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Topical Questions

Volume 654: debated on Tuesday 19 February 2019

To provide the best care, the NHS needs the best technology, and we are therefore bringing together leaders of the digital agenda across the NHS under a new organisation called NHSX. We are also publishing a new code of conduct for the use of artificial intelligence in the NHS. NHSX will report jointly to the NHS and to me, and it will lead this vital agenda so that the NHS can be a world leader in emerging technologies that help to cut costs and save lives.

Meanwhile, in the real world, Scottish Care reports that 30% of social care staff in the highlands are nationals from other European countries. They are paid the real living wage of £9 an hour as a matter of public policy, but that is well short of the Government’s proposed limit of £30,000 for new immigrants in the future. Will the Secretary of State fight in the Cabinet to change that policy, or is he content to let these new immigration policies choke off the supply of labour to our social care sector?

We welcome people working in social care from the EU and from the rest of the world, and we need to ensure that that can continue, but we also need to ensure that we can train people locally to work in social care. That is incredibly important.

T2. GP surgeries across the Wells constituency are innovating with the employment of nurse practitioners, paramedics and other types of clinician to fill vacancies when recruitment of GPs has not been possible. While this often works well, we still have too many vacancies for doctors. What steps will my right hon. Friend be taking to encourage the thousands of GPs in training to consider practice in rural and coastal areas like mine in Somerset? (909325)

My hon. Friend makes an incredibly important point. As important as new technology is and new ways of working and nurse practitioners are, we still need more GPs, and we need more GPs especially in rural and coastal areas. The targeted enhanced recruitment scheme offers a £20,000 salary supplement to attract GPs to parts of the country where there are serious shortages, including in Somerset.

T5. The Terrence Higgins Trust has made it clear that men are being diagnosed with HIV as a direct result of the limited number of places on the current PrEP trial. The Secretary of State has already said this morning that the doubling of the places on that trial is being implemented now, but that commitment was made over three weeks ago; when will implementation be completed across all trial sites including Burrell Street in my constituency? (909329)

I want to see this being implemented as soon as possible. It has already started, but we need commitment from local authorities as well as the NHS to deliver. I am very happy to work with the hon. Gentleman and all other interested Members to see it happen.

T3. Key parts of our NHS workforce are registered and regulated by the Health and Care Professions Council. Does the Minister share their concern about the steep rise in professional fees that they face—in particular, the loss of the 50% discount that applied to graduates within two years of qualifying—and will she look again at whether anything can be done to assist this key group of our workforce? (909327)

My hon. Friend is absolutely right about the need to support and enhance the protections for allied health professionals. One of the recent planned HCPC increases was to raise its annual fees by £16, but it would still remain one of the lowest of any of the UK-wide health and care regulators. It is also important to remember that regulation fees are tax deductible.

T6. The head of NHS Improvement, who is also a Tory peer, has said the biggest problem facing the NHS is that not enough people want to work in it. How did the Secretary of State take Britain’s best-loved institution and turn it into something nobody wants to work for? (909330)

Thankfully, the recruitment both of nurses and doctors is going up, which demonstrates that people do want to work in the NHS, and so they should because it is an amazing place to work and it has a great mission, which is to improve the lives of everyone.

T4.     Last September, the number of medical school places increased by a quarter, as we have just heard. That is great news, but apart from offering premiums, how can we incentivise newly qualified GPs to come to places like Clacton where we have an acute shortage? (909328)

My hon. Friend is absolutely right: the £20,000 bonus is an important part of the solution, but so is having more GPs, and the fact that we have a record number of people going into GP training at the moment is great news that Members in all parts of this House should welcome.

T7. A huge number of GP surgeries are struggling to recruit, and meanwhile lots of locums are making a lot more money being locums than working on permanent GP contracts. Will the Secretary of State consider offering his state-backed indemnity to those who commit to being on a permanent contract with a GP surgery? (909331)

Of course the nature of being in a GP practice is changing. For a long time practices, which are essentially private businesses, also had the benefit of rising property prices that brought additional income on top of their income from the NHS. That is no longer the case because property is so expensive, so many people are changing the way that GPs are employed, so they are directly employed rather than through practices. That move is happening, but it is just one of the many changes we are seeing to try to make sure that being a GP is sustainable, and clearly things are starting to improve because a record number of people are choosing to become GPs.

T8. Mr Speaker, you will be aware of the fantastic work by the Edenbridge War Memorial Hospital in the town just near me, and you will also be aware of the fantastic news that we are having a new clinic built there. Does my hon. Friend the Minister agree that the money from the initial site, which was given by public subscription 100 years ago in memory of the young men who died in the first world war, should now be spent on medical facilities in the town? (909332)

My hon. Friend has been absolutely passionate about securing the best possible outcome for his constituents. As he knows, the Edenbridge War Memorial Hospital is held by NHS Property Services on behalf of my right hon. Friend the Secretary of State. Local NHS bodies in Kent are considering the future of services in the Sevenoaks area, including their nature and possible funding. I am sure that my hon. Friend will recognise that I cannot intervene directly, but I would be happy to meet him to discuss this further.

T9. The Central and East London breast screening service was performing well until last April, when it was transferred from Barts Health NHS Trust to the Royal Free London NHS Foundation Trust, even though the Royal Free and did not have enough staff. The number of women invited plummeted from 3,000 a month to 1,000 a month. Why was that transfer allowed to go ahead, given the clear warnings about what the consequences would be? Who is responsible for this failure? (909333)

The award of the contract for the Central and East London screening service to the Royal Free was approved by both NHS England’s London region and NHS England’s commercial executive group. An agreed recovery plan was put into place to address the various issues. While the service did plummet to 1,100 in April 2018, it is currently inviting 3,000 women per month, which has been the normal monthly invitation rate for the service for the past three years. Women are currently being offered appointments in line with the agreed recovery plan and with the national breast screening standard, with 90% or more being invited within 36 months of their previous screening by October 2019.

The internet and social media have provided huge opportunities and positives for our young people, but we have been far too slow to react to the negatives, including cyber-bullying and issues around body image. Will the Minister responsible for suicide prevention, or my right hon. Friend the Secretary of State, confirm that they are taking a truly cross-Government approach to this issue and that they will seriously tackle the role of the tech companies?

Yes; my hon. Friend is dead right to bring up this subject. The rise in material promoting self-harm and suicide online is dangerous, and it needs to be stopped. I am delighted that, under pressure from this House, Instagram has now decided to take down that material, but there is much more to do. In this country, it is this House that makes the rules, not the global companies.

The greatest damage from prenatal exposure to alcohol is often done in the first few weeks of pregnancy, yet three quarters of women in the recent Bristol University study said that they drank alcohol while pregnant. Will the Minister commit to ensuring that the chief medical officer’s advice is given loud and clear by all health professionals: do not drink alcohol if pregnant or trying to conceive?

I am pleased that the hon. Gentleman has raised this important point. We need to deliver this important public message because, as he rightly observes, the damage caused by alcohol can take place in the earliest part of pregnancy. Anyone seeking to get pregnant should be monitoring their alcohol intake, and in fact withdrawing altogether. It is important that we make the public aware of this, not least because of the rate of unplanned pregnancies, which continues to rise.

Southampton is above the English average with nearly 6% of GP appointments being missed. Nationally, missed appointments cost the NHS more than £200 million a year. Does my right hon. Friend agree that a standardised online booking system featuring a reminder function with the option of cancelling or rescheduling an appointment would save money and reduce waiting times? Does he have any plans for such a system?

Yes, I do. This is one of the sorts of things that NHSX will drive forward. A decent IT system can reduce missed appointments in GP practices by a third—[Interruption.] So, while Opposition Members snigger about using modern technology and want to go back to the past, over here we are providing the best technology for the NHS for the benefit of patients.

A recent answer to a parliamentary question from my hon. Friend the shadow Minister confirmed that in nearly half of cases of mental health crisis, it is not NHS staff but the police who are conveying people hospitals. Will the Department conduct a review into the impact that this is having on people in mental health crisis?

The hon. Lady raises an important point. This is something that I am taking forward with the Minister for Policing and the Fire Service. We are acutely aware of the impact that this is having on policing services, and that is one of the reasons why, in the forward plan, we have directed so much support and priority to ensuring that the NHS 111 service works and that we have the community and crisis care services to back it up.

A report in The Lancet in March 2018 found that most drugs and injections are useless for lower back pain. What will my right hon. Friend do to find alternative treatments?

I pay tribute to my hon. Friend, who recently announced that he will be standing down at the next election, for the amount of attention he has given to broadening people’s minds and to looking at what works and what the evidence shows works. We know, for instance, that social prescribing can help people and ensure that they get the support they need, and he has made a great contribution to that debate.

After reviews by ACAS, Capsticks and Dr Bill Kirkup, will the Minister outline how he intends to deliver justice for both staff and patients of the Liverpool Community Health NHS Trust? How will he ensure that the board members who disgracefully refused to give evidence to Kirkup will be held to account and made to give evidence in future investigations?

I pay tribute to the hon. Lady for her courageous campaigning on this issue. There have been several reports looking into the events at the trust, and we understand that further detail would be helpful to realising her wish that those in senior positions be held accountable. I hope she agrees that the Kirkup report has provided the basis for that, and I am happy to meet her to discuss how the matter may be advanced.

We all want a pipeline of talented staff entering our NHS. In many areas, the health service is a key local employer. Would the Minister welcome proposals for a specialist school in Mansfield, run in conjunction with our hospital trust, to ensure that we equip young people with skills and an aspiration to join our health service? May I meet him to discuss the matter further?

My hon. Friend will have heard the answer that my right hon. Friend the Secretary of State gave about missed appointments, and I would be happy to meet my hon. Friend to discuss the situation in Mansfield. We encourage everybody to use technology to ensure that cancelled appointments are used for the benefit of others.

Mental health services need proper staffing, but 2,000 mental health staff are leaving the NHS every month. How do the Government expect to achieve any ambitions in the long-term plan without adequate staff?

The hon. Gentleman is right. When we put a large amount of money into a service, we of course need more people to deliver it. That is most acute in mental health, which is getting the biggest increase in funding—£2.3 billion of the £20.5 billion overall. I assure him that the Minister responsible for mental health and suicide prevention, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), is working night and day to ensure that we attract the people we need to deliver the services that our people deserve.

May I ask a question in memory of my late friend Stephen Horgan, who died a few years ago from a rare form of blood cancer with just a few months’ notice? In his memory, I am a now a supporter of Bloodwise, an excellent charity that raises awareness of rare cancers. Asking on the charity’s behalf, will the new workforce plan for the NHS include clinical psychologists, particularly those with cancer knowledge, to make the absolute best use of the welcome new resources, which I am sure Stephen’s family also welcome?

Yes, my right hon. Friend puts it extremely well, because he reminds us of who we are here to serve when discussing questions of health and of cancer. He is right to raise this matter, and I can absolutely confirm what he asks for: we will deliver in Stephen’s memory and in the memory of others who have died. That is what gives us the strength to carry on and try to deliver and improve services for everybody.

The Secretary of State talked earlier about a six-week stockpile of medicines, but radioisotopes for cancer diagnosis and treatment cannot be stockpiled. I have asked many times about the future arrangements for radioisotopes post-Brexit, so will the Secretary of State detail them now?

In the event of a problem at the Dover-Calais strait, we will bring in radioisotopes by air, and we have already contracted an aircraft to ensure that that happens. That part of the planning is well advanced.

On Thursday, with Rugby’s mayor, I had the great pleasure to open the new Brownsover surgery, which came about because of the hard work of the patient action group. Will the Secretary of State welcome the work of patient groups in delivering NHS services?

I am absolutely delighted to welcome the work of the group, which has raised so much money, and of my hon. Friend, who stands up and makes the case for Rugby. More broadly, we should welcome all those who want to make a contribution to our hospitals and hospices. We take a broad-minded and open approach to welcoming people who volunteer hours or raise money to improve our great NHS.