House of Commons
Tuesday 27 November 2018
The House met at half-past Eleven o’clock
[Mr Speaker in the Chair]
Oral Answers to Questions
Health and Social Care
The Secretary of State was asked—
Community pharmacies play a vital role in our health service, but we know they can do more, and we are determined to see them do more, to keep people healthy.
I am grateful to the Secretary of State for that answer, because he is absolutely right in what he says. The Dorset Local Pharmaceutical Committee is very active and is promoting the policy of Pharmacy First, which should help to relieve pressure on our general practitioners, and even on our accident and emergency facilities. What is he doing to support that policy?
I agree very much with my hon. Friend that pharmacies can play an increasing role in helping to make sure that people get their healthcare where they need it, and in keeping the pressure off GPs and off secondary care by making sure that people can help themselves to stay healthy. We are piloting 111 directing people to pharmacies as well as to GPs and, where appropriate, to secondary care, and encouraging people to use pharmacies for minor ailments, but there is much more we can do together on this.
The NHS Confederation has warned that, following Brexit, the supply of some medicines and medical technologies may be delayed in reaching patients, and some may not be available at all. The chief executive officer of the Association of the British Pharmaceutical Industry has been clear that we cannot stockpile the amounts we are going to need, because we do not have sufficient cold warehouse storage. The Medicines and Healthcare Products Regulatory Agency is worried therefore that diabetics will not be able to access insulin. What steps is the Minister taking to ensure that community pharmacies are able to supply vital medical supplies post Brexit, particularly in the event of no deal?
NICE Guidance: Head Lice
In the year to June 2017, the NHS spent approximately £569 million on prescriptions for medicines that could be bought over the counter from a pharmacy or supermarket. That is why, following public consultation earlier this year, NHS England issued guidance to reduce the routine prescribing of some medicines for minor, short-term ailments, including head lice treatment.
Yesterday, I met people from the charity Community Hygiene Concern, which provides cheap, reusable and effective bug-busting kits for less than £5. However, because of these NHS prescription guidance changes, these kits are no longer available, which threatens an epidemic of head lice in our schools. Surely head lice should not be considered a minor ailment. Will the Minister please write to Simon Stevens to encourage him to meet me and Community Hygiene Concern to look at this issue again?
I have been itching all morning while thinking about this answer. I do not believe there is an epidemic because of NHS England’s actions. Clinical experts in the NHS advise that head lice can be safely and effectively treated by wet combing; I have very recent personal experience of doing this, as I am sure do many parents in this House. Chemical treatment is recommended only in exceptional circumstances. I had not heard of the charity the hon. Lady mentions, but as we discussed before questions, I am happy to facilitate that interaction.
In France, where head lice are more common per capita than in the UK, people make good use of pharmacies, because it costs money to visit a general practitioner and because the state promotes the role of pharmacies. May I therefore ask the Minister why do we not advertise that we should be using pharmacies more often than not, instead of going to a GP?
Unfortunately, that has nothing to do with the matter of head lice. [Interruption.] It seemed to be slightly tangential, but never mind. The hon. Gentleman was at least attempting to shoehorn his preoccupation into the question, but I will err on the side of generosity. I know that he knows all about heads and all about hair—
Public Health Funding (Local Authorities)
We have had lots; it is just that none come with any idea of how that might be paid for. The Government have a strong track record on public health. Local authorities in England have received more than £16 billion in ring-fenced public health grants over the current spending period. Decisions on future funding for that area of spending are of course for the next spending review.
On current projections, over £800 million will have been cut from public health budgets by 2021, £2 million of which has been cut from vital services in my constituency relating to sexual health, and to tackle obesity and smoking. Will the Minister guarantee that the new NHS long-term plan will reverse the cuts to public health budgets?
I know that Opposition Members like to pretend that the past eight and a half years did not have to happen, but there is a reason why they had to happen—the economy was crashed—and eight and a half years is not a long time to clear up the mess of the last Government. But we are very clear, as the hon. Gentleman should know, that a focus on prevention will be central to the long-term plan. He mentions child obesity—[Interruption.] Opposition Members may wish to listen. The public health grant remains ring-fenced and protected for use exclusively on improving health, but local government spending on health is not just about the public health grant. The Government spend money on many other things, including around the child obesity plan and vaccinations, and that is all around prevention and public health.
As local government is reorganised in Northamptonshire ahead of May 2020, will the Minister consider whether it may not be appropriate in all cases for local councils to manage public health budgets, and whether in some cases it might make sense for the NHS to regain control?
There are active discussions going on between my right hon. Friends the Health Secretary and the Secretary of State for Housing, Communities and Local Government about this, but the bottom line is that Parliament legislated through the Health and Social Care Act 2012 for local authorities up and down the country in England to be public health authorities. We believe that they are well placed to make these spending decisions with the ring-fenced grant—£16 billion —that we have given them.
The underfunding of public health in Cumbria means that the NHS spends only 75p per child per year on preventive mental health care. Added to that, over three quarters of young people with eating disorders are not seen within the target time of a month, and in the event that they are seen, there is no specialist one-to-one eating disorder service to see them, despite the Government promising three years ago that there would be. Will the Minister meet me and our local NHS so that we can get a better deal for our young people on all three of these points?
The hon. Gentleman will remember, of course, that £1 billion extra was put into mental health in the Budget last month, but I would absolutely be interested to hear from him. There are very good things going on up and down the country in local authorities with the ring-fenced £16 billion that we have given them. We are very interested to hear about where there are good examples of things going on, and the long-term future discussions around them will take in the spending review, as I have said.
The Secretary of State claims that prevention is one of his top three priorities, yet this year alone the Government have slashed public health budgets by £96 million. That includes cuts to smoking cessation services, sexual health services, obesity and addiction services and many more. This affects the most vulnerable in our society, so will the Minister do the right thing today and cut the rhetoric, commit to reversing these damaging cuts to public health, and put funding in the long-term plan?
The hon. Lady—my shadow Minister—knows that I have a great deal of respect for her. She mentioned smoking; smoking rates in England are at their lowest ever levels. We hear spending commitment after spending commitment from the Labour Government; it is like the arsonist turning up at the scene of a fire. I will take very seriously, as I am sure will the Treasury, her bid towards the spending review discussions, but yes, prevention is better than cure and it will be at the heart of the long-term plan.
Prevention is indeed better than cure. As well as having a right to expect NHS services to be free at the point of use, we all have responsibility for our own health, and to use the NHS responsibly.
There are many things we need to do to diagnose cancer early, and of course public health is part of that, but there is a much bigger agenda, and that includes more screening. We have seen an increase in the number of people invited to screening, but we need to get the screening right, so I have instituted a review of all our screening processes for cancer and other diseases.
Will my right hon. Friend look at the work done by Connect Well Bromley, a partnership funded by the local clinical commissioning group but delivered by Bromley Third Sector Enterprise and Community Links Bromley? That partnership sets out what is in effect a social prescribing programme of activities and services to deal with wellbeing issues at an early stage. Is that a model for elsewhere in the country?
Yes, it is. I have been briefed on the example that Bromley is setting, which has been brought to my attention by its brilliant local representative, my hon. Friend. Social prescribing systems such as this one are on the rise, because the evidence shows that social prescribing helps to keep people healthy and out of hospital.
A fortnight ago, during his statement to the House on prevention and how the Government intend to keep our nation well, the Secretary of State told me that he would look at my Health Impacts (Public Sector Duty) Bill, which had its Second Reading on Friday. Unfortunately, on Friday, the Government objected to my Bill. Which elements of the Bill did the Secretary of State object to?
I know the hon. Lady has done an awful lot of work on this, and I respect that work. We did look at the Bill, but we thought it was, unfortunately, technically deficient. I know she cares a lot about this, however, as do I, and I want to work with her to see what we can do.
According to Office for National Statistics figures, over the past five years, there have been 150,000 excess winter deaths—a mortality rate twice that in Germany and Norway. What specific work is the Secretary of State doing to reduce the number of deaths this coming winter?
This year, since I became Secretary of State, we have put an extra £420 million in to make sure we are as well prepared as possible. The NHS is of course under pressure, although it is performing exceptionally well, in terms of how much it does for the money going in, and from next year, we will put in the extra £20 billion. I want part of the long-term plan to be about how we can plan for the long term, instead of having this annual cycle of winter pressures.
Earlier this year, I had the pleasure of joining volunteer leader John Goodwin and others on a health walk around Capstone park in my constituency—one of a number of health walks supported by Medway Council. Will the Secretary of State join me in encouraging more GPs to prescribe walking as a gentle, low-impact form of exercise that is suitable for all ages and abilities?
With enthusiasm, I endorse the call from my hon. Friend, who did so much work on this at the Department for Digital, Culture, Media and Sport, both before I was in that Department and when I was Secretary of State there. She made the case brilliantly, and she continues to do so. She is absolutely right.
Every EU worker across our health and social care system—whether in the NHS, or working in public health, in local authorities or in social care—is welcome here, and is supported to be welcome here, and we look forward to the settled status scheme rolling out. We are grateful for their service.
GP appointments are vital for many to lead healthy lives, so will the Secretary of State give his strong personal support to the work of our fantastic GPs, and encourage the NHS to put general practice at the heart of the £20 billion future plan?
The Secretary of State got into a muddle last week with his GP figures, so may I suggest that he download an exciting new app to his phone? It is called a calculator. He has said that there will be more for community and primary care by 2024. Can he guarantee that there will be the extra GPs and district nurses to provide the services that he is promising?
But GP numbers have gone down by 700 in the last year, have they not? There are 107,000 vacancies across the NHS, acute trusts are closing accident and emergency departments overnight, the closure of chemotherapy departments is being considered, and Health Education England’s training budget is the lowest that it has been for five years, with more cuts to come next year. Does the Secretary of State agree that if the long-term plan that he will publish next week is to be credible, he must reverse those training cuts and deliver the staff that our NHS needs?
That was a bit of a surprise, because the hon. Gentleman is normally such a reasonable fellow. I thought that he would welcome the record number of GPs in training, and the record number of nurses in the NHS. Because we love the NHS, of course we want to do more, and we will.
GP Access: Learning Disabilities
People with learning disabilities still face significant health inequalities. Data from 2017 shows that about half of patients with a learning disability received an annual GP health check, and our target is 75% by 2020. We will shortly consult on plans to introduce mandatory learning disability and autism training for all health and care staff.
There are shocking health inequalities between people with learning disabilities and the general population, and that is recognised by GPs: 60% say that they have received less than a day’s training in how to meet the needs of patients with learning disabilities and autism, while 98% say that they would appreciate more training. The Government are clearly failing people with learning disabilities. Will they commit themselves to ensuring that every new GP who is trained in England is also given training in how to meet the needs of people with learning disabilities and autism?
Yes. That is already part of the training framework. As I have said, however, we are consulting from early next year on plans to make training on learning disabilities and autism mandatory for all health and care staff, not just medical professionals.
Let me start by thanking my right hon. Friend the Secretary of State for his support last Thursday on 22q Awareness Day; 22q11 deletion syndrome is second only to Down’s syndrome in its prevalence as a genetic condition, but perhaps surprisingly, there is a remarkably low level of awareness among GPs of this condition, which can lead to avoidable mental health issues in children. Will the Minister meet me to discuss options to increase awareness in the first instance, but also to improve early diagnosis and treatment?
Health Inequalities (England)
We know from recent trends reported to the public health outcomes framework that health inequalities persist in this country. We already have world-leading programmes to address the root causes of poor health, including programmes to deal with childhood obesity, control tobacco and prevent diabetes and heart disease. The Prime Minister has set an ambition to ensure that people can enjoy at least five extra healthy independent years of life by 2035, while narrowing the gap between the experiences of the richest and the poorest, and next year the Secretary of State will set out further plans to achieve that in his prevention Green Paper.
We have known for decades that poverty and economic inequality drive health inequalities. The richer people are, the longer they live, and the longer they live in good health. In addition to the economic analyses of the Prime Minister’s Brexit deal, what assessment has the Minister made of the deal’s impacts on health inequalities, and on life expectancy and healthy life expectancy, which we know are already falling in some parts of the country, and among some groups of people?
The reasons for health inequalities are complex, but obviously we encourage people to make the lifestyle changes that enable everyone to live longer. I simply do not accept that the direct causality that the hon. Lady has outlined is as clear as that. We will focus on programmes that help people to lead healthier lives with better diets; that tackle tobacco control; and that prevent diabetes.
As it is the most deprived children who are most overweight, will the Minister call on Kellogg’s to follow the example of Nestlé and put traffic light colours on all its products so that people can make healthier choices?
My hon. Friend makes an excellent point. Clearly the more we can do to educate people to make informed choices to improve their diet, the better. He is absolutely right: poor health among children used to be indicated by being underweight, but now being overweight is very much an indicator. I congratulate any food manufacturer that is taking action to address the problem.
The Minister and the ministerial team know that many working class people do not have good access to GPs, and that GPs treat them differently from more middle class people, as demonstrated by the number of people from poorer backgrounds with atrial fibrillation who are wrongly diagnosed. If they are diagnosed with an irregular heartbeat or pulse, they are given the wrong drugs. That happens to many ordinary people in this country: there are still all these wonderful GPs prescribing aspirin that will do no good at all. What is going on with GPs and poorer people?
Scotland has the lowest life expectancies of all parts of the United Kingdom, with the figures falling for the first time in 35 years. The average life expectancy in 2017 was 77 years for men and 81.1 for women, compared with 79.2 for men and 82.9 for women in the rest of the UK. What can my hon. Friend do to support the devolved Administration to ensure that Scotland is not left behind the rest of the United Kingdom?
My hon. Friend is right to draw attention to that. I am always very keen to work with the devolved nations to both learn from what they do well and to share our expertise and experience where we are doing better, and I hope we will all co-operate to do exactly that.
Initiating breastfeeding at birth can help reduce to health inequalities. Due to the actions of the Scottish Government, breastfeeding rates in Scotland are at a record high, whereas in England they are falling back dramatically because of local cuts. What will the Minister do to increase breastfeeding rates in England?
I commend the hon. Lady for her leadership on the issue, and she is right that this is one of the most significant public health interventions we can make at the earliest point in life. I will happily line up with her to do more to champion breastfeeding, and there is certainly a lot further to go, not least in ensuring that society is more tolerant of the practice and that women really do enjoy their right to breastfeed.
In June we published chapter 2 of our child obesity plan, which built on the world-leading measures we introduced in 2016, including bold new measures to halve child obesity by 2030.
Will the Minister join me in welcoming the launch this week of South Gloucestershire Council’s Reach programme? It is an evidence-based service for obese and overweight children aged between four and 16 in South Gloucestershire and their families, aimed at improving the wellbeing of young people and building their esteem, and raising issues of weight gain between and among families.
I certainly will; we need a collective effort to achieve the national ambition of halving child obesity by 2030, and that means we need local initiatives such as the Reach programme to support families and help them make positive lifestyle choices. I pass on my congratulations to South Gloucestershire Council on its programme.
Through our work on parity of esteem for physical and mental health, we take eating disorders very seriously. That is not directly related to the child obesity plan, but we are absolutely determined to tackle weight challenges at either end of the scale, because I know that they affect a lot of people.
I have a lot of time for the hon. Gentleman and do a lot of work with him. He knows that we published proposals in the child obesity plan to launch a consultation on a pre-9 pm watershed ban, and we will be bringing that forward before the end of the year as promised.
Young Cancer Sufferers: Costs of Travel
No child or young person with cancer should be unable to access the treatment they need because of the cost of travelling to hospital. Through the healthcare travel costs scheme, which is part of the NHS low income scheme, parents in receipt of a qualifying benefit or on a low income can claim for the reimbursement of travel costs for their children’s treatment. To date, the scheme has helped some 337,000 people.
CLIC Sargent, the charity for children with cancer, has shown that families in my constituency with children with cancer can face a 54-mile round trip to get to their nearest treatment location, which can cost them up to £161.58 a month. Families are incurring thousands of pounds of debt paying for parking and driving their children to their cancer treatment. Does my hon. Friend acknowledge that only 6% of parents of children with cancer are reported as having received financial help from the NHS healthcare travel costs assistance scheme? Does he recognise that the scheme is not designed to meet the needs of children and young people who need highly specialised treatment—
Yes, we do recognise that there is a challenge there. I gave evidence to the all-party parliamentary group on children, teenagers and young adults with cancer, and I have a copy of the “Listen Up” report here. CLIC Sargent is part of the secretariat for that group. We are looking at this issue through the long-term plan, and I look forward to meeting my right hon. Friend along with CLIC Sargent in the next few weeks as planned.
Access to services is very important for those in the poorest areas of my constituency. Warrington Hospital has been losing services over time, but it has now sought to become a cancer hub for north Cheshire. Will the Minister ensure that, in the case of such applications, access to services for the poorest people is considered along with other factors?
Yes, we are interested in access to services for all people, wherever they are on the income scheme. The hon. Lady is right to raise that issue. We need to do better on cancer diagnosis, so I would be interested to hear more about the cancer hub that she mentions.
Sexual Health Services
Since 2013, when local authorities took on responsibility for these services, attendance has increased from 2.9 million to 3.3 million. Tests for sexually transmitted infections and access to long-acting contraception have also increased, which shows that people are taking their sexual health seriously and that services are responding.
The evidence I have is that sexually transmitted infection rates are stable, that rates of teen pregnancy are falling, that rates of abortion are stable and that rates of HIV testing are increasing. However, the hon. Gentleman raises an important point, and I will look into it. The most important thing is not necessarily where or how people access their services, because we want to make tests and long-term contraception available online too. We will keep the issue under review.
As I said in my previous answer, the important thing is to look at outcomes. We can see that levels of teen pregnancy and sexual infection are stable and that more people are accessing contraception. We need to ensure that people can access contraception in the most convenient way for them, and we can see that rates of access are on the increase.
I am extremely grateful that my right hon. Friend the Secretary of State came down to East Devon on his first visit outside London. He was able to visit the health and wellbeing hub that we have created in Budleigh Salterton, learn about the beds that we have kept in Sidmouth and Exmouth, and see Ottery St Mary Hospital. Will the Minister instruct all her officials to work collectively with us and the local community in Ottery St Mary to ensure that the hospital has a great future and fits in with the rest of local healthcare provision?
First, I congratulate my right hon. Friend on his elegant Movember facial decoration. I very much recommend that he keeps it.
My right hon. Friend the Secretary of State was delighted to visit the East Devon constituency recently, where he was impressed by the work at some of the existing community hospitals and care hubs and discussed with Royal Devon and Exeter NHS Foundation Trust how it will work on a sustainable future for the constituency’s community hospital in Ottery St Mary.
We know that patients prefer to be treated in their local area, which is much better for preventing hospital admission and getting people out of hospital for longer. However, such clinical decisions must be taken at a local level in consultation with local people.
Dartmouth has lost its much-loved community hospital. Unfortunately, that loss has been compounded by the closure of River View nursing home, which had been due to house some replacement facilities. The total loss of community beds in isolated coastal communities such as Dartmouth is causing a collapse of trust in such programmes. Will the Minister meet me to discuss the situation in Dartmouth and the loss of nursing home and community beds?
I will of course meet my hon. Friend. She is right that we need to keep such valuable local resources right in the community, where they are most needed and where they keep people out of acute hospital services and surrounded by their friends and family.
The usage of Caithness General Hospital in Wick in my constituency is way below what it was originally designed for, causing my constituents great anxiety if they have to travel over 200 miles to Inverness and back. Mr Speaker, you will tell me that such matters are devolved, so will the Government share best practice on community hospitals with the Scottish Government and NHS Highland?
Wantage Community Hospital was built and opened by the local community in 1927, but it has been closed for two years. Moves are afoot to improve both our local health centre and health facilities in Didcot, but all that must be joined up and the community needs an answer. Will the Minister use her power to convene a meeting of local stakeholders and her officials to find a way through the maze and a future for our hospital?
I will be honest, I am confused. We have heard the Minister say several times that community approaches are important, but our walk-in centre in Eastham is yet again being threatened with closure. Which is it—do this Tory Government want crowded A&Es or proper walk-in centres that will prevent people from unnecessarily ending up at A&E?
I do not think I can make it any clearer: this Government are committed to providing community services right where people need them, and we are putting our money where our mouth is. Last week, the Prime Minister announced a major new investment in primary and community healthcare of £3.5 billion.
Thank you very much.
The Government’s mandate to NHS England for 2018-19 clearly sets out A&E performance, and it will see performance improve. So far this year 18 million more attendances have been seen within the standard, and the NHS is introducing more options for urgent patient care. Of course, as the hon. Lady will know, the extra £20 billion a year that is going into the health service will ensure that more patients are seen in A&E.
According to a recent poll of doctors by the Royal College of Physicians, almost six in 10 doctors report feeling very worried or worried about the ability of their hospital to deliver safe patient care over the winter period. What is the Secretary of State or the Minister doing to help our hard-working NHS staff provide the best possible care for patients?
The NHS faces a challenging winter, but it has been planning throughout the year for this winter. It has been supported by an extra £420 million to redevelop A&Es, improve emergency care and help patients get home quicker. Those plans, more directly, include reducing the extended hospital stays we saw last year, increasing access to GP appointments and increasing the volume of cases that can be treated by emergency dentists.
Last week I visited the A&E at County Hospital, Stafford, which achieved 95.8% on the four-hour target in the week beginning 22 October and has consistently achieved over 95% for the past few months. Will the Minister come to Stafford to see what a great job it is doing, and to see how we can use County Hospital more and bring more services into it?
My hon. Friend has always been an assiduous advocate for his constituents and their concerns. He is right to make that case today. He is also right that, thanks to the hard-working staff in his hospital and across the country, the four-hour target continues to be met for nearly nine out of 10 patients. I will be delighted to come to Stafford.
Does the Minister agree that what considerably exacerbates A&E waiting times at the weekend is when, on occasion, our highly valued NHS staff come under attack? We should have a zero-tolerance approach to any attacks on those highly valued members of staff.
I welcome the Minister to his place. Although he is new, he will know that the A&E waiting target is not a recent initiative. It is a key part of the NHS constitution, but it has not been met for over three years. If he cannot make a commitment today on when the target will be met, will he accept that, at least for this winter under this Government, the NHS will once again be underfunded?
As I said in my earlier answer, we recognise that this winter will be challenging. We recognise that the A&E performance standard is not currently being met, but, as the hon. Gentleman knows, we are investing an extra £20 billion in the NHS to ensure that the standards are met. The NHS will use that investment to treat 250,000 more patients and to improve A&E performance across the country.
Nursing Higher Education
The latest UCAS data from October 2018 show that demand for nursing courses remains strong, with applications exceeding the number of places available this year. The number of acceptances to nursing and midwifery courses in 2018 is consistent with earlier years at approximately 22,000. The final data will be published in December 2018.
Does the Minister accept that student nurses face pressures from the long hours they have to study and the long hours they spend on placements, which makes it very difficult for them also to carry out paid work? Is there any more the Government can do to support student nurses financially as they go through college?
As my right hon. Friend the Secretary of State said earlier, we recognise the vital role that nurses play, and we are determined to support them. We are determined to have more nurses in training and more nurses treating patients. At the moment, a student on the loan system typically achieves 25% more in their pocket than they would have had on the bursary, but the Government recognise that there are still pressures, which is why we have the learning support fund, the exceptional hardship fund and support for mature students.
I talk to local employers who desperately want to support nursing apprenticeships as an alternative to the higher education route, but the uptake of apprenticeships is very disappointing. The levy can be used only for training costs, and trusts have been asked to plug the shortfall in funding for wider capacity building and to cover the 20% of time for which apprentices have to go to off-the-job training. Does the Department recognise this problem? What is being done to address it?
The hon. Lady is right that the number of trusts that currently use the levy is not as high as it should be. We hope that all will do so. It continues to be a priority for us to broaden the routes into nursing. We will address in the long-term plan the specific matter about which the hon. Lady talks.
NHS: Workforce Vacancies
The NHS employs more staff now than at any other time in its 70-year history. It has recruited 18,200 more doctors and 11,000 more nurses are in our wards since 2010. NHS Improvement publishes vacancy rates using provider information. As the hon. Gentleman will know, the record investment that the Government are providing will ensure that the number of vacancies reduces.
With Suffolk’s only psychiatric intensive care unit having been closed down from April to October this year because of lack of staff, and with a two-to-three-month waiting list for counselling, does the Minister not understand that his reassurances do not bear much relationship to people’s lived experience?
I am aware that the local trust has had a number of problems and that there were a number of bed closures—both temporary and permanent —earlier this year. The trust is closely monitoring how those closures are affecting services and patients. The hon. Gentleman will know that beds are being reopened—five beds have been reopened recently—and that there is a plan to put in place the staffing so that the whole ward can reopen in the near future.
The hon. Gentleman will know that the Government are committed to having more nurses and more staff in training, that we are putting in place extra measures to ensure that specialities are supported through that training process and that the extra £20 billion in the long-term plan will ensure that there are the staff and nurses needed to fill those vacancies.
Last week, the Secretary of State claimed that the number of GPs in England had increased by more than 1,000 from June to September, when the data actually showed a drop of 10 full-time equivalent doctors. In 2015, his predecessor promised an extra 5,000 GPs by 2020, but so far there are 1,000 fewer, so how does the Secretary of State plan to meet that target in just the next year?
As the hon. Lady knows from a previous answer, we are committed to making sure that 5,000 extra GP places are available. There are more GPs in training than before, and 52,000 nurses are now in training. We will ensure that the number of GPs in training meets the target.
I find that hard to believe when there is only a year left of the five-year promise.
Scotland has 30% more GPs per head of population, but last year we lost 14% of our EU doctors, and England lost 19%. Does the Secretary of State recognise that the hostile language of the Brexit debate is making the UK seem unwelcoming and making it harder for all four UK health services to recruit?
NHS: Long-term Funding
We are increasing the NHS budget by £20.5 billion in real terms over the next five years. It is a major investment to make sure that the NHS is there for us all.
Royal Stoke University Hospital continues to be in financial special measures, and local clinical commissioning groups are now projecting significant overspends in their budgets. How will the Secretary of State ensure that stressed health economies such as those in Stoke-on-Trent and Staffordshire get a significant share of the additional £20.5 billion?
Clearly, part of the £20.5 billion of extra funding that taxpayers are putting into the NHS over the next five years is for ensuring that services can be put on a sustainable footing, and that includes some of the highly stressed services such as those in Stoke.
Leaving the EU: Medicines and Medical Equipment
The deal that the Prime Minister struck to leave the EU will ensure access to medicines and medical equipment, so it is another good reason to vote for the deal.
Well, of course, while voting for the deal is the best way to ensure the unhindered supply of medicines and medical devices, as a responsible Government we are also planning for the unlikely event of no deal, and that planning includes ensuring that we can continue to get unhindered access after the six weeks for which we are making sure that supplies are available.
We are currently an influential member of the European Medicines Agency, which gives patients access to new medicines six months sooner than non-members. Given that the political declaration reduces us to exploring the possibility of co-operation with the EMA, will the Secretary of State admit that there are no guarantees for patients and that it is very likely that they will have to wait longer?
Many people say that the much-heralded £20 billion extra for the NHS is some sort of Brexit dividend. In the event that our country remains in the European Union, will the Secretary of State confirm that that extra 3.4% a year will continue and that £20 billion will be made available to our NHS?
Traditional and Western Healthcare
The NHS long-term plan, backed by the extra investment by 2023 and confirmed by the Chancellor in the Budget, will set out a sustainable vision for the NHS to make strides towards it being the safest, highest-quality healthcare system anywhere in the world, learning from everywhere and anywhere in the world over the next 10 years.
According to the flyer for the post-launch party, the integrated care systems will be considered. Will the Minister make sure that he looks at the use of homeopathy by French pharmacists, the three quarters of a million doctors using traditional healthcare in the Ayush Ministry in India and the 55,000 state hospitals using acupuncture in the People’s Republic of China?
This month, we launched our vision for the prevention of ill health that sets out measures to help increase life expectancy by at least five years because prevention is better than cure. We need to give people responsibility for their own health, while empowering them to make the right decisions in the right way. We are also saving more than £1 billion on the NHS drugs budget and committing more than £3.5 billion to primary and community care. Next month, we will publish the long-term plan for how we spend the extra £20 billion committed to the future of the NHS.
19 November marked the three-year licence of the cystic fibrosis drug, Orkambi, in the UK, which is still not available on the NHS. Will the Secretary of State confirm whether there has been any further consideration to provide interim access to this treatment for patients, such as my constituents Annabelle Brennan and Cameron Jameson, while these negotiations continue?
The NHS and the National Institute for Health and Care Excellence have written to Vertex, the company involved. I am determined to see progress. We have made the largest ever proposal to Vertex, at half a billion pounds. It needs to engage with this very generous offer, which will mean that everyone wins, most of all those suffering from this awful condition. The ball is in Vertex’s court.
The learning disabilities mortality review—the LeDeR—investigated 1,000 early deaths of people with learning disabilities in hospital settings, but today major concerns have been raised by the parents of Oliver McGowan about the way in which some deaths have been investigated. The Secretary of State knows that 40 autistic people and people with learning disabilities died in assessment and treatment units, and he has called for a year-long review of the use of seclusion in ATUs. But that is not urgent action. Will he commit to stopping the use of ATUs immediately and to looking urgently at how early deaths are being investigated, particularly that of Oliver McGowan?
I have met Oliver McGowan’s mum, Paula, on a number of occasions, so I am more than aware of this case. I have spoken to her about the deeply distressing report she has had on Oliver’s death. The NHS is looking into this case and will continue to work with Bristol University to further develop and improve guidance and local review teams.
I can recommend to anybody spending the night with my hon. Friend in Derriford Hospital, where we learnt a huge amount. The team there were absolutely amazing and it was a brilliant experience. I also learnt a lot about the capital bid, which I have been keeping my eye on very closely. My hon. Friend should hear shortly.
I have a huge amount of sympathy for the hon. Lady’s point. We did act to ensure that the parties came together. The offer has been made and the response from the company has frankly not been good enough. It needs to come to the table; the ball is in its court.
My hon. Friend is right. I welcome the trust’s recent announcement that it now has enough middle-grade doctors and nurses to keep the Prince Royal Hospital’s A&E open 24/7. It has been receiving some excellent support from NHS Improvement, and I hope that it will achieve similar success in improving the quality of care as that support continues.
The hon. Lady makes a very good point. When we last discussed this matter over the Dispatch Box, I said that it was my ambition to come back to her as soon as possible, but we have to agree a cross-Government response, which is imminent. However, she is quite right; we really need to respond as soon as possible.
My hon. Friend will be aware that we have brought forward proposals to have a mental health lead in all schools. We are also introducing a brand new workforce to support schools and improve mental health provision. The first wave of staff are being recruited for training now, and we have 210 applicants for the first wave of places.
I join the right hon. Gentleman in celebrating World Aids Day and ensuring that we redouble our commitment to making sure that we do everything we can. I will certainly look into the precise commitment that he asks for to make sure not only that it is deliverable but that we work not just here but around the world to end this scourge.
The Prime Minister will set out our ambition that three quarters of all cancers will be diagnosed early, up from just half today. Our cancer survival figures are our best ever, but we do not have world-class outcomes yet, as we must and want to. That is why early diagnosis will be absolutely at the heart of the NHS long-term plan—for instance, in radically overhauling the screening programmes that the Secretary of State mentioned earlier.
South Tyneside District Hospital recently surpassed targets for waiting times, yet this Government’s forced cuts under the guise of sustainability and transformation plans have left my constituents fundraising to fight the downgrading of key services in court next month. Why is the Secretary of State presiding over this destruction by stealth of our high-performing hospital and the NHS?
Of course, the STP proposals have to be clinically led and consulted on and discussed with local people. It is right that the allocation of services and exactly how they are configured locally is led locally, so that we can get the best services to people in Tyneside and across the country.
In England, over 80,000 people have a stroke each year and about 20% of them die within a year. Can my right hon. Friend reassure me, the House and my constituents in Corby and East Northamptonshire that he not only wants to drive down that figure but has a plan to do so?
Yes, I can. I feel very passionately about stroke and the impact that it has on people’s lives and the health service. We are working very closely with the Stroke Association to develop the new national plan for stroke in England as part of the long-term plan. That plan will build on the success of the Department’s stroke strategy, which ended last month, and look at how we can improve stroke care across the pathway. It will also, critically, include prevention so that we can protect more people from stroke in the first place.
Despite the Government’s reassurances on the new NHS pay deal, it has left one of my constituents actually taking less money home at the end of the month and being required to pay money back. When I wrote to the Department, the Minister had the audacity to simply respond with a generic factsheet. Does he think this acceptable, and if not, will he give a meaningful reply to my constituent, who has done 30 years in the NHS?
I have recently been contacted by a constituent who works as a paediatrician in a nearby hospital. Last Friday, tragically, a baby died in their ward. The cause of death is unknown. Owing to the lack of a coroner service at the weekend, the baby had to stay for three nights with breathing tubes fixed in. For the parents, these are the last memories of their child. What steps will the Minister be taking to guarantee that the seven days NHS requirement also applies to coroners and histopathologists?
My heart goes out to the parents of this child, my hon. Friend’s constituents, as I am sure it does from everybody in this House. Of course I will happily take up this individual case. But she raises the broader point, too. I am meeting the Justice Secretary on this topic to discuss what further we can do. It is technically a matter for the Ministry of Justice, but I understand entirely why we need to work together to make progress.
Is not the Secretary of State alarmed that fake psychiatrist Zholia Alemi was revalidated in 2013 under the supposedly strengthened revalidation process? Why did the Government not act on the findings of the Sir Keith Pearson report in January last year, which pointed out this exact weakness in the system?
I welcome the new early diagnosis ambition for cancer, but does the Minister agree that for the people of West Oxfordshire, this is about delivery and having the people available to implement the strategy that he has worked so hard to produce?
My hon. Friend is spot on, as always. Just last week, I spent time with the heads of all 19 cancer alliances in England, which are doing so much to deliver the strategy on the ground, including his Thames Valley cancer alliance, led by Bruno Holthof of Churchill Hospital in Oxford. The alliance was clear that we need more people across the board in “team cancer”, as I call it, and that is right. We especially need more radiographers, and we are working through that with Health Education England in the beyond 2021 plan.
Today’s report on the amount of police time spent dealing with emergency mental health cases without support from mental health professionals is echoed by police in my constituency, who say that it takes up almost 40% of their time. Will the Government recognise that this crisis should not be dealt with by police officers, far less in cells, and sort it out?
First, I pay tribute to the work that the police do in dealing with people who are in mental health crisis. They view it as part of their core work, but clearly they should not be picking up the slack where services do not exist. I am working closely with the police service and other interested parties to ensure that we have sufficient crisis care, to enable the police to discharge their responsibilities adequately and in a safe way. We will continue to do that.
My constituent Alice Sloman died during what should have been a routine MRI scan, following complications with the general anaesthetic that had been administered to her. Will the Minister agree to meet me and Alice’s parents to discuss the possibility of people, particularly those with existing conditions, having routine heart checks before such procedures?
Will the Minister support Plymouth’s Peninsula Dental School in training more dentists and encourage use of the underspend in the south-west dental spending pool?
To mark the fact that it will be 10 years since the Autism Act was passed, we will start a formal review of that piece of legislation and the autism strategy, to ensure that they remain fit for purpose and heading in the right direction.[Official Report, 29 November 2018, Vol. 650, c. 4MC.]
My constituents Kirsteen and Wilma Ord have had their lives blighted by the Primodos hormone pregnancy drug. The review that the Government undertook was a whitewash, and now the further review, led by Baroness Cumberlege, will focus only on people in England. She has said that she will consult groups in Scotland, but drug regulation is reserved. What will the Minister do to promise that my constituents will not be let down again?
I met Baroness Cumberlege just last week, and I know she would be open to hearing representations from constituents in Scotland, to add to her understanding of this issue. We are determined to make full use of that review, so that we can learn lessons from this tragedy.
I thank my right hon. Friend for his question. As my right hon. Friend the Foreign Secretary stated yesterday, we condemn Russia’s aggression against the Ukrainian vessels that sought to enter the sea of Azov on 25 November. We remain deeply concerned about the welfare of the Ukrainian sailors detained by Russia and call for their release urgently. Russia has again shown its willingness to violate Ukraine’s sovereignty, following the illegal annexation of Crimea and the construction of the Kerch bridge.
The United Kingdom remains committed to upholding the rules-based international system, which Russia continues to flout. Our position is clear: Russia’s actions are not in conformity with the United Nations convention on the law of the sea or the 2003 Russia-Ukraine bilateral agreement, which provides free passage in the sea of Azov, including for military ships. The United Kingdom ambassador reiterated that position at emergency meetings held yesterday at NATO, the European Union, the Organisation for Security and Co-operation in Europe and the UN Security Council.
In response to Russian aggression, the Ukrainian Parliament agreed to impose martial law in 10 Ukrainian regions for 30 days, commencing at 09:00 local time on 28 November. We welcome President Poroshenko’s reassurances that martial law will not be used to restrict the rights and freedoms of Ukrainian citizens, and that full mobilisation will be considered only in the case of further Russian aggression. We also welcome the Ukrainian Parliament’s resolution confirming that presidential elections will go ahead on 31 March 2019.
Does my right hon. Friend agree that this represents a serious escalation of the ongoing conflict between Russia and Ukraine, which has already led to over 10,000 deaths in Donbass since 2014? Will he recognise that we, as signatories to the Budapest memorandum, have a special responsibility? May I therefore welcome the support we are already giving, including the announcement by the Defence Secretary, following his own visit to Donbass very recently, that we will be deploying HMS Echo to the Black sea in 2019?
May I also welcome the Minister’s statement that what Russia has done is a clear breach of international law? Will he now specifically seek to find opportunities for the Prime Minister to discuss this with President Poroshenko? Will he reiterate his call for the immediate release of the 23 sailors now being held by the Russians, some of whom we understand are now in Simferopol in occupied Crimea and six of whom are badly wounded?
Will the Minister also look at imposing personal sanctions on the military personnel who have already been shown to be involved in co-ordinating this operation, as well as at increasing the economic sanctions on Russia, at least to the level that Canada and the United States are already imposing?
Again, I thank my right hon. Friend. Yes, he refers to a serious escalation that the recent incidents have illustrated, and the UK Government absolutely agree with him on that. I am pleased that he mentioned the recent visit of my right hon. Friend the Defence Secretary. On other proposals, we have no plans to change our conduct of activity in the area.
My right hon. Friend asked whether this is a breach of international law. The United Kingdom’s assessment is that, under the UN convention on the law of the sea, states can require any warship not in compliance with the laws and regulations of the coastal state to leave immediately. However, Russia’s actions in ramming, boarding and seizing vessels do not conform with the law of the sea. Russia’s actions were disproportionate, particularly as the ships had left the area and were returning to the Black sea. The 2003 sea of Azov bilateral treaty between Ukraine and Russia provides for the free passage of the military and civilian vessels of both states through the Kerch strait and in the sea of Azov, so my right hon. Friend is right to suggest that this is a breach of international law. I know the Prime Minister has today received a request to speak to the Ukrainian Prime Minister and that, in her busy timetable, she will be giving that urgent consideration.
On sanctions, measures have been taken in the past in relation to previous activity by Russia and sanctions were recently considered in relation to both the Crimea annexation and of course the building of the Kerch bridge. Any further sanctions will be considered in co-operation with European partners and others. It is very important that there is a sense of unity in response to what has taken place. The United Kingdom was active in calling a meeting of EU partners yesterday, and the other meetings that took place also saw a very strong response from the United Kingdom and others.
The House is right to see this as a serious matter, and it is important that it is not escalated further. That is why we have indeed called for the immediate release of the sailors, and we ask that all parties act with restraint but certainly recognise where the act of aggression came from in the first place.
Thank you, Mr Speaker, for granting this urgent question. I also thank the right hon. Member for Maldon (Mr Whittingdale) for securing it. The shadow Foreign Secretary, my right hon. Friend the Member for Islington South and Finsbury (Emily Thornberry), sends her apologies for not being here to respond, but she is attending the annual lunch of the Labour Friends of Israel.
The events of the past 48 hours have been deeply troubling for all of us who want to see a return to peace, stability and the rule of law across the whole of Ukraine. Instead, incidents such as this make an already intense situation worse and risk widening the conflict. As the NATO spokesman said yesterday, we need to see calm and restraint on both sides and we need both sides to commit to de-escalation. In particular, Russia must abide by international law, as the Minister just stated, which means allowing Ukrainian ships unhindered access to Ukrainian ports on the sea of Azov. There is no excuse for blocking that access, let alone firing on the ships and seizing them. Will the Minister confirm whether he or his colleague will speak to their Russian counterparts and make clear when that discussion will take place?
At the same time, it has been worrying to see the reaction of the Ukrainian Government in declaring martial law. The Minister has said that he has secured agreement from the President that that will not lead to a cessation of any elections that are due to take place in the new year. While these issues are going on, proper democratic structures need to continue robustly to entrench Ukraine on the democratic footing from which we want it to move forward.
The Minister will agree that if the elections do not take place, that will be a backward step—not just for democracy, but for peace, stability and the rule of law, which we want to see across the whole of the region.
I am grateful to the hon. Gentleman for his recognition that the Government’s basic position on international law and our response to this are correct. This recent action has come on the back of further disruption over a lengthy period. Since May 2018, Russia has conducted more than 200 stop-and-search boarding operations of civilian vessels transiting to or from the Ukrainian industrial ports of Mariupol and Berdyansk. The regularity of these boardings has increased over the summer, with Russian border guards deliberately delaying merchant vessels transiting the Kerch straits, and this activity culminated in what we saw the other day. It is important for there to be a strong and united international action.
The hon. Gentleman mentioned what he called a “worrying” response from Ukraine; I am not sure I would necessarily say that. In response to aggression from Russia, the Ukrainian Parliament has taken its own decision to impose martial law in 10 Ukrainian regions for 30 days. Bearing in mind the pressure that Ukraine is under, I should have thought that the position of this House would be strongly to support Ukrainian responses in situations of difficulty.
The United Kingdom did not secure President Poroshenko’s reassurance that martial law would not be used to restrict rights and freedoms—that decision was made absolutely by Ukrainian authorities; we did not need to secure it. I can reassure the hon. Gentleman and the House that the Ukrainian President also made the decision that elections would be unaffected on 31 March, so continued progress in relation to the democratic principles may continue.
We support the action that Ukraine has had to take in relation to this aggression, and our concern about Russia’s international position is clear, which is why we welcome the calls for de-escalation so that these matters do not get worse.
I congratulate my right hon. Friend the Member for Maldon (Mr Whittingdale) on securing the urgent question, and—not that you need it from me—I congratulate you, Mr Speaker, on seeing that this is a very urgent matter that needs to be dealt with.
We are now dealing with a country, in Russia, that is a pariah state. It occupies large sections of Ukraine illegally, and the very fact that it illegally occupies Crimea means that it has no rights under international law as regards this channel or any interventions to shipping that it has been making, notwithstanding the violent intervention made recently.
May I urge my right hon. Friend the Minister and Her Majesty’s Government to make a very big deal of this internationally at the UN, and as loudly as they possibly can? Will they say that this now means that we must have the highest level of sanctions and interventions because this country, which has intervened in Syria and in almost every other area of the conflict in the middle east and now in Ukraine, has to be brought to book—and that we have to do it now?
I am grateful to my right hon. Friend for that. I reiterate that we strongly condemn Russia’s act of aggression against Ukrainian vessels entering the sea of Azov. As he said, that act of aggression is a further example of Russia’s ongoing violation of Ukraine’s sovereignty and territorial integrity, following its illegal annexation of Crimea and illegal construction of the Kerch bridge earlier this year.
We remain clear in our support of the rules-based international system, which Russia continues to flout. Russia must not be allowed to establish new realities on the ground. We expect all parties to act with restraint and Russia to de-escalate the situation immediately, and we are indeed discussing with partners what concrete measures we can collectively take in response to Russia’s actions.
The EU has recently strengthened sanctions related to Crimea by listing individuals and entities responsible for the construction of the Kerch bridge, which connects Russia with illegally annexed Crimea. By acting in unity with our allies and partners, in the UN and the EU, we can achieve much.
I, too, thank the right hon. Member for Maldon (Mr Whittingdale) for securing this urgent question. First, let me be clear that we in the Scottish National party absolutely condemn the aggressive actions of Russia and its clear violation of international law. We join the Minister in calling for the release of sailors and others involved as soon as possible. May I also take this opportunity to commend the work of Ambassador Judith Gough and all her colleagues, as she does fantastic work in Kiev?
We know that Ukraine is aware that we are stronger because of respect for human rights, the rule of law and the right of opposition to question Governments. That is something Russia fails to understand—not just in Ukraine, but in the Russian Federation. Will the Minister set out what work is being done with European partners, given our relationship and how important Ukraine is to EU security? Will he set out what his co-operation is with EU partners? Will he also set out more details on how he is looking at individual sanctions, which have been mentioned?
I am very grateful for such a clear statement from colleagues on the other side of the House—in particular, the condemnation of Russia’s actions and the unequivocal call for the urgent release of the sailors. We welcome that. I thank the hon. Gentleman also for the support he gives to our ambassadors, not only in the region but at the UN, where Jonathan Allen made a particularly strong statement at the Security Council on this matter yesterday.
On the hon. Gentleman’s questions, the EU Political and Security Committee is meeting today to consider the EU’s practical response. As I said earlier, we are discussing with partners what concrete measures we can collectively take in response to Russia’s actions. He can be in no doubt, because of the clear statement by the Foreign Secretary yesterday and clear statements made by ambassadors, that we will continue to do exactly what it takes to try to de-escalate the situation but make clear where we believe the fault lies.
May I, again, thank you for giving adequate time to this urgent matter, Mr Speaker? This is not the first time we have found ourselves discussing Russia’s pariah nature in this House, nor is it the first time we have seen Russia committing acts of aggression—or, indeed, warlike acts—against countries in the region. We have even debated its warlike acts in our own country. So this is a matter not about a foreign nation about which we know little, but about ourselves and our own security.
Does my right hon. Friend the Minister agree that every time we see one of these acts, we see a moment of Russian weakness being expressed through violence, we see a falling oil price being covered up by an act of aggression, and we see riots about the pensioners who have been stripped of their assets by this brutal regime being covered up by further acts of war? Does this not mean that we must stand with the Russian people? We must stand with the democrats, the journalists and the civic activists in Russia, and defend their interests. By doing so, we stand against those who seek to profit from them—not only the warmongers, but those in our own House, even, who are profiting from Russian business in this country and in the United States.
My hon. Friend the Chair of the Foreign Affairs Committee makes a series of strong and clear points. He sets out again the concerns the UK shares about a series of actions that has also caused concern abroad. He also made the wider point about the impact of actions on the people of Russia. I should add that Ambassador Jonathan Allen concluded his statement on Ukraine yesterday by saying:
“As my Prime Minister recently made clear, like others here today we remain open to a different relationship with Russia: one where Russia desists from these attacks that undermine international treaties and international security and desists from actions which undermine the territorial integrity of its neighbours and instead acts together with the international community to fulfil the common responsibilities we share as Permanent Members of the United Nations Security Council. And we hope that the Russian state chooses to take this path.”
He sets out clearly why that should be the case, and why a different relationship is open to Russia, but it must entail a change in behaviour.