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Commons Chamber

Volume 657: debated on Tuesday 26 March 2019

House of Commons

Tuesday 26 March 2019

The House met at half-past Eleven o’clock

Prayers

[Mr Speaker in the Chair]

Oral Answers to Questions

Health and Social Care

The Secretary of State was asked—

Children’s Health and Wellbeing

1. What steps he is taking to help ensure better co-ordination with (a) the Department for Education and (b) other Departments to support children’s health and wellbeing. (910022)

The Department of Health and Social Care works across Government to ensure every child can have the best possible start in life. This includes a significant increase in mental health support in schools.

I thank the Secretary of State very much for that reply. May I first pay tribute to the former Minister, the hon. Member for Winchester (Steve Brine)? I think his actions last night were very honourable, and he has been an exceptional Health Minister.

May I ask the Secretary of State also to look at how we can join up services much more strongly on the ground? Whether it is early years, child mental health or special educational needs and disability support, time and again we hear problems about how services are not joined up.

I agree with the hon. Lady on both counts. My hon. Friend the Member for Winchester (Steve Brine) was an excellent public health Minister, who did exemplary work and drove the agenda with great passion and determination, and he has behaved honourably in every sense.

On the point about cross-government working, the hon. Lady is completely right. The need to join up, breaking down the barriers of silos that sometimes exist between agencies, is vital. There is a huge amount of work under way in all of the areas she mentioned, and I am determined to see that work.

On Friday, I met two clinical commissioning groups that cover my constituency specifically to discuss mental health and children’s health and wellbeing. While it is an extremely complex issue, does the Secretary of State agree with me that, with the perceived rigorous spending rules requiring health providers to spend only on pure health services, it will remain extremely challenging for them to work with other agencies to support methods, such as those to build resilience, that improve outcomes for children’s health?

My hon. Friend is absolutely right to raise this. The most forward-looking CCGs in the country are working with all sorts of partners—the voluntary sector, charities, local authorities—to deliver better services that make people healthier, even if they are not purely medicinal in the first instance. For instance, tennis lessons may sometimes help people, Mr Speaker, as may all sorts of other activities. This is all part of a broadening social-prescribing agenda to get people healthy, however that is best done.

The Secretary of State will be aware that, last Monday, I published my report, with the Royal Society for Public Health, on children’s mental health and social media. May I place on the record my thanks to him for his tweet in support of the report? I have asked Education Ministers and I will be doing this with the devolved institutions as well, but would he agree to a meeting with me—and with the mental health Minister, the Under-Secretary of State for Health and Social Care, the hon. Member for Thurrock (Jackie Doyle-Price)—to look at the report and the recommendations so that we can start working across Government Departments and across devolved institutions?

I would be very happy to meet the hon. Gentleman and his all-party group on social media and young people’s mental health and wellbeing. It is an incredibly important topic. We must make sure that social media is safe and that we protect children’s mental health, which the evidence increasingly shows can be negatively impacted by the wrong use of social media. Social media can be a great, powerful force for good, but it also has its downsides and we need to mitigate those, and there is a lot more coming from the Government soon.

May I ask the Secretary of State to meet the Sport and Recreation Alliance to hear its ideas on how we ensure children and young people lead healthier and more active lives?

Yes, I would love to. I think this is an incredibly important agenda. It ties in directly with the question from my former ministerial colleague when I was at the Department for Digital, Culture, Media and Sport, my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch). There is lots to do on this agenda.

There has been an alarming rise in the need for the use of baby banks for children. While I am proud that organisations such as Little Village in Tooting are doing such amazing work, it is shocking that we even need baby banks in this day and age. Does the Secretary of State agree with me that it is a stain on this Government and highlights the drastic inequalities seen in our society?

We are determined to do everything we can to support people, especially at the time—in the first 1,000 days—that is so critical to people’s whole lives, and that is an incredibly important part of the work. Improving maternity services is important, but the link-up with other broader agencies is also important, and we should not denigrate or downplay the vital role that charities too can play in supporting people.

I thank my right hon. Friend for coming to Hinckley to see co-ordination and social prescribing in action. Will he be taking steps to further develop personal budgets, which save money and improve lives?

Yes, absolutely. Driving the social prescribing agenda, which is based on increasingly strong evidence of the power of social prescribing to help people stay healthy and get them healthy again when they are ill, will also involve wider use of personal budgets. Almost 1 million people have personal budgets.

I join my hon. Friend the Member for Manchester Central (Lucy Powell) in paying tribute to the very hon. Member for Winchester (Steve Brine), and I also pay tribute to my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders). Has the Secretary of State seen Professor Clare Bambra’s research in the Journal of Epidemiology & Community Health this month, showing that inequalities in infant mortality between deprived and more affluent areas fell between 1999 and 2010 when there was a Labour Government, and then increased from 2011 to 2017? Is it not true that only Labour has the range of co-ordinated, cross-governmental policies that reduce inequalities in child health?

No. The NHS long-term plan has a whole swathe of policy in order to reduce health inequalities. The best thing we can do to reduce health inequalities is ensure that more people are in work, and the record number of jobs that have been delivered is a vital part of that agenda.

NHS Workforce

2. What steps his Department is taking to ensure that the NHS has the workforce that it needs to meet the objectives of its 10-year plan. (910023)

The long-term plan sets out how we will make the NHS a world-class employer and ensure that the NHS has the people that it needs. The NHS, led by Baroness Harding, is engaging with people across the sector to develop a people plan. That plan will set out how the challenges of supply and demand reform can be met, and it will be published in the spring.

I thank the Minister for that response. In Cornwall we have set up the Health and Social Care Academy, and we use the apprenticeship levy to enable local people to train within the NHS service or social care wherever they want to. However, there are many restrictions around the levy, and I wonder if the Minister will meet me and others to discuss how the levy can actually be about training and supporting people into the NHS, rather than just restrictions about paying fees.

The apprenticeship levy was obviously introduced to cover the training and assessment costs of apprenticeships at a rate that would meet employee demand. I recognise some of the challenges that there are, and I would be delighted to meet my hon. Friend to discuss the issues that he has raised.

19.   The NHS 10-year plan in Plymouth will be delivered not only by NHS staff but by social enterprise staff. Those staff who work for social enterprise Livewell in Plymouth have had difficulty accessing the NHS pay rise and the NHS pension uplift. Will the Minister agree to meet me and Livewell’s staff so that we can resolve this issue, to ensure that all staff who work for a social enterprise receive the pensions they deserve? (910042)

The hon. Gentleman knows that I wrote to him on 20 March on this issue, and I outlined that officials from DHSC had contacted the scheme administrator about the issues with Livewell. I can confirm that the members there would still be dealt with in the way set out prior to the implementation date, and I am happy to meet him.

The best way that Kettering General Hospital could deliver the NHS’s 10-year plan would be to have the funding for an urgent care hub. I thank the hospitals Minister for visiting recently. What can he do to ensure that that project is delivered?

I was delighted to visit Kettering and to meet the chief executive and the chairman of the trust again. They made very strong representations. The representations by my hon. Friend and the trust have been heard, and he knows that they are at the forefront of my mind.

Changes to the pensions allowance are particularly impacting consultants in their willingness to do additional shifts, or indeed stay in their roles, so what discussions has the Minister had with the Chancellor about the effect of the changes to pension allowances on the retention of consultants in the NHS?

My right hon. Friend the Secretary of State and I have both had conversations with the Treasury and the Chancellor, and there are ongoing discussions.

The Government have done well to get more medical students into general practice, but we are not doing quite so well at retaining GPs later on. What more can we do to make sure that GPs stay in general practice, so that more of our constituents can go and see a doctor more easily?

NHS Improvement has a number of retention schemes in place, for GPs and for nurses, to look at why some people are leaving. The interim plan being developed by Baroness Harding has an employer of excellence work stream, which will report on a number of potential issues.

May I just take a moment, on behalf of the Opposition Front Bench, to thank the hon. Member for Winchester (Steve Brine) for all his work? We found him a decent, fair-minded Minister, and I wish to pass on my personal thanks for the work that he did on the children of alcoholics agenda.

We have 100,000 vacancies across the NHS. The Brexit mess means that we have fewer EU nurses and health visitors. Across the NHS, voluntary resignations are up 55% since 2011, and the professional development budgets have been cut by £250 million. Does the Minister agree that for Dido Harding’s review to be taken seriously, those cuts to continuing professional development must be reversed?

As the hon. Gentleman heard me say earlier, Baroness Harding is developing the implementation plan, which will then feed into the final implementation plan published after the comprehensive spending review. The cuts, as he describes them, are not cuts. He knows that we are increasing the budget for the NHS in real terms and in cash terms up to 2023-24.

The Minister is responsible for workforce, but does not seem to understand that training budgets have been cut. Baroness Harding’s review will only be taken seriously if it is backed up by real investment.

Outsourcing and transferring of staff, whether to wholly owned subsidiaries or the privatisation of clinical services, further undermines staff morale and creates a more fragmented workforce. The Secretary of State went to the Health and Social Care Committee and said no more privatisations on his watch, yet cancer scanning services in Oxford are being privatised. Will the Minister reverse those privatisations, or can we simply not believe a word the Secretary of State says?

The hon. Gentleman can believe everything my right hon. Friend the Secretary of State says. He has delivered on his promise to work with the NHS to deliver a long-term plan, to deliver the funding that will make it possible, and to deliver the workforce that will ensure the plan is not undermined.

Health Inequalities: Life Expectancy

3. What assessment he has made of the effect on life expectancy projections of health inequalities; and if he will make a statement. (910024)

The latest work from the Office for National Statistics shows that life expectancy is projected to increase, but none the less there are inequalities within those figures. That is why we are taking action to reduce smoking, prevent cardiovascular disease and diabetes, improve cancer outcomes, and, of course, tackle childhood obesity. I can also add that reducing health inequalities is an important component of our NHS long-term plan. All local health systems will be expected to set out how they will specifically reduce health inequalities by 2023-24.

Sir Michael Marmot, the world-recognised authority on public health, has warned that the country has, since 2010, stalled in the task of improving the life expectancy of our population. There are already wide inequalities. For example, a Gateshead man can expect to have 57 years of life in good health, compared to the England average of 63.4 years; and a Gateshead woman can expect to have an average of 59.1 years in good health, compared to the England average of 64.1 years. What is the Minister doing to redress those real inequalities?

As I mentioned, the NHS long-term plan will be asking local health systems to specifically address this issue. Certainly, there are particular trends that I personally want to address. They are the real inequalities that affect people with learning disabilities, which are worse than the figures the hon. Lady mentions. We also see that the outcomes she refers to can be laid at the door of a slowdown of heart disease and stroke mortality improvements, so we really need to focus our interventions there. We are also seeing an increase in the fall in life expectancy due to alcohol misuse.

Medway has some of the highest health inequalities in the country. As the Minister rightly says, high inequalities are linked to a greater chance of a stroke. Despite that, the sustainability and transformation partnership and the clinical commissioning group decided to put an acute stroke service in Dartford, which is very close to London and is served by King’s College London. The criteria was not followed correctly. The matter is now with the Secretary of State to review. Can the Minister assure me that the criteria will be re-looked at to ensure that justice is done?

My hon. Friend will know that this has to be reviewed independently, but the Secretary of State does have duties to consider inequalities in all his work.

I, too, wish to pay tribute to the hon. Member for Winchester (Steve Brine), who I sparred with many times in Westminster Hall. We might not have agreed on how to go about it, but he was clearly passionate about improving health.

The Secretary of State’s vision for NHS England includes video links to GPs, diagnostic phone apps and healthy people undergoing gene tests for a few hundred pounds. Considering his own experience of such a gene test, does he not recognise that this just increases access for the well-off, will drive demand in the system and will actually widen health inequalities?

I do not accept that at all. Apart from anything else, we are seeing younger generations be more technologically savvy. We are taking advantage of that technological innovation to spread good health prevention and to help people look after themselves.

I beg the hon. Lady’s pardon; I thought she wanted two questions on this. Maybe I was misinformed. Very well—she can have another question later.

Medicinal Cannabis Products

4. What estimate he has made of the number of prescriptions for medicinal cannabis products that have been issued since November 2018. (910025)

The data that my right hon. Friend asks for is not available, but it is important that we take action to make sure the right drugs are available for the right people.

Was it intended to make them as rare as hens’ teeth? What measures is the Secretary of State taking to support clinicians in actually prescribing?

I met the parents of some of the children whose needs are best met through the use of medicinal cannabis. My heart goes out to those who are fighting for this cause. We changed the law in the autumn to try to make it easier, and I am looking very closely at what we can do to make sure that the intention of that decision is met.

The Health Committee heard last week that patients are dying unnecessarily and up to a million families are being driven to criminality by getting medical cannabis illegally, and the situation has got worse since the Government changed the law in November. When are these families going to get access to medical cannabis for their children and other sufferers that they would have access to if they lived in Germany, the Netherlands, Canada or the United States?

As the right hon. Gentleman knows, I supported and indeed participated in the decision to ensure that access was made legal in the autumn, and I am working right now on trying to make sure that some of the challenges in the system are unblocked. Ultimately, these things have to be clinician led, but my sympathy is with those who are campaigning, whom I have met, because I know of the anguish that this problem is causing.

Prescription Charges: Asthma

5. What assessment he has made of the effect of prescription charges on the health and wellbeing of people with asthma. (910026)

Extensive arrangements are already in place to help people afford NHS prescriptions. Those include a broad range of prescription charge exemptions, for which somebody with asthma may apply.

More than 90% of people on low incomes say they struggle to afford their prescriptions, and 71% told Asthma UK they skipped their asthma medication due to cost. Given the health inequalities in this country, will the Minister investigate that injustice?

People on low incomes who do not qualify for an exemption may be eligible for either full or partial help with prescription charges through the NHS low-income scheme. In addition, for those who do not qualify for that, the prescription pre-payment certificate is available, under which everybody can get all the prescriptions they need for only £2 a week.

Of the 300,000 who have missed out on their prescriptions, a quarter have had a flare-up of their asthma and 13% have ended up in hospital. Does the Minister not accept that prescription charges simply are not cost-effective and should be abolished, as they have been in Scotland?

Almost 90% of prescription items dispensed in the community in England are free of charge. That includes medicines for the treatment of asthma. The fact is that people who, like me, suffer from asthma and need those prescriptions have to decide, as taxpayers—as the people funding our NHS—whether we would rather contribute to those prescriptions or see the underfunding we have seen in Scotland, where GPs have been underfunded by almost £660 million over the last four years. It is a case of priorities.

I miss the former Minister, the hon. Member for Winchester (Steve Brine), but commend him for his principled stance.

The Minister is missing the point on prescription charges. It is now more than 50 years since the eligibility criteria for medical exemption charges were reviewed, and next week prescription charges will rise again, placing a financial burden on many who require regular medication for long-term conditions. Does she agree that it is high time the Government moved to address the very many anomalies in the system? How can it be fair that patients with some chronic illnesses get free prescriptions for all their ailments, while asthma sufferers pay for everything? When will she review this unfair system?

We all miss my hon. Friend the Member for Winchester (Steve Brine), so I thank the hon. Lady for her comments.

Since prescription charges were introduced, Governments of all colours have decided that some patients should pay prescription charges to contribute to the cost of running the NHS, but almost 90% of prescription items are dispensed in the community free of charge, which I think the hon. Lady will agree is an enormous amount.

Orkambi

6. What recent progress has been made in the discussions between NHS England and Vertex Pharmaceuticals on making Orkambi available on the NHS. (910027)

On 11 March, I held a meeting with all the parties to discuss how best to ensure that people with cystic fibrosis and their families can benefit from the best drugs as soon as possible. Vertex, the National Institute for Health and Care Excellence and NHS England met on Thursday and have agreed to take those discussions forward.

Does the Secretary of State support immediate interim access to Orkambi while the negotiations are going on, and has he asked NHS England, NICE and Vertex to consider this option?

We are having constructive discussions—I am delighted that finally Vertex has agreed to participate in them; the parties have committed to providing the data needed for an objective assessment of the drugs in question, and I look forward to the discussions proceeding effectively.

A constituent of mine came to see me in my surgery. He had been born with cystic fibrosis and told me what a transformative effect the drug had had on him. He was lucky enough to be accepted on the trial, but he says we need to raise awareness because millions of people are not getting the drug. What response can the Secretary of State give to him and fellow sufferers?

My hon. Friend’s constituent is absolutely right about raising awareness of the issue and the need for these drugs. I know the impact that cystic fibrosis can have on people and of the hope that these drugs will save lives. We have made a significant offer to the pharmaceutical company, Vertex, to allow these drugs to be provided in the UK, and I very much hope we can come to an agreement.

On NICE decision making, my young constituents Nicole and Jessica Rich have the life-limiting rare condition Batten disease. Last month, NICE turned down a proven treatment for the condition after a year of deliberation. I and several cross-party colleagues wrote to the Secretary of State to ask if we could discuss this urgent matter, but we received a reply from the Under-Secretary of State for Health and Social Care (Baroness Blackwood), saying that she could not meet us because of diary commitments. This is insulting. Will the Secretary of State meet us to discuss this urgent issue?

Yes, of course I will. I understand exactly where that process has got to. It concerns a different drug from the one in the question, but it is also a very important consideration for a number of people.

Will the Secretary of State agree to or consider temporary interim access to Orkambi while the negotiations continue, and has he had any discussion so far on that subject?

I am happy to consider all options that can secure access in a way that provides value for money based on an objective assessment of what is clinically right. That is the basis of our discussions.

I am glad that the Secretary of State is taking a personal interest in this matter. In Thursday’s debate, I mentioned the case of Oli Rayner, who gave evidence to the Health Select Committee. He fell ill in his 30s and was given Orkambi just to make him well enough to undergo a lung transplant operation. Is it not ludicrous to wait until people are virtually at death’s door before being prepared to give them the drug?

That is one very important consideration. Having met people suffering from cystic fibrosis and heard directly the stories they tell about the impact on their lives and how it potentially shortens their lives, I think it is very important that we find a solution, which is why I was so determined to bring the parties together.

Antimicrobial Resistance: Vaccines

The new five-year national action plan to tackle antimicrobial resistance contains the commitment to support more research into new and alternative treatments, including vaccines and diagnostic tests, to promote broader access to vaccines for both humans and animals.

Stopping the spread of diseases such as TB by using vaccines will play a key role in tackling AMR worldwide, so what plans does my right hon. Friend have for building on the excellent work of the UK Vaccine Network, with all the funding that goes with that, to ensure continued UK leadership in vaccinology?

My right hon. Friend is right to raise this issue. Of all the challenges facing the world, the risk that antibiotics will fail to work in the future is a huge one that we cannot afford to allow to come to pass. We are putting significant research money into the production of new antibiotics, and also ensuring that we roll out vaccines so that antibiotics do not have to be used.

The use of antibiotics in the chicken population in the United Kingdom has fallen by more than 70% over the last five years. This is doable: we will provide the money that is necessary to ensure that people can use antibiotics well into the future.

May I beg the Secretary of State to snap out of the trance that he now seems to be in, and wake up to the fact that many of the key researchers in this area are going back to their European homes because of the threat of Brexit? We are losing Spanish nurses, for instance, on whom my constituents absolutely depend for healthcare. Up and down the country, our health system is haemorrhaging talent because of the Secretary of State’s lack of action. Wake up, Secretary of State, and smell the coffee!

I am afraid that I profoundly disagree with the hon. Gentleman, who used to be so sensible. Antimicrobial resistance is a global problem and we contribute to global funds, because only by coming together as a whole world will we be able to tackle it— and that is what we are going to do.

NHS Nursing Associates

Health Education England is leading a national nursing associate expansion plan to train 7,500 apprentice associates in 2019, building on the 5,000 who were trained in 2018.

The University of Northampton successfully carried out its partnership with Northampton General Hospital in training the first wave of nursing associates in the United Kingdom, as the Secretary of State saw when he visited the hospital recently. What can he and his team do to encourage other universities and local hospitals to form partnerships to deliver similar results?

I know that the Secretary of State enjoyed his visit, and was very impressed by what he saw. Health Education England has led the establishment of test site partnerships across England. There were 11 test sites in the first wave and a further 24 in April 2017, and the programme is now being rolled out all over the country.

What discussions has the Minister had with nursing associations and the Home Secretary about the recruitment of nurses and social care workers from the European Union after we leave, and about how it can be made easier?

I know that my hon. Friend the Minister for Care met the Home Secretary last week, and that there are ongoing discussions.

Lyme Disease

The National Institute for Health Research is supporting the study of Lyme disease by researching markers that would offer a faster and more accurate diagnosis. Meanwhile, the National Institute for Health and Care Excellence has published clinical guidance for the diagnosis and treatment of the disease for healthcare professionals.

Lyme disease is often misdiagnosed or diagnosed late, which results in widespread suffering such as joint pain, paralysis and brain damage. Will the Minister therefore join me in congratulating the charity Caudwell LymeCo, which has pledged £1 in research funding, and will her Department commission research on a better test for the disease?

My right hon. Friend is absolutely right to raise this issue. We know that the outcome of Lyme disease depends on whether it is diagnosed and treated at an early stage. That is why my Department commissioned four separate independent systematic reviews of all the relevant literature on the diagnosis, treatment, transition and prevention of the disease, which were published in December 2017 and which assess the existing evidence for the research community, research funders and the public. We welcome all independent researchers who want to do more work on that basis.

My constituents have faced many challenges in relation to Lyme disease. They have had to go overseas in order to be tested and given a diagnosis. However, the NHS does not recognise those tests. What is the Minister doing about that?

Most people are diagnosed and treated successfully by GPs and recover uneventfully, but in a few cases people who are diagnosed late or are not treated adequately may develop significant complications. That is why the National Institute for Health Research welcomes applications for research funds.

22. Earlier this month I visited a young lady in my constituency who was living a perfectly good life but was then struck down by Lyme disease. She has not left the House in over 12 months and is in terrible pain all the time. The NHS in this country did not find a diagnosis from her blood sample; it had to be sent to Germany to get the diagnosis. An awful lot more needs to be done to help these people. (910045)

My hon. Friend is absolutely right to raise this: we do need to do more in this space, and that is why we are investing over £1 billion a year in health research through the National Institute of Health Research.

What evaluation is being put in place to see how effective the 2018 NICE guidelines for clinicians on managing Lyme disease are in improving the treatment of this dreadful disease?

All NICE guidelines are permanently kept under review. If the research we are investing in throws new light on any issues, that will always be taken into consideration.

NHS Access Standards

10. What assessment he has made of the implications for his Department’s policies of the conclusions of the “Clinically-led review of NHS access standards: interim report from the NHS national medical director”; and if he will make a statement. (910032)

It is a great pity to see the hon. Gentleman back up there on the Back Benches as he was such a force—and a rare force—for reason and progress on the Opposition Front Bench until recently.

Standards in the NHS should be based on clinical evidence, and NHS England’s proposals will be rigorously field-tested to gather further evidence on clinical, operational, workforce and financial implications, all with the goal of improving the quality of care.

I thank the Secretary of State for his tribute—although it is not going to change the question I am going to ask. He will be aware that since July 2015 the four-hour A&E target has not been met and last month saw the worst performance on record, so regardless of any clinical reviews, is it not time that Ministers admitted that the four-hour A&E target has effectively been abandoned?

Of course, we are aiming to meet and improve against the targets, including with the injection of the extra money—£34 billion extra in cash terms over the next five years. At the same time we must make sure that the standards to which we hold the NHS are the right ones clinically for the times, and that is what this review of standards is all about.

Cervical Cancer

We have some of the highest HPV—human papillomavirus—vaccination rates in the world. This month we launched a major new national campaign to increase the number of women attending cervical screening across England, and throughout the NHS long-term plan we have committed to radically overhaul screening programmes and further invest in the latest technology to transform diagnosis and boost research and innovation.

Figures from Jo’s Cervical Cancer Trust show that 200,000 women in Greater Manchester have missed their smear test, including half of women aged 25 to 29, yet we know that smear tests save lives. What are the Government doing to raise awareness of the importance of attending screening to prevent cervical cancer?

My hon. Friend is right: cervical screening saves up to 5,000 lives every year, so we cannot do enough to encourage women to take advantage of the screening. It is not the most pleasant experience to go through, but it can save lives. I would encourage everyone to take advantage of the screening, and we will continue to do our best to promote it.

In Newcastle cervical screening rates have fallen since 2010: they range from 85% to just 23% and are consistently lower in poorer areas and among younger women and ethnic minority women, and across the UK women are more likely to die in more deprived areas. What specifically is the Minister doing not just to encourage women to attend but to make screening more available at the weekends, out of hours and closer to where people live?

The hon. Lady makes some excellent points and highlights those areas of the community where take-up is much lower. We need to be more imaginative about how we promote the need for screening, and in that regard I am very pleased to see the work of Jo’s Trust, and also that of the Eve Appeal to raise awareness. We can all do our bit, and I would encourage everyone to spread the word about the need to get screened.

I too want to start by paying tribute to my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders)—he is a big loss to the Front Bench—and also to the Minister I used to shadow, the hon. Member for Winchester (Steve Brine). Credit where it is due: I know cancer charities and campaigners are all tweeting their regret, because the hon. Gentleman was, and hopefully will remain, a true ally of that cause.

Cervical cancer is the most common cancer in women. Smear tests can prevent 75% of cervical cancers from developing, but one in four women do not attend their smear tests and screening is now at a 21-year low. This was not helped by the failure of the outsourced screening to Capita, which failed to write to 48,000 women in six months. What are the Government going to do to ensure that women and girls know what happens at a smear test, what it is for and why it is so important?

As the hon. Lady will know, we have brought that service back in-house, but we should leave no stone unturned in relation to thinking more imaginatively about how we spread the word about the need for screening. I should like to pay tribute to those celebrities who have tweeted pictures of themselves going for their smear tests, because it is only by normalising it and ensuring that everyone realises that it is something they should do that we are going to encourage take-up.

Access to GPs

Primary and community care are set to receive an additional £4.5 billion a year of taxpayers’ money as part of the NHS long-term plan, to ensure that we can get the best possible access to GPs.

In parts of my constituency, it is very difficult for people to see their GP. For example, in the area of Park Wood there is just one GP for 4,000 patients. I welcome the extra money going into primary care that my right hon. Friend just mentioned, as well as the additional GP training places and the fact that a Kent medical school is coming our way, but we need more nurses, physios and other health professionals in primary care. What is he doing to ensure that people can see the right health professional when they need to do so?

This is an incredibly important agenda that is close to my heart. It is at the core of the prevention of ill health to ensure that we have the right primary care services. Yes, that includes more GPs, but it also includes more of the other health professionals who support them. We have 1,000 extra non-GP clinical staff already working in general practice compared with just two years ago, but there is much more to do.

But what is the Secretary of State doing about retaining GPs? This is a real problem, and we have seen more and more GPs taking early retirement in recent years. What is he doing specifically to support retention?

This is a core question that Baroness Dido Harding’s workforce review will be looking into, and work is going on right across Government to try to fix it.

GPs are the first line of defence against superbugs and antimicrobial resistance, and the Secretary of State is already proving to be a world leader in this area. The idea of a resistance tax has the support of other world leaders including Lord O’Neill and Dame Sally Davies. Would he consider this approach?

I am happy to look at all approaches to how we can reduce the overuse of antibiotics in order to preserve them so that they work effectively where they are needed. Of course GPs have a role to play in that, and the number of antibiotics prescribed by GPs has fallen in recent years, but again there is much more work to do.

Will the Minister outline whether his Department is willing to enter into an agreement with medical students to wipe out their student loans if they contract to carry out five years of GP service?

That is an interesting proposition and I would be happy to talk to the hon. Gentleman more about the idea. I was in Northern Ireland last week looking at medical services there and at what we can learn, and that might be another idea.

STPs: Five-year Workforce Plans

13. What guidance the Government have issued to sustainability and transformation partnerships on drafting their five-year workforce plans. (910036)

Workforce is a key priority for the Government, which is why my right hon. Friend the Secretary of State asked Baroness Dido Harding to develop an interim workforce implementation plan for the spring, including a 2019-20 action plan. It is right that local leaders and clinicians should be empowered to shape the services they need, which is why NHS Improvement has written to all system leaders in England to ask for their views on the vision that is coming forward.

The all-party parliamentary group on mental health’s recent report found that workforce is the biggest challenge to delivering improvements to mental health care. Given that there are 4,000 fewer mental health nurses than there were in 2010, what additional guidance and funding will the Government provide to ensure that local partnerships can recruit mental health nurses, and what are they doing to expand medical school places so that we can train more doctors, particularly in psychiatric specialties?

The hon. Gentleman asked a number of questions there. It is true that the NHS has recently asked all sustainability and transformation partnerships and integrated care systems to create new five-year plans by autumn 2019 setting out how they are going to transform services. He will know that mental health is a priority in the long-term plan, and that we are expanding the number of places for clinicians.

Will my hon. Friend meet me to discuss the severe shortage of pathologists to carry out post mortems? Professor Peter Hutton’s report referenced some ideas that we could take forward.

My hon. Friend has already mentioned several such ideas and I would be happy to meet him to discuss them.

16. Cancer Research UK estimates that by 2035 there will be over half a million new cancer cases—up by 150,000 a year on 2015 levels. In order to meet the Government’s ambition of diagnosing 75% of cancers at an early stage, does the Minister accept that the NHS will need a proper training and recruitment plan for its cancer workforce, which must be fully funded in the upcoming spending review? (910039)

The hon. Gentleman is right: early diagnosis of cancer is vital for successful outcomes. The Government are absolutely committed to a cancer workforce with the skills and expertise to ensure that 75% of all cancers are diagnosed early, not just the top 10. As I have said several times, that is why we asked Baroness Dido Harding to develop a detailed workforce plan to ensure that that can be delivered.

Blood cancer is the fifth most common and the third biggest killer in the UK. What assurances can I get that the workforce in that area will be increased?

My hon. Friend has been a champion of this cause for a long time, raising the matter on the Floor of the House several times. He can be assured that, as I said to the hon. Member for City of Chester (Christian Matheson), Baroness Harding has been asked to bring forward detailed plans for the cancer workforce in her implementation plan.

Mental health nurse numbers have fallen for the second month running, and learning disability nurse numbers have fallen by 40% since this Government came to power. Nearly 13,000 mental health staff left their roles between May and October 2018, and the vacancy rate is now almost 10%. The King’s Fund, the Nuffield Trust and the Health Foundation say that

“Urgent action is now required to avoid a vicious cycle of growing shortages and declining quality.”

Is it not time for Ministers to start taking such advice, rather than giving it?

The Department of course takes such things seriously. My hon. Friend the Minister of State for Care met Baroness Harding last week to discuss how to ensure that there are nurses and carers to help people with learning disabilities. The money that has been promised to make that possible comes in the new financial year, which starts next week.

Tackling Violence: Public Health Approach

14. What progress his Department has made on the implementation of a public health approach to tackling violence. (910037)

We are pursuing a multi-agency approach to prevent and tackle serious violence. Healthcare is of course one of the important and relevant agencies that need to work together right across Government to reduce knife crime.

The Government are committed to a public health approach, but we heard the Secretary of State dismiss it just a few weeks ago. What assurances can he give that he is now fully signed up to the approach? What evidence is his Department collating? How is the Department working with the Home Office to ensure that we have a long-term strategy for keeping our young people safe?

I am a huge fan of the public health approach to tackling knife crime. In fact, I was in Croydon yesterday to talk to charities and to students at Croydon College about the role the NHS can play in tackling the scourge of knife crime. I am a big fan of this agenda, and I look forward to working with the hon. Lady and colleagues from across the House.

Relationships and Sex Education

15. What recent discussions he has had with the Secretary of State for Education on ensuring that lessons on HIV and sexual health form a core part of the relationships and sex education curriculum. (910038)

All children should receive good-quality relationships and sex education so that they understand the benefits of healthy relationships and how to protect themselves against sexually transmitted infections, HIV, unplanned pregnancy and abuse.

Does the Minister believe that the £6 million allocated for relationships and sex education is enough when it equates to a few hundred quid per school? Her Department has cut £3.2 billion from public health spending, meaning that many young people now cannot access STI testing, and we are seeing a boom in STIs among young people.

The hon. Gentleman’s question is actually a matter for the Department for Education, but I do not accept his statement. The new relationships and sex education proposals were widely welcomed across the House when they were announced, and we will improve children’s ability to look after themselves and have healthy sexual relationships.

Topical Questions

We all in this House have huge admiration for the dedicated staff who work night and day to deliver world-class care to patients in our NHS. We should recognise that today marks the 75th anniversary of the publication of the White Paper on the establishment of the NHS, delivered in this House by a Conservative Minister, under a Conservative Prime Minister.

The prescription of powerful painkillers has soared, as has the number of overdoses and deaths from these prescription drugs, with some of the worst statistics in the poorest areas of the country. What is my right hon. Friend doing to reverse this worrying trend?

My right hon. Friend is absolutely right to raise this. There has been a rise in opioid-related deaths, and we need to work across Government to tackle the problem. Public Health England is reviewing prescription drug dependence, including opioid dependence, and we recently announced a review of over-prescription in the NHS to make sure patients are taking the right medicines for the right amount of time.

There are still 2,295 patients who are autistic or who have learning disabilities in hospital in-patient settings, despite a Government pledge in 2012 that no one would be in inappropriate settings by 2014. In 2015 the Government said they would close up to 50% of these in-patient places, and they failed to meet that pledge, too, because of a lack of social care funding. Will the Secretary of State now commit to proper social care funding for this programme and renew the pledge to end the misery of these placements by 2022?

The NHS long-term plan has made it clear that learning disability and autism are one of the key clinical pillars in its absolute priorities. This transforming care work is incredibly important. Where people need access to in-patient services for assessment and treatment of their needs, it has to be for as short a time as possible, it has to be as close to home as possible and it has to be with a very clear discharge plan in place.

T3. We all know that early intervention is vital for the most fatal mental health disorders: eating disorders. I warmly welcome how ambitious this Government have been to ensure that under-19s get seen as quickly as possible, and I encourage them to expand it. My constituents in Scotland do not have that, and they still have to wait up to 18 weeks to be seen. The Scottish Government refuse to see me, and they refuse to come in line with the UK Government. Will the Secretary of State assure me he will push this case next time he meets his counterpart in Scotland? (910049)

I will certainly do that, and I am very surprised and disappointed to hear what my hon. Friend has to report. I pay tribute to her work in leading on this agenda, including setting up the all-party parliamentary group. She has campaigned hard to get the Scottish Government to act. Given the progress we have made on the target—by 2021, 95% of children and young people with an eating disorder receiving treatment within one week for urgent cases and four weeks for routine cases—we are on track to meet it. That is something we should be discussing, at the very least, with our Scottish colleagues.

T5. My constituency hosts world-pioneering hubs of medical innovation that have allowed many patients across the UK and beyond to benefit from cutting-edge treatments like endovascular repair for abdominal aortic aneurysms. What work is the Department planning to undertake to maintain patient access to this highly effective treatment and to foster continued healthcare innovation? (910051)

We have a range of work going on to improve access to innovative new treatments, both pharmaceutical treatments and the broader treatments that the hon. Gentleman describes, including ensuring, through an accelerated access collaborative led by the former Labour Minister Lord Darzi, that we drive innovation and that those innovations are taken up by other parts of the NHS.

Order. Last night, in the heat of the moment, I was discourteous to the right hon. Member for Chelsea and Fulham (Greg Hands), and thereafter I apologised to him. However, I take this opportunity in the Chamber today to repeat that apology unreservedly to the right hon. Gentleman, and I hope he will accept it in the genuine and sincere spirit in which the apology is intended.

T4. Mr Speaker, I thank you for your apology, and I think we will call it a day.My right hon. Friend the Secretary of State knows I have been a long-standing supporter of Charing Cross Hospital in Fulham, but I am concerned by the politicised rumours that have surrounded the hospital in recent years. Will he update the House on the “Shaping a healthier future” programme, which many of my constituents believe to be anything but healthy? (910050)

My right hon. Friend was not only a very good Whip, but is a very good constituency MP. He has made his case very well. “Shaping a healthier future” is no longer supported by the Department of Health and Social Care, NHS Improvement or NHS England. The NHS will look at parts of the proposals that are in line with the long-term plan, such as the aspects that are focused on expanding the treatment of people in the community. As for the changes in A&E in west London that are part of “Shaping a healthier future”—for instance, those at Charing Cross Hospital, which he mentioned—these will not happen.

T6.   My constituent, who has terminal secondary breast cancer, has had her personal independence payment assessment refused and is having to appeal the decision, in spite of doctors’ letters detailing her debilitating condition and the treatment regimen she has to go through. What discussions has the Health Secretary had with the Secretary of State for Work and Pensions on how to ensure that medical evidence of that sort is accepted, so that people with terminal and progressive conditions do not have to go through this awful process? (910052)

The hon. Lady makes a very good point. I had regular discussions with the sadly departed Minister for Disabled People, Health and Work, who provided really great challenge within the Department for Work and Pensions about how it handles such assessments. We must do all we can do to humanise them, especially when people are going through periods of ill health.

T9. Breast cancer oncology is the most recent service to be closed at Scarborough Hospital. It follows the closure of the pain clinic, dermatology, the eye clinic and physiotherapy. These are not cuts, but a contrived centralisation by the trust in York. Will the Secretary of State intervene to ensure that there is a full range of service right across my constituency? (910055)

I commend my hon. Friend for his commitment to raising the local priorities of his constituents and for the campaigning he does on behalf of the local NHS. I think that these plans are best worked through by the local NHS. However, if he would like, I would be happy to meet him to discuss the concerns that he has on behalf of his constituents.

T7. Possability People is a disability charity in my constituency that has operated consistently for the last 30 years. Some 85% of its funding comes from the clinical commissioning group, but on 12 March it received a letter saying that the funding would stop in April. That follows the CCG’s decision last year to stop all funding for the low-vision clinic in my constituency. From April onwards, disabled people will have to go to their GP to access these services, which will cost more for the health service. Will the Minister meet me to discuss how we can save money? (910053)

The hon. Gentleman is absolutely right to draw the House’s attention to how vital local community services are in supporting people and to say that we really do need to invest in them. Clearly, these matters of investment are for local areas, which is why we allow CCGs to make these decisions, but I am more than happy to meet him to discuss the matter.

Will the Secretary of State give an evaluation of the “Future Fit” programme? We have secured more than £300 million for investment in our local hospital trust. What is his understanding of where the “Future Fit” programme has got to?

I have called in the independent review panel and asked it to consider all the evidence, at the request of the local council, to ensure that we properly assess all the evidence. We have made the money available, but we must ensure that the plans are the best ones possible for both Shrewsbury and Telford.

T8. I listened intently to the replies the Minister for Care gave to my hon. Friend the Member for North Tyneside (Mary Glindon) and the hon. Member for Central Ayrshire (Dr Whitford) about asthma. Is the Minister aware that, in the area of the Newcastle Gateshead CCG alone, 654 people were admitted to hospital with complications arising from their asthma? Asthma UK tells us that, of the 175,000 sufferers in the north-east of England, more than 100,000 report that they cannot always afford their prescriptions. The strategy is not working, so will the Secretary of State commit to removing prescription charges for asthma sufferers to massively reduce preventable hospital admissions and deaths? (910054)

The Government take this very seriously. The NHS long-term plan sets out priorities for the NHS, and deaths from respiratory disease is a key indicator and an absolute priority. However, it is only right that people who can afford to pay for their prescriptions, like me—I am an asthma sufferer and I can afford to do it—do so. Local areas have to decide those priorities. At the moment, 90% of prescriptions are free.

Can Ministers outline the latest steps to support the children of alcohol-dependent parents? In the forthcoming alcohol strategies, will greater support be promoted for the families of alcoholics, who are often best placed to help to reduce alcohol harm in their loved ones?

Absolutely. My hon. Friend is right to stress the role of families in supporting the children of alcoholics. We made progress on that and were able to announce funding just last week. I pay tribute to my hon. Friend the Member for Winchester (Steve Brine) for all his work—I enjoyed doing it with him—to do everything we can to support the children of alcoholics.

T10. Stoke-on-Trent ranks 13th in the health deprivation index, yet our funding ranks only 46th. Will the Secretary of State explain that? At what point will funding follow need? (910056)

The relative funding across the country for different areas is assessed independently, and by law NHS England makes that assessment. I am happy to write to the hon. Gentleman with the precise details of how those allocations are devised—I am sure that he has got them; they are widely available—and an explanation of the conclusion that NHS England independently reached.

What is being done to improve co-ordination between orthopaedic surgeons, osteopaths and chiropractors to reduce the burden on surgeons?

It is an important part of the agenda that we look right across the piece at interventions that can benefit patients. I know full well, not least because I am married to a former osteopath, the positive impact that that can have.

In a debate on 24 January in this Chamber, many contributors outlined the dangers of using graded exercise therapy in treating ME. What conversations has the Department had with NICE on that issue before the proposed publication of the revised treatment guidelines in October 2020?

There are ongoing conversations. As the hon. Gentleman knows, NICE is updating existing clinical guidance on the diagnosis and management of ME and chronic fatigue syndrome. That guidance will be published in 2020.

I met the Secretary of State to discuss my campaign for a new health centre in Hornchurch and I welcome his subsequent announcement that NHS trusts can apply for NHS property assets. Will my right hon. Friend let me know how and when they can make those applications and whether he will consider fast-tracking any bid we make, given how close we were to receiving capital funding?

There is no better advocate for Hornchurch in the Chamber than my hon. Friend. She made her case with passion and commitment and I was very impressed by it. I will write to her with the full details, once they are published, of exactly how the process will work, and I look forward to working with her.

The north-west of England has only half the number of ambulances per head of population as London. In rural Cumbria, the situation is far worse. Will the Secretary of State agree to our proposal for an additional two ambulances for Westmorland so that we can keep our communities safe?

The hon. Gentleman will know that, in the winter funding round, extra ambulances were provided across the whole country. I am happy to meet him and discuss his proposals, which I will then consider carefully.

ADHD Solutions is a community interest company based in the constituency of the shadow Health Secretary that serves children and young people with ADHD across Leicester and Leicestershire. Fifty per cent. of its referrals come from the NHS, yet it does not get funding for those referrals; however, those NHS services are able to meet NICE guidelines because ADHD Solutions is doing the job. Will the Health Secretary meet me and the shadow Health Secretary to discuss that?

I have corresponded with my right hon. Friend and the hon. Member for Leicester South (Jonathan Ashworth), but I am more than happy to meet them to discuss that issue. From my perspective, services for people with ADHD are a bit of a Cinderella and I would like to do my best to address that, working with colleagues across the House.

With a throwaway answer to the right hon. Member for Chelsea and Fulham (Greg Hands), the Secretary of State has just pulled the West London strategic health framework, which has governed the delivery of hospital and community services for most of the last decade, absorbed tens of thousands of hours and cost hundreds of millions of pounds. Why has he not thought it appropriate to bring forward a statement so that the many of us who are concerned with this issue have an opportunity to interrogate the many very serious implications that this has for the delivery of healthcare across west London?

The hon. Lady and the hon. Member for Hammersmith (Andy Slaughter), who is sitting next to her, have run, over a number of years, totally inappropriate scare stories about what they said were potential changes to A&E in west London as part of “Shaping a healthier future”. It has been one of the worst aspects of local parliamentary campaigning and I am absolutely clear that the changes in A&E in west London as part of “Shaping a healthier future” will not happen. However, there are elements of “Shaping a healthier future” that are about more community services and treating more people in the community. We look forward to working with the local NHS on those parts of the proposal.

Will the Secretary of State, on behalf of this House, thank doctors and nurses in the NHS for the amazing news that death rates from breast cancer are falling at a faster rate here than in the six largest countries in Europe and that, since 2010, death rates have fallen by 17.7%? He will know that I raised the issue of my constituent, Nicola Morgan Dingley, who is suffering from terminal breast cancer. He very kindly wrote to me. Will he agree to meet Nicola so that she can describe to him the challenges faced by women with triple negative breast cancer?

Yes, of course, I would be delighted to meet my hon. Friend and his constituent. He is right that the fall in deaths from breast cancer is huge progress that we have made as a country. I pay tribute to the work of the NHS on that but, of course, every such death is a tragedy and we need to do yet more.

“Shaping a healthier future” was the biggest hospital closure programme in the history of the NHS, with the loss of two major hospitals, including Charing Cross in my constituency. It was fully supported by the Conservative party not only nationally, but locally, as the right hon. Member for Chelsea and Fulham (Greg Hands) well knows. After seven years, millions of pounds wasted in consultants, staff leaving through insecurity and 2 million people across west London threatened with the loss of essential and world-class hospitals, is that it today? Abandoning “Shaping a healthier future” is a victory for the people of Hammersmith, for the Save our Hospitals campaigners and for our Labour council, but there has been appalling judgment by a succession of Governments and Secretaries of State. Will this Secretary of State now apologise to my constituents?

It is astonishing, is it not? My right hon. Friend the Member for Chelsea and Fulham (Greg Hands) has made this case with objective clarity and reasonableness, is supporting his constituents and led to a very positive outcome, keeping the A&Es open but still doing the positive work in the community, and all we continue to get is information that I regard as erroneous from the hon. Gentleman, who has campaigned in the most terrible way on this over many years.

A nine-year-old constituent of mine, Lydia Heptinstall, is a very brave sufferer of hypermobile Elhers-Danlos syndrome. She suffers from joint pain, headaches and numerous other symptoms and cannot do the things that other children can do. Will the Minister meet me to discuss Lydia and what the Government are doing to raise awareness of this condition?

Yes, of course, I would be very happy to meet my hon. Friend and talk about her constituent’s concerns.

I am wearing purple today for Epilepsy Day. What assessment has the Secretary of State made of the causes of ongoing shortages of epilepsy medications? What action is being taken to address those problems and what impact will Brexit have on the supply of those medicines?

I, too, am wearing purple—purple socks in my case—to support this important campaign. Of course, we have done enormous amounts of work across the NHS. I pay tribute to the NHS and to suppliers for working to ensure that, whatever the Brexit outcome, there will be the continued supply of medicines, but there is one thing that the hon. Lady can do if she really wants to make sure that we put this issue to bed once and for all—vote for the deal.

Order. I am sorry for disappointed remaining colleagues, but we must now move on. Before I take a possible point of order appertaining to business of which we have just treated, I want to say something with reference to yesterday’s decisions and tomorrow’s business.

Speaker’s Statement

I understand that the right hon. Member for West Dorset (Sir Oliver Letwin) will be tabling a business of the House motion at approximately 4 pm today. Members have until the rise of the House this evening to table motions to be considered tomorrow under the indicative votes procedure. The indicative votes procedure itself, I must advise the House, will be set out in the amendable business of the House motion, which the House will debate tomorrow. I will leave it there for now. The Leader of the House will be making a supplementary business statement later, after the urgent question on Yemen. I hope, as a guide, that is helpful to the House.

Points of Order

We cannot have a replay of Question Time because people are disappointed with the answers they got or whatever, but if there is some material point of order to be articulated briefly, I will hear it.

Can you advise me, Mr Speaker? I think the Under-Secretary of State for Health and Social Care, the hon. Member for Thurrock (Jackie Doyle-Price), might have inadvertently misled the House in her response to Question 3 on health inequalities when she stated that there was an increase in life expectancy. In fact, the latest figures show that life expectancy has been revised downwards. Public Health England has done an investigation into this trend. Can you advise me, Mr Speaker, on how she might correct the record?

What I would say to the hon. Lady is that every Member in this place is responsible for what he or she says in it. If a Minister believes that an error has been made from the Treasury Bench, it is of course incumbent upon that Minister to correct the record. We shall have to wait to see whether the Minister judges that that is necessary in this case. If it is and it happens, I dare say the hon. Lady will be at least partly satisfied. If it is not thought to be required and therefore does not happen, my advice to her is to persist, if she wishes, through the use of the Order Paper, repairing to the Table Office to table questions, and seeking opportunities to ventilate the matter further at appropriate junctures in the Chamber.

On a point of order, Mr Speaker. As always in Health questions, you did your level best to get as many Back Benchers in as possible, so that we could put questions on behalf of our constituents, but obviously the desire of Members of this House to hold the Government to account on the NHS is such that Health questions is oversubscribed, as always. Every time we have Health questions, there are more people standing than the time allows. As Back Benchers, what can we do either to get more time for Health questions, which is so important, or to have them more regularly, so that Back Benchers can properly represent their constituents?

There are two possibilities. One is that Members can table further written questions—if they have already tabled some—or table them for the first time on the matter about which they are concerned and in relation to which they did not have an opportunity at oral questions. That is one avenue open to the hon. Gentleman and other Members.

Secondly, if the hon. Gentleman has a bigger concern, which I detect perhaps he has, and thinks that the salience of the issues and the level of interest in them are such that they warrant a greater allocation of time in the Chamber, my advice is to write to the distinguished Chair of the Procedure Committee, his hon. Friend the Member for Broxbourne (Mr Walker), to inquire what the Committee might think about allocating greater time to these matters by comparison with others. For my part, as the hon. Gentleman would know, I would happily sit in the Chamber all day and probably all night, listening to nothing other than the dulcet and mellifluous tones of my colleagues in relation to these important matters.

On a point of order, Mr Speaker. Could you further clarify your advice to the House about the processes to be followed tomorrow, and your suggestion about tabling proposed amendments before the rise of the House? There is a risk—we do not know—that the business on the Order Paper might collapse early. Would it not be more opportune to set a time by which all amendments should be tabled in case the business were to collapse and the House rise early?

I am grateful to the hon. Gentleman. I confess that I had not considered that point. The Clerk at the Table, having consulted his scholarly cranium with characteristic speed, has swivelled around to advise me on this matter, and he does not think it necessary; on balance, I do not think it necessary either. The hon. Gentleman is obviously concerned about the possibility that the business of the House might conclude early, but it is not automatically to be assumed that that will be so. If that eventuality were to arise and Members were to be disadvantaged as a consequence, I would have to revisit the issue because my concern is to facilitate colleagues.

As things stand, I am working on the assumption—considering matters lying ahead, and playing for time as I do and as colleagues can see—that this need not arise. We have an urgent question on the situation in Yemen, consideration of the Healthcare (International Arrangements) Bill and a number of other items of business, including the consideration of Lords amendments to the Offensive Weapons Bill and a motion regarding section 5 of the European Communities (Amendment) Act 1993 that is amendable. I give the hon. Gentleman a hint that hon. Members may have expressed an interest to me in amending that motion. I can therefore see some hours of learned and eloquent debate ahead of us. I hope that allays his concern.

Sorry to disappoint you, Mr Speaker. It appears that hon. Members are able to submit oral questions for the weeks beginning 8 April and 15 April. Is that accurate, and has future business been amended?

I am advised that it may be a glitch in the system. The short answer is that the business for those weeks has not been announced. As I think the puckish grin on the hon. Lady’s face testifies, she knows that the business is a matter of some uncertainty at this stage. I do not know any more than she does, and as of this moment I possibly do not know any better than Members on the Government and Opposition Front Benches as to whether the House will be sitting in the weeks of 8 April and/or 15 April. It is a matter still to be determined.

On a point of order, Mr Speaker. I am sure that the whole House will join me in condemning the abhorrent racist abuse directed at England footballers during their match last night. I know that you will agree that we must do everything we can to stamp out this vile behaviour. Can you advise me whether it would be reasonable to expect the Secretary of State for Digital, Culture, Media and Sport to come to the House and make a statement on what the Government are doing to protect our players abroad and what action they are taking to push for the strongest possible punishments?

It is certainly perfectly reasonable for the hon. Lady to hope for a statement. Whether the Secretary of State has a plan to do so imminently—in truth, I do not know. It may be intended. There are other ways in which the House can air its concerns on the matter. I share entirely the hon. Lady’s view. Any and all racist abuse is to be utterly and unreservedly condemned, and all of us who have public voices—if I may put it that way—should take the opportunity to make it clear that there can be no justification for that behaviour by anyone, anywhere and at any time. A huge amount of work has been done by anti-racist organisations in football and more widely across sport to try to change behaviour and change the attitudes that underlie abhorrent behaviour. It is only a pity to note that, despite some fantastic work—of which the hon. Lady will also be well aware—much still remains to be done.

Yemen

I hope you will indulge me for just one moment, Mr Speaker, while I pay tribute to my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), who has left office and, in a normal state of affairs, would have been answering this question. He is a very old friend of mine. We have shared offices not just in the Foreign Office but in Portcullis House. I know that he will make a great contribution to international affairs and elsewhere, not least in the middle east, in the rest of his time in Parliament.

Today is the fourth anniversary of the intervention by the Saudi-led coalition into the conflict in Yemen, at the invitation of the Government of Yemen, which began when the Houthi rebels captured most of the capital, Sana’a, and expelled the internationally recognised Government. Since then, Yemen’s humanitarian crisis, the largest in the world, has continued to worsen, as many hon. and right hon. Members know. We call on both sides urgently to implement the agreements made at the Stockholm peace talks and bring an end to this dire conflict.

The United Kingdom is at the forefront of work towards a political solution to this conflict—there can only be a political solution, in the long term—and we will continue to show leadership as part of international efforts to end the appalling suffering that millions are facing. My right hon. Friend the Foreign Secretary visited the region at the beginning of the month in a display of the UK’s support for efforts to secure peace. During this time, he visited the port city of Aden, becoming the first western Foreign Minister to visit Yemen since the conflict began. He also attended the peace talks in Stockholm last December. This year—the tax year 2019-20—we have committed an additional £200 million of UK aid, bringing our total commitment to over £770 million since the conflict began. This support will save, and indeed is saving, lives by meeting the immediate food needs of more than 1 million Yemenis each and every month of the year, treating 30,000 children for malnutrition, and providing more than 1 million people with improved water supply and basic sanitation.

The UK continues to support the work of the UN, and the UK-led UN Security Council resolutions 2451 and 2452 were unanimously approved by the Security Council in December 2018 and January 2019 respectively. Those resolutions enshrined the agreements made in Stockholm and authorised the deployment of monitors within the UN Mission to Support the Hodeidah Agreement, thus bolstering the peace process further. We believe that the Stockholm conference was a landmark point, as the first time that the parties had come to the negotiating table in over two years, but we all know that there is a serious risk that this window of opportunity to make progress towards lasting peace may slip away. The UK therefore urges both sides to act in good faith, to co-operate with the UN special envoy and General Lollesgaard, and to implement the Stockholm agreements rapidly. We have been clear that a political settlement is the one and only way to bring about long-term stability in Yemen and to address the worsening humanitarian crisis. We shall continue to make every effort to support the UN-led process to get to the solution that so many Yemeni civilians so desperately require.

Thank you, Mr Speaker, for granting this urgent question.

Let me begin by completely agreeing with the Minister about the terrible loss from the Foreign Office Front-Bench team of the right hon. Member for North East Bedfordshire (Alistair Burt), who might well have been answering this question today were it not for his decision on a matter of principle. Labour Members applaud the right hon. Gentleman for that today, as we do the equally principled stance taken by the Minister for Asia and the Pacific. We will miss both the substance and the tone that the right hon. Gentleman has brought to our debates from the Front Bench over the past two years.

Unfortunately, however, the former Minister is one of several Foreign Office and Defence Ministers who have told us repeatedly from the Dispatch Box, in written answers and in evidence to Committees that Britain is not a party to the conflict in Yemen. Most crucially, for the past three years, that phrase has been used time and again by Ministers to explain that it is impossible to assess alleged individual violations of international humanitarian law in Yemen because we are not a party to the conflict. Yet this weekend we read reports in The Mail on Sunday that members of British special forces had been engaged in gun battles with the Houthi rebels in Yemen while providing support to the coalition forces.

I am not for a second expecting the Minister of State to comment on the activities of our special forces—something that the Government never do—but I want to ask him two important questions of principle. First, in the light of these reports, do the Government still stand by their long-standing statements that Britain is not a party to this conflict? We already know about our support for the Saudi air force and our supply of billions in arms for the Saudi coalition. If, in addition to all that, our forces are engaged in actual gun battles with the Houthi rebels and that does not constitute being a party to the conflict, I really do not know what does.

The second question of principle is this. It is an equally long-standing position of the Government that there is no military solution to this conflict. Indeed, the Minister has reaffirmed that today. So I simply ask this: why, if these reports are accurate, are British forces being put in harm’s way trying to deliver that military solution?

Finally, there was one especially disturbing allegation in The Mail on Sunday report that our forces are providing support to locally recruited, Saudi-funded militia and that many of the fighters—up to 40%, it was alleged—are children as young as 13 years old. Is that in any way true? If it is, that would confirm that our forces are not just a party to this conflict but witnesses to war crimes.

I thank the right hon. Lady for the tone of her contribution. She will appreciate—indeed, she expressly appreciated—that in relation to special forces we do not comment either to confirm or deny any involvement. Clearly, she is well aware that we have liaison officers who are based in Saudi Arabia, and have been routinely. I am very keen not in any way inadvertently to mislead the House on this matter, and therefore I will, if she will forgive me, ensure that she has a written response, liaising with the Ministry of Defence, about the issue of other engagement or involvement of British personnel in Yemen at the moment. We still hold to the firm view that we are not a party to the conflict. Clearly, we are supportive of Saudi Arabia, which has been a long-standing ally, as she is aware. There is no military solution to this matter.

I have never been to Yemen myself, but my late father’s first engagement out of Sandhurst was in Aden, in a different time. He had the fondest of memories, as indeed many people living in that country have of this country. That is why we have been a pen-holder at the UN Security Council.

I have also, of course, read the article in The Mail on Sunday, if perhaps slightly later than the right hon. Lady did—only this morning. It makes some very serious allegations. I am keen that we get to the bottom of those allegations. Again, I am very keen not in any way to mislead the House, but allegations made in relation to any engagement that involves bringing child soldiers on board would be appalling. I very much hope that the journalist will be in a position, within the sources that he can reveal, to make it clear what knowledge he had on the ground. Clearly, that will be investigated as a matter of urgency.

Order. I am very much hoping to move on no later than 1.30 pm, so brief questions and answers would be greatly appreciated.

The whole House will be grateful for the words of the Minister and the shadow Foreign Secretary about my right hon. Friend the Member for North East Bedfordshire (Alistair Burt). I have worked with him on international development matters for the last 14 years, and the Government can ill afford to lose such a capable Minister at a time like this.

The welcome change of direction on Yemen that the new Foreign Secretary has ushered in is greatly to be applauded, but there were exceedingly serious, credible and authoritative allegations in the Sunday media that serving British military personnel have been seriously wounded in operations in Yemen. That flies in the face of assurances given from the Dispatch Box on countless occasions, including in emergency debates that you have authorised, Mr Speaker. I tabled a number of questions last night to the Ministry of Defence, and were it not for the all-consuming nature of Brexit, I suspect the House would want to explore this as a matter of urgency.

I thank my right hon. Friend. I know he has a long-standing interest in this issue, not least the humanitarian aspect, from his time as International Development Secretary. He is right; these are very serious allegations, and I am keen that I do not inadvertently give reassurances on the Floor of the House that could turn out not to be the case. We need to have an internal investigation. I will perhaps take this up in writing with him, but I suspect that we will come back to this issue on the Floor of the House before too long.

May I add my own remarks about the right hon. Member for North East Bedfordshire (Alistair Burt)? This is a loss that the Government, never mind the FCO, can ill afford. He was a fine Minister, and I am sorry to see him go.

In the deepening humanitarian crisis, some aid agencies are saying that they cannot now work around Hodeidah, and the cholera crisis is spiralling out of control. How are we using our influence? We have been told that the Government are using their influence through arms sales. What influence has £4.6 billion-worth of arms sales delivered in? The Minister said in response to the shadow Foreign Secretary, on the subject of the Mail on Sunday allegations, that

“we are not a party”

to the conflict, but “we are supportive”. Can he give more detail about what the difference is? What advice is the Foreign Office giving to the Home Office about those who manage to flee the conflict in Yemen, who are being diverted to Sudan at the moment? What advice is it giving about the safety of young families who have been sent there?

For obvious reasons, there is constant dialogue between the Home Office and the Foreign Office. I will get back to the hon. Gentleman on specifics, if I may. As far as the broader issue of arms sales is concerned, I appreciate that other Members may wish to raise this, but let me say generally that, as he will be aware, we have one of the strictest arms sales regimes in the world.

Well, as the right hon. Lady will be aware, it is a regime that came into place under the new Labour Administration.

I can confirm to the right hon. Lady that in my part of the world—in Asia and the Pacific—the issue that I probably spend the most time on is arms licences. All Foreign Office Ministers take that work extremely seriously. I have a strict rule in my mind that if the recommendation is to refuse, I will endorse that, but if it is to accept, I will look very carefully through the papers and will often ask for further and better particulars or will push back to refuse. That causes all sorts of day-to-day concerns with the Department for International Trade, but we do that. We take that very seriously as Foreign and Commonwealth Office Ministers—something I am sure she looks forward to doing at some point in the near future.

I will have to get back to my right hon. Friend on that matter. It is more an issue for the Ministry of Defence, I guess, than for the Foreign Office.

May I echo what has been said about the former Minister, the right hon. Member for North East Bedfordshire? He will be a huge loss to both the Foreign Office and the Department for International Development.

On Saturday in Birmingham, friends of Yemen from across the country came together with a very powerful voice for the diaspora. Can the Minister seek to ensure that, the next time Martin Griffiths is in the UK, he has a meeting with representatives of the Yemeni diaspora who live here, so that their voice can be heard in this process?