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House of Commons Hansard
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Health and Social Care
19 February 2019
Volume 654

The Secretary of State was asked—

PrEP Impact Trial

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1. What discussions he has had with (a) NHS England, (b) Public Health England and (c) local authorities on ensuring that the Government’s commitment to double the number of places on the PrEP impact trial can be implemented in all trial sites as soon as possible. [909299]

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On 30 January, we announced that we will increase access to PrEP, doubling the number of people who can receive this potentially life-saving HIV prevention drug.

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Funding for HIV prevention has become quite complex, with a complex mix of central funding and local authority funding. Cities such as Brighton and Hove still have the highest contraction rates outside London. Will the Secretary of State meet me and the Terrence Higgins Trust to understand how that is impacting us on the frontline and tell us what more can be done?

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Of course I would be delighted to meet the hon. Gentleman to discuss this matter. In the long-term plan, we made it clear that we are looking at commissioning arrangements for sexual health services. I am delighted that the number of new cases of HIV has been falling and that we have been able to declare that by 2030 we want the UK to have zero AIDS. That is an achievable, but hard, goal, and I will work with anybody to make it happen.

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Does the Secretary of State share the widespread concern about the variation in availability of PrEP treatment, which is surely an unacceptable situation?

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There is a variability in availability. Of course the current model of delivery is a trial—we have doubled the size of that trial but it is still a trial that runs until 2021. I am very happy to work with my hon. Friend as well as with the hon. Member for Hove (Peter Kyle) to try to make sure that it is as available as possible.

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Hammersmith is one of the sites that is now closed. When will PrEP be made freely available? Here we have a drug that has almost 100% effectiveness and that will save money for the NHS through HIV protection. When will we see it available to anyone who needs it?

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As I have said, last month we doubled the availability of PrEP, which is an important step in the right direction.

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Colchester is one of the sites that is now closed to men who have sex with men who want to access the HIV prevention drug PrEP. When will the Government’s commitment, made almost three weeks ago, to double the number of places on the PrEP trial be implemented across all trial sites?

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It is being implemented as we speak. I am very happy to talk to my hon. Friend about when it will be rolled out in Colchester.

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I welcome the Government’s commitment to end the transmission of HIV in England by 2030. However, HIV reduction was not mentioned in either the prevention plan or the long-term plan. How will the Government reach that ambitious goal without a concerted and fully costed strategy?

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We do have a concerted and fully costed strategy. Indeed, I have given the commitment of ending new AIDS cases by 2030 with a plan around that. The long-term plan goes into detail about new ways of commissioning sexual health services. This is a very important area, and, as the hon. Lady says, it is an important part of the prevention agenda, and we will make sure that we get it right.

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Order. Before we proceed further, I hope that colleagues on both sides of the House will want to join me in extending a very warm welcome to Democratic New York State Assemblyman Sean Ryan, who is with us today. Welcome to you, Sir, we are delighted to have you.

Future of the NHS

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2. What steps he is taking to secure the long-term future of the NHS. [909300]

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We are increasing the NHS budget by £20 billion, or £33 billion in cash terms, over the next five years. This major investment will support the NHS to continue to deliver world-class care. The long-term plan set out a vision for the NHS, ensuring that every penny will be well spent.

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I thank the Secretary of State very much for his answer. Local accident and emergency departments, such as at County Hospital in Stafford, are absolutely vital for the long-term plan of the NHS. What can he do to ensure that funding is there for these departments because they need an awful lot of block funding and not so much payment by procedure—or payment as you go?

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My hon. Friend, who is an advocate for Stafford beyond compare and an advocate for its A&E—he has personally put much effort into saving it and ensuring that it is in good shape—rightly makes the point that paying per person who comes through the door does not accurately reflect the costs of providing A&E, so we are moving to a much greater proportion of block funding for A&Es, with a smaller element that varies according to the costs of serving everybody, to ensure that the finances follow the need.

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The latest figures show that more than one in five patients visiting Leighton Hospital A&E in Crewe has had to wait for more than four hours, yet instead of receiving support, the trust has been financially penalised, unable to access capital support to fund improvements to its A&E, while at the same time losing out on the performance element of the provider sustainability fund. Can the Minister explain how the Government are supporting Leighton Hospital?

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We are supporting Leighton Hospital through the delivery of the long-term plan and the extra £20 billion—£33 billion in cash terms—the first £6 billion of which comes on stream in April, in two months’ time. It is true that a record number of people are going to A&E. We have to make sure that the record numbers being treated within the four-hour target are supported, but that we also support hospitals to do yet more.

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In Telford, we have been waiting five years for the chance to ask the Secretary of State to call in for review a highly controversial plan called Future Fit. We now have that chance, and the Secretary of State has been really generous with his time in listening to MPs’ concerns. The local council, however, has still not yet made any submission to the Secretary of State. Can he confirm that without that submission he cannot call in that scheme for review?

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My hon. Friend has made the case very powerfully for the future of Telford Hospital, and I have enjoyed working with her, but it is true that the call-in powers that I have as Secretary of State can be exercised only when a scheme is referred to me by a local council. Should that happen, I will consider it very carefully.

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Will the Secretary of State now come clean with the House and admit that the Lansley Act, which fragmented the NHS into tiny pieces, caused huge inefficiencies; and that successive Governments, including the one of which he is a member, have starved the NHS of resources, which has caused a lot of the problems that our constituents face in increased waiting times and increased pressure on staff?

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We care about securing the future of the NHS. That is why we are putting £20 billion extra into it over the next five years—£33 billion extra in cash terms. Yes, we will consider proposals being made for legislative changes, but what we care about is making sure that the NHS gets all the support it needs, and not just political nonsense.

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Does my right hon. Friend agree that one of the vital components to ensure the long-term future of the NHS is community hospitals? Will he meet me to discuss what can be done to recruit more qualified staff, so that beds at the Portland Community Hospital can be reopened?

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I would be very happy to meet my hon. Friend to discuss that, because community hospitals have a vital role to play in the future of the NHS as more care is delivered close to home.

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It was not insignificant, what happened between ’97 and 2010 under a Labour Government. They trebled the amount of money going to the national health service. It was a system of hypothecation, whereby a 1% increase in national insurance went directly to the national health service, and nobody else fiddled with it.

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It is unusual, but I am delighted to be able to agree with the thrust of the hon. Gentleman’s question. As he knows, we both come from Nottinghamshire mining stock, and it is surprising that we do not agree on more, but we do agree on the importance of having a properly funded NHS. That is why we have put the largest ever, longest ever cash injection into the NHS, because we care that it should be fit for the future.

Toxic Air and Children’s Health

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3. What assessment he has made of the effect of toxic air on children’s health. [909302]

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Poor air quality is the largest environmental risk to public health in the United Kingdom. Long-term exposure to air pollution can cause chronic conditions, such as cardiovascular and respiratory diseases, as well as lung cancer, leading to reduced life expectancy. It has a particular impact on children as they grow. There is evidence to suggest that the process of normal lung function growth in children is suppressed by long-term exposure to air pollution.

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In Edinburgh West we have two of Scotland’s most polluted roads, St John’s Road and Queensferry Road, according to recent figures. Studies show that if someone lives with 75 metres of any major road as a child, they have a 29% increased risk of lifetime asthma. Given that across the country there are 2,000 nurseries close to roads with dangerously high levels of pollution, what action can the Minister assure us is being taken, along with counterparts in Scotland and in the Department for Environment, Food and Rural Affairs, to tackle this on a UK scale?

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The hon. Lady will be aware that we have a clean air strategy, which, as she rightly says, is led by my right hon. Friend the Secretary of State for Environment, Food and Rural Affairs. We have a number of measures designed to improve air quality, such as reducing all pollutants, getting more diesel and petrol cars off the roads, and tackling wood-burning fires. We also need to be much more vigilant in advising the public about the risks, and that includes on how they use their cars. Time was when I went to school we used to walk, but too often we see parents dropping off their kids with idling engines, and that causes pollution.

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The Minister is very good at warm words. Why does she not talk to the Secretary of State for Environment, Food and Rural Affairs, because his Department’s plan is to tackle the poisonous air that our children and pregnant women are breathing by 2040? The fact is that children are being poisoned now. Get on and do something about it.

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To be frank, I am not often accused of using warm words, but I will take the compliment. I can assure the hon. Gentleman that we are working very closely with DEFRA, but ultimately we need to encourage the public to change their behaviour, and we need to have a much more open debate about the consequences of bad air.

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Young Bridgen was a bit slow to stand but, now that I have seen him, let us hear from the fellow.

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Will the Minister join me in welcoming the work of UK researchers to develop a new protocol for managing asthma, such as a pill to reduce the number of attacks by targeting airway muscles, developed in partnership with researchers in Canada?

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I will always welcome any research designed to improve the treatment of asthma. Certainly, from a public health perspective, we must do much more to prevent asthma and reduce the likelihood of life-threatening attacks.

Mental Health Provision

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4. What steps the Government are taking to improve mental health service provision. [909303]

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Under the NHS long-term plan, there will be a comprehensive expansion of mental health services, with at least an additional £2.3 billion in real terms by 2023-24. That builds on our ambitious targets for improving community and crisis care, with extra treatment for 370,000 adults per year, and for 345,000 children and young people by 2023.

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Yes, but I think that the Minister is seeking to group this question with that of the hon. Member for Ochil and South Perthshire (Luke Graham). Am I right?

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Yes, indeed. My apologies Mr Speaker.

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I would not want the hon. Gentleman to feel any sense of social exclusion.

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One of my constituents, Mark Verrion, is a patient of Kent and Medway NHS and Social Care Partnership Trust. He was first admitted on a temporary basis following an unfortunate but mild episode. He has now been institutionalised for 11 years, and he has been moved over 100 times during that period, often out of area. The trust has 289 out-of-area placements for adult mental health services, which is an increase of 100 over the past year, and the cost to local health budgets is obvious. Does my hon. Friend agree that my constituent and all the other out-of-area patients deserve local health provision to enable them to remain within the trust area?

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I quite agree with my hon. Friend. Frankly, I am horrified to hear the account he has just given. We have made a priority of getting rid of out-of-area placements, because we know that patients do better when they are among family and friends. Clearly the case he has just outlined, which has lasted the past 11 years, is totally unacceptable. I will give it my personal attention and meet him to discuss it.

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6. What UK-wide steps is my hon. Friend taking to ensure that Scotland is not left behind in mental health provision, especially given that only two thirds of young people are referred within the 18-week timeline, against a 90% target? [909306]

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As my hon. Friend knows, health is a devolved matter, but I am keen to share best practice with colleagues in Scotland, who face many similar challenges. In England, we will test four-week waiting times for access to NHS support in the community and we are committed to sharing that expertise, as we often do, with colleagues in Scotland.

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In the Government’s 10-year plan for the NHS, a growing share of the budget is promised for improving mental health services in the coming years. The mental health services in Wolverhampton are in a desperate state of underfunding now. I am receiving letters from my constituents telling me how they have to wait over a year or more to be treated. One woman told me:

“I personally know people who have attempted to take their own lives, thankfully unsuccessfully… but… aftercare once discharged from hospital”

is non-existent. When will people see the benefits of the 10-year plan? By the time the uplift takes place, it will be too late for some of them.

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As we outlined in the 10-year plan, we fully recognise that there needs to be much more investment in community and crisis care, including direct access via the 111 service. By April, we will be able to put more flesh on the detail of how we will roll that out. I assure the hon. Lady that I am in no way complacent about thechallenges we face in ensuring that our mental health services are what people should expect of them.

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Last week, The Guardian revealed that hospital admissions for eating disorders have surged in the last year. Meanwhile, the number of children and young people with urgent cases of eating disorders who are treated within a week has fallen, and the number of those waiting between one and four weeks has risen. If prevention is better than cure, why do so many children and adolescents with eating disorders end up in A&E?

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The hon. Lady is right in the sense that we have waiting targets for eating disorders, whereby the most acute cases should be seen within a week. We have seen very good progress—indeed, in most areas those targets are met. I will look into the cases that she has highlighted because we need to give attention to where the targets start to be missed. However, I assure her that we recognise that tackling eating disorders among our youngest people through early intervention must be done because prevention is always better than cure.

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On Friday, I joined the brilliant A&E team at the James Cook University Hospital in Middlesbrough for a night, and it was an insight into just how lucky we are to have our NHS staff—they are fantastic. On the subject of mental health, one of the key themes that recurred in the night was the problem of drug addiction and its impact on A&E pressures. What action will the Minister take in the long-term NHS plan to ensure that we can tackle addiction?

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We are aware that substance misuse and addiction have a massive impact on mental health. Again, I point to the fact that we have objectives in the long-term plan, including joining up more effectively with local authorities’ work on mental health. Tackling addiction and substance abuse is very much a priority.

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The Minister will be aware of the high prevalence of mental health issues among ex-service personnel, particularly people who served in Northern Ireland and the middle east. What provision is she making for those who suffer unduly on the mental health front?

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I am grateful to the hon. Gentleman for raising the matter. Through the military covenant, we have an absolute duty to provide the best possible care to those who have made that commitment to service on our behalf. Through NHS England’s commissioning of specialised services, we are determined to ensure that we have the right provision for all our veterans and servicemen. I am in contact with the Ministry of Defence to ensure that we do all we can for them.

Children’s Hospices

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5. What steps he is taking to improve the provision of care and support to children and their families in children’s hospices. [909304]

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In December, NHS England announced plans to increase funding for children’s palliative care services to as much as £25 million a year over the next five years through match funding investment from clinical commissioning groups.

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St Andrew’s children’s hospice, based in Grimsby, which serves my constituency and the wider Lincolnshire area, is greatly valued and much treasured by the local community. Will the Minister clarify exactly how the funding will be delivered and how St Andrew’s can benefit?

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I am grateful to my hon. Friend for mentioning his local hospice. We all have wonderful stories about the fantastic care delivered by hospices, particularly children’s hospices, in our local area. NHS England will match fund clinical commissioning groups that commit to increase their investment in all children’s palliative and end-of-life care services by up to £7 million a year by 2023-24. This, added to the children’s hospice grant, which is currently £11 million a year, could therefore more than double NHS support to a combined total of £25 million.

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But the fact is that, even with those significant investments, most children’s hospices will still be reliant almost exclusively on fundraising and philanthropic donations. Does the Minister agree that, for there to be a proper footing for children’s hospices, there needs to be a much quicker move towards significant support from the state for these important facilities?

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The hon. Gentleman talks about how children’s hospices, and indeed hospices, have traditionally been funded, but what we are looking at is an incredible commitment by NHS England to the value that hospices, and particularly children’s hospices, deliver not only in end-of-life and palliative care, but in respite care breaks and the immensely valuable outreach services that so many of them offer.

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Will the Minister join me in thanking the Donna Louise children’s hospice for its hard work in my constituency—it does incredible work—and in welcoming the new facility for young adults that it is hoping to open in the spring?

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My hon. Friend is absolutely right to raise this. When children’s hospices expand and include facilities for young adults, it can make such an immeasurable difference in their local area. In my area, the Naomi House children’s hospice has opened Jacksplace, which has been such a valuable resource. Hospices should be incredibly celebrated for all such facilities they offer.

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Will the Minister take this opportunity to guarantee that the £11 million children’s hospice grant will be protected for children’s hospices, and indeed further increased as a result of the long-term plan to reflect the growing demand and the complexity of care provided by these lifetime services?

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Yes. I think this is a really strong signal to clinical commissioning groups about how the NHS values the services provided by children’s hospices—not just end-of-life and palliative care, as I say, but the other respite and outreach services they provide. That is why giving them access to up to £25 million will make an immeasurable difference.

Leaving the EU: Contingency Planning

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7. What progress his Department has made on contingency planning for the UK leaving the EU without a deal. [909307]

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17. What progress his Department has made on contingency planning for the UK leaving the EU without a deal. [909319]

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Leaving the EU with a deal remains the Government’s top priority, but we are preparing for every eventuality. I am confident that if everyone does what they need to do, the supply of medicines will continue unhindered.

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Will the Secretary of State say how much has already been spent since the NHS no-deal contingency plans were active, and what the overall bill will be?

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Yes. About £11 million has been spent already. The NHS is not generally buying the extra medicines that are going into the elongated stockpiles, but the pharmaceutical industry is. We will of course eventually buy most of those medicines for the NHS. There have been costs to the pharmaceutical industry as well, but the cost so far to the taxpayer is £11 million. I expect it will remain at about that level, or a little higher.

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Some of my constituents with diabetes have contacted me about supplies of insulin. Will the Secretary of State give us an insulin-specific answer?

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Yes. Whereas across all medicines we have requested that the pharmaceutical industry has an extra six weeks of supplies in case of a no-deal Brexit, in the case of insulin the two major providers have already made stockpiles of at least double that. That shows that those with concerns about access to insulin can know that the plans we have in place for insulin are being enacted even more strongly than elsewhere.

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But the Secretary of State is refusing to provide any reassurance to constituents up and down the country, and particularly to my constituents. I got an email yesterday from a constituent—I have no shame in quoting this—who said:

“I have type 1 diabetes, as does Theresa May, and the supplies of insulin, needles and blood testing equipment all come from Europe. Insulin is perishable. Without it, so am I.”

Will the Secretary of State come to the Dispatch Box and say to my constituents that, whichever disease they have and whichever medical supplies they require, they will get them even if we leave the European Union with no deal? Would not the best thing to do be just to rule out no deal?

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I have already given the assurance that if everybody does what they need to do, I am confident that supplies will be unhindered. In the case of insulin, the stockpiles are already double what we requested. However, on the point about the deal, the hon. Gentleman has a really important point about ruling out no deal being the best thing for people’s supply of medicines. He knows as well as I do that if we want to rule out no deal, we need to vote for a deal, so he and everybody in this House should vote for the deal.

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The serious shortage protocol statutory instrument would allow pharmacists to dispense alternative drugs when there is short supply, but, crucially, without consulting a GP. The problem is that they cannot access patients’ records and might dispense a drug that has previously caused serious side effects. Is the Secretary of State really expecting such extensive shortages that phoning a GP will be impractical?

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This change is to respond to the shortages that happen from time to time regularly in the NHS. Given that the supply of 12,300 drugs is typical across the NHS, there are always some logistical challenges. This protocol is to try to ensure that we can respond to those challenges as well as possible. Pharmacists are highly trained in what they do and perfectly able to carry this out as proposed.

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The problem is that the key issue is not consulting the GP. The medical legal responsibility for any problems normally lies with the prescriber, yet the General Medical Council was not even consulted on this SI. Does the Secretary of State really think that such a significant change should be pushed through with a negative resolution and no scrutiny and debate?

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Well, it is getting scrutiny and debate now. The change that is being proposed is about making sure we can get people the drugs they need. Of course the responsibility is on the pharmacist to ensure that it is the appropriate drug and, if necessary, that the GP is involved. However, it is absolutely right that we make changes to ensure that we have an unhindered supply of medicines whenever there are shortages—whether that is to do with Brexit or not.

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The Secretary of the State spoke with his characteristic self-confidence about the supply of insulin, but at the end of last week Diabetes UK said that

“despite reaching out directly to the Department of Health…we still have not seen the concrete detail needed to reassure us…we cannot say with confidence that people will be able to get the insulin and other medical supplies they need in the event of a no-deal Brexit.”

Why is Diabetes UK wrong and the Secretary of State right?

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Diabetes UK is not a supplier of insulin. Of course, it plays an important role in representing those who have diabetes. We have given Diabetes UK reassurances, including, for instance, that the stockpiles we have for insulin are more than twice as long as we proposed and as required. That is an important assurance.

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I hope the Secretary of State will contact Diabetes UK to give it those reassurances directly.

On the various no-deal medicines statutory instruments that the House will debate today and on other occasions, the Government’s own impact assessments say that, in a no-deal scenario, the NHS will pay more for drugs, UK firms will face more red tape, and NHS patients will go to the back of the queue when it comes to international innovation. Given that the consequences of no deal would be so devastating for the NHS, will the Secretary of State—as, apparently, the Justice Secretary will—resign from the Government if it means blocking no deal?

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If the hon. Gentleman really cared about stopping no deal, he would vote for the deal. There is something else that is worth saying about this shadow Secretary of State. He is a reasonable man—he is a sensible man—and I like him. My politics are probably closer to his than his are to those of the leader of his party, so why does he not have the gumption to join his friends over there on the Back Benches in the Independent Group, instead of backing a hard-left proto-communist as leader of the Labour party?

Acquired Brain Injury

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8. What steps the Government are taking to support charities and other organisations working on treating acquired brain injury. [909308]

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Everyone who has an acquired brain injury deserves to receive the best possible care and rehabilitative service. To ensure that, the NHS long-term plan included £4.5 billion of new investment to fund primary and community health services over the next five years.

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I thank the Minister for that answer. The NHS has a good strategy on community-based care. On acquired brain injury, will the Minister advise me and Headway Hertfordshire, a brilliant local organisation, on how we can be more proactively involved with the strategy and attract more funding from local clinical commissioning groups? Will she meet me and the organisation to discuss this matter further?

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I am delighted that my hon. Friend mentions Headway, which is a fantastic organisation that does great work. I meet it regularly in my own constituency and I would be more than happy to do so with him. The partnership boards of local integrated care systems, which will plan and shape those services, will include the voice of voluntary services and the voluntary sector in their area. His local Headway branch would be well advised to engage with that group.

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Some 1.3 million people are living with traumatic brain injury and related disabilities. Brain injury can be caused by excessive alcohol consumption, particularly among young people. What support will the Government be giving to local health services to increase the use of technology, particularly using creative industry developments, that can help rehabilitation for those with brain injuries?

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There are several points here. On local community services, as the hon. Lady heard, we are putting an extra £4.5 billion into community and local health services. Through the National Institute for Health Research, we fund brain injury research into how technology and other innovations can be used to better support people.

Dementia Care

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9. What plans he has to ensure that improvements to dementia care are included in the forthcoming Green Paper on social care. [909309]

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The social care Green Paper will bring forward proposals to ensure that all adults, including those living with dementia, receive high-quality care whenever they need it. The Government also remain committed to delivering Challenge on Dementia 2020, making dementia care in England the best in the world.

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Sadly, there are an estimated 3,000 people over 65 living with dementia in my constituency. It is clear that the social care crisis is a dementia crisis. Alzheimer’s Society research shows that dementia care providers often charge a premium rate of over 40% more than the standard rate. Will the Minister consider introducing a new dementia fund, as part of the Green Paper process, to end the unfairness facing dementia patients and their families?

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The hon. Lady is absolutely right to raise dementia. It is a massive issue in everybody’s constituency and there is hardly a family that is not affected by it in some way. We are on track to meet our pledge to invest £300 million in dementia between 2015 and 2020. We continue to fund research for dementia treatments and cures. The Care Act 2014 introduced a national threshold that defines the care needs local authorities must meet, eliminating the postcode lottery of eligibility across the UK.

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When the Minister of State looks at the proposals for the Green Paper on social care reform, will she consider the German system of compulsory social care insurance? The rate has increased by only 0.94% since its introduction in 1994, while delivering care for dementia and other impacts that were not assessed back in 1994.

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My hon. Friend tempts me to do some big reveals about the contents of the Green Paper. I will say that it will look at a number of different funding options.

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On dementia in the community, many people with low-onset or mid-onset dementia can, with the right social care, stay in their home. The crucial part is to have the funding necessary to allow people to get social care support. Will the Minister, in the Green Paper, commit specific sums for social care to keep people with dementia in their homes?

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The adult social care Green Paper will look at the long-term sustainability of the funding of the adult social care system. In the meantime the Government are investing by giving councils access to up to £10 billion over the current three-year period, to help to address some of the shortfalls in adult social care funding and to ensure that people have the right services in their local areas.

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The best way to help dementia patients is to have joined-up NHS and social care provision. Will my hon. Friend work with the Secretary of State to take advantage of local government reorganisation in Northamptonshire to develop a combined NHS and adult social care pilot?

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My hon. Friend is absolutely right to raise this point. Integrated health and care systems are very much the way forward if we are to deliver the future of adult social care that we all want. The long-term plan for the NHS was developed in tandem with the adult social care Green Paper and has already shown some of the innovations that we think will make a massive difference, such as the roll-out of the enhanced health in care homes model.

Social Care Green Paper

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10. When his Department plans to publish the Green Paper on social care. [909310]

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The Green Paper on adult social care remains a priority for the Government. We will shortly be publishing this document, which sets out proposals to reform the adult social care system.

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I thank my hon. Friend for her answer. This issue was raised with me recently by Councillor John Spence of Essex County Council. I am concerned that two years later, we are still waiting for the publication of the Green Paper. Of course, we must get it right, but people need change to the social care system and they need it now. What further steps can she take to speed up this process?

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I understand that my right hon. Friend the Secretary of State has met the gentleman my hon. Friend refers to. I understand and share my hon. Friend’s frustration. We need to ensure that the social care system is sustainable in the long term and we have taken some time to get these big decisions right, but I can assure him that the Green Paper will be published at the earliest opportunity.

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Order. The hon. Member for Blackburn (Kate Hollern) could very legitimately shoehorn her inquiry on question 18, which might not be reached, into this question, which has been. It is not obligatory, but don’t be shy—get in there.

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18. Perhaps the Minister can respond about her failings with regard to Government cuts and local government, and particularly the impact on social care, because the Government have created a postcode lottery on the quality of care that residents face, particularly in Blackburn. The Secretary of State spoke about political nonsense to my hon. Friend the Member for Wallasey (Ms Eagle). What is a political nonsense is that Blackburn has faced a 60% funding cut from this Government, whereas Windsor and Maidenhead has had only a 19% cut. The Government are creating a postcode lottery for adult social care in particular, and it is not acceptable. What is the Minister going to do address the inequalities between areas? [909321]

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Nobody can accuse the hon. Lady of failing to take full advantage of my generosity.

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I do not agree with the hon. Lady. What the Government have done is try to tackle the geographical inequalities in care across the country. We have increased councils’ access to funding by up to £10 billion. That is a 9% real-terms increase in funding, but in addition to that, we have established a national threshold that defines the care needs that local authorities must meet under the Care Act. That has really started the work of eliminating the eligibility postcode lottery across England.

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It is two years since the Government promised the social care Green Paper. In that space of time, we have had a lot of words from the Government, but we have also had a lot of neglect from them on this particular issue. Does not this delay, this prevarication, putting long-term issues to the back burner, typify what is wrong with the broken politics in this country?

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First, I welcome the hon. Gentleman to his new location in the Chamber. From that location, he might recognise that actually, there has been a failure of successive Governments to get to grips with this very thorny issue of the long-term funding of adult social care. We are the Government who have decided to tackle the issue. We will no longer put it in the “too difficult” pile, and we will be publishing this document shortly.

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But the Government are not tackling the problem of the long-term funding of social care, are they? Age UK found that 50,000 people who had applied for social care had died waiting in vain for that care in the 700 days after the Government first announced their Green Paper. How many more people will have to die waiting in vain for social care before the Government fix the crisis they have created?

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I cannot stress enough how much money we have made available. The Government have given councils access to almost £10 billion—a 9% increase—to address this issue. Local authorities have a statutory duty to look after the vulnerable, the elderly and the disabled people in their area, and we have given them access to the funding to do it.

Health and Social Care Sector Workforce

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11. What steps he is taking to ensure a sustainable workforce in the health and social care sector. [909311]

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The long-term plan explicitly recognises the importance of the workforce, and my right hon. Friend the Secretary of State has commissioned the chair of NHS Improvement to work closely with the chair of Health Education England in leading detailed work programmes to deliver an implementation plan. Social care plays a vital role in the forthcoming adult social care Green Paper, in which we will set out our plans to recruit, train and retain good people.

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The Minister is right about the workforce challenge for all four health services in the UK, but the number of students in England taking nursing degree courses in the past two years has dropped by 900; and at over 11%, NHS England’s nursing vacancy rate is more than twice that in Scotland. With a 90% drop in the number of EU nurses coming to the UK because of Brexit and fewer students starting degree courses because of the cost, is it not time to follow Scotland by reintroducing the nursing bursary and ending tuition fees?

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I am sure the hon. Gentleman will want to recognise the latest UCAS data for this year’s application cycle, which shows that, compared to the same time last year, there has been a 4.5% increase in the number of applicants for undergraduate nursing and midwifery courses. This is a significant improvement. He will also want to recognise that the loans system provides an extra £1,000. [Interruption.]

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Order. Mr Luke Graham, calm yourself. You aspire to statesmanship, and I wish to cultivate and hone that legitimate aspiration—calm, Zen, statesmanship!

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On Friday, I was privileged to take part in the launch of the health and social care academy in Cornwall. Cornwall NHS and social care providers have come together to train local students, including mature students, within the local health and social care provision without student tuition fees so that they can secure a job in Cornwall. May I invite the Minister to come and see the work we are doing and welcome this local innovation that is helping to address the NHS workforce challenge?

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My hon. Friend rightly points out that there are several routes into healthcare professions, and I am delighted by what is happening in Cornwall. I understand that my right hon. Friend the Secretary of State will be visiting him in the very near future.

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We are in the midst of the worst-ever NHS workforce crisis, with more than 100,000 vacancies. The situation is unsustainable. Well-respected think-tanks say the figure could rise to 350,000 vacancies within a decade. What does the Minister consider a sustainable vacancy level both now and in a decade’s time?

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The hon. Gentleman will recognise that the £20.5 billion in real terms that we are investing in the NHS under the long-term plan will make a significant difference. He will also want to recognise the roll-out of medical places, the fact that more people are applying for nursing places now than they were last year and the detailed implementation plans that my right hon. Friend the Secretary of State has commissioned. These will deliver a sustainable workforce.

Sudden Cardiac Arrest

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12. What steps his Department is taking to improve survival rates from sudden cardiac arrest. [909314]

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NHS England announced in the NHS long-term plan that it would work with partners to improve the community first response and build defibrillator networks to improve survival rates for out-of-hospital cardiac arrests. A national network of community first responders and defibrillators will help to save up to 4,000 lives each year by 2028. This will be supported by educating the general public, including young people of school age, about how to recognise and respond to out-of-hospital cardiac arrests.

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I thank the Minister for her response. Currently, 12 young people a week die from a sudden cardiac arrest, but 80% could be saved if those around them had access to a defibrillator. Will the Minister consider supporting the installation of defibrillators in all schools in England and Wales?

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My hon. Friend is right to highlight the 12 deaths from sudden cardiac arrest in the young. Although the purchasing of a defibrillator is a matter for individual schools, the Government would encourage schools to buy them. The NHS supply chain is engaging with school networks to get good prices for these defibrillators, and the Department for Education has published on the Government website guidance for schools on buying and installing an automated external defibrillator. In addition, in January, the DFE announced plans for all children to be taught basic first aid in schools, including how to do CPR and use a defibrillator.

Mental Health Patient Waiting Times: North-West

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13. What steps his Department is taking to reduce waiting times for mental health patients in the north-west. [909315]

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National waiting time standards for early intervention in psychosis, improved access to psychological therapies and services for children and young people with eating disorders are already being met, or are on track to be met by 2020-21, in the north-west. We will introduce new waiting times and targets under the NHS long-term plan, and we have an ambition to deliver many more treatments for all who need them.

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Adult waiting times in Wirral for talking therapies to treat anxiety and depression are some of the worst in the country. The average waiting time between referral and first treatment is 48 days, and between referral and second treatment, when we know that someone needs help, it is 159 days. Will the Minister thank all the volunteers in Wirral who are trying to help those who are suffering from anxiety and depression, and will she explain to me what she is going to do to stop this crisis?

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First, I certainly thank all the volunteers who do so much to support people in mental ill health. It is worth emphasising the role of the voluntary sector in that regard, and I encourage clinical commissioning groups to consider commissioning additional services form the sector, because so much of that wraparound care is as important as clinical intervention to repairing mental health.

There have been problems with the improving access to psychological therapies programme and with recovery targets in the past. The Wirral CCG has told me that the backlog of more than 1,000 patients has been cleared after it provided additional funds and that the IAPT targets are now being met, but obviously I will keep the position under review, and I thank the hon. Lady for raising the issue.

NHS Hospital Parking Charges

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14. What plans he has to allocate additional funding to NHS hospitals to replace revenue raised by car parking charges. [909316]

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My right hon. Friend is aware of—and, indeed, welcomes— the Government’s commitment to providing an extra £20.5 billion in real terms for patient care over the next five years. Car parking charges are a matter for local NHS organisations, but most hospitals give concessions to some groups of users, such as patients who need extended or frequent access to hospitals.

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Last year, the brain injury charity Headway said that it had paid a family £374 for hospital car parking charges. These charges are unacceptable. They are a stealth tax on patients, a stealth tax on the vulnerable and a stealth tax on staff. Will my hon. Friend scrap them once and for all?

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I commend my right hon. Friend for being a tireless campaigner on this matter. We have always made clear that staff, patients and their families should not have to deal with the stress of complex and unfair charges, and we introduced tougher guidelines in 2014, but I must stress that this is a local matter.

Topical Questions

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T1. If he will make a statement on his departmental responsibilities. [909324]

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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.

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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?

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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.

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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]

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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.

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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]

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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.

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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]

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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.

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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]

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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.

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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]

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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.

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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]

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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.

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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]

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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.

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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]

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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.

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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?

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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.

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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?

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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.

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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?

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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.

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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?

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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.

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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?

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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.

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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?

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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.

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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?

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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.

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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?

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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.

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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?

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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.

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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?

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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.

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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?

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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.