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Oral Answers to Questions

Volume 662: debated on Tuesday 18 June 2019

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.