Centre at Queen Mary’s hospital in Sidcup, a state-of-the-art facility which offers local cancer patients treatment closer to home? Secondly, can my right hon. Friend provide any detail on how the NHS long-term plan will improve cancer services?

Yes. Focusing on early diagnosis will help to save lives. Indeed, the cancer survival rates have never been higher than they are now. About 7,000 people who are alive today would not have been had mortality rates stayed the same as they were in 2010. However, we want to use the most cutting-edge technologies in order to save more lives.

In respect of early screening, how does my right hon. Friend expect the measures that he has introduced to move the service forward in the way that we want to see?

Absolutely central to this is ensuring that we address cancer at the earliest possible opportunity. The earlier the diagnosis is made, the greater is the likelihood of survival, so we want to see more cancers diagnosed earlier across the board.

22. At the start of October, which is Breast Cancer Awareness Month, my local hospital, Stepping Hill, had to shut its doors to breast care patients in my constituency, because its two-week urgent waiting times had risen to five weeks owing to chronic staff shortages and underfunding. What will the Secretary of State do to improve outcomes for constituents like mine who cannot access those services? (907230)

The announcement the details of which I have just set out comes with £1.6 billion of the £20 billion uplift we are putting into the NHS written into the long-term plan, so the funding is there to deliver on this policy, too.

The Secretary of State is right to say that early diagnosis provides more opportunity to cure and treat cancers. Some 60% of those treated for cancer will receive radiotherapy, and nearly every radiotherapy centre in the country has linear accelerators that are enabled to provide the advanced SABR, or stereotactic ablative body radiotherapy, technology, but Government—NHS England—contracts mean that out of the 52 centres in England no more than 20 are contracted to actually use this technology. That means that either patients are not receiving the highest quality life-saving standard of treatment that they could be or that trusts are providing it anyway but are not being paid and valuable data on mistreatment are being completely lost. Will the right hon. Gentleman order NHS England to stop this recklessness, and frankly lethal, nonsense and agree to every—

Order. [Interruption.] Order. The thrust of the question is entirely clear. I was going to offer the hon. Gentleman an Adjournment debate on the subject until I realised that he had in fact just conducted it.

And also, Mr Speaker, the hon. Gentleman’s all-party group is meeting my Minister, the Under-Secretary of State for Health and Social Care, my hon. Friend the hon. Member for Winchester (Steve Brine), on this very matter. Since 2016 we have put £130 million of funding in to try to resolve the issue that the hon. Gentleman talks about: to make sure that all new equipment is capable of delivering advanced radiotherapy. Work on this is ongoing.

In calling the hon. Member for Strangford (Jim Shannon) I promise to make no reference to the result of the match last night between Arsenal and Leicester City.

Mr Speaker, you had a broader smile on your face this morning than my friend the hon. Member for Scunthorpe (Nic Dakin) and I. We still support Leicester and hope we will pay you back some day.

An important aspect of diagnosing cancer is to find the drugs that address it. What has been done to ensure the partnerships between universities and the NHS can continue, so that they can find new drugs and therefore address cancers at a very early stage?

There are deepening relationships between universities and the NHS right across the country, especially in this field of the combination of diagnosis and early treatment. Some of the most advanced technology and research in the world is happening in universities in the UK in order to save lives, which is such an important issue here.

Leaving the EU: Access to Medicines

12. What assessment he has made of the potential effect on access to new medicines of the UK leaving the EU. (907220)

20. What assessment he has made of the potential effect on access to new medicines of the UK leaving the EU. (907228)

We will continue to have access to new medicines through the deal we expect to negotiate with the EU. In the unlikely event of no deal, we will directly recognise batch testing of medicines done in the EU. We are currently consulting on the approach to licensing medicines in a no-deal scenario, but I am clear that patients should not be disadvantaged and should continue to have timely access to new medicines.

The reality is that Brexit uncertainty about future medicine approvals and unresolved issues with the European Medicines Agency have caused research firm Recardio to suspend UK recruitment to a drug trial, posing a risk to its business and interrupting the research. As the EMA has no associate membership for third countries, how does the Secretary of State plan to avoid the UK being left out of future clinical trials despite his bluster?

Not only does the UK bring a huge amount to the table in terms of research, but we fully intend to make sure that we have a robust and seamless system in place. A consultation is out at the moment and we will respond to it very shortly.

The Government have stated that the new EU clinical trials regulations will not be in place before March, but have committed to aligning with it where possible. What progress has been made regarding data sharing to ensure that clinical trials continue and pharmaceutical and research firms do not leave the UK after Brexit?

As part of the EU deal we are negotiating, the relationship with the EMA will be extremely close, so I am sure that that will be a part of our agreement.

Will the Health Secretary confirm that since the referendum the number of EU nationals working in our NHS has actually risen by 4,000, and that regardless of the state of the negotiations their rights will be protected and they will continue to be able to work in the NHS after we leave?

Yes, my hon. Friend is absolutely right. In fact, the number of EU nationals working in the NHS has now risen by more than 4,000 since the referendum, and we welcome them all.


13. What recent progress has been made in negotiations between NHS England and Vertex Pharmaceuticals on making Orkambi available on the NHS for people diagnosed with cystic fibrosis. (907221)

It was disappointing that in July and August, Vertex, the manufacturer of Orkambi, rejected the final offer made by NHS England, as well as rejecting the opportunity for the National Institute for Health and Care Excellence—NICE—to appraise its new medicines, as is required for all companies seeking routine NHS funding for their products. Vertex must re-engage with NICE and NHS England, and I am encouraged that it attended a meeting with NICE on 4 October to discuss next steps.

As the Minister knows, Orkambi is available for cystic fibrosis sufferers in Ireland, Greece, Denmark and a host of other countries around the world, so when will it be available for cystic fibrosis sufferers in this country?

I know that the hon. Gentleman takes a keen interest in this subject and that he campaigns assiduously on behalf of his constituents in this regard. He is right to suggest that Ministers are keeping a very close eye on these negotiations, and we urge Vertex to consider NHS England’s fair and final offer. However, it is absolutely right that we have a system—introduced by the Labour party—in which experts, not politicians, determine the fair price for a drug, based on robust evidence.

I almost thought you had forgotten about me, Mr Speaker.

Last month, speaking on this very subject, the Secretary of State said that he would not let pharmaceutical companies hold the NHS to ransom, but the 5,200 patients who could benefit from Orkambi are left suffering while this war of words continues. What does the Secretary of State have to say, through his Minister, to those patients who are awaiting a resolution to this stalemate?

The hon. Lady makes a correct point, and we are very keen that patients receive this drug. I understand her ire, but perhaps it should be directed at Vertex, the manufacturer. The offer of £500 million over five years for the size of the eligible population is the largest-ever commitment of its kind in the 70-year history of the NHS, and it would guarantee immediate and expanded access to Orkambi and to other drugs.

Preventive Care

Our NHS offers a range of world-leading preventive care services, but we can go further and faster. The Secretary of State has named prevention as one of his top three priorities, signalling a renewed focus on public health, community and mental health services.

I thank the Minister for her reply. She will know, because I have spoken about this to the Secretary of State’s team, about the pressures on my constituency, and particularly on the Church Lane GP surgery. Specifically on preventive services, wearable tech, health tech and medical tech provide an opportunity to keep people healthier for longer, and can provide early digital diagnosis that can relieve pressure on medical services. What more can be done to pursue this way of relieving pressure on the health service?

I completely agree that technology can really help in this way. I recently visited Hampshire County Council, which is using a range of gadgets including a really simple one involving a light bulb that comes on when someone gets out of bed in the night to go for a pee. That is ingenious, and it is helping to prevent avoidable falls.

My constituent Holly Alliston has contacted me about the epipens that her two-year-old son, who has a severe nut allergy, relies on. There is a national shortage of them, and the Northfield Pharmacy has been emailed by NHS England to say that the situation is critical. What is the Minister doing about this? We hear about the possibility of troops having to distribute stockpiled medicines when we leave the EU, but this is hitting us now.

The hon. Lady is absolutely right to raise this matter. We are working closely with all the manufacturers of adrenaline auto-injectors to improve the supply situation as quickly as possible.

One in 10 mums gets post-natal depression, and we know that early identification is key to preventing it from becoming more serious. May I urge the Minister to look at the National Childbirth Trust’s campaign to ensure that all mums—as well as all babies—get a six-week check?

We are really supportive of the Hidden Half campaign, run by the NCT—my colleague the Minister met the trust last week. We must ensure that we are supportive of new mothers’ health needs.

I am really pleased that the hon. Gentleman has raised that. Clearly, early screening is fundamental and one of the key pillars of what we want to focus on with cancers. Prostate cancer affects so many gentlemen up and down the country, and we know that that early detection is the difference between life and death.

Antimicrobial Resistance

17. What steps his Department is taking to tackle antimicrobial resistance and inappropriate use of antibiotics; and if he will make a statement. (907225)

We continue to make good progress against our 2013 AMR strategy ambitions. According to the latest figures, since 2013, antibiotic prescriptions dispensed by GPs have decreased by 13%, and sales of antibiotics for use in food-producing animals dropped by 27%.

That is encouraging to hear because antimicrobial resistance is caused by the excessive and inappropriate use of antibiotics. Given that we have a Matt Hancock app, should not we have a similar app to try to educate people about when it is appropriate and not appropriate to use antibiotics?

I will look at what can be added to the Matt Hancock app—there is always room for more.

As luck would have it, today Public Health England has launched its latest “Keep Antibiotics Working” national public awareness campaign, which aims to educate the public about the risks of AMR and urges them always to take the advice of their healthcare professionals on antibiotics and, when necessary, to challenge them.

AMR poses a grave threat to health. Professor Dame Sally Davies, the chief medical officer, told our Health and Social Care Committee inquiry that if action is not taken to address this

“growing threat, modern medicine will be lost.”

Will the Secretary of State and Ministers heed that warning and ensure that AMR is prioritised?

Absolutely. The UK is a global leader in tackling AMR and we are currently working on the refresh of our strategy. I was at the G20 earlier this month, where Dame Sally Davies, the chief medical officer for England, showed world leadership and led an exercise with world leaders to strengthen understanding by showing how developed countries would tackle an outbreak.

Public Health Funding

18. What recent representations he has received on the potential merits of increasing public health funding to local authorities. (907226)

This Government have a strong track record on public health. Local authorities in England are supported by ring-fenced public health grants of more than £16 billion over the current spending review period. Decisions on future funding are, of course, for the next spending review.

Substance misuse services are due to be slashed by £34 million owing to cuts imposed by central Government. In Hull, and I am sure in many other parts of the country, there is a growing blight on our streets caused by Spice and other substances. How is it in any way helpful to communities, frontline police or the NHS for the Government to cut services that help people deal with their addictions?

As I said, we are spending £16 billion of our constituents’ money during this spending review period on public health grants. Decisions about where we go in future are of course not a matter for me but for the Chancellor in the spending review. This House decided in the Health and Social Care Act 2012 to make every upper tier local authority a public health authority. We believe that it is right for local authorities to make those decisions, with the funding that we give them.

How many health visitors have been lost since 2015? How will the Minister ensure that important investments are made at the start of life to reduce health inequalities?

As I suspect the hon. Gentleman knows, I do not have that figure at my fingertips, but I will provide it to him. Health visitors are a critical part of the puzzle, and local authorities are well aware of that, as are Ministers.

Topical Questions

The Department is working with the NHS to ensure that the £20 billion of extra taxpayers’ money is well spent: supporting social care, backing the workforce, using the best modern technology and strengthening prevention. On that note, I can tell the House that we now have a record number of GPs in training: 3,473—10% up on last year.

I thank the Secretary of State for so promptly accepting our invitation to visit us in East Sussex in January. He will be warmly welcomed. With that season in mind, what assessment has he made of the NHS’s resilience with winter approaching?

Of course winter always challenges the NHS, and this year will be no different. We have put in extra funding, including more capital funding, to ensure that we get the best possible flow through A&E and to ensure there is further funding for social care so that people who do not need to be in hospital can leave hospital.

Last week, The Times reported that a young autistic woman with severe learning disabilities and an IQ of 52 was sexually exploited for months after her care provider had a court accept a plan for her to have sexual relations with men at her home. It is unacceptable that the agency charged with the care of this young woman decided that unsupervised contact with men for sex was in her best interest, yet the Government would give all such care providers a role in assessing the mental capacity of the people for whom they care. Will the Secretary of State urgently investigate this case? Given that the case illustrates the conflict of interest that arises from involving care providers in mental capacity assessments, will he pause the Mental Capacity (Amendment) Bill to allow time to make it fit for purpose?

The hon. Lady is absolutely right to raise this incredibly concerning case. Unfortunately, because the case is ongoing and due to be heard before the High Court very shortly, we are unable to discuss the specifics of the case, but we are incredibly concerned by what it suggests. We have made it clear in statutory guidance to support the implementation of the Care Act 2014 that we expect local authorities to ensure that the services they commission are safe, effective and high quality. Once this case has gone through the High Court, we will look to take further action.

T2. A constituent has just written to me saying that his diabetic care has been moved from John Coupland Hospital to Lincoln Hospital under the mistaken bureaucratic belief that bigger is better. United Lincolnshire Hospitals NHS Trust, which covers Lincoln Hospital, is struggling. It is treating only 69% of people in A&E within four hours, when the figure should be 95%. What is the Minister going to do to ensure that large rural areas get the best and the same healthcare as large cities? (907234)

My hon. Friend is right to highlight this. The Secretary of State was at the trust last week, and I visited earlier in the year. There is a specific range of actions, including partnership with Sherwood Forest Hospitals NHS Foundation Trust; advanced clinical practitioner courses, which started in June; £1.8 million of capital to support improvements to patient flow; and a frailty pilot at Lincoln. There is an intensive programme of work with this trust, because we recognise my hon. Friend’s concerns.

T8. North West Ambulance Service NHS Trust spent £30 million in the past three years on private ambulances. Does the Minister agree that that money would have been far better spent on the recruitment and retention of NHS ambulance staff? (907240)

As the hon. Lady will know, since 2010, the number of paramedics has increased by more than 30% and the pay band has been increased from band 5 to band 6. She will also know from the excellent work of Lord Carter that there was significant variation between ambulance services and a significant opportunity to make savings that can be reinvested in ambulances by addressing differences in sickness rates, “hear and treat” and “see and treat” rates and other variables. We have also committed additional funding for new ambulances, including in the north-west, which will be in place by this winter.

T3. I can personally testify to the passion, the care and the professionalism of staff at Hillingdon Hospital. They do a fantastic job, but, sadly, too much of the physical environment in which they work is no longer fit for purpose. I invite my right hon. Friend to visit and see it for himself and to commit to providing the medical facilities that my constituents will need for the long term. (907235)

My right hon. Friend is an assiduous supporter of his constituents. I look forward very much to taking up his invitation to visit. I have looked into some of the details of the proposal on the table and, indeed, at some of the other proposals that may benefit the Hillingdon area. I look forward to discussing them with him.

T9. I welcome Baroness Cumberlege’s ongoing review of the impact of the use of Primodos pregnancy tests, but for the families affected to have confidence in this review they must be given sufficient time to give evidence. Will the Health Secretary ensure that that happens? (907241)

Yes, of course I will make sure the appropriate action is taken in this case. It is a sensitive matter, and I look forward to discussing it with the hon. Lady.

T4. The NHS diabetes prevention programme, which was one of the first of its kind, has helped many people since 2016. As someone who has been diagnosed as a type 2 diabetic since that point, it is of particular interest to me. Will the Minister assure me that when the long-term NHS plan is published, we will be even more ambitious? (907236)

We certainly will. I do not wish to pre-empt what the long-term plan will say, but it is an excellent opportunity for us to look at how the NHS can best support people who have or are at risk of developing diabetes, and that includes transformation funding beyond next spring and how technology can be used to help people better manage that long-term condition.

T10. Will the Minister provide an update on the revised capital bid by Warrington and Halton Hospitals NHS Foundation Trust to provide Halton General Hospital with a secure future? (907242)

I am not aware of the specific details of that, but I am happy to meet the hon. Gentleman to discuss it if he has particular concerns he wishes to raise.

T5. Spina bifida is one of the most prevalent causes of infant mortality and disability, and a campaign has been running for quite a long time to try to fortify flour to prevent it. Successive Governments have ducked the issue, so will we now please seize it? (907237)

We are continuing to review the advice from our expert advisory groups on safe levels of folate intake, but, continuing our tradition of announcing things to the House first, I want to inform the House today that we are going to issue a public consultation, as of now, on adding folic acid to flour.

The service from the East Midlands Ambulance Service NHS Trust has been a considerable disappointment for many of my constituents in recent months. When I met them about the service, they told me that on a huge number of occasions they have ambulances sat waiting outside accident and emergency departments, rather than getting to the next call. What more can the Government do to make sure we get these A&Es cleared?

The hon. Gentleman is right to say that we need to improve those handovers. We have improvement programmes in place at 11 hospital sites in the east midlands, alongside which we are making a £4.9 million investment in 37 new ambulances. Part of this is also about the length of stay and addressing the pathway.

T6. The recent report from the Royal College of Physicians, “Hiding in plain sight: Treating tobacco dependency in the NHS”, made clear the cost savings and health benefits there would be if doctors identified smokers and referred them to smoking cessation services, so will next month’s plan include that, particularly for pregnant women and mental health patients? (907238)

As my hon. Friend, the chair of the all-party group on smoking and health, knows, those groups are key to delivering our tobacco control plan. We are not complacent at all; the delivery plan that was published in June sets out the actions that different agencies will take to deliver the five-year plan, and that absolutely includes mentor cessation services.

I very much welcome news of the consultation on the mandatory fortification of flour with folic acid, but are the Government consulting on whether it should happen or on how it should happen?

We will be taking evidence, including from the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment, which is meeting as we speak, to look at the safe upper limit of folate levels. I am particularly keen to get that right, but I am convinced that the evidence shows overwhelmingly that this is something we should be doing.

T7. What is it, precisely, about the NHS’s management and leadership that means it seems to be unable to achieve consistent excellence in its hospitals, such as happens at the Salford Royal NHS Foundation Trust? Why is it so hard for lessons learned to be better disseminated? (907239)

My right hon. Friend identifies a critical factor in improving the future of the NHS, which is to have stronger leadership at all levels, to be able to support innovation and to find out the best that is happening elsewhere and bring it to trusts. I know he has a particular interest in that, and I look forward to working with him on it.

Foetal alcohol spectrum disorders mean permanent brain damage. In the United States, studies show that one in 20 children are affected. So when will this Government carry out their own prevalence study, so that we can confirm the extent of this entirely preventable disability in the UK?

Public Health England collects some data on foetal alcohol syndrome, but we recognise that the data do not reflect the range of FASD. These disorders are difficult to diagnose, which is why we are engaging experts and those affected to explore what more could be done to improve our understanding.

I thank the Secretary of State for the extra £5 million for East Midlands ambulance service and for the £4.5 million extra for Nottingham University Hospitals Trust, which will mean at least 150 more beds this winter, all of which will help with winter planning, but does he agree that it behoves us all to play our own part in keeping fit and healthy and to use the NHS services responsibly?

My right hon. Friend makes a very important point, which is that, while we drive to ensure that the NHS is prepared as possible for this winter, it is incumbent on everybody to exercise their judgment, yes, to access the NHS where it is needed and important, but also to make sure that they bear a personal responsibility, too.

The Mid Yorkshire Hospitals Trust is proposing to close our midwife-led maternity unit, telling me that, while it is safe, unless it has 500 births a year, it is not value for money. Is that a new national standard for midwife maternity units, because if so it would close 90% of free-standing units? Will a Minister meet me on this matter, because it is unfair on local parents, and, frankly, we are sick and tired of losing services from our towns?

I am extremely concerned about the case of Logan, a young boy in my constituency who requires round-the-clock care and the handling of his case by Corby clinical commissioning group. I have written to the Minister raising concerns about this case, but is he willing to meet me and Logan’s parents, Darren and Wendy, to talk about how this could perhaps be resolved and to apply any pressure that he can, because, as a family, they should be making memories at the moment, not battling local NHS bureaucracy?

Is it true that the Secretary of State is now so worried about the supply of vital medicines in the event of a no deal or a hard Brexit that he has asked the pharmaceutical industry to extend the period of stockpiling from six weeks to 20 weeks?

No, that is not true. We are working very closely with the pharmaceutical industry to make sure that, in the event of a no-deal Brexit, which I regard as unlikely, we mitigate as much as possible the impact on the supply of medicines and that the supply of medicines can be unhindered.

Will my hon. Friend, the Minister with responsibility for antimicrobial resistance, consider a 10% levy on antibiotics? If such a levy were applied globally, it would raise £3 billion a year, which is the amount specified in the O’Neill review to fund research into this area properly.

I thank my hon. Friend for his consistent work in this area. Stimulating the pipeline for new antimicrobials and alternative treatments is a complex matter. I can assure him that we continue to work with our international partners—I mentioned the G20 earlier —and that absolutely involves market entry awards, which, as he knows, is a global problem that requires a similar solution.

Every week in this country, two children are born with spina bifida or anencephaly, and I am delighted that the Minister has just announced the consultation on the fortification of flour, which could stop 70% of those birth defects. Can he tell the House how quickly he hopes to bring about the conclusion of the consultation?

Let me just pay tribute to the hon. Gentleman for the work that he has done, bringing this matter to the fore and really pushing it forward. The answer is as soon as possible. I also want to make sure that I can involve the other agencies. Public Health England will be very important in this, because, of course, not every woman eats bread and therefore takes the flour supplement.

I am sure that the Minister is aware that October is breast cancer awareness month. I welcome the ambition that the Prime Minister set out at the party conference for 75% early-stage diagnosis. There is some concern that, as breast cancer is already above that, there is no ambition left for it to do even better. Can he assure me and the breast cancer community that that is not the case?

That is certainly not the case. We had a very good debate on breast cancer last week. It is BCAM still this month for another week. The 75% was a target, a new national ambition. It most certainly is not the limit of our ambition.

Will the Government write off the debts of Yorkshire hospitals so that extra money invested can go into patient care?

As the Secretary of State set out, we are making a significant funding commitment to the NHS—the extra £20 billion—but that is not conditional on writing off debt.

Will the Minister please provide an update to the House on work to ensure that we train more GPs for England, particularly for west Oxfordshire?

Yes. My hon. Friend will have heard that we have record numbers of GPs in training— 10% up on last year. I want to see more GPs—5,000 more across the country—and, no doubt, some of those in west Oxfordshire.

I have a constituent who has Turner syndrome, a female-only genetic disorder that affects one in every 2,000 baby girls. Owing to this, she has to take several medications every day of her life, and this is mounting up as she gets older. She works so she is not on any benefits and has to pay for her medications herself. Will the Minister consider exempting those who suffer from lifelong conditions such as Turner syndrome from paying for their prescriptions? Surely, it cannot be right that people in England should be treated differently from those in Scotland, Wales and Northern Ireland, where such prescription charges have been abolished.

I am hearing deeply concerning reports about ambulance waits outside Worcestershire Acute Hospitals NHS Trust, and the Minister is aware of these concerns. We welcome the capital funding that is going into this trust, but will he meet me to discuss what more can be done to improve patient handover, which is concerning for my constituents?

As my hon. Friend says, there is significant capital investment into Worcestershire, as well as a major programme of improvements addressing variation in ambulances, but of course I am also happy to meet her to discuss the matter.

Last week, the chief executive of the Association of the British Pharmaceutical Industry warned that even associate membership of the European Medicines Agency would not do for our life sciences sector, so can the Secretary of State tell us how much longer we will have to wait and how much more we will have to pay for new medicines if we are outside the European medicines market?

We will not have to wait longer; we will ensure that we get the best medicines to the people of Britain long after we are members of the European Union, as we did before we were members of the European Union.

As in the health service under successive Governments of both colours, demand exceeds supply and we cannot carry on indefinitely, but let us hear a few more questions.

Last week, the Royal College of Paediatrics and Child Health revealed that there has been an increase in infant mortality for the first time in 100 years. Four in every 1,000 babies will not reach their first birthday, compared with 2.8 in every 1,000 babies in Europe. This was warned against as an effect of austerity. What assessment has the Health Secretary done on the effects of next week’s Budget on child health and the longevity of our children?

I saw that report and we are analysing it. Last week was Baby Loss Awareness Week, and I am glad that there is more awareness of the issue now than there was previously. It is a very important issue that we are looking at right across the board.

About two hours ago, I rang to book a flu jab less than a mile away from here. Unfortunately, staff said that they had run out and will not be able to do it until 2 November. The Secretary of State is nodding. He seems to know the answer to everything. What is the issue? Will he give me the answer? This never happened under Labour.

If the hon. Gentleman is claiming that there were not enough flu jabs under Labour, I might agree with him, because there are now more flu jabs. More than 4 million flu jabs have already taken place. I am delighted that lots of people want flu jabs because everybody who needs one should get one. The arrival of the flu jab medicine is phased, because we have to ensure that we get the right flu jabs. If the hon. Gentleman could carry on promoting flu jabs for the elderly, I would be delighted.

Nevertheless, the hon. Gentleman has had his say, and I feel sure that he will say it again as often as is necessary.

Will the Minister tell me whether the withdrawal of funding for the Healthy Futures programme in the north-west and Public Health Action in the south-west is likely to help or hinder us meeting the smoking cessation targets in the tobacco control programme?

This comes back to the matter of public health budgets—£16 billion during the current spending review period, with local authorities best placed to make local decisions on what is needed in their local area. That is the same in the right hon. Gentleman’s area as it is in mine.

Last month, the Mayor of Greater Manchester adopted the five recommendations of my report, “Living Well and Dying Well”, which seeks to include hospice care provision more formally in our NHS and social care planning. Will the Minister meet me and representatives of our hospices to see how we might best make use of these brilliant community health assets?

Yes, I am happy to meet the hon. Gentleman to discuss the matter. Hospices provide an incredible level of care right across the UK, and we cannot do enough to support them.

Order. There were 30 topical questions. Although there was scope for many more, I am afraid that we have to stop now. Thank you, colleagues.