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Health and Social Care

Volume 659: debated on Tuesday 7 May 2019

The Secretary of State was asked—

Patient Registration: GP Surgeries

1. What steps his Department is taking to ensure that patients with no (a) fixed address and (b) proof of identity can register at GP surgeries. (910713)

We are very clear that GP surgeries cannot refuse to register somebody who is of no fixed abode or has no proof of identification. Where a practice does not properly provide correct access to vulnerable groups, the commissioner will intervene to ensure that it corrects that. Ultimately, the commissioner can issue a remedial notice and can terminate a contract or practice that still does not abide by its obligations.

Has the Minister seen the report by a mystery shopper from Friends, Families and Travellers who attempted to register with 50 GP practices without ID or proof of address? Twenty-four refused to register her or would not register her; all but two of those were rated outstanding by the Care Quality Commission. The Minister says GPs must properly follow the guidance, but does she agree that the CQC needs to ensure that it uses the inspection regime to enforce that guidance?

I totally agree. I have seen the report, which I welcome; I will certainly take it up with the CQC. It is very important that we use all tools to ensure that everyone has access to the healthcare they deserve, because it is all too easy for some groups to remain discriminated against. I am grateful to the hon. Lady for shining a light on this important issue.

We have one of the very few free at point of need health services in the world. Does the Minister agree, however, that checks are important in cracking down on health tourism? Does she have the latest assessment of the cost of health tourism to our NHS?

My hon. Friend is absolutely right—health tourism is a major cost to the taxpayer, so it is important that we establish that people are entitled to care. However, it is important to ensure that people without proof of ID and of residence are still entitled to healthcare. Where someone is not entitled to it, we will, of course, pursue them for payment.

Radiotherapy Services

2. What funding his Department plans to allocate to radiotherapy services in the next five years. (910714)

One in four people currently receive radiotherapy—a number that will increase if the Government achieve their early diagnosis targets. Ministers dispute that 20,000 people in England annually miss out on appropriate access to life-saving radiotherapy. What is the Secretary of State’s estimate? Will he commit to meeting representatives of the Radiotherapy4Life campaign to discuss how we can improve radiotherapy provision in England?

I am absolutely happy to meet the group. According to the latest figures, about four in 10 of all cancer patients are treated with radiotherapy; it is a critical treatment to tackle cancer. As I say, there has been an investment programme to replace and upgrade radiotherapy equipment, with 80 upgrades or replacements over the past three years, but there is clearly more to do to make sure that people with cancer get the best possible treatment.

24. May I welcome the NHS long-term plan commitment to complete the £130 million upgrade of radiotherapy machines throughout England? I ask my right hon. Friend to confirm that more effective radiotherapy will mean patients experiencing fewer side effects and having shorter treatment. (910737)

Yes, that is exactly right. That is why we have put in place the new LINACs—linear accelerators, the equipment that is being rolled out across the country in a £130 million programme. We are always looking at what more we can do to help people to beat cancer.

Will the Secretary of State agree to look personally at the case for a new satellite radiotherapy unit at Westmorland General Hospital, tied to the Rosemere unit in Preston? I had the privilege last week of driving my constituent Kate Baron to her treatment at Royal Preston Hospital. Wonderful treatment though it is, it is a three-hour round trip that she has had to take on 15 separate occasions—I went with her only the once. Hundreds of people in the south Lakes have to make debilitating, lengthy round trips to get treatment day after day, which is damaging to their long-term health and to their ability to access radiotherapy at all.

I am grateful to the hon. Gentleman for raising that point. He did not raise the individual case with me in advance, but I can see the point he is making. The public health Minister, who is responsible for cancer policy, will be very happy to meet him.

NHS Workforce Vacancies

3. What recent assessment he has made of trends in the level of workforce vacancies throughout the NHS. (910715)

The NHS employs more staff than at any time in its 70-year history. Posts may be vacant for a variety of reasons, including maternity and career breaks. The latest data shows that as of December 2018 about 80% of nursing vacancies and 85% of medical vacancies are filled by a combination of bank and agency staff.

Recent data from NHS Digital shows that there are 720 fewer GPs in the east midlands than just two years ago. According to NHS England, each month thousands of people wait more than four weeks for a face-to-face GP appointment in Nottingham. In January, 3,206 people had to wait more than 28 days between making the appointment and seeing their doctor. Ultimately, that is leaving the GPs we do have overwhelmed and overworked. I know myself that it is creating huge pressures on the emergency department at Queen’s Medical Centre. What is the Minister going to do to change that system?

The NHS long-term plan will set out vital strategic frameworks to ensure that the needs for the next 10 years are met. The hon. Lady will know that we are training an extra 5,000 GPs to work in primary care and general practice. If she writes to me about the specifics of the numbers she mentioned in respect of Nottingham, I will be happy to respond.

Those of us who are campaigning to reopen a full obstetric unit at Horton General Hospital know how important the workforce are to safety in our NHS. At an excellent meeting today, Baroness Harding set out some of the things we can do to increase our workforce, one of which was much better leadership and career planning for the staff we are already retaining in the NHS so that they want to stay longer. What is the Department doing about that?

As my hon. Friend has heard, the Secretary of State commissioned Baroness Harding to bring forward the interim workforce plan. One of the workstreams was looking at retention and the staff we currently have. More than 52,000 nurses are in undergraduate training, and it is essential that they stay in the NHS after training. What Baroness Harding outlined today will ensure that that happens.

Can the Minister confirm today’s Daily Mail report that the NHS plans to recruit thousands of overseas nurses over the next five years? How much of that shortage has been caused by the exodus of EU nationals from the NHS, and how much of it by the Government’s disastrous decision to abolish nursing bursaries?

I will not comment on the specifics of a leak from an outdated version of the plan. The NHS has always recruited nurses internationally and there are no plans to change that. The workforce plan will set out how more nurses, doctors and nursing associates will be recruited and retained inside the NHS.

Many surgeries in my constituency augment the work of GPs with nurse practitioners. Will the Minister join me in praising the work of nurse practitioners and say what more the Government could do to grow their number so that they can continue their excellent work in surgeries around the country?

I absolutely agree with my hon. Friend. Nurse practitioners do an extraordinarily valuable job across the country. The Government are committed to training more nurses and more nursing practitioners. As I said in an earlier answer, that will be set out in the workforce plan.

The workforce shortfall is not evenly distributed across the NHS either geographically or by specialty. The Minister will know that there are particularly serious nursing shortfalls in learning disability and community services. He will also know of the implications of shortfalls—for example, for the ambition to deliver 75% of cancer diagnoses at stages 1 and 2. Will he look again at the evidence on mature students and the impact of losing bursaries on that section of the workforce? Will he meet me to discuss that?

The Chair of the Select Committee is right: the vacancies are not evenly spread and are of particular concern in learning difficulties and a number of other areas. Of course we want to ensure that mature students come back to and stay within the health service. That is why a number of incentives are being put in place to encourage, recruit and retain mature students. I would, of course, be happy to meet her to discuss this matter in more depth.

I appreciate the Minister’s comments about the need for retention and morale-boosting in the NHS. Does he agree that constantly going around fabricating threats of closures when no such threats exist, or talking down the NHS—as some politicians do—does not exactly help recruitment and retention either?

My hon. Friend is completely right. One would have hoped that all Members on both sides of the House celebrate the fact that the number of nurses and the number of doctors in the NHS are now higher than they have ever been in its 70-year history, and that the Government are backing that up with a commitment to invest £33.9 billion.

Cuts in lifetime and annual pension tax allowances are causing senior doctors to retire earlier and younger consultants to avoid working extra hours, as they can end up paying more in tax than they earn from the extra hours of work. What discussions has the Secretary of State had with the Chancellor about the fact that these recent changes are driving doctors from the profession and increasing workforce shortages?

The hon. Lady raises a very important matter. The Government recognise the concerns that have been expressed by NHS doctors, and my right hon. Friend the Secretary of State is engaging in numerous conversations with the Chancellor. I am reluctant to give a running commentary on the nature of those internal discussions, but I can say that we hope to resolve the matter soon.

NHS Mental Health Services (University/College Students)

4. What discussions he has had with the Secretary of State for Education on the provision of NHS mental health services for university and college students. (910716)

The Secretary of State for Health and Social Care met the Secretary of State for Education in February to discuss concerns about mental health and the prevalence of self-harm among young people. “The NHS Long Term Plan” states that we will

“extend current service models to create a comprehensive offer for 0-25 year olds”,

and I expect to have regular dialogue with our counterparts in the Department for Education to make that a reality.

The all-party parliamentary university group has heard consistent evidence about the rising number of students presenting with mental health problems. We have been told that it has increased sixfold in the last 10 years, from 9,675 to 57,000. That poses huge challenges to what used to be counselling services but are now becoming a mainstream part of health provision, funded by universities. What are the Government going to do about it?

Young people often fall out of care when they leave their home addresses to go to university. To deal with that transition, we extended the service to nought to 25-year-olds through the forward plan rather than cutting it off at adulthood. That will ensure that we can do more to achieve continuity of care.

I pay tribute to the efforts that universities have made. They have seized on the challenge posed by the increasing prevalence of mental health problems, and I will continue my dialogue with them.

The students union at Anglia Ruskin University—which is based in Chelmsford as well as in that other “C” place, Cambridge—carried out a big study on student mental health. One of its requests was for students to be able to register with two GPs, one at home and one at university, so that they would not be stuck without a GP in the holidays or in term time. Can we look at that again?

I will definitely look at it. As I have said, the transition poses real challenges, because of a process failure rather than any lack of willingness or commitment on anyone’s part. We must ensure that people retain access to services as they move around.

The all-party parliamentary group on psychology, which I chair, heard just last week that young people who have done extremely well with child and adolescent mental health services are being put on waiting lists when they move away from home to colleges and universities, and are having to start again from the beginning. They are falling through the gaps. Will the Minister ensure that that does not happen any more, that there is no longer a postcode lottery, and that people who have done extremely well in getting into university receive all the support they need?

I see that there is a meeting of minds. Not only do I agree with what the hon. Lady has said, but I have met the hon. Member for Dewsbury (Paula Sherriff) to discuss exactly that issue. There is clearly a systemic weakness in respect of those who move between home and university, and we will continue our dialogue to ensure that it is fixed.

The Minister will be aware of the close and often tragic link between mental illness and suicide, which is now the biggest killer of young people and is at record levels. What specific measures do the Government have to address that issue?

The right hon. Gentleman will be aware that we expect all local communities to have suicide prevention plans, part of which will be that they engage in areas of greatest risk, whether it be regarding place or their populations. Suicide is the biggest killer of young people and I expect local authorities to engage with education providers to make sure that sufficient measures are in place. We are in the process of challenging the plans to make sure they are fit for purpose.

Universities UK has warned that it simply cannot keep expanding to fill the gaps left by inadequate funding for NHS services, after university spending on mental health services rose by almost half in five years. Too often other sectors such as education are left to fill the funding gap this Government have left in mental health, so can the Minister tell me today when her Government will match our pledge to ring-fence funding for mental health?

I have always viewed the ring fence as a ceiling rather than a protection. We have the mental health investment standard and NHS England is challenging clinical commissioning groups that are not spending what we would expect.

This is a systemic weakness. We have treated children up to 18 and then considered them as adults, but the reality is that people do not suddenly achieve majority overnight. We intend through the forward plan to have the children and young people service from nought to 25. That should enable transition and stop people falling off the cliff edge at 18.

Prescription Drugs

Over 2 million prescription items are successfully dispensed in England every day, and we have well-established procedures to deal with medicine supply issues should they occur. We work closely with all those involved in the supply chain to help ensure any risks to patients are minimised when supply issues arise.

I welcome the Minister to her place. She will know from written questions I have tabled that my constituents have real concerns about the availability of the epilepsy drug Sabril, which has been in short supply. She told me last month that supplies would be resolved by mid-April; she has now told me in a written answer that supplies will be resolved by mid-May. It seems there is a disconnect between what the Minister is saying and what is actually happening on the ground. When can she guarantee that this drug will be widely available again?

I thank the hon. Gentleman for raising this issue again. We have expressed our great concern to the suppliers about this problem, and we are working alongside them to ensure that, although there is enough Sabril nationally, we get it in the right place at the right time. We will go back to them and express our concern again.

May I add my congratulations to my hon. Friend the Member for South Ribble (Seema Kennedy) on her appointment? I am sure the whole House wishes her well in her important work.

Related to the question of prescription drugs is that of vaccinations, where rates have been falling, partly driven by alarming and inaccurate material posted on social media, including Facebook. Will the Minister join me in calling on Facebook to remove material that deters people from vaccinating their children? If it refuses to do so, does she agree that legislation may be needed?

I thank my hon. Friend for his question. As he will know, my right hon. Friend the Secretary of State met Facebook last week.

On the issue of vaccination broadly, in 2017 we met the 95% rate for vaccination. Immunisation for everybody is absolutely crucial, but some children cannot be immunised because they are too young and others because they are immune-suppressed; so everybody who can be immunised should be immunised.

I also welcome the hon. Lady to her place.

Close to 100 commonly prescribed medications are in seriously short supply, including painkillers, antibiotics and antidepressants. Worries about Brexit outcomes have led to the stockpiling of medications, which has undoubtedly exacerbated the problem, but I know from my own experience in community pharmacy that there have been concerns about the supply chain for several years, long before Brexit was ever dreamed of. The Government have, however, consistently turned a blind eye to these problems, which place additional pressures on GPs and pharmacists and are most certainly detrimental to patient care. Can the Minister assure me today that she understands the scale of the problem and outline the steps she is taking to resolve it?

I thank the shadow Minister, my Lancashire neighbour, for her welcome. The Department takes this extremely seriously; we have a whole team working on it. There are about 12,500 prescribed medicines in this country, with only between 50 and 100 being looked at by the medicines supply team at any one time. There is no cause for complacency, though. In January this year, we took further steps to make it mandatory for pharmaceutical companies to report any supply issues to us as soon as possible.

Urgent Care: Kettering

6. If he will make provision for (a) a new urgent care hub at Kettering General Hospital and (b) a health and social care pilot in Northamptonshire with the Ministry of Housing, Communities and Local Government. [R] (910718)

The Government are committed to transforming the NHS estate. I discussed the urgent care hub with my hon. Friend and other colleagues in January, and, as he knows, I enjoyed my visit to Kettering General. He also knows that future levels of capital will be determined at the next spending review, after which our prioritisation process will be determined, to identify the strongest transformation schemes. We welcome initiatives from local leaders to strengthen and better integrate the local health and care landscape in Northamptonshire.

When Kettering’s present A&E was built 25 years ago, it was designed to cope with 45,000 patients a year. It is now coping with 91,000, and it is estimated that in 10 years’ time, 120,000 will use the facility. The whole NHS in Northamptonshire recognises that an urgent care hub at Kettering General Hospital is urgently required. Will the Government get on and fund it?

My hon. Friend is a diligent and consistent representative of his constituents on this matter. He will know that I have heard his request and that, as I have said to him before, the spending review will take place later in the year. Priorities will be decided at that stage.

Patient Experience: Digital Technology

7. What steps he is taking to improve the patient experience through the use of digital technology. (910719)

Providing patients with modern digital services that are safe, effective, convenient and personalised is central to our NHS long-term plan.

I thank the Secretary of State for that answer and for the energy that he brings to this brief. Does he agree that digital health not only improves healthcare systems but also provides a platform for place-based and population-based prevention, better diagnosis, patient empowerment, novel mental health therapies and accelerated access to the innovative treatments that I introduced as a Minister? This is now being pioneered in some parts of the country. Will he meet me and the Birmingham health partners to look at an interesting idea for digital place-based health impact bonds?

Yes, I am always happy to meet my hon. Friend to talk about interesting new policy innovations like that. It sounds right up my street. In fact, I met the Mayor of the West Midlands combined authority to discuss this subject only last week. There is a huge amount of enthusiasm and energy in this policy area, which will enable us to improve patients’ lives across Birmingham and, indeed, the whole country.

As the Secretary of State knows, because he is a member, the Babylon Health GP at Hand digital service is based in Hammersmith and Fulham. By the end of this year, it will have run up a deficit of about £35 million for my clinical commissioning group. Given that the clinical commissioning group is cutting GP hours and closing an urgent care centre overnight because it is so short of funds, when are we going to be reimbursed for that £35 million?

I do not recognise the number that the hon. Gentleman talks about, but we are changing the way in which the GP contract works to ensure that this new technology can be most effectively harnessed to deliver patient need in a way that also works for the NHS. I am slightly surprised that he has not yet got up to say thank you for our announcement on primary care services in his part of London, which we are going to be expanding while stopping the closure of A&E. A little bit of gratitude for that would also go down well.


We are absolutely resolute in our commitment to improving care and support for autistic people, and we will launch a refreshed autism strategy, which will include children, by the end of the year. We have also launched a national call for evidence, to hear what we are doing that works and where we need to do more, and we have already received more than 2,000 responses.

I welcome the NHS long-term plan and the steps that will go towards helping autistic people in the healthcare system. Does the Minister agree that we will make a real difference only if we improve the recording of autism in local health and care records? Will she therefore commit to requiring the NHS to record autism diagnoses in each area with the aim of improving autistic people’s health?

My hon. Friend is absolutely right to raise this issue. Reasonable adjustments are critical for improving the experiences of health and care for autistic people. That is why the long-term plan commits to a digital flag in patient records, which will ensure that staff know whether a patient has a learning disability or autism. At the same time, we are looking at how we record where a diagnosis of autism has been made.

In 2017, more than 100 MPs wrote to the then Health Secretary demanding a national target of a three-month waiting time for autism diagnosis because waits were more than four years in some areas. Stockton clinical commissioning group and Stockton Council have reduced waits, but what do current figures show? Will the Government now set a target in line with National Institute for Health and Care Excellence guidance?

I am pleased the hon. Gentleman has raised this issue, because he is absolutely right that we need to drive up performance nationally on diagnosis for autistic people. It is only with diagnosis that people can get the support and help they need. We are collecting data for the first time. It will be published later this year for the first time. It will mean that each area can be held to account and given the help and support it needs to drive up those figures.

Will the Minister further outline the steps that have been taken to push for a UK-wide, ring-fenced uplift to respite care funding for those who suffer from autism, bearing in mind that there is a two-year waiting list in some healthcare trusts for families to access overnight respite care?

That is a really good point. We all know that access to respite care can be incredibly valuable, both for autistic people and their carers and their loved ones. That is why we are supporting CCGs that want to invest in respite care, and we are looking more carefully at how we can direct funding to these important services.

Eight years after the Government pledged to move autistic people out of in-patient units following the Winterbourne View scandal, there are still 2,260 people in such units, many of whom are subject to restraint, over-medication, seclusion and even neglect. Rather than reviews and warm words, will the Secretary of State now act to change things by matching Labour’s pledge of £350 million of extra funding to move autistic people and people with learning disabilities back into the community where they belong?

Of the original 2015 cohort that the hon. Lady mentioned, 6,325 people have been discharged and 476 beds have been decommissioned, but the thing is that people are still coming in. The only way we can achieve permanent, long-term cuts is if we invest in community health. That is why the long-term plan commits to an extra £4.5 billion a year for community health. Local providers are expected to use some of that to develop the right specialist services in the community to reduce avoidable admissions.

National Institute for Health and Care Excellence

9. What recent assessment he has made of the efficiency of decision making by the National Institute for Health and Care Excellence. (910721)

Wherever possible, the National Institute for Health and Care Excellence aims to publish recommendations on new drugs within a few months of licensing and now publishes draft guidance on cancer drugs even before licensing. Many thousands of patients have benefited from rapid access to effective new drugs as a result.

The Secretary of State will know that Maryam is now nine months old. We have been waiting nine long weeks for NICE to announce a decision that I am told it has already made. Spinal muscular atrophy babies have been waiting 16 months for the care they need, which is longer than many SMA babies live without treatment. There is another closed-door meeting tomorrow. If NICE finally decides to provide Spinraza on the NHS, how long will it be before Maryam and the other babies get their first dose?

The hon. Lady rightly raises an important case, and I have met her about it and followed it closely. As she says, there is work ongoing and happening this week to try to make progress. NICE is currently developing technical appraisal guidance on the use of the drug Spinraza, to which she refers. We are working to ensure that we can get it right.

As chairman of the all-party parliamentary group on multiple sclerosis, may I urge my right hon. Friend to ask NICE to expedite its perfectly proper processes on the licensing of cannabis-based drugs, particularly for the treatment of multiple sclerosis, Parkinson’s and motor neurone disease?

Yes. My hon. Friend raises another important area where progress is being made on the ability for people to get access to drugs that could help them. We now have a medicinal cannabis programme in place, as we discussed in this Chamber a couple of weeks ago, so that those with acute conditions and with clinical support for using medicinal cannabis can get it. We are also working as rapidly as we reasonably can to normalise the ability to use medicinal cannabis within the NHS.

Kuvan, Orkambi and Spinraza—these are just three life-changing drugs to which thousands of patients are being denied access on the NHS. Patients have waited far too long for the drugs they desperately need, and for some, as we have heard, it is a matter of life and death. Does the Secretary of State agree that the NICE appraisal process for rare diseases is just not fit for purpose?

I do agree it is important that NICE constantly tries to get those decisions made objectively, robustly and as fast as possible. There is cross-party support, and I hope continuing cross-party support, for these judgments being made independently so that they are taken not by Ministers but by clinicians. We can all agree that this has to be done as quickly and as efficiently as possible.

Mental Health Funding

11. What recent assessment he has made of the effect on patient outcomes of regional variations in mental health funding. (910724)

Funding allocations to clinical commissioning groups vary to meet the needs of local populations, including mental health needs. These allocations are determined by a formula managed for the NHS by the Advisory Committee on Resource Allocation. For mental health, the formula takes into account patient-level data covering community, out-patient and in-patient mental health services, as well as improving access to psychological therapies activity and hospital episode statistics.

One in three early intervention in psychosis services in the north of England does not meet the standard that NHS England expects. What is NHS England doing to end this postcode lottery and ensure that my constituents can access the same high-quality mental health services as people in other areas of the country?

The hon. Lady is right to highlight this. Good care depends not only on money but on performance, and we expect the Care Quality Commission to be very challenging in inspections so that we can guarantee consistency in the quality of services, rather than experiencing the postcode lottery she mentions. I am disappointed that the CQC rated Sheffield Health and Social Care NHS Foundation Trust as requiring improvement following the inspection in May and June last year, but we expect that challenge to continue so that there are obvious improvements.

The additional money for mental health in the NHS long-term plan is very welcome, but does the Minister share my concern that it is essential that that money reaches the frontline and results in improved services and improved access to services? What steps is she taking to ensure this money does result in improved services?

My hon. Friend will know that, in addition to the additional £2.3 billion, we are clear that this money will lead to more rapid treatment. NHS England will also be giving a really direct challenge to clinical commissioning groups and trusts to make sure improved services are delivered on the frontline.

Nursing Associates

Health Education England is leading a national nursing associate programme with a commitment for 7,500 nursing associate apprentices to enter training in 2019. It is also working with health and care providers to develop a talent pipeline of future nursing associates, as well as sharing how providers are deploying currently qualified nursing associates.

I thank my hon. Friend for that answer, and I thank the Secretary of State for his welcome announcement last month on “Shaping a Healthier Future” in London, which has gone down very well locally. How many more nurses does the Minister for Health think London will need over the spending review period? What specific measures is he taking to improve London’s offer to would-be nurses?

My right hon. Friend is absolutely correct that the Secretary of State’s announcement has gone down extremely well. He will know that there are now more nurses in training than ever before—over 50,000—and he will know that London, in particular, will get its share of those nurses. He should be reassured that we are creating routes into nursing via nurse training, nursing recruitment and, indeed, nursing associates, and their recruitment into valuable roles across the health service will benefit his constituents.

Does the Minister know that when I went to a restaurant the other night with my wife there was a hum and a buzz coming mainly from the young women there? I asked, “Who are all these young women?” The maître d’ said, “They are all young Spanish nurses who are going home. This is their last evening in Britain.” Nursing associates will not fill that gap; these are young people coming in at the classroom assistant level of qualification. We need more nurses now, and we want to stop this haemorrhaging of nurses who are going back to the rest of Europe.

The hon. Gentleman will know that nursing and nursing associate training places are being increased; that more funding is going in to increase nurse training places by 25% every year, from last September; and that we are announcing an expansion of nursing associates. He will see tomorrow, when new figures are announced, that more nurses are working in the NHS than this time last year.

Diffuse Intrinsic Pontine Glioma Awareness

13. What recent discussions he has had with Cabinet colleagues on recognising 17 May as diffuse intrinsic pontine glioma awareness day. (910726)

The NHS long-term plan makes it clear that cancer survival is a Government priority, and we wholly support any activity to raise awareness of devastating cancers such as DIPG. The overwhelming message from two powerful debates last year, here and in the other place, spearheaded by the late Baroness Tessa Jowell, was that better outcomes for children and adults with brain tumours lie in better research. That is why we announced £40 million, over five years, to stimulate innovative brain tumour research, working alongside the Tessa Jowell Brain Cancer Research Mission.

As the Minister will be aware, having DIPG awareness day on 17 May is very important in raising the awareness of this fatal illness, which is often overlooked and where the prognosis has not improved in the past 40 years, despite 40 children in the UK dying from it each year. How will the people suffering from DIPG benefit directly from the funding that she has outlined? Does she commit to keeping the House updated on measures to combat this serious illness?

Let me begin by paying tribute to my constituent Paula Holmes, who made me aware of DIPG, and to all the work she has done in memory of her daughter Katy, one of the 40 children who died from it. We rely on researchers to submit high-quality research proposals in this difficult area, and the National Institute for Health Research has put out a highlight notice asking for research teams. We stand ready to translate any new discoveries as quickly as possible into new treatments and diagnostics for patients, and I am happy to keep the House updated.

Flour Fortification: Folic Acid

We have announced our intention to consult on the mandatory fortification of flour with folic acid. We are fully committed to this and we will be launching the consultation as soon as possible.

I am grateful to the Minister for that answer, but the Government said in January that the consultation would happen soon. As it was originally announced in October, people are becoming frustrated. Can she say that this will happen before the summer? Can she confirm that it will be about how we go about mandatory fortification, rather than about whether we should do it?

I share the hon. Gentleman’s frustration, and I know that Members have been waiting for this. I am reassured by my right hon. Friend the Secretary of State that this will happen. I am going to be making it happen before the summer, and I will return to the House to update it.

23. The Healthy Start scheme, which provides food vouchers and coupons for free vitamins, reaches only about a third of children living in poverty. It is also woefully out of date; it is worth only £3.10 and it has not been updated since 2009. What are the Government doing to improve both the scale and impact of this important scheme? (910736)

I thank the hon. Lady for her question. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), says that she is looking into it and that we will report back.

Dementia Support

We are absolutely committed to making this the best country in the world in which to live with dementia by 2020. Already, more than two thirds of people with dementia receive a diagnosis; there are 2.85 million dementia friends and 346 areas in England are dementia friendly; and the £250 million dementia discovery fund is the largest venture fund in the world aimed at discovering and developing therapies for dementia.

I thank the Minister for her reply. I recently met representatives of the Alzheimer’s Society, which is, as the Minister will know, pushing forward with a campaign for more support for those suffering from dementia. Can she assure me that, despite what she has just said, this will be one of the main focuses of her Department during the comprehensive spending review?

We are absolutely committed to ensuring that everybody, including those who live with dementia, has access to the care and support that they need. We have noted the very important contributions of the Alzheimer’s Society and of a number of other reports. We are considering a number of different funding options and are keen to draw on the best practice of what works so that no one ends up spending their life savings on their care.

My friend and constituent Malcolm Haigh, who is known locally as Mr History because of his forensic knowledge of the history of Batley and Spen, is now living with dementia. We know that social prescribing for dementia sufferers really does work, and I congratulate Kirklees Council on its innovative Community Plus scheme, which uses social prescribing for dementia. What auditing is going on that will look at the community groups that are offering these singing clubs and walking and cycling groups, and how we audit them in order to make the best of social prescribing so that we take the burden off the NHS?

Mr History sounds fabulous. There will be a new academy of social prescribing, which will look at some of the incredibly valuable work done by communities up and down the country and really be able to draw out some of that best-value analysis.

Mental Health Services

16. What steps his Department is taking to increase awareness of rare, genetic and undiagnosed conditions in mental health services. (910729)

Steps to increase awareness of rare conditions in care settings and speciality services, including mental health services, are being taken through the implementation of the UK rare disease strategy. The Department published an update to its implementation plan for achieving the commitments and strategy in England in February this year to coincide with Rare Disease Day.

I thank the Minister for her answer. Specific mental health problems are common symptoms of the genetic and often undiagnosed condition of 22q11.2 deletion syndrome and therefore many people with the condition need access to knowledgeable mental health services, but families often report being unable to get the support that they need. With Mental Health Awareness Week fast approaching, will the Minister meet me to discuss increasing awareness of 22q11.2 among NHS mental health practitioners and ensure that people with the syndrome can access the services that they need in all parts of the United Kingdom?

I thank my hon. Friend for his question. Of course I will be happy to meet him. He is right to identify the fact that people with long-term conditions are more likely to suffer from mental ill health. It is very important that we achieve good care co-ordination so that all those issues can be tackled in the round. We will continue to work to ensure that professionals are made aware of these conditions.

I have spent much of the past week supporting the parents of a child who has a very, very rare genetic condition and who now needs the support of child and adolescent mental health services. It has become very clear to me that CAMHS is set up only to deal with mainstream children who can go through perhaps its anxiety counselling courses and who can process information in a certain way. It does not seem at all geared up to help children who have very complex needs and perhaps learning disabilities. What can we do to make sure that those children who are more vulnerable are not left behind?

The hon. Lady is entirely right. I am particularly concerned about the impact on young people going through a period of mental ill health who have neurodiverse conditions and other conditions. It is very important that we tackle the entirety of the individual’s need. Clearly, we need to do more to make sure that all children with whatever conditions can access help when they need it.

My ambition is to reach Question 17 so that the House, Mid Sussex, the nation, the European continent and the world can hear the right hon. Member for Mid Sussex (Sir Nicholas Soames).

Best Practice

Mr Speaker, I share your ambition in reaching Question 17 to be able to say that the long-term plan for the NHS sets out ambitious goals to embed a culture of quality improvement of which my right hon. Friend would be proud.

Thank you very much, Mr Speaker, for getting this far down the list of questions. I know that my right hon. Friend the Secretary of State has a serious ambition to try to drive this plan forward, but it is unacceptable that best practice is not better disseminated throughout the NHS. It is completely unacceptable that there are such wide divergences in standards between hospitals, and it requires the everyday attention of the Secretary of State himself to drive this change through.

I agree entirely and enthusiastically with my right hon. Friend. The need to improve services in the NHS just to bring them up to the best that is in the NHS is vital and urgent. We can lift the quality of care that all our constituents get simply by learning from the best. We have schemes such as the “getting it right first time” programme, which is brilliant at teaching hospitals how to do things the way the best hospitals do them, and we want to see more.

A recent report in the British Journal of Surgery demonstrates that the introduction of the Scottish patient safety programme resulted in a 36% drop in post-surgical deaths. Will the Secretary of State join me in congratulating all the surgeons, anaesthetists, theatre teams and ward staff who achieved this, and would he like to visit Scotland and see the programme in action?

I always love visiting Scotland and would love to come and see this programme in action; I have heard and read about it. In improving quality across the NHS, we need to improve the ability of the NHS to look everywhere—outside the NHS in England, as well as at other hospitals—to find and emulate best practice.

This is a general question about best practice in the NHS, into which the hon. Member for Bosworth (David Tredinnick) could legitimately shoehorn his concerns about acupuncture, chiropractic therapies, osteopathy and other non-drug based, non-addictive options for pain management, about which I think he is keen to expatiate.

19.   Mr Speaker, I am clearly in your good books and I am most grateful. Will my right hon. Friend the Secretary of State explain why so little use is made of these three therapies in the health service, and why NICE has not made any attempt to look at hospitals in China, 50,000 of which use acupuncture for lower back pain? (910732)

Mr Speaker, I am glad that you have used your considerable flexibilities to bring this question in, because I wanted to say that NICE is in the process of developing a guideline on the management of chronic pain, which will look at the biological, physiological and social factors, including some treatments mentioned by my hon. Friend. There is progress in this space, and I am glad that we have been able to raise this matter in the House today.

As well as looking at best practice in the NHS, it is vital that we look at best practice in social care. Given that 70,000 people with dementia were admitted to hospital unnecessarily with falls, dehydration and infections just last year, how is the Secretary of State going to put a laser-beam focus on standards in social care?

The hon. Lady is absolutely right. I am glad that this discussion of improving quality across the NHS and social care has united the House in its enthusiasm to see best practice and ensure that people learn from it. We have seen an awful lot of learning in social care, as most social care is delivered by private sector providers, but there is more to do and there are different levers that we can pull. When social care providers lose their good or outstanding status, they also often lose their contracts, so there is an awful lot of pressure on them to learn from best practice around the country, and I would only emulate that.

Stem Cell Donation

Since 2011, the Department has provided more than £26 million to NHS Blood and Transplant and to Anthony Nolan, to improve stem cell donation, and is now establishing a unified UK stem cell registry. I would also highlight the inspirational work of Team Margot, who are working to increase the number of people on that stem cell register by enrolling themselves in the transatlantic rowing race. I urge all hon. Members to support that campaign.

I hope the Minister will join me in praising my constituent Peter, who has myeloma and set up the “10,000 donors” register. There are now 22,000 donors registered, but Peter has a rare ethnic mix of English, Irish, Chinese and Portuguese. What more can be done to encourage donors from minority communities?

My hon. Friend is absolutely right. We have spent a lot of time encouraging donors from minority communities, but the real issue with regard to stem cell donation is that it is about genetic composition. We live in a wonderful society where we all have heritage going back in various, very complex ways, but that makes finding a suitable donor for stem cell donation extremely difficult. It is therefore important that we encourage people to take the test to establish their genetic heritage so that we can have more and more diverse people on the register.

Violence Against Women and Girls

20. What recent steps Public Health England has taken to help ensure that the violence against women and girls service commissioning guidelines are implemented throughout the NHS. (910733)

I thank my hon. Friend for her important work on the whole issue of violence against women and girls. Clinical commissioning groups are the primary commissioners of NHS services, and, as such, play the lead role in ensuring that service commissioning guidelines on violence against women and girls are implemented through the NHS, as informed by evidence available and current guidance.

Public Health England is planning to update the public health outcomes framework this summer, but there are no planned outcome measures for victims of domestic abuse or sexual violence. Will my hon. Friend liaise with the Home Office and the clinical commissioning groups to consider measures so that we can all be confident that victims are getting timely access to appropriate services?

My hon. Friend is knocking on an open door, because this issue is very close to my heart. The public outcomes framework does include a measure of reported domestic abuse incidents and crimes that is intended to give an indication of the scale of the issue in each area, and we expect CCGs to commission services as a response to exactly those issues. I have written to CCGs to remind them to commission appropriate sexual violence services, as well as those already commissioned by NHS England so that we have proper support for people who have been victims of these terrible offences.

Topical Questions

It is the goal of the Department to support everyone to live longer, healthier lives. I will be working right across the health and social care sector to deliver the goal of five years of extra healthy life for people in the UK. In doing that, I am delighted that we will now have on the ministerial team the enthusiasm and assistance of the Under-Secretary, my hon. Friend the Member for South Ribble (Seema Kennedy).

In achieving those goals, the Secretary of State will be concerned that while many patients can obtain GP appointments for emergency cases on the same day, quite a lot of people have to wait three or four weeks for non-emergency appointments. Can the Government do anything to improve that situation?

Yes, I entirely understand my hon. Friend’s concerns. We are acting to make sure that there is better access. We have a review of access to primary care. But, more than that, the biggest increase of the £39.9 billion of extra taxpayers’ money that we are putting into the NHS is in GP access, primary care and community care to make sure that we get ahead of the curve and help people to stay healthy rather than just treat them in hospital.

Can the Secretary of State explain why 200,000 nurses have left the NHS since 2010 and why today we are short of 40,000 nurses?

The good news is that we have record numbers of nurses in the NHS. We have more staff in the NHS than at any time in its history. While of course in any very large organisation like the NHS there is always turnover, what matters is having the people we need. We are putting more money in, we are going to need more people, and we are developing a plan to make that happen.

We have about 90 nurses a day leaving the NHS, so rather than posing for the newspapers by the stables like a character from a Jilly Cooper novel, why does the Secretary of State not show some actual leadership and reverse the cuts to development, reverse the cuts to training places and reverse the abolition of the training bursary so that we can start to recruit the nurses and midwives our NHS needs today?

What I will not reverse is the increase in the number of people who are helping to improve lives and save lives in our NHS. It is only because of the extra money that we in this Conservative Government have put into the NHS that we can be confident that we are securing its future to deliver better care for every single person whom we represent in this House.

T5. Patient-GP ratios across the Witham constituency are under pressure and the highest in the country. Will my right hon. Friend use the forthcoming comprehensive spending review to secure more investment in not only GPs but Witham health services? (910742)

My right hon. Friend is right to raise that. That money is already committed. Of the extra £33.9 billion that is going into the NHS, the biggest increase is going into community and primary care, because I understand how important it is for people to get decent access to their GP services in Witham and across England.

T2. The council chair of the British Medical Association recently said:“The only thing that is certain, is how disastrous leaving the EU will be for the NHS… no type of Brexit can ever offer the same benefits we currently have.”Does the Secretary of State agree with that sentiment, or can he tell the House how he thinks Brexit will improve the NHS? (910739)

No, the NHS is going to be there for us no matter what the outcome of Brexit is. The British people voted for Brexit, and we are going to deliver Brexit, and then we are going to get on to doing all the other things. Even over the last few months, we have been able to put extra money into the NHS to ensure that its future is guaranteed.

T6. I was pleased when the Department of Health and Social Care accepted that changes to our pensions legislation are driving early retirement and reduced hours among senior consultants. Can the Minister give an update on what discussions are being had with the Treasury to attempt to find a solution to that issue? (910743)

My hon. Friend will have heard me say in answer to the earlier question that my right hon. Friend the Secretary of State and the Chancellor are in discussions about that matter. It would be unfair of me to comment on the progress of those discussions, but we hope to resolve them soon.

T3. Maternity Action reports that migrant women requiring maternity care from NHS hospitals are being deterred from receiving treatment by charges and fear of immigration sanctions. Will the Secretary of State meet me and campaigners to discuss what we can do to address that worrying situation? (910740)

T9. Some 1,486 of my constituents have been diagnosed as suffering from dementia. The Alzheimer’s Society is urging that, to provide the best support and care, carers should have tier 2 training. Is the Minister doing everything possible to achieve that? (910746)

T4. In the north-east, over half of domiciliary care workers are on zero-hours contracts, 40% have no relevant qualification and, as the recent Low Pay Commission report shows, rates of non-payment of the minimum wage are rising, but enforcement is not. What will the Secretary of State do to improve the pay, conditions and training of careworkers who provide such an essential service? (910741)

This is all about getting more money into the system. That is why we have increased spending on adult social care by 9% over the last three years. We are focusing on attracting more people into adult social care, which is why we had the “Every Day is Different” recruitment campaign, to ensure that we get more brilliant-quality staff into adult social care roles.

T10. Does the Secretary of State agree that nursing associates are an excellent new role on the frontline of the NHS, delivering hands-on care for patients? If so, what more can be done to get more of them across the country? (910747)

My hon. Friend is absolutely right. That role has been introduced to help build the capacity of the nursing workforce and support nurses and wider multidisciplinary teams. As he will have heard me say earlier, I am delighted that Health Education England is leading the national nursing associate training programme, with a commitment to train 7,500 nursing associates this year.

T8. Tens of thousands of children are born every year with brain damage as a result of pre-natal exposure to alcohol, yet most clinical commissioning groups are not providing support for those with foetal alcohol spectrum disorders, despite Government guidance telling them to do so. Will the Government take the action needed and provide support for those suffering with this life-limiting and lifelong condition? (910745)

The hon. Gentleman is right. Foetal alcohol spectrum disorders are not sufficiently widely understood across the NHS. We must ensure that we give support to those who are affected and also raise awareness, not least to encourage people to understand the risks they are taking when they drink alcohol during pregnancy.

Over many years, High Wycombe has established a dramatic way to help tackle obesity. To that end, a week on Saturday, the mayor, a number of councillors and I will be weighed in public, to check whether we have put weight on at taxpayers’ expense. If the Government wish to extend that programme to other Members of the House, I will be happy to ask to borrow the weighing tripod.

The only thing that is weighty about the hon. Gentleman, in my experience as a county colleague, is his brain.

I would be delighted to encourage that which my hon. Friend encourages. One thing that leads to people putting on weight is high levels of stress, so perhaps we could put some contentious issues behind us to reduce stress levels and allow all of us to lead healthier and happier lives.

I am sure that the hon. Member for Manchester Central (Lucy Powell) is experiencing no stress. I rather imagine that she is still celebrating that rocket of a goal last night by Vincent Kompany.

It was a magnificent and very important goal, Mr Speaker.

I would like to put it on record that my husband is an A&E consultant. The Secretary of State will know that one of the massive factors in gaps in rotas is that A&E doctors and other hospital doctors are facing notional tax rates of 90% or more from taking on extra shifts. It is not a very Tory policy, this. What is he doing about it?

This policy has come up a couple of times in questions today, and rightly so. I am having discussions with the Chancellor. It is a tax policy, and I do not think that my right hon. Friend would be incredibly enthusiastic about me announcing tax changes at the Dispatch Box. It is something that we are talking about and working on. It is the unintended consequence of tax changes that were designed for other parts of the economy.

The appropriate and safe disposal of drugs and medical equipment has recently been raised with me by my constituents in Corby. Will he keep in mind these concerns when reviewing policy in terms of both awareness of what to do and the ease with which it can be done?

My hon. Friend raises an important issue. The NHS faced the loss of a contract last year, which was then safely put back into place. The point he makes about guidance is absolutely right, and if he wants to come and talk to me about it, I will be happy to discuss it.

It is deeply concerning that in the past 10 years the number of prescriptions for opioid drugs has risen by 9 million. In this time, codeine-related deaths have more than doubled to over 150 a year. While I welcome moves to label opioid medicines, what further measures will the Secretary of State take to protect people from the dangers of opioid addiction?

As the hon. Lady may know, I am very concerned about this. We are working on what we can do to ensure that opioids are prescribed and used only when they are the most appropriate and right treatment. Opioids save people from significant pain and are used every day right across the NHS, but opioid addiction is a very serious problem. Some other countries have got this wrong, and we must get it right.

I thank my right hon. Friend the Secretary of State for coming to County Hospital in Stafford on Saturday. Does he agree that he saw there the importance of small accident and emergency departments sustaining the whole of the regional health economy by giving support to the larger ones?

Yes. It was brilliant to go to County Hospital in Stafford and see the hard work and team work and to be able to thank NHS staff both in Stafford and across the country working over the long weekend. My hon. Friend is a brilliant and diligent voice of Stafford. I have already stopped A&E closures in west London. I do not think that we should be seeing the closure of small A&E units, and I will work with him on the issue.

As the Minister is aware, I have become concerned about the rising number of suicides in my constituency. When I talk to professionals in the area, they tell me that it is not just funding that is causing some of the problems but the lack of staff. What more can the Minister do to ensure that we have the mental health staff that we desperately need?

I am grateful to the hon. Lady for raising that. She is right to do so. We are aware of some of the specific issues in her constituency, and I look forward to visiting and taking up some of the discussions directly.

The Secretary of State has been kind enough to visit Worcestershire Royal Hospital, which serves people in my constituency. He saw for himself how small the emergency department is there. With £20 billion going into the NHS, does he agree that there is a good opportunity to look again at returning services to Redditch—in particular, the maternity and A&E departments, which have been removed?

It was brilliant to visit Worcester hospital—another medium-sized hospital, but with a small A&E department that was working incredibly hard given the facilities. I pay tribute to all the work of staff there and very much take on board the points that my hon. Friend has made.

Order. We have a lot to get through. I shall take one more question, and then we must move on.

Today I met representatives of the Teenage Cancer Trust. As we await the publication of the workforce implementation plan following the publication of the NHS long-term plan, what plans does the Minister have to ensure sustainable funding for the teenage and young adult cancer specialist workforce?

I thank the hon. Gentleman for his question; I had the pleasure of meeting representatives of the Teenage Cancer Trust recently as well. Cancer is an absolute priority for the Government. Our aim is for 75% of all cancers to be detected at an early stage by 2028. As my right hon. Friend the Secretary of State has said, the workforce plan will be reporting imminently.