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Oral Answers to Questions

Volume 623: debated on Tuesday 21 March 2017


The Secretary of State was asked—

Domestic Students of Medicine

1. What steps he plans to take to increase the number of opportunities for domestic students to study medicine. (909354)

We are funding 1,500 additional medical school places each year to ensure that the NHS can continue to deliver safe, compassionate and effective care well into the future. Around 500 places will be made available in September 2018, and the remaining 1,000 places by September 2019.

In Taunton Deane, we are desperately short of trained health professionals, from dermatologists to nurses, but one of the worst shortages is of GPs, with some practices not even able to get locums. I know Ministers are working on this, but could my right hon. Friend update me on what the Department is doing to encourage more medical students to become GPs? It is hard to believe they do not want to come to Somerset, but what are we doing to encourage them?

There is no greater champion for Somerset than my hon. Friend. What I would say to her is what I would say to all medical students, which is that general practice is going to be the biggest area of expansion in the NHS over the coming years; in fact, we are planning to have the biggest increase in GPs in the history of the NHS.

It will take many years for the doctors the Secretary of State has just talked about to come on stream, and we have a workforce crisis in the NHS now, partly because of the cuts the Government made in the last Parliament, but also because of their irrational pursuit of the hardest of Brexits. He could do something very simple today to address this crisis in the short term, and that is to announce that all EU nationals who do vital work in our NHS will be able to stay when we leave the European Union.

The one simple thing the Government are not going to do is refuse to listen to what the British people said when they voted on 23 June. We will do what they said—it is the right thing to do. However, the right hon. Gentleman is absolutely right to highlight the vital role that the around 10,000 EU doctors in the NHS play in this country. I can reassure him that the number of doctors joining the NHS from the EU was higher in the four months following the referendum result than in the same four months the previous year.

23. Does my right hon. Friend agree that Kent, with its excellent academic institutions and strong life sciences sector, would be an ideal location for a new medical school, and will he support emerging plans to establish one? (909376)

I can absolutely confirm that the garden of England would be an ideal place for a new medical school—alongside many other parts of the country that are actively competing to start medical schools as a result of the expansion in doctor numbers. It is an independent process run by the General Medical Council, and we will await what it says with great interest.

On this wonderful first day of spring, will the Secretary of State think anew about the training of GPs? We want more GPs, we want them highly trained and we want them to know that someone who suffers from atrial fibrillation should not be neglected and should not be put on aspirin or warfarin, but should be given the new anti-coagulants.

The hon. Gentleman speaks very wisely about this, and he is one of a number of people who say we need to look at the training we give GPs on patient safety, on growing, new areas like mental health, and on things like the identification of cancers. This is something we are having an ongoing discussion with the Royal College of General Practitioners about.

Given the importance of training new doctors and nurses to the future of the health service, will my right hon. Friend welcome the building, which will commence later this summer at the Anglia Ruskin University in Chelmsford, of a new medical school that is solely there to train doctors to meet the needs of people in Essex and beyond its borders?

I absolutely welcome that, and I know my right hon. Friend has personally championed it as a local MP. The historical mistake that those on both sides of the House have made is not to do long-term workforce planning for the NHS, and that is something we want to put right.

Plans to train more UK doctors are absolutely welcome, but the Secretary of State knows that it takes at least 10 years to train a doctor, so what is his response to the surveys by the British Medical Association and the GMC showing that, having been left hanging for nine months, 40% to 60% of EU doctors are thinking of leaving?

My response is the one I give many times in this House, which is to stress to all those doctors how valued they are as critical parts of the NHS. We do not see any evidence of the number of doctors joining from the EU going down. The NHS is one of the best health services in the world, and it is a great place for people from other countries to work and train.

The workforce is one of the biggest challenges right across the nations of the UK, and particularly in rural areas, as we heard earlier. With a 92% drop in the number of EU nurses coming to the UK and a 60% increase in the number who left last year, how does the Secretary of State plan to avoid an NHS staffing crisis immediately post-Brexit, before there is time to train anybody extra?

The hon. Lady needs to be very careful in her use of statistics, because she will know that one reason for the drop in the number of nurses coming from the EU is that prior to the Brexit vote we introduced much stricter language tests, as that is better for the safety of patients and a very important thing that we need to get right. We are very confident that nurses will continue to want to work in the NHS, because it is a great place to work.

A&E Waiting Times

2. What estimate he has made of the number of patients who waited more than 12 hours for treatment in A&E in the last 12 months. (909355)

6. What assessment he has made of the reasons for the increase in the number of patients waiting more than 12 hours to be admitted to A&E in the last 12 months. (909359)

Between February 2016 and January 2017, there were just under 3,500 waits of longer than 12 hours from decision to admit to admission. That is completely unacceptable, which is why the Government took urgent steps to free up NHS bed capacity in this month’s Budget.

Earlier this month, the chair of the Royal College of General Practitioners said that the “best place for GPs” is working within their communities to provide the highest possible general practice quality. What forecast has the Secretary of State made of the reduction in A&E waiting times next winter as a result of the new GP triage units in A&E departments? Does he agree that this is simply a small sticking plaster on the gaping wound that is our drastically underfunded NHS?

Let me just tell the hon. Lady what is happening to what she says is a “drastically underfunded NHS”. In her local hospital, St George’s, we have got 36 more doctors—[Interruption.]

Order. The hon. Lady had a question, it was rather overlong and the least courtesy she can do the House is to listen quietly and with good manners to the reply.

Thank you, Mr Speaker. To continue, let me say that in this so-called “drastically underfunded NHS”, the hon. Lady’s local hospital—St George’s in Tooting—now has 36 more doctors working in A&E than there were in 2010. However, we also think that as a lot of people go to A&E departments with minor injuries and things that can be dealt with by GPs, we need to have GPs on site, and this Parliament we are planning to have 5,000 more doctors working in general practice.

In January, more than 1,000 patients at the Countess of Chester’s A&E unit had to wait more than four hours and only 81% of patients had to wait less than four hours. Now that the 95% target has been abandoned, until at least midway through next year, what guarantee can the Secretary of State give my constituents that we will not get a repeat of this next winter?

On the contrary, we have not abandoned the 95% target—we have reiterated its importance. There is, however, one part of the United Kingdom that has said it wants to move away from the 95% target—Wales. The Welsh Health Minister said last week:

“You can go to A&E and be there five hours but have…a good experience.”

That is not looking after patients; it is giving up on them.

On this important issue of A&Es, does the Secretary of State agree that it makes no sense at all for my local clinical commissioning group to be bringing forward a business case to spend an extra £300 million on bulldozing Huddersfield royal infirmary and downgrading our A&E?

I recognise the very strong arguments my hon. Friend makes and the strong campaigning he does on behalf of his constituents. We are waiting for the final recommendations to come from his local CCG, but I agree that too often we have closed beds in the NHS when we do not have alternative capacity in the community, and we need to be very careful not to repeat that mistake.

The cost of presenting with a minor ailment at a pharmacy is only 10% of the cost of presenting at A&E. What more can be done to help persuade those who present themselves to A&E that the pharmacy sector could be a better use of their time?

I entirely agree with my hon. Friend on that. Despite the current debates, the pharmacy sector has a very bright future, and we have set up a £40 million integration fund precisely to help pharmacists to play more of a role in the NHS and, in particular, to reduce pressure on A&Es.

This year, the winter crisis in A&E has been the worst ever. Things have got so bad that, rather than waiting in A&E, record numbers of people are just giving up—I am sure there are many who wish the Secretary of State would do likewise. In January, nearly 1,000 people were stuck on trolleys waiting more than 12 hours to be admitted to A&E. Will the Secretary of State accept that that is far more than just a small number of isolated incidents? After five years in the job, he has to accept responsibility for the crisis he has created.

I accept responsibility for everything that happens in the NHS, including the fact that, compared with 2010, we are seeing 2,500 more patients within four hours every single day. We are also seeing a big increase in demand, which is why there were particular measures in the Budget to make sure that we return to the 95% target, including £2 billion for social care, which is £2 billion more than the Labour party promised for social care at the election.

The urgent care centre at Corby has done much to relieve the pressures on Kettering A&E, and it is a class leader. Given the announcement of £100 million for new triaging projects, would the Secretary of State like to visit the Corby urgent care centre to see this beacon of best practice at first hand?

That is a very generous offer, and if I possibly can, I would love to take my hon. Friend up on it.

Cough-assist Machines

3. What steps his Department is taking to ensure that clinical commissioning groups follow best practice commissioning policy on access to cough-assist machines for people with muscle-wasting conditions. (909356)

Cough-assist machines are one of a variety of respiratory treatments that may be appropriate for sufferers of conditions such as motor neurone disease or muscular dystrophy. In the end, it is a matter of clinical judgment.

There are good examples of best practice cough-assist commissioning policies for muscle-wasting conditions that can be followed by health boards and CCGs. Given the hard work being done to extend the lives of those who suffer from muscular dystrophies, what support and assistance can the Department provide to Muscular Dystrophy UK to ensure that such policy is more widely adopted?

It is not for the Government to direct clinicians regarding the efficacy of particular treatments; it is for clinicians to decide, based on guidance from the National Institute for Health and Care Excellence and others. In developing its recent motor neurone disease guidance, NICE found that the evidence base for the routine use of cough-assist machines was weak. However, the matter is kept under review, so that may change as and if new data emerge.

NHS: Export of Procedures

4. What assessment he has made of the effectiveness of the export of procedures developed by NHS professionals. (909357)

Many NHS bodies work with their international peers, and each makes its own assessment about the effectiveness of intended collaboration, rather than any determination being made at a national level. Trusts should only pursue opportunities that deliver value for money and do not impair their ability to deliver NHS services.

A team of clinicians at Southmead hospital in my constituency, led by Professor Tim Draycott, have developed and are now exporting internationally a system of maternity healthcare that is transforming maternity safety and childbirth. What is the Department doing to provide further support and ensure that the evidence base the team have developed is embedded and incorporated in policy making in this place?

My hon. Friend will be aware that the professor to whom she refers has presented his findings to the Secretary of State. Partly in response to that, we have set up an £8 million innovation fund to help to take such initiatives forward and to spread best practice throughout the country.

May I endorse what the hon. Member for Bristol North West (Charlotte Leslie) said? In the area of diabetes, for example, our country has some of the best clinicians in the world. Will the Minister ensure that the next time the Prime Minister goes on an official delegation she takes one of these professors with her to show the rest of the world what we are able to do for conditions such as diabetes?

The right hon. Gentleman is an acknowledged expert on diabetes. I have visited facilities around the world, including in Abu Dhabi, where Imperial College London has a joint venture with the diabetes centre there. The UK is an acknowledged expert, and we are launching the national diabetes prevention programme, which will roll out across 10 pilot sites for type 2 diabetes prevention work. I shall encourage the Prime Minister to consider the right hon. Gentleman’s proposal that we expand that work on other trade visits, certainly those for health, around the world.

Mental Health Treatment

5. What steps his Department is taking to reduce the number of mental health patients having to travel out of their local area for treatment. (909358)

This Government were the first to set a national ambition to eliminate inappropriate out-of-area placements by 2020-21. By then, no adult, child or young person will be sent away from their local area to be treated for a general mental health condition.

I thank the Secretary of State for his response. My 17-year-old constituent Jess needed an acute mental health bed. The nearest available was in Colchester. She was allowed to go home some weekends, but it meant an 800-mile trip for her mum. We can only imagine the emotional and financial hardship that that caused. The Secretary of State tells us that he is working on this matter, and I believe that he does want to improve things, but what progress has actually been made, as this is really, really not good enough for Jess and others?

I agree with the hon. Lady and she makes her case very powerfully. We need to make progress and we need to make it fast, particularly for young people, as their recovery can be very closely linked with the potential of their parents to come to visit them. Nearby places such as the Sheffield Health and Social Care Foundation Trust, which do not serve her constituents, have eliminated out-of-area placements and saved £2 million in the process. It is about spreading that best practice.

16. Schools are often the first point of contact for young people with mental health problems. Does the Secretary of State share my view that we must ensure that school-age children have access to mental health services wherever they are? (909369)

My hon. Friend speaks very wisely on this matter. In the end, schools are a vital place in which to spot mental health conditions early. We know that around half of mental health conditions become established before the age of 14, and this will be a big part of the Green Paper that we publish later this year.

Does the Secretary of State recognise the ways in which poverty, the associated financial strain and deprivation intersect with mental health; understand the need for him to work with the Secretary of State for Work and Pensions to ensure that mental health is properly recognised in personal independence payment assessments; and recognise that the problem is more acutely affected if people have to travel out of their area of residence?

I can reassure the hon. Lady that I have had a number of discussions with the Secretary of State for Work and Pensions. Indeed, we are producing a joint Green Paper on health and work precisely to make sure that we address those issues.

Some innovative and award-winning work is being done by Bradford District NHS Care Trust. It is working alongside excellent voluntary organisations and charitable organisations such as the Cellar Trust in Shipley, which is delivering much improved support for mental health patients. Will the Secretary of State congratulate the work that is being done in Bradford, and would he like to pay a visit so that he can share this best practice with other parts of the UK?

I am happy to congratulate the Cellar Trust, and to pay a visit if I can find the time to do so. My hon. Friend is right to say that voluntary organisations play a vital role. Very often, they can see the whole picture and they treat the whole person, not just the specific NHS or specific housing issue, so he is right to commend its work.

Recent figures show that 18 mental health patients were placed more than 185 miles away from their home for treatment, including five from the northern region—Jess is one such example. Their families will have to travel the equivalent of Manchester to London, or further, to visit them. We have also learned that £800 million was taken out of CCG budgets, which could be funding services such as mental health in-patient beds, just to help NHS England balance the books. Will the Secretary of State tell those patients and families why they should be treated so far from home when their local CCG should be able to fund the in-patient beds they need?

With great respect to the hon. Lady, we are the first Government to count out-of-area placements, and to commit to eradicating them. What she does not tell the House is the context, which is the biggest expansion in mental health provision anywhere in Europe, with 1,400 more people being treated every single day, and an extra £342 million being spent this year on mental health compared with last year.

GP Recruitment

As part of our plan to improve access to general practice, we are taking steps to ensure that there will be an extra 5,000 doctors by 2020. We are increasing the number of GP training places, recruiting up to 500 doctors from overseas and encouraging doctors who have retired to return to general practice.

I am aware of a number of issues with the recruitment of GPs in my constituency, such as at St Luke’s surgery in Duston. Will my right hon. Friend meet me to discuss the issues with that surgery in particular?

I am very happy to meet my hon. Friend. He will know that the surgery got an £80,000 grant this year through NHS England’s general practice resilience scheme, but I am aware that there are lots of pressures on surgeries such as St Luke’s and I am happy to talk about it further.

I am delighted to hear the Secretary of State issue some information about the additional GPs who will be coming on stream in the coming years. How many will be coming to north-east Lincolnshire and when will they be there? We have a critical shortage of GPs and people are struggling to get appointments.

The hon. Lady is absolutely right that areas such as Lincolnshire find it particularly difficult to attract GP recruits, which is why we have set up a fund that gives new GP trainees a financial incentive to move to some of the more remote parts of the country. This is beginning to have some effect, and I am happy to write to her with more details.

I warmly welcome the Secretary of State’s efforts to recruit more GPs, and I know that he wants all GPs and, indeed, doctors to have high levels of job satisfaction. Is he aware of the fact that reasonable numbers of doctors are leaving the UK to work overseas? Given the cost of medical training and the money that taxpayers put into that education, will he look at that issue, perhaps by requiring a certain commitment to the NHS?

My hon. Friend raises an important point. There is currently no evidence of an increase in the number of doctors going to work abroad, but there is an issue of fairness because it costs around £230,000 to train a doctor over five years. In return for that, there should be some commitment to spend some time working in the NHS, and we are consulting on that at the moment.

GPs around the country are facing unprecedented pressures as they work to deliver the highest possible standards of care, despite underinvestment and increasing patient demand. A record number of GP practices closed in 2016. Are the Government really serious about addressing the problem for the sake of GPs and their patients? If so, why has the promised £16 million resilience fund not been delivered in full, when it was promised by October 2016? There is very little evidence to date of the Government delivering on any of their promises in “General Practice Forward View”, no sign of the extra £2.4 billion, no sign of—

Order. We have got the general drift. May I gently say to the hon. Lady that the longer the Opposition Front Benchers take, the less time there is for Back Benchers on both sides? This is becoming a worsening phenomenon. It is not only the fault of the hon. Lady, but it really must stop. It is not fair to Back-Bench Members.

During my time as Health Secretary, the real-terms investment in general practice has gone up by £700 million or 8%, and we are planning to increase it by 14%—£2.4 billion—over this Parliament. A lot of extra money is going in, but I recognise that there are still a lot of pressures.

The Secretary of State’s plans to recruit doctors will be widely welcomed in Leicestershire, but should he not be making greater use of already properly regulated practitioners—those who are regulated by the Professional Standards Authority—of whom there are 20,000, including hypnotherapists?

My hon. Friend’s ingenuity in bringing these issues up in question after question never ceases to amaze me. As he knows, we recognise that the pressure in primary care cannot just be borne by general practice, but we must always follow the science as to where we get our help from.

Only recently, a surgery has been closed down in the borough of Halton. There is a clear shortage of GPs. Despite the efforts of the clinical commissioning group to try to find replacements, that has not happened. How will merging CCGs help, and can the Secretary of State rule out any merger between Warrington and Halton?

This is something on which we take guidance from what local CCGs say. There are times when the CCGs feel that their scale is not big enough to have the impact they want.

The hon. Gentleman says from a sedentary position that we set up the CCGs. I remind him that CCGs came together without central prescription as to what their size should be, but we will always listen to the advice we get on the ground if people want to change their size.

Mental Health: Digital Platforms

8. What steps his Department is taking to use digital platforms to encourage people to access help to support their mental health and wellbeing. (909361)

The Prime Minister herself announced our commitment to developing and expanding digital mental health services, and we have backed that with an investment of more than £65 million. This work includes improving digital technology for the mental healthcare system, developing digital tools and therapies, and improving mental health information and services provided through and 111 platforms.

The Minister will know that for people with mental health problems, attending accident and emergency or going to see their GP is not always the best point of intervention, so I welcome measures to improve accessibility. Stockport Healthy Minds, which serves my constituency of Cheadle, provides a range of services such as online self-help courses, one-to-one therapy sessions, and group workshops. What is her Department doing to provide projects like Healthy Minds with the support and accessibility they need?

In addition to the funding that we are providing to improve the mental health pathways through and 111, we are providing £500,000 for the development of six digital tools, with a particular focus on children and young people’s mental health. I pay tribute to the work of Healthy Minds in my hon. Friend’s constituency and to her own championing of this issue.

Order. It is always a pleasure to hear the hon. Member for Hyndburn (Graham Jones), but can I just say to him that it is a good idea to bob consistently, and then one knows of the interest of an hon. Member? On this occasion, he looked at me meaningfully but was not bobbing; I am not psychic. But let us hear the voice of Hyndburn: Graham Jones.

I am very grateful, Mr Speaker, for your asking me to ask a question. Mental health is a really serious, and growing, problem. I have been out with my local police force and I appreciate the emphasis on digital technology, but what are we doing on the frontline as well? We cannot just have digital operations. In the Lancashire constabulary, because of the Government’s cuts, we are removing the mental health worker from the frontline force. While we may be doing something around digital, we are removing mental health services, because that post goes on 31 March. Is this not ridiculous? Is it not the case that the Government do not have a coherent policy on mental health?

Order. I was quite tough on the hon. Member for Burnley (Julie Cooper), but the hon. Gentleman took his time—he really did.

The hon. Gentleman misrepresents the situation entirely. Not only are we investing an extra £1 billion year in mental health services and expanding mental health services at a faster rate than anywhere else in Europe, but we have invested £15 million extra in places of safety for those in crisis and are expanding triage services, precisely to address the problem that he raises of those in mental health crisis who come into contact with the criminal justice service.

While digital platforms can be useful in guiding patients to the right service, does the Minister accept that there are still huge shortages of people who can carry out talking therapies, and long waits for child and adolescent mental health services? When are the Government going to stop talking about improving mental health services and actually ensure that the money is going where it is needed to recruit staff?

We are working extremely hard on increasing staff. We are not only introducing our new mental health workforce strategy, which we will publish shortly, but increasing the number of people who are seeing these services. Four million extra people have seen psychiatry services—talking therapies—and 90% of those patients are being seen within six weeks, which is exceeding our waiting time target.

Data Research

9. What assessment he has made of the potential effect of the EU general data protection regulation on the availability of data for research in the health sector. (909362)

We have engaged fully with the health and research community to ensure a positive and beneficial application of the GDPR in the UK. My hon. Friend is right that data are vital to the delivery of safe and high-quality care, but we need to ensure that there is a trusted system in place, and that people understand that their information is secure and have confidence in its use.

I thank the Minister for that answer, but I have to tell her that when the EU’s general data protection regulation becomes enforceable next year, it will be more difficult to share data. Cancer charities, including Cancer Research UK, are concerned because the progress of life-saving research, especially into rare and children’s cancers, would not have been possible were it not for data-sharing. Will she do what she can to shield the UK from this harmful regulation, given that it disproportionately affects us because of the wealth of our data?

We have been clear that we are going to introduce the data regulation. We are working on exactly how we will do that in a balanced way that encourages data-sharing for the purposes of research in a sustainable NHS. We have set up a sub-group to examine the impact of the GDPR on research. It is hosted by the Wellcome Trust and includes members of the Health Research Authority’s confidentiality advisory group, the NHS Confederation, the Medical Research Council, the Department of Health, and the PHG Foundation. We will ensure that this works in an effective way to address the concerns that my hon. Friend has raised.

Enriched Culture Medium Test

10. If his Department will take steps to introduce the enriched culture medium test for group B streptococcus for pregnant women; and if he will make a statement. (909363)

My right hon. Friend will be aware that Public Health England published a paper in June 2015 precisely on this subject, but it concluded that within the currently accepted clinical guidelines there are no clinical indicators for testing women using enriched culture medium methods. This test is not, therefore, recommended for routine use at present.

My hon. Friend will be aware from his reading of the British Paediatric Surveillance Unit report that the incidence of group B strep has increased by 30% over the last 15 years. Does he agree that this matter has gone on for far too long, and that the Government must come to a conclusion to prevent further tragedies?

As my right hon. Friend will be aware, the UK National Screening Committee is reviewing the evidence for antenatal screening, including the use of enriched culture medium tests for group B streptococcus, following a public consultation. I understand that its recommendation will be published very soon, and I assure him that I will consider the recommendation very carefully and write to him with my view.

“General Practice Forward View”

11. What steps his Department is taking to ensure that NHS England’s “General Practice Forward View” has the funding necessary to achieve its goals. (909364)

“General Practice Forward View” announced that investment in general practice will increase from £9.6 billion in 2015-16 to more than £12 billion in 2020-21. This represents an increase of 14% in real terms, which is almost double the increase for the rest of the NHS. Two years into the forward view, we remain on track to deliver that.

I appreciate the Minister’s response, but the reality on the ground in areas such as Redcar and Teesside is that we face a deficit of £281 million by 2020. How can he reassure my constituents, who are already finding it hard to get an appointment with a GP, that already scarce services will not become even more so?

We do recognise that in parts of the country there are shortages of GPs. As Members have heard, we are planning to have 5,000 more doctors working in general practice by 2020, and a proportion of those will be in Teesside. It is important that we meet that goal.

GPs in Wycombe cite long hours, bureaucracy and the declining attractiveness of the partnership model as reasons why people do not want to be in general practice. Will the Minister ensure that funding within the forward view is directed to deal with those key problems?

Yes, and the contract discussions that we have just completed with the British Medical Association addressed a number of the issues that my hon. Friend talks about, in terms of the pressures on doctors working in general practice. We acknowledge that the workload pressures are enormous, and, through the contract, we need to do all that we can to mitigate them.

More than 80% of clinical appointments are carried out by GPs, but they receive a proportionately much lower level of funding. What steps will the Department of Health take to make sure that all sustainability and transformation plans abide by NHS England’s recommended allocation of funding to general practice?

One of the criteria by which STPs are being judged is the extent to which they are making this tilt from secondary into primary care, exactly as the hon. Lady suggests. That is precisely why the extra funding for primary care that I have set out is so important and why it is happening.

“General Practice Forward View” talks about supporting general practice to improve digital technology for patients. Given the recent data challenges, does the Minister agree that putting a national data guardian on a statutory footing to protect patients and professionals is becoming an imperative?

I know that my hon. Friend has introduced a private Member’s Bill in this area, and the Government intend to support it.

The support that is provided to GP practices in relation to IT, information and so on is absolutely crucial to their effective operation, but problems continue today in my constituency with the service provided by Capita. Capita cannot, for example, now get prescribing certificates for locums and new GPs. When are the Government going to get a grip on this failing contract and, if Capita cannot perform adequately, get someone else to do it?

The hon. Lady is right. There have been issues with the Capita contract, and we have been let down by Capita. We are working hard to get that sorted, and my colleague the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood), meets Capita weekly to get this fixed. We are making progress, and we believe that the issues that the hon. Lady refers to will be fixed in the foreseeable future.

There is a shortage of GPs across Northamptonshire, especially in Kettering, and the age profile of local GPs means that a very large number are about to reach retirement, which will make the problem worse. What can be done to encourage experienced GPs to stay on longer and to encourage those who have retired to come back?

My hon. Friend is absolutely right that one of the things we need to achieve is either to encourage older GPs to work part time or to make it easier for them to step down into more of a mentoring role. With the Royal College of General Practitioners, we have brought forward a scheme called GP Career Plus, which enables GPs in 10 pilot areas—the pilots are being rolled out now—to work as mentors across practice areas, and not to feel as though they have to retire, as GPs too frequently do at the moment.

Heart Disease and Paediatric Services

12. Which hospitals providing congenital heart disease services do not meet the standard for the co-location of paediatric services; and what plans his Department has to stop providing congenital heart disease surgery at those hospitals. (909365)

Standards for paediatric co-location for congenital heart disease services are not currently met by the Royal Brompton, Leicester and Newcastle hospitals. NHS England is consulting on proposals to cease commissioning level 1 surgical services from the Royal Brompton and Leicester. No final decisions have been made on the proposed changes. Public consultation continues until 5 June 2017, and I encourage my hon. Friend to participate in that consultation.

Mr Speaker, you are absolutely correct in your comment.

Does the Minister agree that the standards review found that not all clinicians are in agreement about how essential the co-location of paediatric services is, bearing in mind that a child being treated right now at the Royal Brompton will have 24-hour access to all necessary medical specialties? Will he tell us what improvements co-location at the world-class Royal Brompton hospital would achieve?

My hon. Friend has considerable expertise, but I am advised that having all relevant children’s specialties on the same site is the optimal model of care for the most critically ill children. It promotes closer, more integrated ways of working between specialist teams, and ensures rapid access to key services, such as paediatric surgery, at the most critical times when they are needed.

Mortality rates for the treatment of congenital heart disease fell from 14% in 1991 to 2% last year. The Royal Brompton, where the service is threatened with closure, does better even than this. What evidence is there that the closure programme will produce any further improvement, and if there is none, why is it being pursued?

The hon. Gentleman is right to point out that we have some world-leading patient outcomes for congenital heart disease, and I recognise the statistics that he read out. This is being driven entirely by seeking to improve patient outcomes across the country—improving them even on that very good performance—and to ensure greater resilience of service in some areas where there are relatively low volumes and an over-reliance on locums. I accept that that is not the case at the Royal Brompton, but it is in some of the others.

The Leeds heart unit is performing very well, and is free from the threat that it was facing, unfairly, a few years ago. Will lessons be learned, however, from the disastrous Safe and Sustainable review process, which pitted hospital against hospital and clinician against clinician? Can we find a much better way—I hope the Minister will tell us that this is happening now—to reconfigure such services?

I recognise that when the proposal was put forward back in 2012, it led to a process that we felt was wrong, and we therefore stopped it. This process, we hope, is being conducted in a more rigorous and fairer way, and will lead to outcomes driven, as I say, by improving patient experience.

PFI Liabilities

13. What the estimated cost of private finance initiative liabilities to the NHS is in (a) 2016-17 and (b) the subsequent three financial years. (909366)

Labour’s legacy cost from the 103 hospital PFI schemes entered into between 1997 and 2010 was a public sector liability of £77 billion. The estimated total NHS PFI payments for the financial year ending at the end of this month is £1.97 billion, and the totals for the next three financial years are £2.04 billion, £2.11 billion and £2.16 billion.

Those are alarming figures, so what are the Government doing to support the trusts affected by those expensive and inflexible PFI and other deals reached under the previous Labour Government? What assessment has the Minister made of what the funds could be buying in the NHS now if it was not saddled by this Labour debt legacy?

My hon. Friend is right to point out that the Opposition constantly complain about the cost of the PFI programmes that they themselves initiated. The Government are making large efforts to support trusts in dealing with the PFI legacy. We are giving the seven trusts worst affected by PFI schemes access to a £1.5 billion support fund over a 25-year period. In 2014 alone, trusts negotiated savings worth over £250 million on their contracts.

21. On the subject of financial liabilities, what assessment has the Department made of the potential effect of changes to the discount rate on the amount of compensation paid out by the NHS Litigation Authority? (909374)

The Department is urgently undertaking work to understand what the impact on the NHS will be. There have been regular meetings with the NHS Litigation Authority since the announcement. The Government will adjust the NHSLA’s budget to meet the additional costs associated with the change in the discount rate.

The hon. Member for Southport (John Pugh) shoehorned Question 21, which we did not reach, into a Question that we did reach. He blurted it out so quickly that it took us a while to notice that it had absolutely nothing whatsoever to do with the private finance initiative. Very naughty boy!

PFI always was idiotic. It carried on under the coalition Government and has left a huge financial hangover. Will the Minister have a word with his colleagues in the Treasury, because the Treasury figures on hospital liabilities are different from the figures that some of the hospitals themselves produce? As there is a discrepancy, we do not even know what the liabilities are.

The hon. Gentleman has been assiduous, as is his wont, in trying to get to the bottom of the costs of the PFI impact on the hospital in his area. If he has a discrepancy, it would be very helpful if he pointed it out to me in writing. I will then respond to him.

Social Care: Unmet Needs

14. What plans his Department has to increase the provision of social care for people with unmet needs. (909367)

Social care continues to be a key priority for the Government. That is why local authorities in England will receive an uplift in the money available for social care over the next three years of 17% in cash terms. That significant uplift will allow councils to support more people and sustain a diverse care market.

Does the Minister recognise that the figure he has just given—the additional £1 billion in the Budget—is just half of what is needed to fill the shortfall in social care? Will he tell the House what he is doing to ensure that the sector gets the additional money and to stop councils being bankrupted by their social care requirements?

The 17% cash uplift over the next three years exceeds what we have been asked for by a number of stakeholders in the sector. I have conceded at this Dispatch Box many times that the sector is under pressure. The additional moneys that we have come forward with will help to alleviate that and will make a big difference. In Lancashire, the figure is not 17% over three years; it is 18% over three years.

The Minister is quite right that central Government are providing extra money for essential care and allowing local councils to raise a precept on the council tax for social care. How will the Government ensure that councils actually spend that money on social care?

Much of the money will go through the better care fund and there is conditionality on that. We expect councils to spend this money, as they have requested it, on social care and we believe that that will be the case. We understand the pressures and have acted.

But 1.2 million older people are living with unmet care needs. The £1 billion that was announced in the Budget for this year is not enough to prop up the failing care sector, when many councils are suffering contracts being handed back. Given that 1 million people over the age of 65 do not have adult children, will the Minister explain how all those people living with unmet care needs are meant to manage?

The figure on unmet care needs comes from an Age UK analysis. I am meeting Age UK to go through its recent report, but we do not accept that analysis because the Care Act 2014, which had cross-party support, set statutory consistent definitions for what care councils have to provide. It is illegal for that not to be met, and our follow-up work with the Local Government Association has indicated that it is being met. Furthermore, we have put in a 17% increase over the next three years.

Childhood Obesity

15. What recent assessment he has made of the Government’s effectiveness in tackling childhood obesity in the inner cities. (909368)

Our childhood obesity plan includes a number of measures, such as the soft drinks industry levy, reformulation and school-based interventions, that will help all children, including those in inner-city communities. We will monitor progress carefully, including through the national child measurement programme. We will routinely publish developments on all key measurements for the programme, but it stands to reason that those who are most in need will benefit most from these interventions.

I thank the Minister for that answer, but it remains the case that childhood obesity is twice as high in deprived areas as it is in more affluent areas. In Tower Hamlets, 20% of children are obese and a third are overweight. What will the Government do to reduce childhood obesity and when will the plan be published?

The childhood obesity plan has already been published. I think the hon. Lady may be talking about the reformulation targets and the baseline data, which are coming out imminently. The experts in Public Health England are working feverishly to make sure that the data are exactly as they should be. One measure I think she will be particularly keen to see is the investment in schools committed to by the Chancellor in the Budget, including the voluntary healthy rating scheme, which will be published in June.

What measure is being used to ascertain the success or otherwise of the strategy and when will we know whether it has worked or not?

As I mentioned, we will be publishing the reformulation baselines against which all future success will be measured. They will include measurement across all industry targets. In addition, we will of course have the voluntary healthy rating scheme for primary schools to recognise and encourage their contribution to preventing obesity.

Topical Questions

As part of our ambition to make the NHS the safest healthcare system in the world, I will today be speaking at the largest ever conference on learning from avoidable deaths and what we can do to improve care in the future. As part of that, I can inform the House that the NHS Litigation Authority will radically change its focus from simply defending NHS litigation claims to the early settlement of cases, learning from what goes wrong and the prevention of errors. As part of those changes, it will change its name to NHS Resolution.

My constituent Pauline Cafferkey was cleared of misconduct last September, following a very public case surrounding her return from Sierra Leone and her contraction of Ebola. Will she receive an apology from Public Health England and will it reimburse her legal costs?

With respect to Pauline Cafferkey, who is a very brave lady and who gave very good service to this country and the people of Sierra Leone with her work during the Ebola crisis, the hon. Lady will understand that disciplinary procedures are an independent matter. They are not dealt with by the Government. They have to be done at arm’s length and we have to respect whatever is said or done.

T3. I was pleased to see the Government commit to new funding for emergency care in the Budget. As the MP for Derby North, a constituency particularly affected by poor air quality, I am concerned that respiratory admissions to A&E have risen at twice the rate of general admissions over the past five years. What steps is the Department taking to address this issue? (909346)

We are firmly committed to improving the UK’s air quality and cutting harmful emissions. We have committed £2 billion since 2011 to increase the uptake of ultra-low emission vehicles, support greener transport schemes and set out how we will improve air quality through a new programme of clean air zones. In addition, in the autumn statement we announced a further £290 million to support electric vehicles, low emission buses, taxis and alternative fuels. I regularly meet the Department for Environment, Food and Rural Affairs to see how we can roll out this work.

The Government have not met the four-hour target for A&E since July 2015. In the NHS mandate, finally published yesterday, the Secretary of State is effectively telling hospitals that they do not need to meet it in 2017 and that it only needs to be met in aggregate across hospitals

“within the course of 2018”.

Is that not the clearest admission that the targets will not be met next year, because in the next 12 months the NHS will be denied the funding it needs and, as a consequence, patients will suffer?

Apart from observing that if the hon. Gentleman cares so much about the 95% target he might want to ask his colleagues in Wales why they are looking at scrapping it, on the money let me be very clear: in the next year, the NHS will be getting about £1.5 billion more than his party were promising at the last election and the social care system will be getting £1.5 billion more than his party were promising at the last election. We are doing our job.

The Secretary of State says he is doing his job, so why does he not take that up with NHS Providers, which is warning that because of the underfunding, it will be “mission impossible” in the next 12 months to deliver standards of care. Returning to the NHS mandate, did you notice, Mr Speaker, that in that mandate there is no mention whatsoever of Brexit, even though the NHS relies on 140,000 NHS and care workers? I know that the Secretary of State is not a member of the Cabinet Brexit committee, but will he use his considerable influence with the Prime Minister to ensure that when she triggers article 50 next week, she will finally give an absolute guarantee of the rights of all those EU workers in our NHS?

First, let me first reassure you, Mr Speaker, that I will be attending the Brexit committee when it is relevant to the NHS; in fact, I shall attend it this week, because issues relating to the NHS are coming up in it. What we are not going to do in that committee, however, is to take steps that would risk the welfare of British citizens living in countries such as Spain, Ireland and France. That is why, although it is a top priority for us to negotiate the rights of EU citizens living in Britain, including those working in the NHS, it has to be part of an agreement that protects the rights of British citizens abroad.

T4. Last Friday, Laurel Bank surgery in my constituency attended a careers fair at Bishop Heber High School. Does the Secretary of State agree that that kind of outreach work by GPs among young people encourages them to study medicine and work in our great NHS? (909347)

I absolutely agree. What I think my hon. Friend should tell her constituents—I am sure she will—is that general practice is going to be the most exciting, fastest-growing part of the NHS, where care is going to be transformed, making this the right thing to do.

T2. Is the Secretary of State aware that my constituents are deeply disappointed with what he got out of the Budget? That poor deal for the NHS means that they face the closure of A&E in Huddersfield and the closure of Huddersfield hospital, and they no longer have a dentist who will take on an NHS patient in the whole of my constituency. (909345)

With great respect to the hon. Gentleman, what was secured in the Budget was £2 billion for social care, which is £2 billion more than his party was promising at the last election.

T6. Following the publication of the report of the all-party parliamentary group on rare, genetic and undiagnosed conditions on the UK rare diseases strategy, what plans does the Minister have to introduce an implementation plan for NHS England? (909349)

Frist, let me pay tribute to my hon. Friend for his leadership of the APPG on rare diseases. I am sure he will join me in feeling proud that the UK is a recognised leader in research, treatment and care for rare diseases in particular. We are at the forefront of the genomics revolution. He is right that the UK strategy for rare diseases needs to be translated into an implementation plan, and that is one of my personal commitments.

T5. Will the Secretary of State explain why my area of Hull, with its in-built health inequalities and poorer health outcomes, is getting just £13 million out of the additional money for social care set out in the Budget, while the local authority area that the Secretary of State represents in Surrey is getting £21 million-worth of additional support? (909348)

The formula is based on the better care fund formula, which is based on the spending power of local authorities. Let me tell the hon. Lady that, over the next year, that improved better care fund is going up by 35%, and Surrey’s allocation is going up by only 5%.

T8. As the Secretary of State knows, I am the vice-chairman of the all-party group on pharmacy. Will he update the House on the progress of the decriminalisation of dispensing errors by pharmacists? What is the hitch? (909351)

T7. Last week, leading trauma surgeon, Dr Duncan Bew, said his surgical team sees more young patients with serious stab injuries than people with appendicitis. This is a societal problem. Will the Minister inform us of his Department’s public health approach to tackling this issue? (909350)

The hon. Lady is absolutely right to say that this is a serious issue. I commend the brilliant work done by NHS trauma centres throughout the country, which are world-beating, but, as well as setting up those centres, we have established much closer co-operation with local police forces so that we can work out where the crime hotspots are and help the police to prevent such things from happening.

T9. As the Secretary of State knows, we have a crisis in GP recruitment in rural north Lincolnshire. Does he agree that the best way to enable doctors to get to know our glorious county would be to establish a medical school at Lincoln University, and will he join our campaign to make that possibility come true? (909352)

As my hon. Friend will have heard from the Secretary of State earlier, a number of areas are competing to secure a new medical facility. One of our criteria will involve encouraging doctors to be trained in areas where there are shortages, and I am sure that Lincoln University will take that factor into consideration.

The British Medical Association said recently that the funds for sustainability and transformation plans that were announced in the Budget would be completely inadequate for the task. Health trusts throughout the country are being forced to consider rationing treatment and ending or downgrading local services such as A&E, which will result in even longer waits and journey times to access care. Why do the Government not call STPs what they really are—secret Tory plans to decimate the national health service further?

This is a year in which funding for the NHS has risen by £3.8 billion in real terms. I do not know how the hon. Gentleman can say what he has said, given that in 2015 he stood on a platform to give the NHS £1.3 billion less this year than it is receiving under the Conservatives.

T10. As the House heard earlier from my hon. Friend the Member for Corby (Tom Pursglove), there is an excellent urgent care centre in that part of north Northamptonshire. There are plans to create a replica in Wellingborough. I understand that the Secretary of State may visit the centre in Corby; if he does, will he drive half an hour down the road and visit the site in Wellingborough where that proposed excellent urgent care centre will be built? (909353)

I feel the onset of a happy visit to Northamptonshire. What might clinch it for me would be the promise of a potential meeting with the famous Mrs Bone.

Last week, to the distress of its vulnerable residents, Aldingham House care home in Blackheath became the latest care home in south-east London to close. Do the Government accept that the care home industry is at breaking point, and, if so, what are they doing about it?

The number of care home beds in the country has remained broadly constant at just over half a million over the last 10 years. There is variation and churn between areas, but I believe that the 17% cash-terms increase that we have injected into the social care market in the Budget, and the better care fund that is to come, will make a difference.

I welcome the new nursing associates role that is currently being piloted. Will other areas, such as Portsmouth, be able to offer the same opportunities in the future, and will the new role be open to older people wishing to return to the workplace?

As my hon. Friend knows, we are launching a second wave of nursing associates at the beginning of April. I am pleased to be able to confirm that Southern Health NHS Foundation Trust, which manages Portsmouth Hospitals NHS Trust, is one of the trusts that will receive nursing associates, and that the system is partly designed to give social care workers opportunities to upskill.

The Secretary of State will be aware of a recent High Court case concerning a surrogacy issue that has led to legal limbo. Does he agree that the existing legislation has let children down, and that reform is urgently needed?

I can confirm that the High Court has made a judgment, that the current orders for parental orders are discriminatory, and that the Government will act within a reasonable timescale. We intend to lay an order before the summer recess in an attempt to address some of the challenges.

One of my constituents, Harriet North, has been diagnosed with TRAPS—tumour necrosis factor receptor-associated periodic syndrome. Her consultants say that the drug Anakinra will not only transform her life, but will save her life. Will my hon. Friend meet me to discuss how we can get the best treatment for Harriet, and if it is possible for NHS England to review the decision on this?

My hon. Friend has raised this case with the Department and has been making a number of pleas on behalf of his constituent. It is a very difficult case and I would like to pass on my sympathies to his constituent. Obviously, the National Institute for Health and Care Excellence is independent and this drug is not recommended for TRAPS. I do not know the details of the case because it is confidential, but I will be very happy to meet my hon. Friend and his constituent to see if anything can be done.

I do not know if you spotted the rather topical news story about children’s dentistry this morning, Mr Speaker: there were 1,464 hospital admissions for children for teeth extractions across one clinical commissioning area of Birmingham last year, the highest figure since 2010-11. How does the Minister account for this, and what is he going to do about it?

The figures for child extractions are clearly disappointing and two key actions need to take place: less sugar, which we expect the soft drinks levy to help with; and getting more fluoride on to teeth, particularly through fluoride varnishing. That has increased across the NHS over the last year, and by 12% in Birmingham. We hope that that will make a difference.

The NHS mandate was published yesterday, just days before coming into force. Can the Secretary of State set out the reason for the delay, because it allows very little time for scrutiny of this important document by this House? Will he also set out how he is going to prevent money being leached from mental health services and primary care to prop up provider deficits, so that we can meet objective 6 on improving community services?

My hon. Friend makes very important points. The reason for the delay was because about a month ago we had wind that we might be successful in securing extra money for social care in the Budget, and we needed to wait until the Budget was completed before we concluded discussions on the mandate. Our confidence as a result of what is in the Budget has enabled us to make the commitments we have made in the mandate, including making sure that we continue to invest in the transformation of out-of-hospital care.

The Secretary of State will be aware that many migrants in the UK are not registered with GPs, yet now when they come to Britain they have to pay an NHS fine. What is he doing, with the Home Office, to ensure that migrants are registered with a GP and are aware of community health facilities?

I am not quite sure whether I understand the right hon. Lady’s question, but there is not a fining system for migrants; what we say is that people who come to the UK as visitors should pay for their healthcare, or pay the visa surcharge if they are coming for a longer period. There is an exemption for public health, because it is important for everyone that we make sure that we treat people for things like tuberculosis.

The Secretary of State is aware of the concern that I and the people of Witney have about the future of Deer Park medical centre, which is a vital local resource. I am grateful to him for meeting me and for our correspondence. Please will he confirm that he will press the Independent Review Panel for a response at the earliest opportunity, given that the clinical commissioning group is determined to close this vital practice in three days’ time, and that he will consider the views of the patients of Witney very carefully indeed?

I am very happy to relay that concern to the IRP, and I thank my hon. Friend: we had a highly constructive meeting, and, as a new MP, he understands just how important this is to the constituents of Witney. He made the case very powerfully.