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Health and Social Care

Volume 670: debated on Tuesday 28 January 2020

The Secretary of State was asked—

Access to GPs

With your permission, Mr Speaker, I will answer Questions 1, 4, 6, 11 and 20 together. [Interruption.] General practice is a popular subject.

We will create an extra 50 million appointments a year in primary care so that everyone can go to the GP when they need to.

There are many families with children in Gedling. What is being done to ensure that patients, particularly families with young children, can access GP appointments when they need them?

Obviously this is an incredibly important subject, and I know the frustration many families feel at not being able to access a GP appointment when they need it. We have a whole-scale programme of work to improve access. This includes recruiting 6,000 more GPs and 26,000 primary care staff other than GPs— increasingly patients at GP surgeries can be treated by nurses—and increasingly enabling people, especially those who find it difficult to travel, to use technology to get the treatment they need.

Hastings has a shortage of salaried GPs and GP services—locum GPs are available, at the right price. Will the Secretary of State please outline what steps he is taking to increase the number of salaried, rather than locum, GPs and GP services in Hastings and Rye?

My hon. Friend is right to ask. It is incredibly important that we get the right number of GPs, not least to reduce the amount spent on locums, who can be very expensive and often do not know the local population as well as salaried GPs. Her local clinical commissioning group is developing a new-to-practice fellowship in Hastings for GPs starting out in practice in order to encourage more doctors into practice and then to support them. It is also working with primary care networks so that more can become GP trainers and take on students. We are expanding the numbers going into GP training—there were record numbers last year—but I want the numbers to go up again and to make sure that Hastings gets the GPs it needs.

As part of the council area with the second-largest population increase in the country, the people of Biggleswade, Sandy, Arlesey and Stotfold are at their wits’ end over access to GP appointments. What special attention will the Secretary of State pay to those areas of large population growth to make sure that increases in housing are matched by increased access to GPs?

That is an incredibly important point. We have a manifesto commitment to ensure that where there is new housing there is also new primary care. Just as a new housing estate will often require a new primary school and new transport links, so we need to put in the GPs as well.

I thank the Secretary of State for visiting Tettenhall Wood surgery in my constituency during the general election campaign. Will he work with me to increase the numbers of patient appointments back up to where they were before?

Yes. My hon. Friend has already become an incredibly strong voice for Wolverhampton, and it was a pleasure to visit Tettenhall medical practice, which has joined with other GP practices to form a primary care network, which I hope will strengthen its resilience and enable it to provide extended access to appointments, which is what he is campaigning for. I am pleased, too, with the extra 16,000 appointments in Wolverhampton in the last quarter. As this shows, we are driving up the number of appointments, but we also appreciate, understand and feel the frustration people feel when they cannot get decent access to GP appointments.

Changes to pension contributions mean that some senior GPs, including in Newbury, are being hit with extra tax charges if they work overtime, which is leading to the paradoxical situation of GPs paying to work and so reducing their hours or taking early retirement. What steps is the Secretary of State’s Department taking to address this situation?

Tax is, of course, a matter for the Treasury, and the Chancellor would not be thrilled if I announced tax policy in the middle of Health questions, tempting as that may be. However, we have been working with the Treasury, and also with the Academy of Medical Royal Colleges, the British Medical Association, employers in the NHS and others, to deliver on our manifesto commitment to sort this out.

You rather surprised me then, Mr Speaker!

The Secretary of State mentioned primary care networks. As he will know, two weeks ago GPs rejected the new service specifications in those networks. This has been described as a debacle, and as leading to more red tape and taking GPs away from patients. If the Secretary of State is going to fix these contracts, can he tell us how he is going to do it—or is he content to see more GPs walk out of primary care networks before they have even got off the ground?

Primary care networks have been an incredibly successful innovation, covering the whole country and allowing practices to work together. Of course, the negotiations with the BMA over the GP contract are always tough: they have been in every year in which they have taken place. The hon. Gentleman will understand why I want to get the best possible value for the money that the NHS spends, but I also want to see a successful conclusion to this negotiation, and we are working with the BMA to that end.

The Secretary of State describes primary care networks as a great success, but a local medical committee in Buckinghamshire and Berkshire has just warned that they will cost each practice £100,000 more. Having failed to deliver the 5,000 extra doctors that the Government previously promised, having failed to recruit more GPs in the poorest areas, having now bungled the negotiations over this contract, and having failed to fix the pension tax changes for which he was partly responsible, how on earth can the Secretary of State be trusted to deliver on the Prime Minister’s promise to cut GP waiting times to less than three weeks?

It is a bit of a disappointment to hear the hon. Gentleman talk down primary care. We are making record investments in primary care, we have record numbers of GPs in training, we are seeing an increase in the number of appointments in Wolverhampton and across the country, we are negotiating with GPs to strengthen general practice, in the last year we have introduced primary care networks that help to make primary care more sustainable, we are improving the technology that is available in primary care, and, for the first time in a generation, the proportion of the total NHS budget going into primary and community care is rising, whereas there were cuts under Labour. I think the hon. Gentleman should be standing up and saying thank you.

Hanwell health centre, which works hard to serve many of my constituents, has told me that it has been trying to appoint a salaried GP for three years, as well as a large number of nurses. There is generally a four-week wait for an appointment, although the centre has provided 75 more appointments to cope with demand. Under the Secretary of State’s plans, when will those waiting times come down?

This is precisely why we need to recruit more GPs, in the hon. Gentleman’s constituency and across the country, and also recruit more other clinicians to general practice. [Hon. Members: “How?”] I will tell you how, Mr Speaker. In the first instance, the record numbers of GPs in training will help, but that is not the entirety of the plan. I urge the hon. Gentleman to get on board and support general practice.

In 2015 the Secretary of State’s predecessor promised 5,000 more GPs by 2020. The Secretary of State repeated that promise when he took over the job, but my constituents are finding it increasingly difficult to get a GP appointment within three weeks. Will the Secretary of State now apologise to everyone who is waiting for failing to keep his promises?

The commitment that we have made is that we will have 6,000 more GPs and 26,000 other clinical staff in general practice. That is the commitment that we have made, and that is the commitment on which we will deliver.

In rural communities such as mine, GP surgeries often serve huge geographical areas with relatively small patient numbers. Coniston, for example, has a roll of about 900 patients, yet the next nearest surgery is two lakes away. Will the Secretary of State commit to establishing a strategic small surgeries fund to ensure that small surgeries in rural communities remain sustainable for the long term?

The hon. Gentleman makes an incredibly important point. General practice, where 90% of all NHS appointments take place, needs to reach every part of this country, including his beautiful constituency, which is, as he says, very sparse. Of course we need to ensure that the practices there are sustainable, and again this is an area in which technology can be of particular help. There is great enthusiasm for using technology so that the travelling times of patients and sometimes of GPs can be reduced.

Adult Social Care

The Government have enshrined in legislation through the Care Act 2014 a council’s statutory duty to meet eligible needs for adult social care. We have given councils access to up to £1.5 billion more dedicated funding for social care in 2020-21 to help them to meet this requirement.

Figures from Age UK show that 1.5 million people aged 65 and over have an unmet social care need, and Age UK estimates that this figure will rise to 2.1 million by 2030 if we carry on as we are. In my constituency, that equates to 3,012 older people with unmet needs and 2,517 older people providing unpaid care. Those are real people who are not getting the help they need. The Prime Minister said last summer that he had a plan to “fix” social care. Where is it?

As I have explained, the Care Act sets out the requirement that entitles individuals to a care needs assessment and sets a minimum national threshold at which care should be delivered. We have backed councils up by giving them access to £1.5 billion in additional funding in the next financial year. In the hon. Member’s constituency, that will equate to an additional £5.1 million from the new social care grant. This is something that the Government take very seriously.

According to the Institute for Fiscal Studies, more than 1.8 million older and disabled people are currently going without the support that they need to live independently. This crisis has come after the Conservative Government abolished the independent living fund and cut nearly £8 billion from adult social care budgets. In 2017, we were promised a Green Paper, but there has been nothing. Months ago, the Prime Minister stood on the steps of 10 Downing Street promising to “fix” social care, so when will the Government finally publish those plans?

We just do not recognise the figures that the hon. Lady is parroting. Public spending on adult social care in 2018-19 reached £17.9 billion in cash terms, which is the highest level on record. Since 2016-17, our sustained investment has enabled spending to increase by 7% over this period. But do not take it from me—the Local Government Association said last year:

“This is the biggest year-on-year real terms increase in spending power for local government in a decade and will allow councils to meet the rising cost and demand pressures they face in 2020/21.”

While the Scottish Government spend 43% more per head on social care, this Government’s NHS Funding Bill does nothing to address the £6 billion funding gap in England. Does the Minister accept that she cannot fix the NHS without fixing social care?

I completely agree with the hon. Gentleman that adult social care and the NHS are indelibly linked. The one must support the other, and the one drives costs with the other. The over-65 population is projected to rise over 50% by 2035, so putting social care on a sustainable footing where everyone is treated with dignity and respect is one of the biggest challenges we face in society. That is why it is one of the Prime Minister’s biggest priorities.

Scotland introduced free personal care for the elderly in 2002, and this has now been extended to those under 65 who need it. Will the Minister follow the Scottish Government’s lead and introduce free personal care so that people can live with dignity in their own homes?

The Prime Minister has set out his plans. He wants to seek political consensus and bring forward a plan for adult social care this year, and we are looking at a whole range of solutions, including free personal care. The issue we see in Scotland is that the initiative must be backed up with a huge amount of money. The money that the Scottish Government used to give to individuals covered around 50% of their care home costs and now only covers around 25%. That is why we must ensure that we address this issue with a long-term view.

It is time to tackle unmet need, which is clear from my hon. Friends’ questions. Ministers say that they want to seek a consensus on the future of social care, but we already have a proposal with wide-ranging support, including from former Conservative Chancellors in the Lords, major national charities, and the official Opposition: free personal care funded from taxation. Will the Minister accept that the way to move things forward is for the Government to join the existing consensus on introducing free personal care?

The Prime Minister said that the Government will deliver on our promises. We will bring forward a plan for social care this year—

This year. However, there are complex questions to address. A Joint Committee of the Housing, Communities and Local Government Committee and the Health and Social Care Committee came up with an entirely different solution—a social insurance model—which shows why we want to build a consensus. Even the Liberal Democrats have said that they want to build cross-party consensus, but we know the hon. Lady’s view on cross-party consensus: her way or the highway.

Given that we will not end the annual cycle of winter crises until we fix the problems in adult social care, does the Minister agree that, however important the commitment that people will not have to sell their home, the absolute priority in any discussions with the Treasury must be to get more money to local authorities so that they can discharge their responsibilities to older and more vulnerable people?

My right hon. Friend did some incredible work in this area when he was Secretary of State for Health and Social Care. In fact, he presided over the Department being renamed to draw reference to the importance of social care. He is absolutely right that we must ensure that councils have the money they need for the short term, but we must also work towards a consensus so that everybody will have safety and security and that nobody will be forced to sell their home to pay for their care.

I declare my interest as a member of Kettering Borough Council. Taking advantage of imminent local government reorganisation in Northamptonshire, will the Minister continue to encourage local councils and the two local hospitals to bring forward innovative proposals under one budget for an integrated health and social care pilot in Northamptonshire?

My hon. Friend has already been a really good champion of collaborative health and social care work. He has made some excellent suggestions, and we have seen how things such as the better care fund, through which health and care pool their resources, can have a positive effect for local communities. I encourage his local area to look closely at how that sort of work can be maximised and moved forward.

As the Minister will know, the particular problem in rural areas is that need is not just unmet, but unseen. What steps has the Minister taken, or what does she have in mind, to fix the situation and find that need so that it can be met?

My hon. Friend is right to draw attention to rural sparsity and the challenges facing rural communities. We are committed to undertake a review of relative needs and resources, and it will be a thorough evidence-based review of the costs facing all authorities, including how factors such as rurality, sparsity and other geographical features affect the cost of delivering services across the country and how to account for them in a robust manner.

For the record, I declare my interest as the spouse of an NHS doctor. The Pinn Medical Centre in my constituency is due to close its walk-in service so that Harrow CCG can save money, but the likely diversion of patients to local A&E services will end up costing the NHS more. Will the Minister join me in encouraging the CCG to consider the wider context of NHS budgets and to support the service while local NHS providers consider how to increase access to GP appointments in line with our manifesto commitments?

My hon. Friend is right to highlight the importance of access to primary and community services within Pinner. My right hon. Friend the Secretary of State will be happy to meet him to discuss the matter further, but we will support anything he is doing to assist his local services.

PrEP Commissioning

3. What discussions he has had with the Secretary of State for Housing, Communities and Local Government on providing assistance to local authorities preparing for the routine commissioning of PrEP. (900429)

I have spoken to the relevant Ministers in the Ministry of Housing, Communities and Local Government, and my officials are working closely with other key stakeholders to ensure that we deliver routine commissioning of PrEP—pre-exposure prophylaxis—to help end new HIV transmissions. This is a key interest not only of many hon. Members but of many broader stakeholders, and I know the issue is particularly dear to the hon. Member’s heart.

I am grateful for the Minister’s response and for the Secretary of State’s announcement that he wants routine commissioning of PrEP by April, but what he and the Department have not done is spell out how they will achieve it. The PrEP trial will end this year, and we need a guarantee that every single person who needs and wants PrEP will get it from April.

I assure the hon. Gentleman that NHS England and NHS Improvement have already agreed to fund all the ongoing costs of the drugs for PrEP going forward. We will provide information on how the other elements of the programme will be funded and how commissioners will be supported. He is right that the trial ends in July, but routine commissioning will be rolled out from April—we will make sure they dovetail. It is hugely important that PrEP is available for each and every person who wishes to access it.

In October last year, the Government confirmed that the local authority public health grant will increase by 1% in real terms in 2020-21. However, this funding has not yet been allocated to local authorities. How will the Government financially support local authorities to establish the routine commissioning of PrEP by April?

As I said, NHS England and NHS Improvement have already agreed, within the ring-fenced funding for public health, to fund the ongoing costs of drugs for PrEP going forward. There will be an additional allocation of funds to cover the PrEP roll-out completely[Official Report, 3 February 2020, Vol. 671, c. 1MC.].

NHS: Take-up of New Technology

5. What steps he is taking to ensure the take-up of new technology by the NHS to support effective delivery of its services. (900431)

24. What steps he is taking to ensure the take-up of new technology by the NHS to support effective delivery of its services. (900451)

Using the best technology is good for patients, clinicians and the NHS. Work is under way to drive through the use of new technology, including electronic referrals and electronic prescribing, and to end the painfully slow logins in some trusts.

My right hon. Friend will know that the Future Fit programme, if passed, would have brought not only £312 million but a lot of innovative, pioneering technology into the county of Shropshire. Unfortunately, as he knows, the programme has been blocked thus far by the Labour-controlled, medically illiterate Telford and Wrekin Council. Does he agree that investing in technology would help patients and clinicians and would save money in the long term?

Yes, I do. It is striking how much clinicians working on the frontline are desperate for improvements in the technology they use. Our announcement over Christmas that we will have a single login, which is seemingly so simple, brought enormous enthusiasm from clinicians who spend hours of their week doing things that most of us can do with the click of a button on the systems we use.

My hon. Friend has been an assiduous campaigner for health investment in Shrewsbury, both physical capital investment and investment in modern technology.

I welcome the phasing out of outdated technologies, such as fax machines, in the NHS. As the switch-off date approaches, what steps is NHS England taking to ensure that patient records can be transferred electronically between primary and secondary healthcare providers?

My hon. Friend is spot on. We are driving interoperability so that the right people can see the right records at the right time. We will mandate that technology used in the NHS must allow for such interoperability, and we will set standards.

My hon. Friend started the “axe the fax” campaign, in which I was happy to play my part. Faxes are terrible for efficiency and for data security—even straightforward email is so much better—and we will drive up data security by axing the fax across the NHS.

What specific investment is being directed to supporting the 11 new radiotherapy IT networks that are required to provide a world-class radiotherapy service and improve cancer outcomes and survivability?

Radiotherapy is a good example of part of the NHS that can benefit hugely from improved technology now and from the cutting-edge artificial intelligence-type technologies that are coming down the track. I am happy to look at any specific proposals the hon. Gentleman has. We have a broad programme to support the technology needed in radiotherapy.

I am disappointed that the Secretary of State could not come to the opening last Friday of the Advanced Wellbeing Research Centre in my constituency, which is looking at linking research into the prevention and treatment of chronic diseases with physical activity, using new technologies including robots. I am pleased that he has contributed £14 million to this project. He has missed that opportunity, but may I invite him to come to the centre and to discuss how he can help to set up a centre for child health technology, again using innovative and technological solutions, towards which we will expect his contribution to be helpful?

The hon. Gentleman is a man after my own heart. I am sorry that I missed the ribbon cutting, as I love a good ribbon cutting, especially where the project sounds so brilliant and innovative, bringing different parts of the NHS together and helping clinicians in order to help patients. I am glad that he is as enthusiastic as I am about our £14 million investment.

Health and Social Care (Buckinghamshire)

8. If his Department will fund the digital transformation of health and social care services in Buckinghamshire; and if he will make a statement. (900434)

We are driving forward the technology agenda across the NHS, as we have just been discussing. Buckinghamshire Healthcare NHS Trust is one of the many trusts being considered for digital aspirant funding, which is the next generation of funding to bring hospital trusts into the 21st century.

I am grateful for that, but will the Secretary of State support moving to devolved, multi-year and unified budgets, to enable the delivery of digital technology and, in particular, best value, against specific outcomes?

Yes, my hon. Friend is spot on. We recognise the need for a multi-year capital settlement in the NHS to support exactly that sort of planning and to modernise, and the Treasury has confirmed that we will publish that settlement at the next capital review.

University Hospital of Hartlepool

9. What discussions he has had with the Hartlepool and Stockton-on-Tees clinical commissioning group on the future of services at the University Hospital of Hartlepool. (900435)

My right hon. Friend the Secretary of State has had no discussions with the CCG on the future of services at the University Hospital of Hartlepool.

Hartlepool’s hospital is vital to our community, but its future very much depends on consultancy-led services. What reassurances can the Minister give me that consultancy-led services will be returned to that hospital?

I am conscious that both the energetic Mayor Ben Houchen and the hon. Member have campaigned on working to reinstate accident and emergency and maternity services at Hartlepool’s hospital. Although there are currently no plans that I am aware of to change the model of services, and reconfiguration matters are for the CCG, I am happy to meet him and the Mayor to discuss the hospital if that is useful.

Thank you, Mr Speaker. As another north-east MP concerned about local healthcare, I asked the Prime Minister two weeks ago about retention of the stroke service at Bishop Auckland Hospital. Has the Minister made any progress on that point?

My hon. Friend is already a doughty champion and spokesperson in this House for her constituents on health matters—indeed, she was just that in yesterday’s Second Reading debate on the NHS Funding Bill. I am pleased to inform her that my right hon. Friend the Secretary of State has already met the chief executive of the NHS and the regional NHS director responsible and discussed this matter with them.

Life Expectancy

Although life expectancy at birth remains the highest it has been, we want everyone to have the same opportunity to have a long, healthy life, whoever they are, wherever they live and whatever their background. We are committed to giving everyone five extra years of healthy life by 2035, and to addressing the needs of areas with the poorest health.

Life expectancy advances depend on good local service provision. Does the Minister agree with me and the people of Jarrow that, following the devastating closure of St Clare’s Hospice, we should take all possible steps to ensure that palliative care provision is put in place urgently in Jarrow constituency? Will she meet me to discuss this important issue?

I am unaware of the closure of that hospice, but my door is open to the hon. Lady. If she would like to see me at the back of the Speaker’s Chair after questions, we can arrange a suitable time to discuss the issue.

Today, a baby girl born in Liverpool can expect to live 13 fewer years in good health than a baby girl born in Richmond. A new study from University College London shows that being wealthy adds nine years to healthy life expectancy. Does the Minister agree that such health inequalities are an injustice in society that must be addressed urgently?

The best way to improve life expectancy is to prevent health problems from arising in the first place. Prevention is one of the top five priorities for the health service, and we are taking action to help people live longer and healthier lives. The Government have a proven track record of reducing the harms caused by obesity, tobacco and other substances. That is where we need to focus our efforts to ensure that life expectancy rises in all areas throughout the country.

The most shocking trend in life expectancy is that people with learning disabilities die so early—on average 25 years younger than the general population. We must see action to learn the lessons from each of those early deaths. The contract for the University of Bristol’s running of the learning disability mortality review ends in May, and there is now a growing backlog of cases, so will the Minister tell the House what the future of this important review is, and what staff resources are needed to continue the vital work of reviewing and reporting on early deaths?

We will introduce mandatory training for all health and social care practitioners. I hope that that will address the particular problem that the hon. Lady has brought up. It comes back to the substantial life expectancy issue, which is that regardless of the group, prevention is key.

In her initial response, the Minister rightly emphasised the importance of rising healthy life expectancy, as well as life expectancy more generally. Will she therefore join me in welcoming the forthcoming report from the all-party group on longevity—[Interruption.] If the Minister is listening, will she welcome the report, which will give the Government practical advice specifically on how to use prevention to raise the levels of healthy life expectancy?

I could not agree more with my right hon. Friend. We want everyone to have the same opportunity to have a long and healthy life, whoever they are, wherever they are and whatever their background. We will certainly look at that report.

I welcome the fact that one theme underpinning the NHS long-term plan is prevention, to help enable people to live better lives for longer. Does my hon. Friend agree that supporting people to make healthier choices, combined with improved screening and diagnostic services, will help to increase life expectancy?

I very much agree, and that is where the Government are directing their efforts. My hon. Friend mentioned screening; we have put extra resources into screening and scanners, including in Peterborough. We are absolutely attacking on screening programmes and on obesity and tobacco—all those issues that we know affect life expectancy and cause harms. The Government have made those issues their top priority.

Health Inequalities

We are determined to address the long-standing inequalities that exist in many areas, be they in access, outcomes or people’s experience of their local health service. Our world-leading childhood obesity plan, NHS health checks, the tobacco control plan and the diabetes prevention programme all see us leading the way, but there is undoubtedly more targeted work to do on this complex issue, particularly in areas of high need.

The recent mental health prevention Green Paper recognised the link between deprivation and poor mental health outcomes. Along with the proper funding of frontline and early intervention services, mental health inequality needs urgent action, so when will the Minister get to work to sort out this mess? People in east Hull desperately need access to services that are currently not available.

I agree with the hon. Member. I and my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), who has responsibility for the mental health element of the portfolio, are working hand in glove on this. Often, it is the dual toxicity of addiction—be it substance or alcohol abuse—and mental ill health that drives health inequalities. We are targeting the matter and working together on access to make sure that we drive down these health inequalities.

Many people with severe conditions such as agoraphobia face inequalities in accessing life-saving services such as cervical smear tests. What is my hon. Friend doing to ensure that these services can be administered outside a clinical setting, thus reducing health inequalities for those who, for whatever reason, are housebound?

No woman should be denied access to vital screening. I believe that my hon. Friend is referring to a particular matter in her constituency where it has been very difficult for somebody to access screening. I am happy to meet her to see how we can work through this. We are actually working on a home kit for cervical screening, which should help in time, but nobody should be denied access. We are committed to improving access for all women, and I will be happy to meet her to see what we can do.


Ministers have not received any recent representations. However, as we know, Baroness Cumberlege is leading the independent medicines and medical devices safety review, which includes an examination of what happened in the case of Primodos. Her review has had lengthy engagements with people who have been affected.

As the Minister is aware, the hormone pregnancy drug test Primodos was taken by around 1.5 million women in the ‘60s and ‘70s, leading to birth defects, miscarriage and stillbirth, and, 50 years on, those affected still wait for justice. The review into this scandal, announced in 2018, was very welcome, but can the Minister confirm that, if it is merited, she is open to establishing a comprehensive public inquiry following the publication of the review to ensure justice for those affected?

Baroness Cumberlege’s review is examining what happened in the case of Primodos and will determine what further action is required. Ministers will consider any recommendations very carefully. We do not have a date for the publication of the review, but it will be very soon. Perhaps we can continue the conversation then.

Accident and Emergency Waiting Times

19. What recent assessment he has made of performance against waiting time targets for A&E services throughout England. (900445)

Winter is the most challenging time of year for our NHS, when cold weather and an increase in flu cases place additional pressures on the service. As ever, the NHS staff have done an amazing job this winter, and the NHS has seen a significant increase in demand, with 1 million more patients attending A&E in 2019. The December figures, when compared with those in 2018, show a 6.5% increase on attendance at A&E.

I do not know whether the Minister is aware, but we have a winter every year. We have had one for the past 71 years, and yet these are the worst A&E waiting times in history, and they are the culmination of the policies that his party has followed for the past nine years: the cuts in social care, the number of GPs driven out of practices, and this Government’s failure on prevention. All of that has led us to the worst A&E waiting times in history, and the Minister’s answer does not start to look at the failure that he has delivered.

Well, as I pointed out to the hon. Gentleman—he may not have heard this—demand in A&E has significantly increased this winter. He asks about GPs. I am sure he fully supports our clear commitment to 50 million more GP appointments and 6,000 more GPs. I am sure he also welcomes, in his own constituency, the £19 million investment by this Government in 2017 in a new urgent treatment centre, which will serve his constituents and is due to start work this summer.[Official Report, 29 January 2020, Vol. 670, c. 6MC.]

Between winter 2018 and winter 2019, the proportion of A&E attendances in Bradford that were seen within the four-hour target fell by seven percentage points, putting patients at risk and overstretching already pressured staff. In Health questions in October last year, I warned the Minister of these very real dangers, but he refused to meet me even to discuss the matter. Will he now answer the question as to why further funding was not made available to stop staff and patients at Bradford Royal Infirmary being put at risk?

I remind the hon. Gentleman that Bradford treated more people in A&E this winter than in any previous one, and although he may have omitted to do so, I want to pay tribute to and thank the staff at Bradford for that work. The Conservative party is the party that is investing in our NHS, our A&Es and our staff, and the hon. Gentleman should welcome that.

I think it is time that we shook this Government out of their complacency. On their watch, the four-hour A&E waiting target has never been met, and performance is getting worse each month. It is no wonder they are putting so much effort into getting rid of it. We agree with the president of the Royal College of Emergency Medicine, who said:

“Rather than focus on ways around the target, we need to get back to the business of delivering on it.”

Does the Minister agree?

First, 1.7 million more people are being seen within the four-hour target now than before 2010. I hope that the shadow Minister will acknowledge that that reflects the significant increase in demand due to the number of people going through the system. He talks about the review of standards. That is a clinically-led review, and I am sure he would want to let those clinicians lead it. We will see what it reports and will consider its recommendations when they come back to us. In the meantime, we are getting on with investing in our NHS, and improving services.

Topical Questions

As well as working to protect the public from infectious disease outbreaks, we are working to improve technology and recruit the workforce that the NHS needs. Figures just out show that we have record numbers of nurses working in our NHS—up by over 7,800 on the same time last year.

May I acknowledge the good work done by the Minister for Care, my hon. Friend the Member for Gosport (Caroline Dinenage), resulting in a regional breakdown of the transforming care programme? It shows where progress is not being made, and that the target of 35% of in-patient beds being closed down will not be met by this March. How will the Secretary of State shut down these hell-holes, and will he hold to account commissioners who are still sending people with learning disabilities to them?

I am really pleased that my right hon. Friend has driven forward, and is holding us—and, in turn, the NHS—to account for delivery of this vital agenda; it is incredibly important to get this right. The number of people with learning disabilities and/or autism who are in in-patient settings is falling, but not as fast as I would like. We have a clear commitment in the long-term plan to bring it down by half. As she says, there is a target to bring it down by the end of March. The Minister for Care has done a huge amount of work to drive this forward, and we will do everything we can to ensure that all these people, who are some of the most vulnerable in the country, get the best support they can in the right setting. I welcome my right hon. Friend’s scrutiny.

T3. The West Suffolk Hospital has been in the news for all the wrong reasons. I guess all Members try to keep their fingers on the pulse of their local hospitals, but does not the fact that West Suffolk constituents are represented by both the Secretary of State and the Under-Secretary of State for Health and Social Care, the hon. Member for Bury St Edmunds (Jo Churchill), show that something has gone fundamentally wrong in the scrutiny and oversight of our NHS? What has gone wrong, and what is the Minister going to do about it? (900454)

I would not draw that conclusion about my right hon. and hon. Friends. What I would say, though, is that I want all staff to feel that they can speak up and have the confidence that anything they raise will be taken seriously. That is why I requested on 17 January that NHS England and NHS Improvement commission a rapid and independent review into how the West Suffolk NHS Foundation Trust has handled this issue. I will be happy to update Members, including the hon. Gentleman, when that review reports.

T2. Last week, due to ongoing workforce challenges, Northern Lincolnshire and Goole NHS Foundation Trust temporarily transferred all oncology services to Grimsby’s hospital. This is not acceptable to local patients. Will the Secretary of State join me on a visit to Scunthorpe General Hospital so that we can discuss this and other issues with local NHS staff? (900453)

I appreciate the concerns raised by my hon. Friend about that matter. I understand that the changes, which have been made for patient safety reasons, are temporary, with a review to follow led by the Humber, Coast and Vale cancer alliance. As we monitor the results of the review closely—I will continue to take a close interest in this matter—either I or my right hon. Friend will be happy to take up her invitation for a visit.

T8. In my constituency, year-on-year reductions in funding of both adult and young people’s mental healthcare mean that some of our most vulnerable citizens are falling through the net. Can the Government guarantee that adequate funding will be made available to tackle the mental health crisis now? (900459)

There have been year-on-year increases in funding for mental health services, but there is also an increase in demand. The long-term plan has the largest increase reserved for mental health services, because we want to see mental health and physical health treated on a par.

T4. Labour’s private finance initiative contract means that Royal Stoke University Hospital is paying double the interest on its debt than if it had been funded directly from the Treasury—money that should be going to improve patient care. Will my hon. Friend agree to look at how these costs can be mitigated? (900455)

I am grateful to my hon. Friend, who, along with my other hon. Friends who represent Stoke, has raised this issue in the past; they are right to highlight it. My hon. Friend is absolutely right that Labour’s PFI deal has left the trust burdened with debt. My Department’s PFI centre of best practice supports trusts in ensuring best value, and I will happily ask it to work with him. Yesterday I also committed to meet him and my other hon. Friends to discuss this matter.

Throughout the election there were empty promises from the Conservatives, and one of those promises was to tackle the social care system—but there is still no Green Paper. There are dementia patients who are trapped in hospital due to an inadequate social care system, and yet this Government still do nothing. How many more families have to suffer before this Government act?

In Maghull, Formby and Crosby in my constituency, the health facilities are simply not fit for purpose. Significant house building will only make matters worse and make it that much harder for the Secretary of State to deliver on the promises he set out earlier in today’s Question Time. Will he meet me to discuss how to get the funding so that we have the state-of-the-art, high-quality facilities that my constituents and medical staff need?

I spent much of the latter part of last year travelling around the hon. Gentleman’s part of the world and meeting then candidates. I am very happy to meet him to see how we can use the record levels of capital investment in our NHS—the record levels of funding that he should support—to support his constituents as well as everybody else’s.

T5. Tameside Hospital A&E has seen a huge increase in patient numbers, often leading to overcrowding, with patients being assessed and treated in unsuitable areas. The Government have rightly responded by committing to building a new urgent care centre for Tameside. Will the Secretary of State update the House on when construction is due to begin? (900456)

We want to begin construction urgently. My hon. Friend has been assiduous in promoting and supporting this project, which he has raised with me a number of times. I look forward to meeting him in the next week or so to go through the details of when we can see it open.

T6. My right hon. Friend will know that the A&E services at Burnley General Hospital were closed in 2007 by the then Labour Administration. Given our record investment in the NHS, and the pressures on the A&E, will he agree to meet me to talk through the future of the hospital and the services we can provide locally? (900457)

My hon. Friend, like his colleagues, has already proved himself to be a doughty champion for his constituency. The urgent care centre at Burnley General Hospital will continue to play an important role in meeting urgent care needs locally, but he is right to highlight the broader importance of Burnley as part of the health ecosystem in his area. I would be delighted to meet him.

There are real concerns in east London about the big delays in the breast cancer screening programme, meaning that many women are not getting their first screening until close to their 53rd birthday. Will the Minister meet me and other concerned east London MPs to ensure that we tackle that, to the benefit of our constituents?

I would be delighted to meet the hon. Lady and other east London MPs. Mike Richards has done a review of screening, and we need to level up and ensure that everybody can access screening.

T7. In December, more than 2,200 patients waited in excess of 12 hours in A&E departments in north Wales. What is the Secretary of State’s response to the Welsh Government, who have managed the health board in special measures for nearly five years? [R] (900458)

I worry about the delivery of health services to people in Wales. Although this issue is devolved, I am the UK Health Minister, and my hon. Friend is right to raise that issue for his constituents. The number of people waiting more than one year in Wales is over 4,000. In England, despite the much larger population, it is only just over 1,000. The Welsh NHS, frankly, is an advert for why people should not want the Labour party running the NHS.

A number of women in my constituency have recently been in touch who are going through the menopause and struggling to access hormone replacement therapy, which they really need. What assessment has the Secretary of State made of current supplies of HRT, and what is he doing to address the shortages?

That is obviously an incredibly important issue. The shortages come from problems with factories outside the UK. We have been working hard on it through the autumn. I am advised that the shortages are starting to be mitigated and that production is back up and running, but we keep a close eye on it, because I understand how important it is.

T9. Will my hon. Friend commit to working with me to secure the long-term future of hospice services in any reorganisation of the Mount Vernon Hospital site in my constituency? (900460)

We are very committed to hospice services, which is why an additional £25 million went into hospices last year. I am certainly happy to meet my hon. Friend to discuss the hospices in his area.

Cuts to local government budgets have led to cuts to public health budgets, which have led to cuts to preventive services, which have led to greater demand in A&E and social care. It is bad for individuals, and it is terrible for the health and social care system, yet this weekend, we saw media reports that there are more cuts coming to local government, especially in the poorest communities. Can the Secretary of State assure us that he will tell colleagues in the Treasury and the Ministry of Housing, Communities and Local Government that those cuts cannot take place?

I do not need to, because we are clear that there is an increase in the spending power of local authorities and in the public health grant.

T10. Last week was Cervical Cancer Prevention Week. Will my hon. Friend join me in commending the work of my constituent Maria Dullaghan and the charity Jo’s Cervical Cancer Trust, which campaigns to raise awareness? Will she underline the Government’s support for Sir Mike Richards’s review of the adult screening programme? (900461)

I am delighted to join my right hon. Friend in congratulating Jo’s Cervical Cancer Trust on the work it does. I had the pleasure of meeting its team only last week, who do fantastic work to raise awareness of vital cervical screening. He is right about Mike Richards’s review. We must ensure that we screen all the available population in order to see cervical cancer eliminated for good, which would be brilliant. I am delighted to support this year’s “Smear for smear” campaign. There is nothing shameful about human papillomavirus, and we must bust the myths, because being tested can save someone’s life.

Following the desperately upsetting news headlines last week about preventable baby deaths at East Kent, including that of Harry Richford, aged just seven days old, whose death was described by the coroner as “wholly avoidable”, will the Secretary of State join me and Harry’s family in calling for a full, transparent public inquiry?

I thank the hon. Lady for raising this issue, and also my hon. Friend the Member for Dover (Mrs Elphicke), who made an excellent speech last night about this very issue at East Kent. I would like to reassure the hon. Lady that the Care Quality Commission conducted a further investigation of the whole trust last week and will take enforcement action if necessary. On Monday, I asked it to provide a summary report within 14 days. The Healthcare Safety Investigation Branch has examined 26 individual maternity cases at the trust, and it has already reported on 15. It was also asked on Monday to complete its work within 14 days and to send in a summary report to give us further information.

The Secretary of State will know that my local Labour party has been running an outrageous campaign saying that the Parsons Green walk-in centre is set to close. The clinical commissioning group has confirmed that that is not the case, and the facility is both busy and popular. Will he join me in condemning this latest scare tactic from my local Labour party about local NHS facilities that are both popular and well used?

That is absolutely right. Last year, my right hon. Friend campaigned for and secured the long-term future of the Parsons Green walk-in centre. That announcement was made, and then the scaremongering carried on, supported by the local Labour party and the hon. Member for Hammersmith (Andy Slaughter), who is a disgrace in the way he campaigns because it worries vulnerable people who think that things are going to close. I pay tribute to my right hon. Friend and send a message to people far and wide in Parsons Green that their walk-in centre is staying open.

Order. I am sure the Secretary of State would acknowledge that I am trying to get the last few questions in, and I think we can speed up rather than trying to make any last final points.

May I ask the Secretary of State what screening plans are in place for those arriving in the UK from China, and has a contingency fund been established to tackle the potential effects of the coronavirus?

Of course, it is incredibly important that we have appropriate measures in place for those who return from China—not only those returning from outside Wuhan, but those returning from Wuhan should they do so. Those are being put in place, and of course we are making budgets available to ensure that all necessary support is given.

Order. Unfortunately, that is the end of questions. I hope that we will get in a few more next time.

The House will wish to be aware that there will be a statement today after the conclusion of proceedings on the Direct Payments to Farmers (Legislative Continuity) Bill. I cannot confirm a time exactly, but it should be before 3.30 pm, and the start of proceedings on the Third Reading of the Bill will serve to give some notice of the likely start time. I hope that is helpful to Members.