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Health and Social Care

Volume 663: debated on Tuesday 23 July 2019

The Secretary of State was asked—

Leaving the EU: Access to Drugs

Our highest priority is for patients to continue to have access to medicines and medical products in all Brexit scenarios. As a responsible Government, we will minimise any disruption in our exit, deal or no deal.

On 26 June, we set out our approach to ensuring continuity of supply. I discussed this last week with the head of the NHS, and Professor Keith Willett wrote to all NHS trusts yesterday to advise on no-deal planning.

Concerned breast cancer charities have asked me and others to ask the Secretary of State if he will confirm to us, and to them, whether he is leasing enough ferry capacity to ship in medicines in the very likely event of shortages in the UK when we leave the EU.

Yes, we secured the requirements ahead of a potential exit on 29 March, and we are doing the necessary work to ensure that capacity is available, whatever the Brexit scenario, on 31 October.

My constituent Jonathan Fisher, known as the Bold Joff, has complex health needs due to a rare genetic condition called Lowe syndrome. He requires six regular medications, three of which come from the EU. They are all vital to his health, but one in particular, Epilim, is critical to his epilepsy care. What reassurances can the Secretary of State give to Jonathan and his mother, Fiona, that when we leave the EU there will be no disruption to his supply of this vital medication?

The assurance I can give is that, ahead of 29 March, we put in place the measures that are necessary to ensure that the hon. Gentleman’s constituent and others get the medicines they need, and we have taken forward those proposals and that work ahead of an exit from the European Union on 31 October.

The Secretary of State will be aware of the expert evidence, including from the BioIndustry Association, warning that, although we may be able to stockpile the bog-standard drugs, it will be very difficult to do so for specialist treatments. What guarantees can he give that we will have access to those specialist medicines?

Ahead of 29 March, we managed to put in place a full programme to ensure access to drugs. Of course, the approach is not just about ensuring stockpiles—there are adequate stockpiles for so many medicines all the time—but is about ensuring the flow of materials and finished drugs across the channel via ferries and, where necessary, aircraft.

Rural Areas: Health Service Funding

NHS England is responsible for funding allocations to clinical commissioning groups, which already take into account the relative health needs of local areas. NHS England is now introducing a new community services formula, which will better recognise the needs of rural, coastal and remote areas.

Will the Minister update the House in more detail on how the Department plans to support CCGs such as Northumberland, where managing the extra costs associated with the extreme rurality of communities like the Coquet valley, the most rural in England, means it simply is not possible for community nurses and general practitioners to reach as many patients in a day?

Adjustments are already being made in the funding formula for differences in costs related to rurality or location. Northumberland CCG will receive an extra £1.1 million in funding this year to provide emergency ambulance services in sparsely populated areas. By 2023-24, Northumberland CCG will receive £98.5 million more funding.

My hon. Friend has already spoken to me about Rothbury Community Hospital in her constituency, and I would be delighted to speak to her about it again.

People in rural areas need more investment in social care services. I do not always agree with the Daily Mail, but is it not right when it says that we now need a national dementia fund and an all-party approach to defining the nature and funding of the social care system in this country? Successive Governments have failed in that respect, and older people, disabled people and their families are being let down as a consequence. When will we see some action?

The hon. Gentleman is right, which is why the Green Paper will have long-term plans on mental health and, indeed, dementia. I think he will be pleased to see that when the Green Paper is released shortly.

What can the Minister do to expedite the provision of primary care services in those rural areas where the population is growing fast as a consequence of new housing?

My right hon. Friend is right to raise that point, which has been raised with me several times. The new funding formula that the independent advisory committee is setting up will take into account the growth in population. It will look at the growth in the electoral register every year, rather than over a five-year period, as it does now, so it will be able to respond more quickly than is currently the case.

Will the Minister bear in mind the fact that dementia comes in many different forms? My mother had one form and she lasted a number of years, but it finally took hold. My sister, on the other hand, went within a short period of time, because she would not eat at all. My best friend at the time in the National Union of Mineworkers, Peter Heathfield, finished his life being violent, struggling with three people who tried to get him to the toilet. Bear that in mind carefully, Minister. Dementia is not a static illness; it is very different for different people.

I do not always agree with the hon. Gentleman, but he is right to make that point. I know from very personal experience that dementia affects people in different ways, which is why I am proud to be part of a Government who are committed to delivering in full on the challenge on dementia 2020, to make England the best country in the world for dementia care.

The huge rural area covered by the Morecambe Bay NHS Foundation Trust has and needs three hospitals, but it is funded as if it had only one. As a result, the trust has been fined more than £4 million in debt interest over the past three years. That money could have been spent on nurses, paramedics or doctors. Will the Minister intervene to stop this at once?

I met the hon. Gentleman recently to talk about ambulance provision in his constituency and the Morecambe bay area, and I hope he is now satisfied with the progress we are making on that. I will look into the individual case he mentions and respond to him.

Rural Areas: Access to Health Care

3. What steps his Department is taking to ensure the accessibility of health services for rural populations. (912112)

The long-term plan that the Department published in January commits to delivering fully integrated community-based healthcare in primary and community hubs. It confirms that the standard model of delivery will be developed for use in smaller acute hospitals that serve rural populations.

I thank the Minister for his answer, but some rural villages, including some in Devon, have no ambulance service at all—a fact masked by high-level statistical reporting. Will the Government work with me and the National Centre for Rural Health and Care to expose the real rural healthcare deficit, which is so masked, and work with us to rectify the situation and provide the appropriate care and medical support necessary by putting in place a robust and accountable rural health and care strategy and plan?

I know that my hon. Friend has worked with the National Centre for Rural Health and Care and chairs the all-party group on rural health and social care. She is right to mention the fact that there are particular challenges in the delivery of the best-quality healthcare that we want to see in rural areas. I would be delighted to work with her and the all-party group on the matter.

It has now been almost 18 months since health commissioners proposed that the two options for acute medical care in east Kent be put forward for public consultation. My constituents, particularly those in rural areas, are simply fed up with waiting for a new hospital. Will the Minister please confirm for me today just when a full public consultation on the future provision of acute services in east Kent will finally take place?

The hon. Lady asks a good question on behalf of her constituents. I cannot confirm today when that will happen, but I will look into the matter and write to her to make sure that she gets the answer.

One in 10 women have endometriosis. The average wait for diagnosis is seven and a half years and can be even longer in rural areas, and there is currently no test for it. Researchers at the University of Hull previously developed biomarkers for cancer testing and have recently developed a project to test for biomarkers in urine to help to identify endometriosis. They need £10,000 in seed funding to get the project off the ground; will the Minister please meet me to discuss how we can secure the funding?

The hon. Lady has invited me to meet her to discuss that funding. She will be pleased to hear that I will be delighted to do so.

Cystic Fibrosis Treatment

4. What steps he is taking to ensure that people with cystic fibrosis receive the latest treatment for that condition. (912114)

18. Whether he plans to hold a further meeting with Vertex Pharmaceuticals to ensure that new drugs to treat cystic fibrosis can be approved. (912133)

We want patients living with cystic fibrosis to get the best care possible. Progress in specialised treatment for patients with CF means that people are living healthier and longer lives, but I recognise that it is frustrating for everyone, in particular patients and their families, that a deal on Orkambi has not been reached. It is for Vertex and NHS England to enter negotiations. I urge Vertex to consider the latest offer from NHSE.

I have heard from people in Dudley and across the country about the difference that those new treatments make, but patients have been waiting for three and a half years now. Some families are having to take extreme measures to secure access to the drugs. Will the Minister and the Secretary of State meet me, people with cystic fibrosis or their parents, and the Cystic Fibrosis Trust so that we can get the whole thing sorted out and the wait for the drugs is not drawn out any longer with another summer or year of impasse?

I recognise and share the frustration of patients and their families. The situation has been going on for far too long. I again urge Vertex to accept the offer. The hon. Gentleman has been in touch about a meeting, and I understand that we have responded to say that we will give him a firm date shortly.

Sufferers of CF, as we have heard, are well used to the new hope of changes in the Government, but it soon becomes yet another false dawn: they are left drowning in their disease without access to Orkambi. The Minister has to lean in on the business end of the job that she has to do. Will the Government use their leverage, support the buyers’ club—the drastic action that CF sufferers are having to take—and supplement access to the equivalent of Orkambi? That might finally get Vertex to the table to do a deal on this important issue.

As I said to the hon. Gentleman and other hon. Members in the Westminster Hall debate on the drug, a deal is the preferred option. However, the attitude taken by Vertex, which has been called an outlier in this situation, means that my right hon. Friend the Health Secretary has instructed NHS England to look at other options.

Over the past three years, all of us in this House have heard the numerous calls for Orkambi to be made available to cystic fibrosis patients. The Minister could go down in history if she takes the all-important step this week, while still in her job—I hope she will still be in the job tomorrow—of announcing an alternative route to access cystic fibrosis drugs, such as a Crown use licence or clinical trials. Today, before we break for recess, will she commit to that so that families can have Orkambi now?

The National Institute for Health and Care Excellence process is important, because it is an independent expert review and the way in which we allocate resources sensibly. The Crown use licence is not a quick or easy solution, and it is open to legal challenge, which might delay things even more. Vertex has been offered the biggest settlement in NHS history, and I urge the company to accept it. However—I have said this on numerous occasions from this Dispatch Box and in Westminster Hall—the Secretary of State has urged and asked NHS England to look at other options, such as the ones to which the shadow Minister has referred.

Healthcare Staffing Levels

5. What assessment he has made of trends in staffing levels of registered (a) doctors and (b) nurses since 2010. (912115)

Across the UK, the number of registered nurses and doctors has increased over the past nine years. In England, there were over 112,000 doctors in NHS trusts in March 2019, 17,000 more than in March 2010, and over 8,000 more nurses than in 2010. There is more to do, and the NHS people plan will ensure a sustainable workforce for the long-term future of the NHS.

As the Secretary of State may be aware, earlier this month—conveniently in the Holyrood recess—we learnt that medical students who come from the rest of the United Kingdom and want to apply for an undergraduate course at Scottish universities will find their chances greatly diminished. Most Scots are appalled by this policy. In fact, the British Medical Association, the Royal College of General Practitioners and medical schools are all expressing concern. Does the Secretary of State agree that the Scottish Government need to be attracting the brightest and the best—no matter where they come from across the United Kingdom—to address the GP crisis?

Yes, I do. I was surprised by the recent news that I read about medical schools in Scotland being told to discriminate against medical students from elsewhere in the UK. I understand that the Scottish National party itself accepts that this is discriminatory. I doubt that the policy will last and I look forward to an SNP U-turn.

Mitie recently signed a £150 million contract at St George’s Hospital, but staff are already facing job cuts. My union, the GMB, balloted its members; 99.6% of them voted to take industrial action. Will the Secretary of State commit to visiting staff on the frontline and show them solidarity during this very difficult time?

I am always very happy to visit hospitals around the country, including St George’s. Of course, the individual management of staff is a matter for the hospital itself. I look forward to discussing with the hon. Lady what more we can do.

The Secretary of State has quite rightly outlined the global progress that has been made on the medical and nursing workforces, but he will be aware that the picture is very different in mental health services, with the loss of 4,000 mental health nurses over the last decade. Indeed, the fill-rate for doctors entering higher training in child and adolescent mental health services this August is only 63% and only half the higher trainee posts in general adult mental health have been filled. What is the Secretary of State going to do to turn the very good rhetoric on mental health into a reality on the ground for patients?

The increase in funding for mental health services, which is the largest increase as part of the overall £33.9 billion increase, goes to mental health services. Of course, the vast majority of that will go towards employing more people. As my hon. Friend says, we need to encourage more people into training in mental health services and psychiatry, as well as mental health nursing, which is also under pressure. The expansion of these services ultimately means that we need to have more people doing the work: supporting people to improve their mental health and supporting people with mental ill health. My hon. Friend is absolutely right to raise this issue, which is right at the top of the priorities for the NHS people plan.

Sexually transmitted diseases such as syphilis and gonorrhoea are on the rise. Will the Secretary of State target more resources at staffing and investment to ensure that we tackle this rise?

We have recently announced that the way in which we are going to proceed with regard to sexual health services is co-commissioning between local authorities and the local NHS. This is the best way to ensure that we get the services on the ground. I would just slightly caution the hon. Gentleman; although he mentioned that some sexually transmitted diseases have been on the rise, others have been falling quite sharply. We have to ensure that we get the details of what we try to implement right, but I support the direction of travel that he proposes.

What can we do to make the workload terms and conditions more attractive for salaried GPs and GP partners compared with locums? GPs in my constituency tell me that a great number want to be locums, but that not so many want to be salaried or GP partners because of the workload. What can we do about that?

My hon. Friend is dead right. This is an important part of the work that Baroness Dido Harding is leading in the NHS people plan to ensure that we can make careers in the NHS—whether as doctors, other clinicians or more broadly—the most attractive that they possibly can be. This week we announced a pay rise for doctors and earlier this month we announced a long-term agreement with junior doctors, which I am delighted they accepted in a referendum with over 80% support. But there is more work to do.

The rules around annual and lifetime allowances are having an impact on the NHS workforce in Scotland, and the options contained in the recent consultation on doctors’ pensions do not provide the level of flexibility necessary to resolve this situation. We know that the solution lies with the Treasury, so what pressure can the current Secretary of State put on the Chancellor to ensure that urgent reform takes place to stop this terrible impact on our NHS workforce?

I have been working hard with the Chancellor of the Exchequer to ensure that we can resolve this important issue. The hon. Gentleman will have seen the consultation document that we put out yesterday to resolve the problem. The consultation is open and asks open questions about the best way to fix it. I am absolutely determined that we will fix it to remove some of the unintended consequences of changes in pension tax law. It is a pity, though, that the SNP spokesman did not stand up to accept that the proposal mentioned by my hon. Friend the Member for Angus (Kirstene Hair), which would discriminate against people from outside of Scotland, is wrong and should be withdrawn.

The Secretary of State is in denial. There is a crisis in GP retention. In fact, there are now 1,200 fewer fully qualified permanent GPs than there were in 2010. Because of this, patients are waiting longer than ever to get a GP appointment. He has promised, as he did again today, to address this, but it is a fact that the situation is getting worse, with a pension system that is effectively charging GPs to work extra hours. Does he really believe that this is the best way to retain GPs in the NHS? Does he have a detailed plan, and can he explain how he is going to sort out this mess?

I think it is worth starting with a few facts. One fact is that I published a detailed plan yesterday, on which we are consulting, to tackle the pension issue. The other two facts that are worth noting, and that the House will want to know about, are the following. First, there is a record number of GPs in training—3,473. Secondly, the overall number of GPs is rising, with, as of March 2019, 300 more doctors working in general practice than a year earlier. I want to see that number continue to rise.

Social Care Services: Accessibility

All councils have a statutory duty to look after people’s care and support needs in their areas. In total, between 2016 and 2017, and in 2019-20, the Government have given councils access to £10 billion more social care funding.

Given that the Government have promised a spending increase for the NHS in the regions, is the Minister aware that at the current funding levels, Greater Manchester Health and Social Care Partnership will be operating on a predicted deficit of £2 billion by 2021? Will she advise on what work has been done in partnership with the GMHSCP to avoid this huge deficit?

There is no doubt that the system is under pressure, but that is why the Government have been putting an enormous amount of money in and giving councils access to additional funding to be able to address the growing need—up to £10 billion over the past three years. We know that people are living longer and living with much more complex conditions. This situation is only going to get worse, so we do need to find a more sustainable way to deal with it in the long term. The hon. Gentleman will be interested to know that Manchester will receive an additional £42.9 million for adult social care funding in 2019-20.

Figures from the Care and Support Alliance and Age UK show that at least 1.4 million older people in England are not receiving the care and support they need. We know that this figure will be much, much higher owing to the number of working-age disabled people who are being denied the care and support they need to lead better lives. Speaking as co-chair of the all-party parliamentary group on adult social care, how much longer do we need to wait until the Government publish the long-awaited Green Paper on social care and finally start to show some much needed leadership in this vitally important area of public policy?

First, I pay tribute to the hon. Lady for her work in the APPG on adult social care. It is really important that we have an APPG that represents this really important issue. As I said, the fact that we have an ageing population is a growing issue that we have to face as a nation, and, in fact, as a world. Her area of Wolverhampton will receive an additional £22.1 million for adult social care in 2019, but we know that that is not a long-term solution and we will be publishing a Green Paper at the earliest opportunity.

The Government’s utter chaos over Brexit has already impacted on recruitment in the social care sector. Scottish Care told the Scottish Affairs Committee that providers have lost 67% of their intake from the European economic area. The fact is that this Government’s actions are putting the health of the sick and elderly at risk. Will the Government make an assessment of how the staffing crisis in social care is impacting on the rate of hospital admissions?

The hon. Gentleman is right: we do have a number of vacancies—a large number of vacancies—in adult social care. That is why, earlier in the year, the Government announced a recruitment campaign, “Every day is different”. It ran for a few months, with enormous success. There have been 14% more apply clicks on the relevant Government jobs site as a result, so we have just announced that we are going to expand and extend that recruitment campaign, with an additional £4 million of funding.

Among those most affected by lack of access to social care are the 2,300 autistic people and people with learning disabilities stuck in inappropriate in-patient units because of a lack of funding for community placements. Labour, my party, has pledged to spend £350 million per year to support moving as many of those people as possible into community placements. I note that the Health and Social Care Secretary actually pledged extra funding for social care if he became Prime Minister, so will the Care Minister tell us if he now promises to match Labour’s pledge and ensure that autistic people and people with learning disabilities can live in homes, not hospitals?

The hon. Lady is absolutely right. One of the biggest issues we have had with people with learning disabilities and autism ending up in in-patient settings is a lack of community provision. That is why the NHS long-term plan commits to an extra £4.5 billion a year for primary and community health services, and local areas will be expected to use this investment to develop the sort of specialist services and community crisis care that will help divert people away from in-patient care settings.

Mental Health: Young People

8. What steps his Department is taking to help prevent mental health illness among young people. (912120)

We are committed to improving early intervention and prevention to ensure that young people with mental health problems do get the best start and the earliest possible treatment. To that end, we are introducing new school-based mental health support teams. The first 59 of these will start being operational by the end of December this year. The next wave of 124 more teams was announced on 12 July.

With half of all lifetime cases of mental ill health beginning at the age of 14, will the Minister say how well the training promised to constituencies such as mine will help to stop these problems worsening as people get older?

My hon. Friend is right: people with mental health conditions do tend to develop them as children. Clearly, the earlier we can give them support to help them manage those conditions, the better for their long-term wellbeing. Equally, however, we need to make sure we have sufficient community services when they leave school and get older, so that having invested in their wellbeing, it can be continued through later life.

Is the Minister confident that the mental health of the 5,000 children with special educational needs who spent time in school isolation booths last year was not harmed, and if not, what representations has she made to the Secretary of State for Education about this practice?

The hon. Gentleman, as usual, raises a very important issue indeed. Of course, people with special educational needs will be at risk of mental ill health more than any other cohort of children. I am having regular meetings with the Under-Secretary of State for Education, my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi), who has responsibility for children and families, about this very vulnerable group. Having targeted mental health provision across mainstream schooling generally and put in such investment, we now really need to home in on the groups at highest risk.

Will the Minister outline what discussions have taken place with the devolved Administrations to ensure that best practice and best results are implemented UK-wide, especially considering that Northern Ireland has the highest level of mental health issues pro rata in the whole of the United Kingdom of Great Britain and Northern Ireland?

As usual, the hon. Gentleman raises an extremely important point. Of course, health is a devolved matter, but that is not to say that all four nations cannot learn more from best practice in each place. I am pleased to say that we are now increasing our contact with representatives of the devolved Governments, and we will very much be sharing such best practice.

Referrals to child mental health units from primary schools for pupils aged 11 and under have risen by nearly 50% in three years. BBC research last week also found that primary school children are self-harming at school, and in four cases children under 11 had attempted suicide while at school. This is deeply shocking, so what is the Minister doing to ensure that primary school children will have support from trained mental health professionals when they return in September?

The hon. Lady is quite right to raise that, and it is incredibly troubling to see those figures. The investment we are making in mental health support teams will be of assistance. For primary schools that are well led and gripping this issue, there is some very imaginative and innovative practice to bring emotional wellbeing into the classroom from the moment pupils arrive. We need to make sure that those mental health teams start acting as soon as possible. This is something that we need to address collectively with schools and as a society to make sure that we get treatment to people at the earliest possible time.

NHS Facilities

Modern, fit-for-purpose facilities are better for patients, the NHS staff who work in them and the taxpayer, so the Government have already provided £3.9 billion of new capital investment to deliver new, upgraded facilities across the country.

I thank the Minister for visiting the site of the proposed new Longton health centre in my constituency recently. Does he agree that we must deliver new primary care facilities such as this to make sure that improvements in health in my local community continue?

I very much enjoyed the visit. The new £5 million Longton medical centre will provide general practice service for more than 12,000 patients, and it will be a fantastic community health scheme. My hon. Friend will be pleased to hear that yesterday I wrote to him outlining the capital options that might be available. He is right, and that is why this Government believe in transforming the primary care estate. It is a key enabler for delivering the long-term plan, and it provides better care for patients.

A year on, NHS Property Services is now having to remarket the site of Bootham Park Hospital. In the light of this complete failure and the failure to listen to health professionals locally, will the Minister ensure that the One Public Estate bid is seriously considered as the sale moves forward?

I met the hon. Lady about this disposal last December, and I have followed the matter carefully. The local health system has not wanted to continue using the site, but I am happy to assure her that I will look at bids from all comers. It is not my decision; it is a decision for local healthcare bodies and NHS Property Services.

The Minister will be aware that our general district hospital was closed to new admissions in recent weeks, and the reason given was delayed transfers of care. Ever since I was elected, many others have joined me in looking at how we can provide a step-down, step-up facility—a community healthcare hub—with beds in the St Ives constituency. I wonder what funding is available to achieve that aim.

My hon. Friend is right. He will have heard me say in response to my hon. Friend the Member for Stoke-on-Trent South (Jack Brereton) that we are already making available £3.9 billion extra to provide these facilities. We should not be complacent, however, and it is important to recognise that we want world-class facilities for world-class care. One of the benefits of the long-term plan is that we can create a stable environment for capital investment, and we can make the case for more capital investment at the spending review.

Government cuts have already resulted in significant downgrading and loss of vital services at South Tyneside District Hospital. Since the Department refused to fund the next phase of downgrading, the trust has approached the local authority to borrow £35 million from the treasury to see it through. Does the Minister agree with me and my incensed constituents that it is wrong that we are now being asked to pay for further cuts to our hospital?

The hon. Lady will know that the Government are putting more cash and more money into the NHS than at any other time in its history. There will be £33.9 billion extra going in by 2023-24.

NHS Workforce Vacancies

Question 10 is about workforce vacancies, and I can tell the House that one workforce vacancy has just been filled, because Boris Johnson has just been elected as the leader of the Conservative party.

The NHS employs more staff now than at any time in its 70-year history, with significant growth in newly qualified staff from 2012. Our full people plan will help to tackle these issues for the long term.

Words are all well and good, but it is actions that actually count, and the Government are not creating a health service that supports its workforce. The striking health visitors in Lincolnshire have each lost more than £2,000 a year since they were transferred from the NHS to the Conservative-controlled county council and many have had their professional status downgraded. Does the Secretary of State agree that rather than shifting the responsibility for cuts to health services on to local government, the NHS should deliver fully resourced healthcare services and pay its staff properly?

The NHS is delivering healthcare services and it is paying its staff properly. It is working with local authorities to deliver the best possible health services right across the country. We absolutely need to recruit more people to the NHS and we are recruiting more people to the NHS.

Vulnerable Older People

12. What steps he is taking to ensure that (a) adequate resources and (b) highly trained personnel are allocated to health services for vulnerable older people. (912126)

The NHS is responsible for ensuring adequate resources and a high-quality workforce that can deliver a comprehensive health service for all people, including vulnerable older people. That is clearly happening. We are supporting that through investing an extra £33.9 billion in the NHS.

I have also just heard the news that we have a new Prime Minister. I am thinking of the man who stands outside with a sign saying that the end of the world is nigh.

The fact of the matter is that the end of life for many of my constituents is tough, because the people in the care sector who support them are poorly paid, poorly resourced and poorly trained. Surely we should go for well-managed, highly trained, highly skilled people in the NHS for every age?

The hon. Gentleman is right, which is why we have ensured that we are putting more money into the NHS and more money into primary care, with £4.5 billion in real terms on primary medical care and community health services. It is why we commissioned Baroness Dido Harding to produce the “Interim NHS People Plan”, which she has done, and why we are working on ensuring that we have the health service workers to provide excellent care for all people in the community.

Health Inequalities

The Government recognise the importance of reducing inequalities and have included a commitment to that in the NHS long-term plan. We know that public health services, such as immunisation, screening programmes, smoking cessation services and many other initiatives, can significantly improve health outcomes to combat some of the inequalities faced by ethnic minorities and those living in less affluent areas.

I thank the Minister for her response. After nine years of Tory austerity, advances in life expectancy, which steadily increased for 100 years, have now ground to a halt and have even gone backwards in some of the poorest areas. How does the Minister plan to reverse that damning trend?

Life expectancy has been increasing year on year, but it is also true that it is an international phenomenon that that rate of increase is coming to a halt. None the less, life expectancy in England is the highest it has ever been: 79.5 years for men and 83.1 years for women. We will continue to invest in our public health programmes and look at the wider issues facing society that can also contribute to good health outcomes, such as housing, work and so on. There is a lot that can be done; it is not just about NHS spending.

One of the best ways of getting early public health help across the doorstep is by investing in health visitors to give that much needed early support, especially to new parents to help to ensure that every child gets the best start in life. One of the best achievements of the Cameron Government was the creation of 4,200 additional health visitors. Does the Minister share my concern that since 2015, with the responsibility now having gone to local government, there has been a 26% reduction in the number of health visitors? That is something of a false economy.

I do share my hon. Friend’s belief that health visitors are probably the most important army in the war against health inequalities. They provide an intervention that is very family-based and not intimidating. It is based on good relationships and means we can provide intervention at the earliest possible time. He is right to highlight the massive investment we made during the Cameron Government. There has been a decline since, which we really must address if we are to get the earliest possible intervention and the best health outcomes for children.

We finally got to see the prevention Green Paper yesterday evening, and it rightly highlights the appalling inequality in healthy life expectancy and the fact that being overweight or obese is now the leading risk factor for disability and years lived with disability. Will the Secretary of State please reassure the House that he will act on the evidence? The prevention Green Paper makes it very clear:

“The Soft Drinks Industry Levy…has been hugely successful in removing the equivalent of over 45,000 tonnes of sugar from our shelves.”

The House really needs to hear reassurance that we will not roll back on those kinds of issues.

I reassure the hon. Lady that the Government are committed to following the evidence; that is very much a theme in the prevention Green Paper. The evidence will speak for itself. Clearly, she is absolutely right to highlight obesity as the biggest risk factor in impeding healthy life expectancy. That is why, across Government, we should be vigilant about tackling it.

King George Hospital A&E Department

14. Whether his Department’s decision of October 2011 to close the A&E department at King George Hospital, Ilford, has been rescinded; and if he will make a statement on future services at that hospital. (912128)

The hon. Gentleman will be pleased to hear that I can confirm that there will continue to be an A&E at King George Hospital, Ilford. The NHS has concluded that there is need for such provision now and in future.

I thank the Minister for that reply. I hope that it will stop some of the more lurid scaremongering and campaigning, which is unfortunately diverting people in my constituency from looking at the most important issue: how we use the King George Hospital site in future. Will he confirm that steps are being taken to integrate North East London NHS Foundation Trust and King George Hospital services to deal with social care and other matters?

Autism and Learning Disabilities

15. What additional funding he plans to allocate to the NHS to reduce the number of people with autism and learning disabilities held in in-patient settings. (912129)

The NHS long-term plan commits to an extra £4.5 billion a year for primary and community health services by 2023-24. Local areas will be expected to use part of this investment to develop specialist services and community crisis care to reduce avoidable admissions and lengths of stay for autistic people and those with learning disabilities.

I do not know whether the Minister has seen the report from the Children’s Commissioner, but it says that the number of children with autism or learning difficulties in mental health hospitals has doubled in recent years. Many are very far from home. Their parents are not consulted properly on their care, and they are in for much longer than they need to be. What proportion of the money that she mentions will go towards trying to ensure that children can have support in their home, so that they are not in this situation?

The hon. Lady has hit on a really important point. The truth is that a lot of children who end up in an in-patient setting are not diagnosed with autism or a learning disability until they are there; they normally come in on a mental health diagnosis. There are a few points to make here. One is on making sure that early intervention is there as early as when a child is in school. That is why the Government have made a commitment to having mental health support available from a very early age, in schools. This is also about making sure that families do not get to crisis point, and that the investment is there in the community, so that children get the support that they need at every possible step.

Missed GP Appointments

Missed appointments are a waste of NHS resources, and we believe that encouraging patients to use the NHS sensibly and responsibly is the right approach. We are encouraging a range of local schemes to help to reduce missed appointments, with clinical commissioning groups and practices embracing technology and adopting a variety of approaches, such as text reminders, patient-recorded bookings and the increased use of online systems that make it quick and easy for patients to change and cancel appointments.

A GP surgery in my constituency has reported that in one month this year, 78 people failed to keep their appointment and failed to cancel it. Those failures led to the surgery losing 11 hours’ working time. The surgery has announced that it will consider removing patients from its register if they miss three consecutive appointments. Does my hon. Friend support that proposal, and does she think that the policy should be rolled out across other surgeries?

Local NHS organisations know their populations best, and that is why the Government support locally led initiatives to reduce missed appointments. The evidence shows us that people are less likely to miss an appointment if they have a convenient option. Swale CCG has a “Did Not Attend” campaign, which will run across the region this summer and support his constituents in making sure that they use their appointments responsibly.

Is the Minister aware of any research that has been done, not just on missed appointments, but on repeat offenders who periodically miss their appointments, and the effect that has? What can be done to ensure that that is not repeated beyond today?

There is no overall estimate of the number of people who miss their appointments. We want to encourage people to be responsible, but we also want to make booking appointments as easy as possible by having things such as online and text booking. NHS England will shortly conduct an access review, which will look at ways of developing a coherent offer to patients in terms of how they access their practice appointments. We will therefore make things easier, and hopefully bring down the number of people who miss an appointment.

Strategy and Action Plan: Improving Lives

17. What progress has been made on implementing his Department’s strategy and action plan, “Improving lives: the future of work, health and disability”, published in November 2017. (912132)

I am pleased to say that we have made strong progress against the commitments in the Command Paper my hon. Friend refers to, and I thank her for her role in delivering those advances. I can advise the House that the number of disabled people in employment is now 400,000 higher than it was in 2017. There is, however, much more to do, and on 15 July we launched a consultation on measures to reduce ill health-related job loss. We are seeking views on how employers can best support people with disabilities and people with long-term health conditions to stay and thrive in work.

I thank the Minister for her really helpful response, and I congratulate her on the fantastic work she has done in her position. Last week, the next Prime Minister announced his intention to look again at the tax treatment of at-work referral health services as a benefit in kind to employees, given how crucial fast access to health and support is to so many people. Will the Secretary of State and the Minister work with the new Prime Minister in bringing forward an urgent review, as the current tax regime goes against our focus on prevention and reducing demand on the NHS?

Absolutely. We will continue with the emphasis on work being good for people’s health. We need to look at what we can do to make it easier for employers to help their employees, which is good for everybody—it means that everyone can still make an economic contribution, and that we retain the existing workforce, and it is good for people’s wellbeing. We absolutely will look at what we can do to incentivise best practice.

It is difficult to see how lives will be improved and people supported to stay in work by NHS England’s decision, supported by Ministers, to encourage CCGs to phase out their walk-in centres—I am thinking, in particular, of the three walk-in centres that serve my constituents. I urge Ministers, even at this late stage, to set aside new funding streams so that Alexandra Avenue, the Pinn and Belmont Health Centre can continue to provide a 365-day, 8 am to 8 pm walk-in service to my constituents.

I do not share the hon. Gentleman’s view on this. Clearly, it is important for CCGs to have the freedom to determine their best primary care arrangements. Walk-in centres are convenient for people who are in work and who perhaps work away from home, but ultimately, we keep people with disabilities in work by having bespoke support for them, and that is better organised by having good primary care services near the home.

Topical Questions

This week, the Department has released a consultation on the future of clinicians’ pensions, a new five-year deal to support our approach to community pharmacy, the Government’s prevention Green Paper and a £20 million collaboration with the Prince’s Trust on the NHS widening participation initiative, which will allow and support more apprentices into the NHS. There has been a lot done just this week, and there is a lot more still to do.

Another item for the Secretary of State’s list might be to engage with his counterpart in Scotland on the issue of the NHS taper on the pensions programme. When I raised the issue with a Treasury Minister, she seemed unaware that there was more than one NHS in the UK. If there is some co-ordination and joint representation to the Treasury, that might assist matters. Would the Secretary of State agree?

Of course, in solving this problem, many of the changes can take place within the NHS, and we are working on that with the Treasury. I am happy to ensure that discussions take place with devolved colleagues, but of course, the NHS is devolved in Scotland.

T2. Provision of in vitro fertilisation in Redditch has been reduced from two cycles to one. I warmly welcome the work that the Minister has done to increase equity across the country, but what more can she do to address the postcode lottery in this and other areas, such as hip and knee surgery? (912136)

My hon. Friend is right: the postcode lottery is not acceptable, and patients manage to get around it; my local clinical commissioning group, having funded three courses of IVF, has had to reduce that to two, because demand has doubled owing to the lack of provision in neighbouring CCGs. I have made it very clear that it is unacceptable for any CCG to offer no IVF cycles at all; I have given them that guidance.

My I pursue the question asked by the Chair of the Select Committee, the hon. Member for Totnes (Dr Wollaston)? We know that obesity is a major cause of cancer and other diseases, and we know that we have severe rates of childhood obesity, so why does the prevention Green Paper say only that the sugar tax “may” be extended to milkshakes? The evidence is clear. Is the Secretary of State not kicking this into the long grass?

I have asked the chief medical officer to review the evidence to ensure that our policy for tackling obesity is evidence-driven. Follow the evidence: that is what we do on this side of the House.

A year ago the Secretary of State said, to great fanfare, that prevention was one of his priorities. Now the prevention Green Paper has been sneaked out in the night on the Cabinet Office website. Health inequalities are getting wider and wider, and life expectancy is stalling, but the Secretary of State still cannot give us any clarification on the future of the public health ring-fenced grant. Is it not the truth that he has buckled under pressure from the sugar industry, is not taking on the alcohol industry, and is not taking on the tobacco industry? That is more about trying to get in with the new Prime Minister than putting the health needs of the nation first.

I thought that the hon. Gentleman would welcome the prevention Green Paper, which was published yesterday. We have been working very hard to publish a huge amount of policy, including the Green Paper, which contains about 80 different policies to ensure that we prevent people from becoming ill in the first place. However, it is also part of a broader drive, which Conservative Members support, to ensure that we are the healthiest of nations, and that people can take personal responsibility for their health, as well as relying on the NHS, so that it is always there when people need it.

T7. Has the Secretary of State given further consideration to providing extra funds to meet the challenges of running unavoidably small hospitals, such as Scarborough and the Friarage in Northallerton? (912143)

My hon. Friend has campaigned on this matter for a while, and I was pleased to meet him to discuss it earlier in the year. We absolutely recognise the challenge that small acute providers face, and over the past two years the Advisory Committee on Resource Allocation has been considering how we might meet that challenge. The committee has endorsed a new community services formula to reflect the pressure in remote areas, which may help the two hospitals mentioned by my hon. Friend.

T3. My constituent Catherine is undergoing post-operative breast cancer treatment. A new drug, Pertuzumab, which has been approved by the National Institute for Health and Care Excellence, has been shown to improve a woman’s life chances. The drug was prescribed for Catherine by her oncologist at the Mid Yorkshire Hospitals NHS Trust, but that was overruled by NHS England, although in the neighbouring trust patients are allowed it. Can the Minister guarantee that women who could extend their lives by taking this drug have access to it, no matter where they live? (912138)

When drugs have been approved by NICE, there is an obligation to prescribe them. If the hon. Lady will write to me, I shall be able to look into this matter more closely.

I welcome the consultation on NHS pensions that was announced this week, and while I do not think that 50:50 is the ultimate solution, I welcome the invitation to present other proposals. However, given that this is causing an issue now, how quickly does the Department think that it will be able to turn the outcome of the consultation into action?

We are working very hard to turn it into action as soon as possible, and I can give my hon. Friend an absolute commitment that the new rules will be in place in time for the new financial year.

T4. I am not going to shout at the Secretary of State this morning, but I will say to him that Huddersfield is a typical town, and a lovely place in which to live and work. Given that it is so attractive, why is it so difficult for us to find doctors and dentists who can give a good service to my constituents under this modern NHS? (912140)

The hon. Gentleman will know that the Government have produced an interim people plan setting out the course and the trajectory that will mean more doctors and nurses being trained. He will also know that we have opened new medical schools this year, and that more doctors are now being trained.

I should declare that I am chair of the all-party group on eating disorders. Despite eating disorders affecting 1.25 million people across the UK and being the most deadly of mental health issues, the average time dedicated to training about eating disorders in a five-year medical degree was found to be only three or four hours; in some cases, there was none at all. Will the Minister agree to look into this and perhaps report back to the all-party group?

I certainly will. This recommendation was also made by the Public Administration and Constitutional Affairs Committee following its report into the death of Averil Hart, and we are in discussions with the royal colleges to see what more can be done, in terms of training medical staff and doctors in mental health, because we want to make sure that intervention happens at the earliest possible stage, which means that all our medical professionals need to understand it better.

T5. Constituents of mine recovering from mental health problems have told me that when they have shared their desire to return to work with jobcentre staff, jobcentre staff have used that as a trigger to move them from employment support allowance to jobseeker’s allowance, with, obviously, the financial loss involved in that. Do Ministers agree that whoever is still in their job by the end of the week could usefully talk to the Department for Work and Pensions team about how people with mental health problems can be supported back into work without being penalised? (912141)

Yes is the short answer, and the hon. Gentleman will be pleased to know that I have regular discussions with colleagues in the DWP to see what we can do to humanise all our processes for benefits claimants, because it is important that when people suffering from mental ill health interact with organisations of the state, we are not causing them harm. I can assure the hon. Gentleman that that is very high on the list of things in my in-tray.

I greatly welcome the publication of the prevention Green Paper. How will that strategy enable people to keep well by living in warm homes?

Clearly, the need for join-up across Departments of Government is a vital part of this agenda, as my hon. Friend knows from her work across different Departments; the specific point she raises is one example of that, and we must drive it forward.

T6. In the north-east, we die on average two years younger than those in the south. The Northern Health Science Alliance estimates that that costs our economy £13 billion a year, on top of the emotional and personal costs. The Secretary of State talks a lot about technology in health, but what is he doing about equality in health—or should I ask Alexa? (912142)

Technology and the data that show these inequalities are an important part of the answer, but of course it is much broader than that, and tackling health inequalities is an underpinning part of the long-term plan for the NHS; it is absolutely critical in order to address the sorts of inequalities that the hon. Lady rightly raises.

Life skills courses can be key to helping people out of depression, loneliness and isolation, and into work and training, yet the course in Glossop in my local area has been cut by the county council, in spite of it having a £2.8 million underspend this year. Do Ministers agree that local authorities should be looking to spend the public health money that they have, and to use it effectively?

Yes, emphatically we do, and there is a drive across the country for more of the sort of social prescribing that the hon. Lady talks about. The clinical solution to many people’s health issues, and in particular mental health challenges, is often about changes in behaviour and activity, and the support people are given, rather than just drugs. On the face of it, the project the hon. Lady mentions sounds very good; of course I do not know the details, but I would be very happy to look into it. However, we wholeheartedly and emphatically support the broad direction of travel of helping people to tackle mental illness both through drugs where they are needed and through activity and social prescribing.

I recently met three care workers who work for Sanctuary Care. Between them, they have 60 years of experience of, and dedication to, caring for vulnerable people, but Sanctuary Care has decided to cut their pay and conditions because they were TUPE-ed over from the Borough of Greenwich. Is this the way to treat dedicated care staff? Will the Minister meet me and those care staff to discuss what is going on at Sanctuary Care, whose chief executive gets a handout of almost a quarter of a million pounds a year, while it cuts low-paid staff’s wages?

I thank the hon. Gentleman for raising that, because one of the things that I have learned in this role is that working in care should never be described as unskilled. It is probably one of the most skilled professions, and it requires people with exactly the right principles and values to deliver it. We are clear that people should be paid a fair and decent wage, and I am more than happy to meet the hon. Gentleman to discuss it further.

The Minister with responsibility for mental health is a very sympathetic person. Unfortunately, that does not seem to translate into action. Our clinical commissioning group has stopped funding the voluntary sector to provide counselling, and now it is taking counselling services out of GP surgeries as well. Will she look into that?

Yes. What the hon. Lady has just outlined to me flies in the face of the advice that I and the clinical directors of NHS England are giving CCGs. We are clear that voluntary sector provision of additional services is crucial in the support of people with mental ill health. Unfortunately, some commissioners seem to want to medicalise everything, but that is not the key to good treatments, and I will look into it.

The prevention Green Paper talks about the risk of an opioid epidemic. In Scotland, we feel that that is already here, with 1,187 deaths in Scotland last year, 394 of them in Glasgow. Will the Secretary of State work with the Scottish Government and Glasgow health and social care partnership and support the opening of a medically supervised drug consumption room in Glasgow?

Yes, the risk of an opioid epidemic across the UK is a serious one. We have seen that risk materialise in the United States. I was as shocked as anyone to see the recent figures for the growth in opioid addiction in Scotland. While public health and the NHS are devolved to the Scottish Government, and they must lead on tackling this issue, for the UK elements of my responsibilities, we in England will do absolutely everything we can and put aside all party politics to tackle this serious problem.

In January the Health Secretary declared air pollution a health emergency, yet today, tomorrow and Thursday we will see ozone layers in the south and south-east of England that will be a health hazard to the old, the young and the sick. Unlike in equivalent situations in other countries, the Government have released no warnings to people or advised how they should take appropriate action. How bad does air pollution have to get before the Government use their not inconsiderable communications budget to warn people to take appropriate action?

We have. Through Public Health England, which is the responsible agency, we have absolutely put out communications, which I heard this morning. The communications that the hon. Lady asks for are out there. Of course air pollution is a significant risk to public health. I am delighted that it is falling to its lowest levels since the industrial revolution, but there is clearly much more that we need to do.

Can the Secretary of State confirm that the Care Quality Commission has recently inspected Calderdale and Huddersfield NHS Foundation Trust, and that patient safety was raised as an issue during that inspection? If that is the case, what action is he taking?

Clearly, patient safety is a massive priority for the Government. I do not know the exact details of the site that the hon. Lady is talking about, but if she would like to drop me a line, I will definitely find out and get back to her.