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Commons Chamber

Volume 662: debated on Tuesday 18 June 2019

House of Commons

Tuesday 18 June 2019

The House met at half-past Eleven o’clock


[Mr Speaker in the Chair]

Oral Answers to Questions

Health and Social Care

The Secretary of State was asked—

Care Home Safety

No compromise can be made on the safety of care homes, and that is why the Government introduced robust inspection regimes led by the Care Quality Commission. Latest figures from 3 June show that 80% of care homes have been rated good or outstanding for safety, with 84% of adult social care providers rated as good or outstanding overall.

I draw the Minister’s attention to one example of a care home run by a private provider: Ellesmere House, which offers residential care for dementia sufferers. In February 2015, there was a serious safeguarding incident leading to the death of a resident after an incident with another resident, yet its latest CQC report underlines continued failures in management. Is the Minister confident that we have a generation of providers with the skills, training and facilities needed to keep dementia sufferers safe and well cared for?

I thank the hon. Lady for that question. It is of course incredibly concerning when we hear cases of abuse or neglect in care homes. That is why the Government asked the CQC to inspect them in the first place and why we have put in place training through Skills for Care and given councils access to a lot more funding to help support them. However, abuse and neglect of any kind must not be tolerated.

I welcome the fact that the latest report from the Care Quality Commission indicates that four out of five adult social care services in England are rated either good or outstanding, but there is no room for complacency. Will the Minister expand on how she will ensure that that becomes five out of five?

My hon. Friend is absolutely right to highlight that four out of five care homes are rated good or outstanding. That is largely down to the more than 1.5 million adult social care professionals, who work with great professionalism and integrity. We drive up quality by supporting them better and ensuring that we can recruit more people into this incredible profession. We have had a very important adult social care recruitment campaign called, “Every day is different”, which looks to attract people with the right values into the sector to drive up quality and provide robust social care.

I know from my family’s personal experience that just because care homes have a CQC rating of good does not mean that there are not dangerous and serious issues lurking beneath the surface that impact patient safety and care. Will the Minister outline today what the Government are doing to look into reports from CQC homes that are rated good?

The hon. Lady has often spoken very movingly in the House about her personal experiences, and she is absolutely right: abuse of vulnerable people is absolutely abhorrent. We are very determined to stop it, and we want to prevent it from happening in the first place through the tough inspection regime. We want to shut down poor-quality homes and, most importantly, we have made sure that across the country, police, councils and the NHS work together to help to protect people in the long term.

The integrity of CQC ratings was dealt a mortal blow by the uncovering of abuse at Whorlton Hall by BBC “Panorama”. Watching the abuse on that programme is made worse by the knowledge that the abuse may have started five years ago. The unpublished inspection report from August 2015 described allegations of assaults on patients, the undocumented use of a seclusion room and the use of rapid tranquilisation not backed by an organisation policy. I do not have any confidence that the review called by the CQC will uncover the truth behind that abuse. Will the Minister agree to set up an inquiry into this matter, so that we can establish whether the care regulator is fit for purpose?

The hon. Lady is absolutely right: abuse of any kind must not be tolerated, and we have heard horrific accounts of abuse that must be tackled. That is why in May, we announced much stronger commissioning oversight arrangements, where people are put in place out of area. Local commissioners must visit regularly. The CQC has commissioned two independent reviews, and the findings and recommendations of both will be published. The point is that opportunities to intervene have been missed, and we must be open and transparent in getting to the bottom of what happened.

NHS: New Technology

To increase the access to new technology across the NHS, we have expanded the accelerated access collaborative to get the best technologies in faster, and NHSX is delivering our tech vision to drive forward digital transformation of the NHS.

I welcome the way my right hon. Friend has really put a stamp on ensuring that technology is at the heart of his health policy. Can he tell me whether the accelerated access collaborative will engage locally, particularly with the sustainability and transformation partnerships, so that it eventually leads to better outcomes for our constituents?

Yes, my hon. Friend is absolutely right. There is a reason why we care about using the very best technology in the world in the NHS, and that is that it improves treatment for patients. The regional delivery of better technology is critical. The 15 regional academic health science networks are a key part of the AAC and they work closely with local hospitals.

24. The Secretary of State will know that in Greater Manchester we spend over £1 million a year on keeping and storing paper-based assessment records made in the early years by health visitors. Will he work with us to eradicate that cost and get the digital licences we need? (911425)

Yes, 100%. One of the reasons we have put NHSX in place is to drive exactly this policy agenda, where we can get better treatment for patients and save money.

Earlier this year, the Secretary of State attended the launch of a report on artificial intelligence by the all-party parliamentary group on heart and circulatory diseases. Can I get a commitment from him that AI is very much part of the future through the NHS long-term plan?

A most enthusiastic commitment! My hon. Friend has led on this agenda and driven it, because it is all about using technology to save lives. The report that he mentions is optimistic about the power of using data better to ensure that people can live longer.

On new technology and saving lives, I met the Secretary of State last month to discuss making the innovative enzyme replacement therapy Brineura— the only treatment available for Batten disease—available on the NHS urgently. I have heard nothing since that meeting, and the wait is agonising for the families, so what will he do urgently to make this life-saving treatment available to children in England?

I had an incredibly moving meeting with the hon. Lady, my hon. Friend the Member for North East Somerset (Mr Rees-Mogg) and others, and some of the families and children who have Batten disease. I have since met the chief executive of the NHS. The decision on the availability of the drug in question is, of course, one for the National Institute for Health and Care Excellence and NHS England, but I have had those meetings and I continue to make the case.

The electronic prescription service is now used by more than 90% of GP practices, and more than 70% of prescriptions are issued in that way. As well as providing a better patient experience, how much money has this saved for the NHS?

My hon. Friend is dead right to say that this provides a better service and saves money. I do not have the figure at my fingertips, but I will write to him with the answer and ensure that it is published for the whole House to see.

Patients in my constituency have to travel vast distances—often in excess of a 200-mile round trip—to be seen at Raigmore Hospital. As and when properly working visual teleconsultations are brought into being, when that technology is developed, may I appeal to the Government to share the technology with the Scottish Government and with NHS Highland?

Absolutely. Places like Caithness are a great example of where GP consultations that can be done over the phone or over a video conference can save people hours and hours. Of course they sometimes need to see their GP in person, but not always. We are driving this agenda hard in England, and I would be happy to work with the NHS in Scotland to ensure that that technology is taken up there, too.

Male Suicide

Men remain the group at the highest risk of suicide and continue to account for three quarters of all suicides. Clearly, targeting suicide in men must be the main thrust of our suicide prevention strategy. We are investing £25 million to support local suicide prevention plans in every local area, and that funding is testing different approaches and sharing best practice. We also announced £600,000 yesterday to support local authorities with exactly these processes.

It devastates me to have to tell the House that St Helens has the highest rate of suicide in the country, and three quarters of those who take their own lives are men. We know that working class men in deprived areas are 10 times more at risk than those in the most affluent areas, so will the Minister recognise class and community, and poverty and place, as key factors in male suicide and its causes? Will she come to St Helens to see and support the vital work that is being done to prevent the tragic crisis of suicide that is affecting more families in my community?

I agree with much of what the hon. Gentleman says, and I would be delighted to go to St Helens, not least because the more we can do to share good practice around combating male suicide, the more we can prevent it. Everybody in this space wants to do more to prevent suicide, and location is important, too, which is why a big part of my plan is to ensure that we are putting in good measures in the places that attract more suicides.

A few weeks ago, I held a debate in this Chamber on the subject of suicide in the farming community. What are my hon. Friend’s plans to improve the mental health of males under 40 in rural areas?

I am delighted that my hon. Friend is highlighting the farming community. He is right that the incidence of suicide is particularly high in that community, not least because those people work in remote areas, have less engagement with others and have access to the means. We must ensure that all vulnerable men feel that they can reach out to people who can support them. I encourage everybody to get the message out that if we see people who look vulnerable or struggling, we should be comfortable about reaching out to them. We have heard amazing stories of when just the simplest intervention, such as, “Are you all right, my friend?” can make the difference between life and death.

Sharing information saves lives when it comes to suicide prevention, but families are too often unnecessarily excluded because clinicians may be unaware of or do not follow the consensus statement guidance on seeking consent and sharing information in the patient’s best interests. I thank the Minister for meeting me and the National Suicide Prevention Alliance recently. She will know that the Matthew Elvidge Trust has highlighted the importance of how consent is sought, and it has suggested the following wording:

“In our experience, it is always much better to involve a family member, friend or colleague whom you trust in your treatment and recovery... This will result in you recovering much quicker. Would you like us to make contact with someone and would you like us to do this with you now?”

The Minister will agree that there is a huge difference between that and just asking someone whether their mum can be phoned. Will the Minister set out how she will raise awareness of the consensus statement?

I am grateful to the hon. Lady for her continued interest in this matter. She will recognise the cultural challenge of encouraging all practitioners in the NHS to embrace the change, because we quite rightly have a culture in which discretion is paramount. Practices are in place to encourage information sharing, and I highlight our support for the Zero Suicide Alliance—£2 million was provided last October—and central to its work will be spreading understanding of the consensus statement throughout the NHS.

NHS Staffing

The interim people plan that we published this month puts the workforce at the heart of the future of the NHS and will ensure that we have the staff needed to deliver high-quality care.

The Secretary of State will be aware that recruitment and retention is particularly difficult for hospitals in special measures, such as the Worcestershire Acute Hospitals NHS Trust, which he recently visited. Such hospitals have to rely heavily on agency staff, which puts pressure on their finances. What specific steps is he taking to help those hospitals with their financial and recruiting pressures?

We are working closely with that trust, and it was good to visit and see just how hard working the staff are. They are dedicated to the cause and well supported by their MPs. My hon. Friend is quite right to make that case, and we have a direct package of support for the Worcestershire Royal Hospital and the trust more broadly because it faces unique challenges, some of which are not at all of its own making. The staff at Worcester are working incredibly hard to deliver for their local citizens.

My constituents find it very difficult to access their GP, as we have a recruitment shortage in the constituency. The “General Practice Forward View” pledged to boost the GP workforce by 5,000 by 2020. Are the Government on course to meet that target?

We retain that target of 5,000 more GPs. We have managed to increase the number of staff working around GPs, because a GP does not need to do everything in primary care, so we have a more mixed workforce with physios and practice nurses working alongside GPs. There is more work still to do, and the NHS long-term plan sets out how we will make that happen.

The leadership team at King’s College Hospital NHS Foundation Trust has asked for assistance from NHS Improvement to put in post a clinical director at the emergency services department, which has just been rated inadequate by the Care Quality Commission. This vital post, however, remains unfilled. What assurances can my right hon. Friend give that NHS Improvement can help trusts when they request assistance in this way?

My hon. Friend makes an important point. This is a vital post in a hospital and a hospital trust that does amazing work—some of the best medicine in the world is done at King’s—but it also has significant challenges with delivery, especially with respect to meeting financial targets and delivering value for money. King’s needs that support, which we are putting in place. I will raise the specific issue of the post he mentions with the head of NHS Improvement.

The Royal Stoke University Hospital, in partnership with Staffordshire University and Keele University, is training the next generation of clinicians, but the Secretary of State will know those universities need to be properly resourced to continue that vital training. What conversations is he having with the Department for Education to make sure that partnership thrives?

The hon. Gentleman raises an important point. We have expanded the number of medical training places; we have more people going into medicine; and we have a record number of GPs in training. This takes time, of course. I spoke to my right hon. Friend the Secretary of State for Education about this recently, and I will make sure that we keep pushing hard.

Our future immigration policy will be key to ensuring that our NHS is sufficiently staffed across the country. What discussions has my right hon. Friend had with the Home Secretary specifically on the £30,000 annual minimum income? I believe that limit is very detrimental to the sector.

I have had those discussions, and the Migration Advisory Committee has raised a specific concern about social care. We need to deliver better social care, with people coming from all around the world in addition to domestically trained people. I take on board my hon. Friend’s point.

Pinderfields Hospital in Wakefield has struggled to retain midwives. As a result, the trust has proposed to cut and close the popular midwife-led maternity unit in Pontefract. Local mums are up in arms, as it is completely unfair. We keep seeing this pattern. When the NHS is under pressure from austerity, from shortages or from management issues, it is the services in towns that are hit. What will the Secretary of State do to make sure we have enough midwives across the country so that we can keep Pontefract’s midwife-led unit open and so the NHS can continue to sustain services that are vital to our towns?

The right hon. Lady, as always, puts the case for Pontefract very powerfully. The truth is that we will need more nurses and more midwives, as well as other health professionals, over the next five years because we are putting in a record amount of funding. More people are needed to deliver better services, and I am happy to meet her to discuss this specific case. Coming from and representing towns myself, I understand the importance of keeping services such as maternity services close to the people they serve.

Will my right hon. Friend make sure that his interim people plan looks again at the hugely underutilised resource of the allied health professions, including osteopaths and chiropractors? What is the point of having a professional standards authority to regulate them if the Department will not use them?

My hon. Friend makes an important point, one that we have frequently discussed. As he knows, I am married to an osteopath, so I do recognise the value that osteopaths bring to all of us.

Research shows that the ratio of registered nurses to patients is one of the most important factors in patient safety, so members of the Royal College of Nursing are calling on the Secretary of State to follow Wales and Scotland and to bring in safe staffing legislation. What is his answer to them?

Of course we need to have the right number of nurses. We need to make sure that we also put in the funding. If the SNP Government in Scotland had put the same funding increases into the NHS in Scotland, there would have been half a billion pounds more there over the last five years. So let us start with getting the money in that we are putting in in England, but is not fully being reflected by the SNP Government in Scotland.

The SNP in Scotland spends £185 a head more than England, so the Secretary of State should check his figures. At over 11%, the nurse vacancy rate in England is more than double that in Scotland. Whereas student nursing numbers have increased every year in Scotland, there are 570 fewer nursing students this year in England. Is it not time to follow Scotland’s approach, reintroduce the nursing bursary and end tuition fees?

I am not going to let the SNP spokesman get away with this. Normally, she brings a thoughtful contribution to health debates, but she said that there is more spending in Scotland per head. The truth is this: the increase in spending in England over the last five years is 17.6%, but in Scotland the increase is only 13.1%. That represents half a billion pounds less: the increase in spending that we have seen in England that they have not seen in Scotland. She should recognise that fact.

Mental Health Services

Under the NHS long-term plan, there will be a comprehensive expansion of mental health services, with additional funding of £2.3 billion a year by 2023-24. That will give greater mental health support to an extra 345,000 children, at least 380,000 more adults, and 24,000 more new and expectant mothers.

Across the country there is a real challenge in recruiting qualified mental health nurses. Will the Minister work with me and the Devon Partnership NHS Trust to encourage as many qualified professionals as we can to come to work at the excellent in-patient wards at North Devon District Hospital?

I completely agree with my hon. Friend; it is important that we have the right workforce in place. That is a considerable challenge, but it is essential if we are to achieve the best outcomes. I am pleased that the Devon Partnership NHS Trust has seen an increase of 47 mental health nurses between February 2010 and February 2019, which shows that it is doing exactly as he says and going out of its way to recruit the best possible people. That work must continue, as is recognised in our “Interim NHS People Plan”

I recently met representatives from Somerset’s NHS trust and its child and adolescent mental health services to look at young people’s mental health services and I heard some worrying stories of bed allocation. This has led to teenagers with mental health problems being moved out of the county, sometimes a huge distance from home, or sharing wards with very young children. So what is the Department doing to ensure that young people are not held in care for extended periods, which can exacerbate their difficulties, and that provision is sufficient for them to remain close to family and friends in an appropriate environment?

It is essential that we end the practice of out-of-area placements because, as my hon. Friend rightly says, being in close proximity to family and friends is clearly going to aid the recovery of anyone suffering from mental ill health. This has been a particular problem for children and young people, and a particular problem in the south-west, but I can report to him that NHS England is making sure that we have more adequate bed provision across the country, and we will continue to drive down these out-of-area placements.

Somebody is much more likely to need mental health services if they have experienced childhood adversity. The all-party group on the prevention of adverse childhood experiences has looked in detail at the evidence base on policies to prevent this adversity. What is the best thing the group can do to influence the Government’s prevention strategy?

I have to say, the hon. Gentleman does it very well: he continually makes noise about this important issue. He is absolutely right that adverse childhood experiences inform people’s future mental health, or mental ill health. We are currently looking at our provision for early years intervention and the first 1,001 days—the hon. Gentleman and I have discussed the importance of that—but we need to make sure that state organisations take advantage of every contact they have with children, to ensure that we pick people up when they are vulnerable.

My learning disabled constituent, who also has mental health and substance abuse issues, was placed in poor-quality housing and left without food and heating by a local care provider called Focus. What is the Department doing to ensure that subcontracted social care providers are fit for purpose?

The case that the hon. Lady mentions is clearly very concerning. It is for local authorities to make sure, when they commission care providers, that they are fit for purpose and discharge their responsibilities in the local care plan, but we also need to recognise that people with learning disabilities as well as mental health issues are particularly vulnerable. We need to make sure that local authorities and local NHS services work together more effectively to ensure that care needs are not neglected.

I was interested to see recent comments by the Secretary of State regarding the use of music to combat over-medicalisation—I should declare that I am married to a music therapist—so does that mean he shares my interest in the use of music therapy to combat mental health issues, as well as dementia and other conditions?

I am pleased that my hon. Friend has declared his interest in this matter. He is right that mental wellbeing is about not only clinical interventions but very much the kind of things that he describes—wider social prescribing. We cannot overstate the role of the third sector in giving wraparound support to people going through periods of mental ill health. I am giving clinical commissioning groups the clear message that they need to look at what else they commission in this space, alongside clinical interventions.

In Manchester on Saturday, people were giving away free “Unknown Pleasures” t-shirts, partly to mark the 40th anniversary of one of the greatest albums ever made. But, as anyone who knows the history of Joy Division will know, there is also the important related issue of male suicide and people were being encouraged to donate to charities, particularly those that work with young men at risk of suicide. I was sent one of the t-shirts, Mr Speaker, but I thought you might rule it out of order if I wore it. These charities obviously do great work, but they are trying to fill real gaps in the system. How can we ensure, when we consider long-term health plans and long-term mental health services, that there are not gaps that people fall between?

The hon. Lady articulates the issue extremely well. The purpose of local suicide prevention plans is very much to make sure that we have a joined-up approach to combating male suicide and to identify exactly where the gaps in the services are. The £600,000 that we announced yesterday for the sector-led improvement package is to enable local authorities to share expertise and to make sure that, holistically, they provide the leadership to make sure that the gaps are plugged. I am grateful for the hon. Lady’s interest in this matter.

This week, the Children’s Society published research to show that more than 110,000 children and young people were turned away from mental health services because their problems were not deemed serious enough—that is despite suicide rates for teenagers almost doubling in eight years and research from YoungMinds that shows that three quarters of parents feel their child’s mental health has deteriorated while they wait for treatment. Why are so few children able to get the support from mental health services that they so desperately need?

As the hon. Lady and I have discussed previously, I would be the first person to recognise that we are not where we would like to be in respect of the provision of mental health services, but that is why we are investing an additional £2.3 billion to expand access for children by 345,000. In addition to that, we are investing in a brand new workforce in all our schools so that we can have exactly the kind of early intervention that will not require more lengthy periods of care and treatment. It is essential that we equip all schools and young people with tools to manage their wellbeing.

Junior Doctor Contract: Exception Reporting

6. What recent assessment he has made of the effectiveness of the exception reporting process in the junior doctor contract 2016. (911406)

Our junior doctors work incredibly hard caring for patients around the clock. We introduced exception reporting in 2016 and it has been a major step forward in ensuring safe working. The British Medical Association, NHS Employers and the Department reviewed the effectiveness of exception reporting as part of the junior doctor’s contract agreement, which we announced last week. Revisions will be made to exception reporting subject to the endorsement of the BMA.

Is the Minister aware that research by the Hospital Consultants & Specialists Association shows that, despite thousands of exception reports from junior doctors in unsafe hospital trusts, no changes to shift patterns were made at all. The chief executive of NHS Employers has said that, undoubtedly, there are circumstances where trusts would like to make changes, but because they do not have sufficient staff in place they are unable to do so. What can the Minister do to ensure that, in future, these changes are actually implemented?

The hon. Gentleman is right: every exception report has to be addressed. Changing the rota is one possible outcome. He will recognise that there are other possible outcomes as well: the doctor may agree to work extra hours and be given extra time off; timing of the ward rounds in clinics may be adjusted, so that educational opportunities can be taken: and timing of the ward rounds can be adjusted so that support from other senior staff can be there as well. There are many ways around this.

Thames Valley Scanning Contract

7. For what reason he chose not to refer the Thames Valley PET-CT scanning contract to the independent reconfiguration panel. (911407)

I am aware of the views that have been expressed on this matter. I can confirm that, having taken advice, we considered that the letter received from the Oxfordshire health overview and scrutiny committee does not constitute a valid referral under the relevant regulations. However, I have emphasised to NHS England, Oxford University Hospitals and InHealth the importance of continuing local discussions and working together at pace to find a service offer that works best for patients.

The Churchill’s PET-CT cancer scanning service is world renowned, yet NHS England, apparently with the consent of this Government, is forcing it into partnership with a private company. That is what is happening. It is not a discussion; it is being forced into a partnership. NHS England has even warned the trust against staff raising their voice on this issue because of their concerns about patient safety. Surely this unprecedented partnership is illegitimate and must be called in by this Government.

As I have said to the hon. Lady, we do not consider it to be a valid referral. What I would say is that NHS England remains committed to ensuring that the public are involved in decision making. Part of the extensive public engagement included completing a 30-day engagement about the phase 2 procurement proposals in 2016. I understand the strong passions that this has raised on both sides of the House and I urge all parties to continue working together.

I have made it clear to my constituents that, in principle, I have no objection to private companies providing NHS services, but totally legitimate concerns have been raised about the consultation involved in awarding this contract. May I simply thank the Minister for agreeing to meet Oxfordshire MPs this afternoon? I know that she is very much engaged in this issue and, although it may not technically be overseen by the Department of Health and Social Care, I know that she will do all she can to help us to reach a solution.

I thank my right hon. Friend for his question. I am looking forward to the meeting this afternoon. As I have said, I am assured that the decision will maintain services in Oxford and that there will be improved patient access, with new scanners in Milton Keynes and Swindon for people living there as well.

Surely the reason we have got to this point is that the clinical commissioning group was never actually consulted on what was right for the local population. How can the Minister ensure that, in future, centralised procurement services and local CCGs are always consulted as a matter of course?

As I have said, there has been engagement with local people, Members of Parliament and the local health community. I think that the outcome that we are all looking for is good PET-CT scanners for the people in Oxfordshire and for the whole of Thames Valley.

Free Prescriptions

8. What steps he is taking to ensure that vulnerable people are not unfairly penalised for incorrectly claiming free prescriptions. (911409)

Last year, prescription and dental fraud cost the NHS an estimated £212 million. It is absolutely right that the Government take steps to recoup that money, so it can be reinvested into caring for patients. Our system for claiming free prescriptions should be simple for people and clinicians to understand, which is why we are currently piloting technology that allows pharmacies to check digitally whether a patient is exempt from charges before prescription items are dispensed.

I appreciate the Minister’s response, but I am afraid that that is just not the reality out there. One of my constituents—a woman with severe learning disabilities and anxiety, who is entitled to free prescriptions through her employment and support allowance claim—was hit with a £100 penalty charge when the NHS failed to obtain the correct information from the Department for Work and Pensions. My office challenged that decision and got the £100 back to her, but the situation was extremely distressing, and the communication is clearly at fault and punitive. Will the Minister implement a review into the prescription penalties to protect vulnerable people?

It is distressing to hear of such a case, and these situations are very distressing for patients and their carers. The NHS Business Services Authority has taken steps to make things clearer, including with an easy-read patient information booklet and an online eligibility checker. We are also running a national awareness campaign, but of course we do need to ensure that people are not claiming for things to which they are not entitled.

I have constituents who are furious at repeatedly receiving penalty notices that subsequently have to be quashed. The system is rubbish, isn’t it?

I do not agree with my right hon. Friend that the system is rubbish. If somebody does receive a penalty charge notice incorrectly, there are procedures in place to challenge that notice. If somebody thinks they have received a penalty charge that they should not have received, they should contact the NHS Business Services Authority.

What is not rubbish is the very pithy line of questioning typically deployed by the right hon. Member for New Forest West (Sir Desmond Swayne). I will call the hon. Member for Westmorland and Lonsdale (Tim Farron) if his question consists of a sentence, rather than a speech.

Access to prescriptions is made much harder given the closure of 233 community pharmacies in the last two years, so will the Minister introduce an essential community pharmacies scheme to support rural pharmacies such as those in Cumbria and keep them open?

We recognise the importance of community pharmacies. Pharmacists are specialists who have a great role in primary care, which is why they are highlighted in the NHS long-term plan.

Since 2014, 5.6 million penalty charge notices have been issued, including a staggering 1.7 million to people who are entitled to free prescriptions. FP10 prescription forms and the criteria for eligibility for free prescriptions are far from straightforward. Some people in receipt of universal credit are eligible for free prescriptions and some are not—and, by the way, universal credit is not mentioned at all on the form. Those claiming exemption on grounds of low income can see their eligibility change from one month to the next. Is it any wonder that some patients tick their box? What steps are the Government taking to sort out this chaotic system that is too often treating vulnerable people like criminals?

A wide range of activity has been undertaken to help people to understand whether they need to pay for their NHS prescriptions, and I remind the House that 84% of NHS prescriptions are available for free. My Department and the DWP are working together to provide further clarity to universal credit, and hopefully we will be adding a universal credit tick box to the prescription form.

NHS: Changing Places

9. What steps he is taking to ensure that people can access Changing Places facilities when they use NHS services. (911410)

Last year, I announced £2 million funding for NHS trusts in England to install Changing Places facilities in hospitals; this is now available for trusts to bid for. We estimate that 250,000 people in the UK cannot use standard accessible toilets, and the fund could help to install well over 100 more Changing Places facilities.

Many of the disabled children who use Changing Places facilities also have a life-limiting or life-threatening condition. I welcome the increase in Changing Places facilities, but in this national Children’s Hospice Week could I ask my hon. Friend to go further in protecting these vulnerable children by increasing the children’s hospice grants to £25 million to give them the financial security they need?

I am really pleased that my hon. Friend has mentioned that it is Children’s Hospice Week. It is a great opportunity to pay tribute to the incredible work that children’s hospices do up and down the country, supporting some of our most poorly children and their families. I thank my hon. Friend for the work that she does on the all-party parliamentary group for children who need palliative care. The short answer to her question is yes; the NHS will match fund CCGs that increase their investment in children’s palliative care, including hospices, by up to £7 million. That is increasing support to a total of £25 million a year by 2023-24.

There are only about 40 Changing Places facilities in the NHS at the moment. I congratulate the Minister on the work she is doing on this, but will she continue to work with campaigners like Lorna Fillingham in my constituency to make sure that it not only happens quickly and on a timely basis but that we build on it in the future?

I am grateful to the hon. Gentleman because it was he who introduced me to Lorna Fillingham and the amazing Changing Places campaigners in the first place. It is really down to their incredible work that we have seen the growth of this very important issue. There are about 38 Changing Places facilities on NHS England estates at the moment, but the £2 million pot will definitely help to improve that number significantly.

NHS Staff Retention

The interim people plan sets out how the NHS will become a great employer with the culture and leadership needed to retain staff. NHS programmes to retain its highly talented staff are already having an impact. There are now more nurses working in the NHS than at any other time in its 70-year history. In addition, about 1 million NHS workers will benefit from the new Agenda for Change pay and contract deal.

I welcome the recent announcement of a consultation on NHS pensions arrangements for senior personnel. I hope that that will look at the taper impact, which raises the effective tax rate to an unacceptably high level. Retention of key personnel is critical across the Shropshire health economy, as well as in other parts of the country. Can my hon. Friend reassure me that senior-level changes in Shrewsbury and Telford Hospital NHS Trust’s management will not delay the Secretary of State’s consideration of the Independent Reconfiguration Panel’s report on proposed acute hospital reconfiguration?

I thank my right hon. Friend for his welcome for the pensions proposals and the consultation. The Department has received initial advice from the Independent Reconfiguration Panel on the Future Fit hospital reconfiguration. The Secretary of State is currently considering that. He will respond to the IRP’s advice in due course, and I will ensure that he informs my right hon. Friend.

May I thank the Secretary of State again for saving the A&E department at Charing Cross Hospital, which was a very, very popular move? Our brilliant hospital will benefit from the work that the Government are doing to increase the number of nursing associates across the NHS. What more can we do to get more nursing associates at Charing Cross Hospital, Chelsea and Westminster Hospital, and across the whole NHS?

I thank my right hon. Friend for his comments on saving the hospital department—that is very important. He is right to raise the important role of the nursing associates, who deliver hands-on care in a range of complex settings. Thousands of nursing associates began training in 2017 and in 2018. Health Education England is leading a programme to recruit more than 7,500 into training in 2019, and I am sure that some of them will benefit his constituency.

15. Bradford NHS Trust is pressing ahead with plans to set up a wholly-owned subsidiary company. Last week, 97% of Unison members voted for strike action. Given that the trust is currently run by a temporary chair and a temporary chief executive, and is acting on guidance from a now-defunct body, will the Minister, to improve retention, call on the trust to drop these plans and keep the NHS family as one? (911416)

The hon. Lady knows that a wholly-owned subsidiary is created as a legal entity. It is 100% owned by NHS organisations. It is also the case that local trust board members sit on the boards of those subsidiary entities. It is therefore appropriate that the local organisation takes that decision.

The King’s Fund says that the earnings threshold in the Government’s immigration proposals, which was mentioned earlier, will definitely impact on the ability to retain and attract NHS staff. The proposals for a transition period during which many social care workers would only be allowed to come here for a limited time with no entitlement to bring dependants will, again, negatively impact on the ability to retain staff. When will this Government realise that immigration is good for our public services and good for our country, and that badly thought out policy in this area that impacts on the retention of NHS staff is wrong and nonsensical?

The hon. Gentleman is right—immigration has benefited the national health service. This Minister, this Secretary of State and this ministerial team celebrate the fact that global immigration has benefited the NHS. From 2021, the new system will allow people with skills to come to the UK from anywhere in the world. It will remove the cap on skilled migrants, abolish the requirement to undertake the resident labour market test, and should improve the timeliness of being able to apply for a visa.

NHS Funding: Cambridgeshire

11. What recent comparative assessment he has made of the adequacy of NHS funding in Cambridgeshire and local population growth. (911412)

NHS England is responsible for the allocation of resources to clinical commissioning groups. Funding is distributed on the basis of a weighted capitation formula informed by the Advisory Committee on Resource Allocation. Population estimates are provided by the Office for National Statistics. This year, as the hon. Gentleman will know from a debate that we had last week, ACRA recommended and NHS England accepted a wide-ranging set of changes to that formula. Those changes are likely to benefit his constituency.

We had a discussion last week, but the Minister was unable to answer my question so I will try again. Is Cambridgeshire’s clinical commissioning group correct that it will have less money to spend on providing health services next year than it does this year?

As I pointed out to the hon. Gentleman last week, we recognise that historically, Cambridgeshire and Peterborough CCG has received less funding per person than neighbouring CCGs, but as I also pointed out to him, the CCG has received an absolute increase of 5.7% in 2019-20, bringing the funding up to £1.1 billion. We had a disagreement about the figures, because I could not agree the figures that he provided. As he knows, I have promised to write to him when I have been able to resolve his figures.

Childhood Obesity

12. What recent assessment he has made of progress in implementing Childhood obesity: a plan for action, chapter 2, published in June 2018. (911413)

14. What recent assessment he has made of progress in implementing Childhood obesity: a plan for action, chapter 2, published in June 2018. (911415)

The Government are taking a world-leading approach to obesity. We have held consultations on ending the sale of energy drinks to children, calorie labelling in restaurants, restricting promotions of sugary and fatty foods by price indication, and further advertising restrictions, including a 9 pm watershed. We are considering all the feedback, and will respond later this year.

Alongside prevention, we have to do more to help the growing number of children who are already overweight or obese. It is more than a year since the Health and Social Care Committee highlighted the lack of tier 3 and 4 services. Voluntary groups such as Shine Health Academy in my constituency fill the gap. They take children on referral from GPs, but they do not receive any public funding. There can be no other serious health condition affecting children where the NHS says, “Sorry, we can’t help.” Will the Minister take action and agree to meet me to discuss it?

I completely agree with the hon. Gentleman that childhood obesity is a massive challenge to our nation. It is a problem internationally, and we are taking serious steps to tackle it. I am happy to meet the hon. Gentleman to hear more about Shine.

Public health budgets have fallen by over 5%, with millions more in cuts anticipated. In both Lewisham and Bromley, the ring-fenced public health budget has fallen by 2.6% this year. The Government expect local authorities to play a greater role in tackling obesity while simultaneously cutting funding to councils, schools and the NHS. When will the Minister take action to tackle childhood obesity by restoring funding for public health?

I have set out to the hon. Member for Sheffield Central (Paul Blomfield) the measures we have taken. Through the childhood obesity trailblazer programme, we are working with local authorities—I am hoping to visit one in Blackburn later this week—that want to see how they can use their powers to best effect, doing things such as limiting new fast-food outlets. We have spent billions of pounds over the past five years. The public health grant will be subject to the spending review.

Given that 46% of food and drink advertising is spent on unhealthy food—and unhealthy foods are three times cheaper than healthy food—will the Minister follow in the footsteps of her predecessor, and go to the Netherlands to look at the Marqt supermarket, which has 16 stores around Amsterdam and does not market any unhealthy food to children? It is a profitable business and a model for our supermarkets, so will she go and look at it?

I thank my hon. Friend for his interest in this area. The Amsterdam model has been very successful, but it is not just about food—it is about place and culture. I would hope to be able to visit the model very shortly.

If the hon. Member for South West Bedfordshire (Andrew Selous) has been trugging round Amsterdam in pursuit of the public interest he is a remarkably assiduous and dedicated fellow. We are all deeply obliged to him—it is way beyond the call of duty, but we are appreciative none the less.

We now come to topical questions. I call Justin Madders.

The hon. Gentleman will think it is a conspiracy, but he will get his moment in a moment. I call Mrs Hodgson.

Thank you, Mr Speaker. The Government’s second childhood obesity plan will celebrate its first birthday a week today, but we will not be celebrating. The Government have ducked and dived on their responsibility to the children in this country and have failed to produce any policies as a result of the six consultations the plan has promised, but the rate of childhood obesity is still at a record high. Instead of waiting for the chief medical officer to report on obesity, will the Government act now to tackle the childhood obesity crisis, and introduce and implement the policies they have consulted on already?

We have a very ambitious aim to halve childhood obesity by 2030. We are still considering all the answers to the consultations, and we are hoping to respond to them very shortly.

Topical Questions

This week is Children’s Hospice Week, Loneliness Awareness Week, National Breastfeeding Week and Learning Disability Week, and today is International Fathers Mental Health Day. The Government have made plans to more than double funding for children’s palliative care and end-of-life care services, developed a loneliness strategy and launched a consultation on folic acid in flour to support expectant mothers, and yesterday the Prime Minister announced a package of further work to support people from all backgrounds in the UK with their mental health. I and my brilliant ministerial team will continue to drive forward the health of the nation.

I want to bring to the Secretary of State’s attention some mental health waiting times that my constituents have recently come to me with. Someone with an urgent referral for trauma counselling is looking at a minimum six-month wait. A teenager who has attempted to take her own life is waiting over a year to see a psychiatrist. Several adults have been told there is a three-year wait just to get a diagnosis of attention deficit hyperactivity disorder. These waits are appalling. The Secretary of State billed himself as the leadership candidate for the future, but he is the Secretary of State for Health now. What is he going to do to address this appalling waiting system?

The hon. Gentleman is right that we need to ensure that access to mental health services improves. As part of the increase in funding we are putting into the NHS, the biggest increase is in mental health services, and it is a critical part of what we need to do to address the sorts of problems he rightly raises.

T3. Will my hon. Friend take up as a matter of urgency the recommendations of the Public Administration and Constitutional Affairs Committee report on eating disorders treatment, which we have released today to follow up on the Parliamentary and Health Service Ombudsman’s report from 2017, named “Ignoring the alarms”? Does she agree with us that too many people are dying from eating disorders, which still have the highest mortality rate of any mental health condition, and that much more must be done to train health professionals, support sufferers and their families, and enhance and accelerate treatment and care in the community? (911428)

I thank the Committee for its report, which follows the health ombudsman’s report on the tragic death of Averil Hart. It is clear that we have made significant improvements in eating disorder provision since then, but there is still more to do. We have made considerable progress with regard to treating children, and that progress now needs to be translated to the care of adults with eating disorders. My hon. Friend is right that it is the mental health disorder that has the highest mortality rate. At any one time, 1% of the population will be suffering from an eating disorder, and we need to make this more of a priority to make sure that services are available.

I know the shadow Secretary of State will be brief, because he will not want to crowd out his colleagues. That would be an uncomradely thing to do—inegalitarian no less—and he would not do that.


I dare say that this is the Secretary of State’s final outing at Health questions, because we believe he has secured transfer to pastures new. In his time here, he has failed to deliver a social care Green Paper and failed to deliver a prevention Green Paper, while he is privatising Oxford cancer scanning services and we have hospitals charging £7,000 for knee replacements. Does he really think that is a record deserving of Cabinet promotion?

I am agog—and aghast. Over the last year, we have not only delivered £33.9 billion of increased funding, but we have produced the long-term plan for the future of the NHS. Starting this year, with the money already flowing, we are seeing the biggest increase in funding for community, primary care and mental health services. We have developed our work on the prevention agenda, and we have instituted a new verve and energy into the adoption of new technology in the NHS. I look forward to driving forward all these things in the future.

Will the Secretary of State tell us about the verve and energy in his own constituency in Suffolk, where 32 health visitors are being cut because of his cuts? He is apparently now supporting a candidate who wants £10 billion-worth of tax cuts for the richest in society. Will that not mean further cuts to public health, further cuts to social care and, ultimately, cuts to the NHS as well?

For the majority of its 71-year history, the NHS has been run under the stewardship of a Conservative Secretary of State. At this moment, it is getting the biggest funding increase and the longest funding settlement in its history, along with the reforms to make sure that everybody can get the health care that they need.

T4. What steps is my right hon. Friend taking to improve the diagnosis and treatment of prostate cancer, in particular increasing the use of new technologies such as gel spacers, laser ablation and MRI in diagnosis? (911429)

More than 94% of men survive prostate cancer for one year, and 86% for five years, but there is more to do. That is why last April the Prime Minister announced £75 million over five years so that 40,000 men can take part in innovative research into early diagnosis and treatment. The long-term plan sets out our commitment to speed up the path from innovation to business as usual, spreading proven new techniques and technologies faster. Safer and more precise treatments in diagnostic techniques will continue to improve prostate cancer survival.

T2.   Kensington has an ageing population, many of whom will need residential care at some point, yet our council seems determined to move needy elders out of the borough, far from family and friends. Our last ever council-owned care home was sold off to a provider of caviar care, which lets luxury flats at £300,000 a year, with care, plus caviar, on top, for those who can afford it. Will the Minister explain what, if any, statutory obligations councils are under to provide affordable residential care for their residents? We are not all billionaires in Kensington. (911427)

The Care Act 2014 gives councils a responsibility to provide residents with a choice of quality care options in a local area. More broadly, we are backing up councils with increased funding. Over the last three years, we have increased funding in real terms by 8%. That has given councils access to about £10 billion to help ensure that there is provision in local areas.

T7. Will the Secretary of State assure my constituents in Kettering that taking advantage of the local government reorganisation in the county to establish a combined health and social care pilot is one of his Department’s very top priorities? (911432)

The House will not be surprised to know that the hon. Gentleman has raised this with me and my right hon. Friend the Secretary of State on a number of occasions. I am happy to reconfirm to him that we do consider it a top priority to make sure that all of his constituents get the care they need.

T5. With abortion rates for women over 30 rising, I am sure the Secretary of State will agree with Professor Lesley Regan, the president of the Royal College of Obstetricians and Gynaecologists, who said:“Women must have access to effective contraception and sexual health services to enable them to take control of their health and fertility by preventing unwanted pregnancies and sexually transmitted infections.”Does the Secretary of State also agree with Professor Regan’s comments on the need to end the fragmentation of commissioning, and the underfunding of services that disproportionately affect women? (911430)

The hon. Lady is quite right. As part of the long-term plan, we have considered the best way to commission sexual health services, which were moved over to local authorities five years ago. We think that the responsibilities are sitting in the right place, but we need to see far more co-commissioning, where local authorities and the NHS together ensure that there is more joined-up provision, rather than the siloed provision that she mentions.

T10. I welcome the successful trial of the new NHS app. How does the Department plan to use APIs to allow third-party developers to improve the app for patients? (911435)

My hon. Friend is quite right to celebrate the development of the NHS app. More than 80% of people are now able to use the NHS app to link to their GP practice. Our plans for the year ahead include API-based connections to a number of third-party products, including the NHS app. More importantly, I want the opening of this system to allow other innovators to be able to develop products for patients to use in a way that we have not imagined before. I want a load of innovations so that people can get the best possible access to their NHS.

T6. In York, it has taken 46 weeks for children and young people to commence the diagnosis process for autism—and demand and the number of referrals is going up. It takes a further 12 months, once there is a positive diagnosis, for parents even to access the SEND—special educational needs and disability—course. Precisely what service improvements can families expect to see in the next 12 months, and how will they be achieved? (911431)

The hon. Lady is absolutely right to draw attention to this issue. We are very concerned about the diagnosis times, which is why we are reviewing our autism strategy this year and are extending it to include children, whereas before it catered only for adults. We want to ensure it remains fit for purpose. We have launched a national call for evidence and have already received in excess of 1,000 responses.

Patient safety in the NHS depends on compassionate care training and staffing levels, but it also depends on patient safety systems. What progress is the national health service making towards implementing those systems in every place where patients are cared for?

Patient safety, as my hon. Friend suggests, remains an absolutely key priority for the NHS. NHS Improvement and NHS England are developing a national patient safety strategy, which will sit alongside the NHS long-term plan. It will be published this summer and will build on existing work to provide a coherent framework that the whole NHS can recognise and support.

T8. There are fears that NHS medical data could be on the table as part of a desperate post-Brexit trade deal with the US on digital services, where patient data would be mined by companies to develop medical technology that would then be sold back to the NHS. What guarantees can the Secretary of State give that private companies will not be profiteering from NHS assets in that way? (911433)

I wish my hon. Friend, with whom I have worked closely and whom I admire very much, great success in her leadership bid. I wish her more success than I had. With the hon. Member for Streatham (Chuka Umunna) sitting next to her, I am sure they will run a great race. I want to reassure her that, as I said the week before last, the NHS is not on the table in trade talks. We now have that assurance from the Americans. NHS data must always be held securely, with the appropriate and proper strong privacy and cyber-security protections.

I am sure the Secretary of State means well, but I am not entirely sure that the hon. Lady’s joy at the endorsement from the right hon. Gentleman was undiluted.

Will the Secretary of State support one of the key recommendations of the joint report from the Health and Social Care Committee and the Housing, Communities and Local Government Committee into the future funding of social care, which is for a German-style system of social insurance?

Absolutely. We are very keen to look at the Select Committees’ recommendations and the contributions of all key stakeholders. We are committed to ensuring that everyone has access to the care and support we need. The Green Paper will include ideas to protect people from high and unpredictable care costs.

T9. Over the weekend, I was contacted by a number of parents of severely disabled children with very distressing news. Up until now they have been receiving five pads a day, because their children, grown up or otherwise, are very severely disabled. However, they have been told by the clinical commissioning group that that has been cut to three. This is incredibly distressing. Some of the parents are on universal credit and the additional cost they will have to pay themselves will be £80 a month. That is unacceptable. Will the Secretary of State agree to meet me and representatives of my constituents, the parents of these very disabled children from Eastbourne, so that we can try to sort this out before it really gets out of hand? (911434)

I am very grateful to the hon. Gentleman for raising this case. The ministerial team has not seen the details in advance, but if he would like to write, the appropriate Minister will of course meet him.

The inquiry into the contaminated blood scandal, the biggest treatment disaster in the history of the NHS, is currently taking place in Leeds. What is the Department doing to compensate the victims of this scandal and to make sure their voices are heard?

My hon. Friend will wish to know that we are collaborating fully with the inquiry, and it has raised with us several issues about payments. We have made available an additional £30 million to give to those affected and will consider any conclusions the inquiry ultimately draws.

As the Minister will know, two weeks ago I went to the Netherlands with Teagan Appleby’s mother, Emma, to collect one month’s supply of medical cannabis. The Department laid down the requirements for Emma to meet with Border Force, and she met them by providing a UK prescription. Will the Secretary of State and Ministers meet me to ensure that there is no more ambiguity in a policy that currently criminalises parents in possession of a UK prescription bringing their much-needed medicine into the country?

As the hon. Lady and other colleagues know from having worked on this important issue, we acted swiftly to change the law to make sure that medicinal cannabis was available. Those patients for whom it is clinically appropriate can now be prescribed medicinal cannabis. As she knows, whether to prescribe is a clinical decision, but those prescriptions are available and flowing and are being issued where it is judged clinically appropriate for the patient. We will continue to work on this to make sure we get it right.

My constituent Max is aged eight and has Batten disease. He is one of only two sufferers of this disease who are not receiving the medicine that can improve their quality of life and keep them alive. Eleven other children in this country with Batten disease are receiving the drug, which is very effective but very expensive. The drug manufacturer has offered six months’ free supply to Max and the other person not getting it and has made other proposals to NHS England, which is currently refusing even to have meetings with the drug company to discuss how my constituent, this dying child, may receive the drugs he needs. Will my right hon. Friend intervene and use whatever reserve powers he has to ensure that my constituent gets this life-saving drug?

My hon. Friend speaks for the whole House about the need for these rare diseases to be given the attention they need so that sufferers such as Max can get the medicines if at all possible. As he knows following our meeting, the formal legal responsibilities lie with NHS England and NICE. I have raised this case, and that of others mentioned earlier, with the chief executive of NHS England and will raise it once again following this Question Time. We will do all we can to resolve this.

Thousands of my constituents will be left without access to dental care because a Swiss-owned investment firm has decided to shut three practices in my city. What is the Department doing to ensure that the people of Portsmouth have access to vital oral health services?

I understand the hon. Gentleman’s concern. As I understand it, the Colosseum dental group practices will remain open until 31 July. NHS England has put in place plans to ensure that where possible patients currently undergoing dental treatment will complete their course of treatment before the practice closures and is working with other local dental practices to provide additional capacity to treat patients as well as considering the longer-term options for procuring dental services in the Portsmouth area.

I declare an interest as a doctor’s wife. If the sub-dean at Chelmsford’s brilliant new medical school continues to teach the students and work in the hospital, she faces a 90% tax rate. If she continues to do the weekend hours the hospital needs, she faces having to pay more in tax than she is earning. Will the Minister look again at the taper, which is driving our consultants out of our hospitals?

As I said in response to an earlier question, we are putting out a consultation on pensions that will allow for looking at a number of issues, including the taper.

Order. I am very sorry, but, as in the national health service—under Governments of both colours, I emphasise—demand invariably exceeds supply. I will take the remaining questioners whose names are on the Order Paper and who wished to ask substantive questions but did not manage to get in. That seems only fair, as they have been bobbing up and down for the duration. Let us hear them.

Regardless of which type of Brexit we face this autumn, bureaucracy, customs charges and stockpiling costs will inevitably drive up the price of imported drugs and medical devices. Will the Secretary of State undertake to provide additional funds for NHS England and the devolved nations to cover those Brexit-induced costs and to avoid cuts in clinical services?

Additional funds have already been provided to ensure that medicines are available throughout the country, whatever the Brexit scenario.

Given the increased likelihood that the next Prime Minister will be determined to leave the European Union at the end of October, deal or no deal, will the Secretary of State update the House on what preparations are currently being made to protect the import of critical supplies such as insulin and radioisotopes?

Meeting the need for unhindered medicine supplies was an incredibly important piece of our Brexit planning, which was successfully completed ahead of 29 March. Of course we are updating those plans as we speak, but the ability to reassure people that there will be no impact on the supply of medicines is an important part of that work.

Syria: Civilians in Idlib

To ask the Minister for the Middle East what assessment he has made of attacks on health facilities and the fate of civilians in the Idlib area of Syria, and if he will make a statement.

The Government are extremely concerned by the current escalation of violence in north-west Syria, and are appalled by the disgraceful and wholly unwarranted attacks on civilians and civilian infrastructure such as hospitals and schools. The UN has confirmed that since the end of April at least 25 health facilities—including at least two major hospitals—and 37 schools have been damaged by airstrikes and shelling in north-west Syria. These attacks are a clear breach of international law, and we call on the regime and Russia in the strongest possible terms to cease them and end the suffering of those in the Idlib governorate.

The deteriorating situation is causing immense suffering to a civilian population who, as the hon. Lady will know, are already highly vulnerable. Even before the current escalation of violence, nearly 2 million people in the region had already been forced to leave their homes at least once, and nearly 3 million are in need of humanitarian assistance.

Let me take this opportunity to highlight, briefly, the assistance that we are providing for those who are in such dire need across north-west Syria. Last year alone, the UK provided over £80 million in humanitarian assistance in the region, which included supporting the provision of food, shelter and other essential items for those caught up in the conflict. We are continuing to support that effort this year as well. In response to the recent situation, the partners of the Department for International Development are scaling up their humanitarian response to meet the growing needs on the ground by, for instance, supporting health facilities.

A further escalation of violence, triggering waves of displacement, would be likely to overwhelm an already stretched humanitarian response. Once again, I call on all parties to cease violence in Idlib, to respect previously agreed ceasefires, and to bring an end to the needless and deplorable attacks on civilians, hospitals and schools in the region.

The first thing that has to be said, Mr Speaker, is that, as you and I both know, it should not be me who is standing here. It should be Jo Cox, and, three years after her brutal killing, we miss her every single day.

The second thing that I must do is thank you, Mr Speaker, for welcoming the surgeon David Nott to Speaker’s House to discuss his book and his work, which has included helping the Syrian people. It was kind of you to host him.

As the Minister has said, the conflict in Syria has escalated once again and despite talks of so-called reconstruction it is far from over. Just in recent months reports say that nearly 500 civilians have been killed due to airstrikes.

This is a complex conflict but I want to focus on simple facts today and, as the Minister has described, we have seen yet again the bombing of hospitals. Reports from the region tell of scores of hospitals being attacked, and millions of people in the Idlib area are in desperate need of healthcare.

A bad situation is being made much worse by our failure to enforce the basic rules of conflict. What representations has the Minister made to UN agencies about fixing this system, because people there are saying the UN system is simply not working—the co-ordinates of those hospitals are not safe with the UN, and the protection that should be in place for medical systems in Syria, even at this late stage in the conflict, has now failed? What meetings has the Minister had to discuss this with UN agencies, what action is he proposing to take, and what work is he doing with our colleagues in the international community to fix this broken system?

Secondly, I would like to ask some questions about UK aid. The Minister mentioned food and basic supplies, but what about medical supplies, and what assessment have the Government made of the current risks given the political situation we are now facing in relation to Syria and the effectiveness of UK aid? It is a simple thing, surely, to get basic medical supplies that are needed over the border to the doctors who require them. Also, what action has the Minister taken to prioritise civilian access to medical supplies?

Finally, it is Refugee Week this week, and I do not always thank the Government but on this occasion I would like to thank them, and specifically the Minister for Immigration, who is not in her place at the moment, for her decision to extend the VPRS—Syrian vulnerable persons resettlement scheme—that brings vulnerable refugees to our country. But we need to go so much further than that. We have failed to deliver against the values of this country when it comes to the victims of this conflict. What conversations is the Minister having with his colleagues in Government about getting more vulnerable Syrians to the UK for safety and shelter, and will he meet me and a delegation of Members of Parliament to discuss that point? We have failed Syria but we need not to continue to fail Syrians; will the Minister help us get more Syrians to safety?

This weekend many people will gather in towns and cities across our country for “Great Get Togethers”: they will remember our colleague Jo, and they will think about what we have in common, not what divides us. So I simply finish by asking the Minister to work with all of us across this House for the people of Syria.

I am very grateful to the hon. Lady, and of course I join with her in her heartfelt tributes to our colleague Jo Cox.

The hon. Lady will know that we committed £400 million in the Brussels conference in March to Syria. That puts us in the premier division of donors to this. [Interruption.] She shakes her head, but that is a huge amount of money.

The hon. Lady asked what we are doing about refugees and she will know full well that in general refugees are best helped close to their homes so they can return to their homes, but she will also be aware of the refugees we have taken from this region to the UK, and I hope she will salute the local authorities who are warmly accommodating those refugees, including my own local authority.

The hon. Lady asked what we are doing with our partners. She might be aware that on 10 May and 14 May the UN met in emergency session to discuss the deteriorating situation and she might also be aware that later on today it will be meeting in emergency session to discuss this deteriorating situation, and the UK will play a full part in that discussion. The important thing is to get back to UN Security Council resolution 2254; it is the cornerstone and basis of any long-term settlement in Syria.

The hon. Lady asked about other partners to this, and I am sure she will share my concern that the Sochi agreement of last year between two of the principal players in this has unfortunately not been carried out in the way we would wish and that the deteriorating situation is in significant part due to Russia’s attitude towards what appeared at the time to be a very promising new beginning. I entirely agree with the hon. Lady that we need to work with others to attempt to bring some sense to the warring parties in this, but I emphasise that the UK is simply one player in this, and it is of course a multi-dimensional jigsaw.

Thank you, Mr Speaker, for granting this urgent question, and I thank too the hon. Member for Wirral South (Alison McGovern), my co-chair of the all-party group on Syria.

The much respected and senior British military officer Colonel Hamish de Bretton-Gordon has just returned from Idlib where he is an adviser to the Idlib health directorate and he says this today:

“Nearly 700 civilians have been killed this year in Idlib and there are 500,000”

internally displaced people crammed into Idlib

“many without homes living in the open and off scraps”.

He adds that there is

“evidence of another chemical attack. There have been 29 attacks on hospitals by Russian and Syrian aircraft with many now out of commission. A handful of hospitals and doctors are now trying to care for 3 million civilians.”

The Minister will know that the Foreign Office is collecting evidence of those involved in atrocities and breaches of international humanitarian law. Can he confirm that the Foreign Office is seeking to identify, name and shame not only the aircraft attacking these hospitals, which are mainly marked with red crosses, but the pilots and people operating those planes? This is clearly a breach of international humanitarian law; it is arguably a war crime and we must ensure, wherever we can, that there is no impunity for such grotesque actions.

I entirely agree with my right hon. Friend: either the regime and its supporters’ statements are wildly inaccurate or its targeting is wildly inaccurate. He will know that the UN provides co-ordinates of sensitive sites including schools and hospitals. He will share my despair at the number of those institutions, including two major hospitals, that have been damaged in this, and I am sure he will also share my enthusiasm that those who responsible for this are, sooner or later, brought to book.

I thank my hon. Friend the Member for Wirral South (Alison McGovern) for asking this urgent question. I feel she spoke for the whole House when she spoke of Jo Cox at the beginning of her speech, and I thank the Minister for his response.

Once again we find ourselves here in this place shocked and appalled at the threat to hundreds of thousands of civilians in Syria. We had Aleppo, we had Raqqa, we had Ghouta, and now today it is Idlib: homes and livelihoods destroyed; civilians and children fleeing and dying; and, yet again, hospitals bombed and deliberately targeted.

Three years on from UN Security Council resolution 2286, medical facilities are still being hit in Syria—an unthinkable 29 hospitals in the past six weeks according to some reports. Amnesty International says these attacks targeting hospitals constitute “crimes against humanity”. The International Rescue Committee says that these attacks continue to happen with “absolute impunity”. This is shocking and reprehensible; even wars are supposed to have rules.

What steps is the Minister taking with our international partners to ensure that these appalling attacks on health facilities do not go by with impunity and, as he says, that these people are brought to book? Can the Minister tell us more about the UK’s promised protection of civilians strategy—exactly when it will be delivered and whether it will be accompanied by a clear framework for accountability and implementation?

It is absolutely necessary that we urgently get all sides around a table to find a peaceful, political resolution to this horrific conflict. That is the only thing that will bring the carnage in Idlib to an end. That is the only thing that will protect the lives of those health workers still operating in Idlib and the civilians they are working to save. So what is the Minister doing to realise this? That peace must be achieved, and let me end by echoing the words of the president of Médecins Sans Frontières who put it so simply when she called on all warring parties to:

“Stop bombing hospitals. Stop bombing health workers. Stop bombing patients.”

I am grateful to the hon. Gentleman for his remarks and questions. It is important that we work with international partners to apply pressure to those who are responsible. He will be well aware of the difficulty of working with the regime in Damascus and its supporters, but the Sochi agreement at the end of last year held out such promise. Those were baby steps, perhaps, but it was the start of a process that might have brought some sense to this troubled region. I very much regret that Russia has decided to take the steps that it has and I prevail on it, even now, to think about its responsibilities that it signed up to with Turkey at Sochi.

It is important that the UN continues to meet in emergency session. I look forward to its deliberations this afternoon and we will take a full part in them. Ultimately, UN Security Council resolution 2254 has to be applied. That is the only way that we can restore peace and equanimity to this very troubled part of the world.

It is definitely a war crime to attack either a school or a hospital—there is no doubt about that. Do we have good evidence that Russian aeroplanes have attacked such targets and if so, are we raising the matter in the Security Council, which is in emergency session, as the Minister stated?

I am grateful to my hon. Friend for his question. Russia is clearly a party to the current situation. It is supporting the regime and is responsible for a lot of the trauma that is now afflicting the Idlib governorate, and it must be held to account. It must be answerable for the consequences of its actions. As my hon. Friend said, the deliberate targeting of schools and hospitals is a crime. It is caused by criminals and, as with criminals everywhere, they must ultimately be called to account.

We also pay tribute to Jo Cox’s memory in the House today and to David Nott and his incredible work as a surgeon in Idlib; he recently won the Robert Burns humanitarian award for what he has done.

We in the Scottish National party are shocked and horrified by the reports that, since Syrian regime forces and their Russian allies began their offensive in Idlib in April, more than 24 medical facilities have been attacked. Tragically, the targeting of healthcare facilities is not new in Syria’s civil war. The US-based Physicians for Human Rights documented more than 500 attacks on medical facilities between 2011 and 2018.

The deliberate and strategic bombing of hospitals carrying out their medical functions is a war crime. These latest attacks have eliminated vital lifelines for civilians in desperate need of medical care and medical centres are no longer sharing their co-ordinates with the UN for fear of being a target of Syria and their allies. However, the prevention of and protection from mass atrocities remain almost wholly absent from the UK’s national framework of civilian protection. What steps is the Secretary of State taking to cover this glaring omission? Furthermore, will he ensure that the upcoming review of the Government’s protection of civilians in conflict strategy reflects the changing nature of modern conflict, which blurs the lines between combatants and non-combatants?

I am grateful to the hon. Gentleman for his remarks. He must know that what we are able to do depends very much on access and safety and whether or not we can get to those who are most in need. At the moment, that is extremely problematic. We would prevail upon all parties to this to allow humanitarian access and to allow those of us who wish to protect civilians to be able to access those civilians wherever they are, so that the necessary protection can be afforded. However, he has to understand the difficulty of assuring the safety and security of those now delivering aid, and I pay tribute to those who provide aid under extremely difficult circumstances. He will be aware that a number of those individuals in our troubled world today have paid with their lives for that. It is absolutely a duty that we in Government and our agencies have to ensure that they are not put at risk more than is absolutely necessary in trying to do their vital work.

I very much support what the hon. Member for Wirral South (Alison McGovern) said about taking on more refugees from the area, and I pay tribute to my right hon. Friend the Minister for Immigration for her decision. What does the Minister think can be done to help to make the good Russian people aware of what is being done in their name by their Government? Surely they would be as horrified as the rest of us by the deliberate targeting of hospitals, schools and other humanitarian facilities.

My hon. Friend is right to say that the Russian people would indeed think that, if they knew the full extent of the actions being taken in their name by President Putin’s Administration. This is a terrible calumny. It is a devastating thing for which Russia must ultimately assume responsibility. We have to hope that members of the Russian Administration are ultimately called to account for these atrocities. Knowing the Russian people as I do—I suspect that my hon. Friend knows them rather better than I do—I know they are good people and often misunderstood, since they are often seen through the prism of Moscow and the terrible acts, I am afraid, that President Putin and his people are too often associated with in our world today.

I congratulate the hon. Member for Wirral South (Alison McGovern) not only on securing this urgent question, but on the very moving way in which she introduced it, and I absolutely share and endorse her tribute to Jo Cox.

It is heartbreaking to read the testimony coming out of Idlib, and it is horrific that there have been 257 attacks on hospitals and medical workers in the last year alone. I say to the people who are carrying out these attacks that it is beyond grotesque. The fact that doctors feel that they can no longer share co-ordinates with the United Nations is also a damning indictment of the international community’s failure to protect some of the most vulnerable. I am reassured that the Minister wants to see people brought to book, but what further support could the UK provide to the United Nations or others to gather evidence, so that when the time comes and justice can be done, the information will be there?

The hon. Lady knows that this is an ongoing piece of work, as my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell) rightly referred to. It does not relate simply to this current offensive; it goes back a long, long way. In particular, we have been at the forefront of condemnation of the regime with respect to chemical weapons, which are an abomination. All those who have been involved in the use of these illegal weapons must be called to account. Clearly, our imperative at the moment is humanitarian assistance—of course it is—but a slower piece of work is gathering evidence that ultimately will be used to ensure that those criminals who have been involved in perpetrating these atrocities are brought to book.

This shocking new bombing campaign will lead remorselessly to more innocent loss of life, and up to 2 million people could be displaced into Turkey. I recently met a constituent who works very closely with charities that operate there and in the area, one of which is Syria Relief. What engagement has the Department had with charities on the ground, such as Syria Relief, which can do this work and have the local knowledge? Is work ongoing in that respect?

The truth is that we engage on an ongoing basis with charitable organisations, but I will not comment specifically on those organisations, really for their security. Much of our effort is channelled through the UN and its agencies, but I salute those across the charitable sector who engage in this extremely difficult and traumatic work. I will continue to engage with them as much as I can, the better to understand the challenges they face and their experiences on the ground.

The Minister and everyone who has spoken has rightly pointed out that this is a complex political situation, and that it is complex for us to do anything about it. However, there is one piece of the jigsaw that we are entirely responsible for, and that is the number of refugees that we allow into this country. I speak as someone who has refugees from Iran and Kosovo in my own family who grew up in a place that has always provided a safe home for every wave of desperate refugees, and I ask the Minister, in the light of what we know is going on in Idlib: can we not do more to bring more people here?

The first thing to say about the recent onslaught in the governorate of Idlib specifically is that virtually all those involved are internally displaced people within that governorate. They are therefore not accessible, and it would simply not be practical to remove them to a place of safety in this country. The hon. Lady knows very well that we have been generous in relocating people who have been triaged by the United Nations, with the most vulnerable and needy being relocated to this country. We have all taken people from right across the demographic, but the UK has been particularly impressive in relocating vulnerable people, including women, children, elderly people and disabled people. That is the mark of a truly humanitarian nation, and I am immensely proud of that.

Can I just be clear about the Government’s position on civilians in Idlib? Is it the Government’s view that the Russians and the Syrians are being reckless and careless in the delivery of their ordnance, or is it their view that they are deliberately targeting medical facilities?

Our investigation into this is ongoing, and I am not going to pre-empt the outcome of our investigation into attribution or, indeed, intent. All I would say to my hon. Friend is that it seems to us that a very large number of schools and hospitals, including two major hospitals, have been hit, and that a regime and a country that were intent on protecting civilians, particularly the most vulnerable, would do their utmost in any conflict to avoid those targets. I see no evidence of that having been done, and the consequences are as we have seen. It is vital, if those institutions have indeed been deliberately targeted, that the criminals responsible should be held to account.

What is the Government’s latest assessment of the assertions about a chlorine chemical weapons attack in the Idlib area on 19 May? We have heard the Minister’s responses—“Let’s bring people to justice. Let’s find who they are. We really implore the Russians not to do this”—but this is happening every day. We are a permanent member of the United Nations Security Council, and we are supposed to eyeball those who are committing these atrocities and deliberately targeting hospitals, but what are we doing, other than saying, “Oh, well, let’s take them to court at some point in the future”? That is not remotely good enough. The UK and our allies need to show some backbone in this and show that there are consequences for these grotesque war crimes, because every day that Russia gets away with this makes the world a less safe place. It is not being governed by the rules that we are supposed to have set up so that we can all live under international law.

First, I have an apology for the hon. Gentleman. Yesterday in the urgent question, I think I associated him with the Opposition Front Bench. I am afraid that this was a facet of my general excitement on that occasion, and it was of course entirely wrong. My apologies to the hon. Gentleman. I share his frustration—I really do—and I hope that that has come across, at least in the tone of some of the things I have been saying, but I have to ask him what on earth he thinks we could be doing, other than the things that we are doing with our partners and through the United Nations. Ultimately, this has to be dealt with not by escalating the situation but by dialling it down and ensuring that we restore the focus on UN Security Council resolutions. Although I am all ears, I doubt very much that the hon. Gentleman has many suggestions beyond that.

I thank the Minister for his response. In my constituency, we have six Syrian Christian families who have been relocated under the Government scheme. The community and church groups are helping those families with accommodation, education for their children, pastoral care, language instruction and furniture and clothes. Other members of those families are threatened in and around the Idlib area, and I spoke to the Immigration Minister about this the other week. Will the Minister work with her to reunite those families in the United Kingdom, and particularly in my constituency of Strangford?

As I indicated in my remarks, my local authority has also been active in this area. It is important that the process should be conducted properly, and that relocations to places of safety in the United Kingdom should be done on the basis of assessed need. We all know of heart-rending cases, particularly involving families and children, where the best option is indeed relocation to this country, and I am proud of what this country has been doing in that regard. Ultimately, however, I do not think that this situation will be resolved simply by removing people from their homes. The sense we get is that most of them ultimately wish to return home, and I am proud of the fact that this country is in the premier division of providing financial assistance to ensure that proper humanitarian aid and support is given to those in the region itself.

I am grateful to my hon. Friend the Member for Wirral South for securing this urgent question and for reminding us of the legacy of our dear departed colleague. I would like to ask the Minister to think again and to talk to his colleague, the Minister for Immigration. Her announcement yesterday about the resettlement schemes was welcome, and he is right to say that this country gives an enormous amount in aid, but my hon. Friend the Member for Birmingham, Yardley (Jess Phillips) is also right to say that we could do so much more. There are 12 million people who have been displaced by this conflict in Syria, of whom 6 million are internally displaced and at least 6 million are in the border countries or not far off. The Minister is right to say that we want people to stay close to their country of origin, but we could be resettling so many more people and giving them a home, safety and sanctuary. I think that that is what the people of the United Kingdom expect from us in living out our values, so will he think again and talk to his colleague, the Immigration Minister, about increasing those numbers?

I am pleased that the hon. Lady welcomes yesterday’s statement, which indicated that these matters are always kept under review. The Government will have heard the views being expressed across the House on this matter, but I come back to the central point that we have relocated people. They tend to be the most vulnerable, and that is important. One of the things that characterises this country—I hope she will endorse this—is that we have looked after, first and foremost, the most vulnerable: women, children, the disabled, the elderly and the sick. That is a tribute to the people of this country and their generosity, and I do not think it is right simply to dismiss some of the other aid and assistance that we have been giving in this terrible situation.

My constituent Sarah Ainsley, who is a sixth-former at Woodbridge High School, came to see me recently to express her concern about the Syrian refugee situation closer to home in Calais, where conditions for refugees—particularly young people coming of age—are not what we would expect for any of our children, and we should not expect them for children and young people in those circumstances. What assurances can I give her that the Government are taking that issue seriously in their bilateral conversations with the Government of France? Further to the points made by my colleagues on these Benches, does the Minister accept that there is more that the UK Government could be doing in the region, notwithstanding what is already being done?

The hon. Gentleman will have heard yesterday’s statement and will hopefully have been reassured, at least in part. The situation in Calais clearly goes well beyond Syria and is part of a much bigger piece. I hope that he will agree that the way to resolve that situation is to ensure that we prevent people from making perilous journeys in the first place. That is the view taken by both the French and UK Governments. Although it is a big piece of work and will take a long time, the imperative has to be to deal with the things that drive people to make that journey and end up in the unsatisfactory situation in France that he describes.

The signatories 70 years ago to the fourth Geneva convention, which is international humanitarian law, would not have been surprised that the hon. Member for Wirral South (Alison McGovern) has had to request this urgent question.

As a constituency MP with more than 40 Syrian families seeking refuge in my home town of Clydebank in West Dunbartonshire, it is my duty to represent them here. I have two specific points to raise with the Minister. First, in engaging with the United Nations, and maybe reforming international humanitarian law, we need to recognise that NATO leads on what is now called the importance of civilians in operational planning to ensure the protection of civilians. Secondly, with any increase in refugee numbers, will he assure existing refugees across the whole United Kingdom of Great Britain and Northern Ireland that the necessary investment to ensure their safety, wellbeing and health will not only continue but increase?

I am pleased that the hon. Gentleman’s local authority area has been helpful in accommodating refugees. My experience in my constituency is that they have been warmly welcomed, and I have been pleased with how they have been accommodated in my small part of the south-west of England. Refugees clearly need to be provided with the necessary resources to sustain themselves and to look forward to a potential long-term future, meaning all the things that those of us who are fortunate to have been born and brought up in a pacific part of the world take for granted. I am sure that that applies in his constituency, as it does in mine.

The hon. Gentleman is of course right to underscore the importance of the protection of civilians. As I said earlier, the difficulty in Syria, as in many conflicted parts of our world today, is with providing access to civilians. Our first duty must be to ensure that those who are undertaking that work are safe, and we will continue to ensure, so far as we possibly can, that that is the case.