The Secretary of State was asked—
Leaving the EU: NHS Workforce
1. What recent discussions he has had with the Home Secretary on ensuring that the NHS has the workforce it needs after the UK leaves the EU. 
The 150,000 EU nationals working in our health and care services do a brilliant job and we want them to continue doing it. I am in regular talks with Cabinet colleagues to inform both domestic workforce plans and the Government’s negotiations with the EU.
The Secretary of State will be aware that that figure represents in excess of 5% of the total workforce in the NHS. This matter will have to be addressed, engaging with the recruitment sector, the employment sector and, indeed, the devolved Administrations. Is that how he will handle it?
We absolutely will be taking a UK-wide approach. The numbers for England are actually slightly higher than those the right hon. Gentleman talks about—about 9% of doctors and about 19% of nurses are EU nationals. However, we are still seeing doctors and nurses coming to the UK, and we need to do everything in all parts of this House to reassure them that we see them as having a bright and vital future in the NHS.
If students with four As at A-level continue to find it very difficult to get into a medical degree in this country, is it any wonder that we have to import them from Europe?
My right hon. Friend makes a very important point. That is precisely why last year we increased the number of medical school places with, I think, the second biggest hike in the history of the NHS—a 25% increase. We absolutely do believe that this country should be training all the doctors and nurses that we need.
The truth is that EU staff no longer want to come here. Doctors and nurses are leaving in their droves, and thanks to the abolition of the NHS bursary, our nurses of tomorrow are going to have to pay to train. When will the Secretary of State understand that this staffing crisis has not materialised out of thin air but is directly attributable to his actions and the actions of his Government over the past seven years?
The hon. Lady may have noticed a little thing called Brexit that happened last year, which is the cause of understandable concern. If she looks at the facts about how many doctors came from the EU to the NHS in the year ending this March, in other words, post-Brexit, she will see that 2,200—[Interruption.] Someone asked about nurses. I happen to have that information here: 4,000 nurses joined the NHS from the EU in the year ending in March.
One of the consequences of free movement in the European Union is that proportionately we take in rather fewer doctors, in particular, and fewer nurses from the Indian subcontinent and other places. What assessment has the Secretary of State made of the capacity to revisit the strong relationship we had with those workforces in the immediate post-war years?
My hon. Friend makes an important point. We want to attract the brightest and best into the NHS from all over the world, wherever they come from, if there is a need. The only caveat I would make is that we have imported a number of doctors from very, very poor countries that actually need those skills back home. We have to recognise that we have international responsibilities to make sure that we train the number of doctors and nurses we need ourselves.
The Secretary of State should know that staff shortages are not just bad for patients—they are also costing a lot more, in Nottingham and elsewhere, because of locum and agency costs. Is it not clear that if we start restricting access from the EU for staffing purposes, it will cost the NHS an absolute fortune more?
Let me reassure the hon. Gentleman that there is no intention to restrict access to vital professions such as the clinical professions in the NHS post-Brexit. We have said many times that we will have a pragmatic immigration policy. The long-term solution is not to depend on being able to import doctors and nurses from anywhere, because the World Health Organisation says that there is a worldwide shortage of about 2 million clinical professionals; we are not the only people facing the challenge of an ageing population.
I welcome the Secretary of State’s words and his deeds in terms of recruiting more doctors and nurses domestically, but as he said, hospitals such as mine in Basingstoke rely on the best and the brightest from around the world. What can he do to make sure that when we need to recruit nurses, in particular, we have the travel permits and work permits available to enable them to move in swiftly rather than having to wait for long periods of time?
My right hon. Friend is absolutely right to make that point. Nurses are, in fact, on the Home Office’s tier 2 shortage occupation list, and they will remain so for as long as we need them to do so. The bigger issue is that for a long time we have relied on being able to import as many doctors and nurses from the EU as we need to, and that has meant that we have not trained enough people ourselves. That is bad for EU countries and for our own young people.
Doctors and Nurses
2. What steps are being taken to increase the supply of doctors and nurses in the NHS. 
12. What steps his Department is taking to increase the number of doctors and nurses working in the NHS. 
Last year this Government announced one of the biggest expansions of medical training places in the history of the NHS, involving funding 1,500 additional medical school places every year—of which 500 start this September—and reforms that will enable universities to offer up to 10,000 additional nurse training places every year.
Swindon clinical commissioning group secured pilot funding for its successful video campaign to recruit additional GPs to fill vacancies in our local community. Will the Secretary of State commit to exploring further innovative ways to match newly qualified staff to vacancies that they might not have considered?
My hon. Friend makes a really important point. In parts of the country, GP shortages have been successfully addressed as the CCG has done in Swindon. An important part of this is persuading people who go into medicine that general practice is one of the most exciting and rapidly changing parts of medicine today. We have seen a 9% increase in the number of medical students choosing to go into general practice since 2015.
Further to my hon. Friend’s question, may I ask the Secretary of State what he is doing to ensure that enough doctors are recruited, developed and retained at my local hospital, Stepping Hill?
I heard a lot about Stepping Hill when I went to visit my hon. Friend; I think it was last year. I had the privilege of visiting the hospital more recently after the horrific terrorist attacks, and I commend the hospital for the brilliant work that it did in the wake of the bomb. The hospital has done a good job of recruiting; I think it has recruited 93 more doctors and nearly 300 more nurses since 2010. A national programme to help all trusts to retain their nursing staff has been launched by NHS Improvement in the last week.
In this country, we are short of approximately 40,000 nurses, and applications for nursing places have gone down by 23%. Can the Secretary of State tell us why he and his Government think that that is the case?
The hon. Lady happens to work in an NHS hospital in which there has been a big increase in the number of nurses. Across the country, there are actually 13,000 more nurses working on our wards than there were in 2010, but she is right: we need more nurses and nursing staff, and that is why we are expanding the number of nurse associates. This year we are, for the first time, opening up an apprenticeship route into nursing, which means that people from non-traditional backgrounds—particularly band 3 healthcare assistants—will find it much easier to get into nursing. That is how we will expand the workforce.
According to the latest NHS indicators published by the House of Commons Library last week, the number of GPs is estimated to have fallen over the past 12 months, and the figures for March 2017 are expected to show a further fall. Why is that?
We have had a big increase in the number of medical students choosing to go into general practice, but we have also had an increase in the number of GPs retiring early. That is a problem that we are urgently addressing.
May I congratulate my right hon. Friend on serving as Health Secretary for three Parliaments, and say to him that besides doctors and nurses, he should look to increase the use of properly regulated acupuncturists, herbalists, homeopaths, chiropractors and osteopaths, who would reduce the burden on doctors and nurses in the health service.
Over those three Parliaments, I have learned to expect questions from my hon. Friend in a similar vein, and I commend him for his persistence in championing that cause. As he knows, I think the most important thing, with all such issues, is to follow the scientific advice.
When the Government removed the nursing bursary and introduced tuition fees, the Secretary of State said that it was being done, as he has repeated this morning, to fund 10,000 extra student nurse places. The universities are saying that no extra places have been commissioned, however, so when will we see an expansion of student nurse training?
I always welcome the hon. Lady’s forensic interest in matters south of the border, but given that Scotland has just seen its first fall in life expectancy for over 100 years, she might want to think about her own constituents. With respect to the number of nurses, we now have more than 50,000 nurses in training, and we are confident that we will deliver a big increase in the supply of nurses to the NHS.
We still have a nursing bursary and we have no tuition charges, so the Secretary of State may want to explain why universities claim there are no additional places. In addition, we are losing almost half of junior doctors at the end of their foundation years. What action is the Secretary of State taking to find out why?
At the heart of this is the need to open up avenues for more flexible working for both doctors and nurses. If the hon. Lady followed what we have done in England—by successfully pioneering such working, we have reduced agency spend by 19% in a year, whereas it is still going up in Scotland—she might find the NHS in Scotland has more money to spend on her own constituents.
Will the Secretary of State confirm what specific actions he is taking to help trusts, such as the Worcestershire Acute Hospitals NHS Trust that runs the Alex hospital in my constituency of Redditch, which are in special measures? Such trusts face special pressures in recruiting and retaining staff.
I welcome my hon. Friend’s first question to me. I am very aware of the issues faced by the Worcestershire Acute Hospitals NHS Trust, which I visited during the difficult winter period that it has just come through. It now has a new chief executive and leadership team, who have made a very promising start. From the experience of many other hospitals that have been through difficult patches, we have found that it is usually never about the commitment of staff, but about getting the right leadership in place. I can assure her that I saw outstanding commitment from the staff of the trust.
The number of nurses has fallen for the first time in a decade, which is why we need fair pay now. I read in the newspapers that the Health Secretary now supports the Labour party policy of scrapping the cap, although he did not vote with us last week. Given that he supports our policy, when he soon sets the remit for the NHS Pay Review Body, will he tell it to scrap the cap, and will he publish his instructions before the summer recess?
I did not vote for the hon. Gentleman’s amendment, because—as usual—Labour Members have told us a lot about how they want to spend the money, without having the faintest idea of where it will come from. He is ignoring an elephant in the room: if we had followed the spending plans he campaigned for in 2015, the NHS would have £2.6 billion less this year, which is the equivalent of 85,000 fewer nurses.
I want to talk about the spending plans for 2017, in which the Secretary of State can find £1 billion for Northern Ireland, but nothing for nurses in England. Would it not be fairer not to go ahead with further cuts to corporation tax, and to put that money towards giving our doctors and nurses a fair pay rise?
Let me tell the hon. Gentleman what extra money is going into the NHS: three years ago, £1.8 billion, which was not asked for by Labour; two years ago, £3.8 billion, which is nearly £1 billion more than Labour was promising; and this year, £1.3 billion. That is a lot of extra money. Why is it going in? Because, under this Government, we have created nearly 3 million jobs, and that strong economy is funding an improving NHS.
3. What steps he is taking to increase the number of dermatologists in the NHS. 
Health Education England is responsible for meeting the workforce requirements of the NHS in England. The number of dermatologists in the NHS continues to grow, with 18% more consultants and 13% more doctors in training since May 2010. HEE’s latest workforce plan shows a 2% increase in funded training places for dermatologists compared with the previous year. Dermatology remains a popular choice for doctors, and it typically enjoys 100% fill rates.
I am pleased to say that, through a combined approach by the clinical commissioning group and Musgrove Park hospital in my constituency of Taunton Deane, it has been possible to prevent the long-term closure of the dermatology department and to put in place an interim service, with a full service reopening in 2018. Given the seriousness of the conditions of people coming through this department—including an increasing number of cases of skin cancer—will my right hon. Friend give further assurances about how we can ensure there is a sufficient supply of specialists in this area?
I know that my hon. Friend has campaigned actively to ensure that dermatology services at Musgrove Park hospital in her constituency have been retained following a consultant retirement, which prompted the temporary arrangements. I am pleased that, since the beginning of April, Somerset CCG has successfully commissioned regular dermatology clinics at Musgrove Park using specialists from Bristol, with a view to restoring a full service from next April. We recognise the important service that dermatology clinics provide and are committed to encouraging that specialty in Somerset and nationally.
Dermatology is one of the specialisms that is particularly dependent on doctors from other EU countries. Is it not becoming clearer by the day, whether on the staffing crisis in the NHS or the threat to our pharmaceutical industry highlighted by the Health Secretary in his letter today, that the extreme hard Brexit being pursued by the Prime Minister is disastrous for our NHS? What are the Minister and the Secretary of State doing to pull the Prime Minister back from that damaging course?
Order. In relation to dermatologists is, I think, what the right hon. Gentleman had in mind.
I cannot tell the right hon. Gentleman precisely how many of the excellent dermatologists come from the EU, but I can tell him that, since the referendum, 562 non-UK EU doctors have come to work in the NHS.
St Helier Hospital
4. When he last discussed the future of St Helier Hospital with the Epsom and St Helier University Hospitals NHS Trust. 
The Secretary of State recently met the chief executive of Epsom and St Helier University Hospitals Trust and was impressed by the fantastic work staff are doing despite the surroundings and facilities, which are clearly in need of improvement, for which the right hon. Gentleman has been campaigning. Any significant service change must be subject to consultation with local people, be based on clinical evidence, consider patient choice and have support from GP commissioners.
Indeed the Secretary of State did visit the hospital on the first day of the election campaign—nothing suspicious about that timing. The Minister will have heard that 43% of the estate is unsuitable for the delivery of modern healthcare yet, thanks to the hard work of staff, St Helier is one of the few hospitals that manages to keep on top of A&E waiting time targets. Would he like to be the bearer of good news and confirm that the Government will reinstate the £219 million that the Secretary of State cancelled to enable a new hospital to be built?
As the right hon. Gentleman knows, the south-west London sustainability and transformation plan area is in the process of turning its proposals into plans, with public consultation when appropriate. It has yet to make any recommendations. As he knows, it set up four local transformation boards to consider how best to transform services, including at both Epsom and St Helier hospitals, for the decade beyond 2020. It would therefore be wrong for me to prejudge those conclusions at this stage.
Rather than having empty political campaigns, does my hon. Friend have a sympathetic ear for an alternative, well thought-out plan for healthcare in Sutton which works clinically and financially and listens to all residents in Sutton?
My hon. Friend is right. We need to look to the proposals coming from the clinicians on the ground who are responsible for running acute services for the whole of south-west London. They have made it clear that they intend to consult the public once they have made their recommendations transparent. They intend to retain all five hospitals but to look at the configuration of services among them, and that needs to be led by clinicians.
5. What assessment he has made of the adequacy of the number of GPs. 
In answering my first Health question, may I thank the cardiac intensive care unit team at Barts hospital in London, where my father-in-law, the just retired Supreme Court Justice Lord Toulson, sadly passed away last week? They did absolutely everything they could and showed the very best of the NHS.
We have committed to there being an extra 5,000 doctors in general practice by 2020 as part of a wider increase in the total workforce in general practice. NHS England and Health Education England are working together with the profession to increase the GP workforce. We believe that that is an essential part of creating a strong and sustainable general practice, and indeed NHS, for the future.
In recent years, the number of family doctors in Sunderland has plummeted. All the evidence shows that doctors are more likely to stay in the areas where they have trained. Does the Minister accept that new medical school places should be created in areas such as Sunderland, where there is the greatest need to recruit and retain general practitioners?
I thank the hon. Lady for her question. Since 2016, Sunderland’s GP Career Start scheme has recruited 10 newly qualified GPs. A further five newly qualified GPs will be recruited each year over the next three years. I understand her point about medical school provision. Undergraduate medical education is delivered in the north-east in partnership between Newcastle and Durham universities. There are currently 25 medical schools in England offering just over 6,000 Government-funded medical school places. We are funding 1,500 additional places each year. Five hundred have already been allocated, with 24 of them in Newcastle.
Recruiting more GPs in Cheltenham is vital to share the growing workload they face, but rising indemnity costs, particularly for out-of-hours care, can act as a disincentive. Does my hon. Friend agree that this must be addressed decisively?
Indeed we do. We recognise the role that GPs play in the delivery of NHS care. Following the GP indemnity review, additional money was included in the contract last year to address indemnity inflation. We said in our manifesto that we will ensure appropriate funding for GPs to meet rising costs in the short term and work with the industry to produce a longer term solution.
17. As the number of GPs goes down, there is increasing pressure on the time they have with their patients. One area being missed is that of suicide and self-harm. We now know there is an increased risk of suicidal behaviour for those on unstable and irregular zero-hour contracts, and that those on employment and support allowance are more than two thirds more likely to take their own life. What are we doing to advise GPs on that?
The hon. Lady, who chairs the all-party group on suicide and self-harm prevention, does a huge amount of work in this area. The GP patient survey last year showed that 85% of respondents rated their GP experience as good. We are investing about £30 million of taxpayers’ money in the releasing time for care programme, which we hope will increase the time GPs can spend with patients on issues such as those she raises, but in my new role I am very happy to meet her.
GPs are the first line of defence against antibiotic resistance, which has the potential to be an uncontrollable global new black death. Will the Minister confirm that the UK will retain its position as a world leader on this issue, and will he tell us when the global antimicrobial resistance innovation fund will open for applications and when the pilot reimbursement model for drug development will begin operating?
The Government have committed £50 million of official development assistance towards setting up the global antimicrobial resistance innovation fund. We are one of the world leaders on this subject. I am meeting my hon. Friend and my hon. Friends the Members for Stafford (Jeremy Lefroy) and for York Outer (Julian Sturdy) shortly, when we can take this forward.
I spoke to one GP last week who told me that because he has been unable to recruit help he has only been able to take one week’s leave in three years. That is clearly not sustainable. The morale of GPs is at an all-time low, the number of GPs continues to fall, surgeries are closing, and patients are finding it harder and harder to get an appointment. The Secretary of State promised an extra 5,000 GPs by 2020, but given that it takes 10 years to train a GP will the Minister tell the House how exactly he is going to deliver on that promise?
I thank the hon. Lady for her question and I look forward to engaging with her on such matters. The “General Practice Forward View” is a landmark document, which was published in April last year. As she knows, it sets out extra investment that GPs have been calling for for years: £2.5 billion a year for GP services. That means investment is rising. The good news, as the Secretary of State said, is that more people are coming into general practice. We want to continue to encourage that, but we also have to take action to prevent early retirements and to bring people back to general practice. We are indeed doing that.
6. What steps are being taken to broaden routes into nursing. 
Developing new routes into nursing is a priority for the Government. That is why we launched, as the Secretary of State set out, both the new nursing associate role and the nursing degree apprenticeship earlier this year. They will open new routes into the registered nursing profession for thousands of people from all backgrounds and allow employers to grow their own workforce from their local communities.
My constituents welcome the manifesto commitment to expand the number of clinical staff for mental health. What more can my hon. Friend say about plans for mental health nurse training and how they will benefit dementia services, in particular, in my constituency?
Health Education England’s “Workforce Plan for England” for 2016-17 indicated an increase of more than 3% in the number of mental health nurse training places. It stated:
“The current level of mental health nurse training is the highest of any nursing branch as a percentage of the workforce it serves”,
which should allow for an increase of some 22% to more than 8,000 full-time equivalent staff members in the mental health workforce by 2020.
The fact is that when the Government chose to charge students record levels of tuition fees and scrap their NHS bursary, the Secretary of State and his Ministers were warned that that would lead to a fall in the number of applications, and what has happened since then? The number of applications for nursing degrees has fallen by 23%. Given that the Secretary of State has already acknowledged that we cannot continue our over-reliance on EU staff following Brexit, when will Ministers understand that the biggest challenge facing nursing recruitment is not our policy on the EU, but the Government’s own health policies?
The hon. Gentleman is right to draw attention to the fact that we continue to have a surplus of applicants for nursing degree courses in this country. The level of that surplus has fallen somewhat as a result of the change in funding structures. We shall have to see where it ends up, because at present universities are not recruiting directly outside the UCAS system, but we are confident that there will be more applicants than places this year by a ratio of some 2:1.
Does the Minister agree that there are opportunities for more mature students to gain access to courses easily, and that more work must be done with adult learning institutions to provide courses that allow such direct access?
The hon. Gentleman is right to point out that the more mature workforce, particularly people resuming careers later in life—perhaps, in the case of women, after they have had children—is an important source of experienced professionals, and we need to do more than we have been doing to try to encourage such people to return to the workforce.
Accident and Emergency Departments
7. What steps he has to secure the future of accident and emergency departments. 
Last year our A&Es saw 1,800 more people every day within the four-hour target than they did in 2010. We also have nearly 1,500 more emergency care doctors and over 600 more emergency care consultants.
A&E departments and associated acute care services at district hospitals such as Stafford and Burton are a critical part of the regional emergency infrastructure, enabling the large city-based departments to deal with major trauma specialist cases as well as day-to-day emergencies. Will my right hon. Friend ensure that that vital emergency infrastructure is protected, enhanced and funded?
I absolutely agree with my hon. Friend that an emergency care network that works well for his constituents is essential. As he fully understands, that will mean relying on a network of hospitals. I recognise the concern at his own local hospital, for which he campaigns extremely vigorously, and I assure him that I shall be watching very carefully what happens there.
Will the Secretary of State now confirm what the Prime Minister said when she visited west Yorkshire, namely that it was scaremongering to talk of the closure of Huddersfield A&E? Will he also confirm that we should have a real plan with a gold-standard university for a new medical school in Huddersfield, so that we can really attract talent? That would do a great deal for morale, which would lead to the recruitment of good doctors and nurses everywhere.
The hon. Gentleman is right to say that it is time we had more medical schools, given that health and social care will be one of the fastest-expanding areas of the economy in the coming years. I think the Prime Minister was absolutely right to say that there should be no scaremongering about important local plans that will improve services for patients.
Will the Secretary of State reassure my constituents that the component parts of the NHS can communicate with each other sufficiently to ensure that decisions such as the one by a medical dean to remove accreditation for anaesthetic training will not lead to the closure of A&E departments in hospitals such as Houghton general, where my father was treated so well last Friday?
The hon. Lady’s father is a splendid fellow, and he is now in another place. [Laughter.] I was referring to another House of Parliament.
I was concerned about the general laughter following that comment, Mr Speaker.
I am delighted that my hon. Friend’s father was treated so well, and I very much enjoyed my visit to the hospital recently. She is right: where there are changes in the patterns of training, we need to be very careful to ensure that they do not interrupt the delivery of local services in a disadvantageous way.
The boundaries of the sustainability and transformation partnerships are bound to cause concern about the future of A&E and other acute departments given the nature of them. My area, south Cumbria—relatively sparsely populated and rural—is lumped in with Lancashire, which is largely urban. Will the Secretary of State confirm that the voices of rural communities will not be dwarfed by those of the larger urban ones, and in this week, as we celebrate the 25th anniversary of Westmorland general hospital, will he give guarantees that it will not be closed and will indeed not receive any downgrading as a result of the STP process?
Westmorland general hospital has a very important future in the NHS and I am happy to give the hon. Gentleman that assurance. I do not think he should be concerned about STP footprints covering both rural and urban areas. However, where there is an issue in his constituency, and many others, it is the response times for ambulances in the most remote areas, and we are looking at that.
Another threat to A&E units is the capped expenditure process, which will mean hundreds of millions of pounds cut from NHS budgets. That was sneaked out during the election, but so far we have had nothing but silence from this Government. It is time that we had the truth: when did the Secretary of State sign off these plans and when is he going to publish them?
The capped expenditure process is an NHS England initiative to meet its statutory duty to live within its budget, and I support the principle that in a period where real expenditure on the NHS is going up by £5 billion, those benefits should be spread fairly among patients in all parts of the country.
8. What progress is being made on improving end-of-life care. 
In July 2016 the Government published “Our commitment to you for end of life care”. This set out what everyone should expect from their care at the end of life and the actions we are taking to make high quality and personalisation in care a reality for everyone. By 2020 we want to significantly improve patient choice, including ensuring an increase in the number of people able to die in the place of their choice, including at home.
I thank the Minister for her reply, and it is welcome news that there is such a focus on end-of-life care. Will she meet me to discuss the Access to Palliative Care Bill presented in the other place, to look at how we can improve access to palliative care across the whole of the UK?
I will be delighted to meet my hon. Friend, who is a committed and passionate campaigner in this area. I am keen to explore anything that improves care and choice for all patients at the end of their life.
22. Croydon’s NHS, including end-of-life care, has been funded below the London average every year since the Conservatives first came into government. That is leading to the closure of services in Croydon that are available elsewhere, and to longer waiting times for GPs or the A&E in Croydon. When will Croydon’s funding be brought up to the London average?
The amount of resource that is dedicated locally is a matter for clinical commissioning groups, and we continue to make sure that funding is fair. I suggest the hon. Gentleman takes that up with his CCG.
Healthcare: CCG Guidance
9. What guidance he provides to clinical commissioning groups on decision-making processes to improve healthcare provision. 
Clinical commissioning groups, as statutory organisations, have a duty to deliver the best possible services and outcomes for patients within their financial allocation. NHS England supports them in this by providing several sets of guidance, as do the National Institute for Health and Care Excellence and other arm’s length bodies.
I thank the Minister for that answer. He will know that the clinically driven Future Fit process in Shropshire could lead to hundreds of millions of pounds of investment in our local hospital. That is being jeopardised by Telford CCG and Labour-controlled Telford council. When there is this gridlock and impasse between two local CCGs over a long period of time, what more can the Government do to break the deadlock?
I am aware that my hon. Friend has been concerned about this for a long time. An independent review of Future Fit is taking place, and he will know that Professor Simon Brake has been appointed as the independent chair of the joint committee of CCGs, agreed between them both. The review will report in July and be considered by the local CCGs before next steps, including on public consultation, are decided. Clear rules apply to any significant reconfigurations and I expect these to be followed in Shropshire as anywhere else.
Patients at the Manchester Royal infirmary with serious congenital heart problems found out last week that the services will now no longer be provided in Manchester, or in fact anywhere in the north-west, due to a Government review of services which means that staff cannot be retained and recruited. What has the Minister got to say to those patients who now have to go to Leeds or Newcastle to get the lifesaving surgery that they need?
I understand that this is an independent review of services, and it will report in due course.
Does my hon. Friend agree that, when political activists mislead and misinform my constituents about the future of our Princess Royal hospital, the CCG should communicate directly and clearly with residents so that they can be reassured that our A&E and our women’s and children’s services are safe?
Yes, I do. The CCG should communicate directly with patients, and that should be clinically led when making the clinical case for any service reconfigurations. As I said to my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski), there are clear guidelines that the CCGs must follow. There are now five tests that must be met before any reconfigurations are brought forward, and that should be the same for my hon. Friend’s area as for everywhere else in England.
The Abingdon community hospital is a treasured asset in my constituency, but in trying to find savings of £176 million, the local clinical commissioning group is launching a consultation on its future imminently. May I seek reassurance, on behalf of my constituents, that the hospital will not close and that, as part of the consultation, their voices will be not only heard but acted upon?
Clinical commissioning groups have a statutory responsibility to consult the public, and Members of Parliament have a key role in ensuring that members of the public engage with those consultations, as I do in my area. I will be following the hon. Lady’s case closely, and she is welcome to come and see me about it if she likes.
Tobacco Control Plan
10. When the Government plan to publish a tobacco control plan. 
The UK is a world leader in tobacco control, and we will publish a new tobacco control plan shortly, building on our success. That plan will set out new national ambitions to further reduce smoking prevalence, particularly among disadvantaged groups.
I need to declare an interest as a Suffolk county councillor. Given the health responsibilities of local government, will the Minister tell the House what can be done to deal with the situation in which the actuarial advice from local government and other public sector pension schemes is that they are not at liberty to disinvest from tobacco stocks?
I will have to look into the exact point that the hon. Gentleman raises, but I should like to welcome him to his place. I worked closely with his predecessor, and the hon. Gentleman has a tough act to follow. When we publish the tobacco control plan, there will be clear local tobacco plans as part of it. We in the Government can give the best evidence of what works, but we need to recognise what is needed in each local area. I know that he has specific needs in his local area in relation to tackling this issue.
I welcome the Minister to his place. Does he agree that it is vital that anyone who approaches the national health service with a smoking-related disease should be pointed towards smoking cessation services? Does he also agree that it is vital that local authorities continue to run those services?
Yes, absolutely. Local authorities have an obligation to do that, but as I said to the new hon. Member for Ipswich (Sandy Martin), it is important that local plans come forward alongside the new national plan. Local solutions are needed for different areas, and that will be the case in my hon. Friend’s borough just as it is in my area of Hampshire.
Last week marked the 10th anniversary of the smoking ban across the UK, but sadly the celebration was dampened by the fact that we have yet to see the Government’s new tobacco control plan, which was promised in December 2015. The previous two Health Ministers I have shadowed repeatedly said that we would see the plan shortly, but they failed to set out an updated strategy for working towards a smoke-free society. I welcome the Minister to his new post—we have worked well together in the past on the all-party parliamentary group on breast cancer—and I am hoping that, although he has not yet given us a date for the plan, he will be able to give us an indication. Is it going to be published before Christmas?
I thank my hon. Friend for her question. I think I can call her that; we have worked closely together in the past. I am new to my ministerial post, but I have been through the plan, and it is I who has to stand up and defend it. I want to be sure that it is right and that I am as happy with it as everyone else in the Government. My intention is that it will be published before the summer recess.
Within East Sussex, Wealden has the highest number of smoking-related deaths. I welcome the update on the tobacco control plan, but how will my hon. Friend raise awareness and provide equal access for rural communities?
Rural communities are as important as any other. It is up to East Sussex County Council to come forward with a local tobacco control plan, and I know my hon. Friend will be taking a close interest in that, as she does in all matters when representing her constituents.
Dental Surgery: Children
11. What steps he is taking to reduce the number of children admitted to hospital for dental surgery. 
Public Health England leads a wide-ranging programme to improve children’s oral health. Its oral health strategy, which was published last year, showed a marked improvement across the country in the proportion of children with no obvious tooth decay—it rose from 69% in 2008 to over 75% in 2015. NHS England is finalising plans for the “Starting Well” programme, which will operate in 13 high-needs areas to improve the oral health of under-fives.
Prevention and early intervention are crucial, but no NHS dentists are accepting new patients in Dewsbury, which has the second-worst provision in the country. Children in Dewsbury have five times the national average level of tooth decay. I have asked for help on this for two years, but absolutely nothing has been done. Can you tell me why the dental health of children in Dewsbury is so unimportant to this Government?
I cannot, but I hope that the Minister can—preferably rather briefly.
I will try, Mr Speaker.
NHS England recognises the significant challenges in dentistry in Yorkshire, which was why it ran a pilot scheme from January until the last week of June to improve access to primary care dentistry in the Bradford City, Bradford Districts and North Kirklees CCG areas. The pilot will inform the wider work that the NHS is considering across Yorkshire.
I declare an interest which is probably fairly well known.
The Minister will be aware that the answer is early-years prevention. A huge campaign, which is making progress, is being led by the chief dental officer, for whom I have considerable admiration. Is the Minister prepared to meet me and the chief dental officer to discuss that progress? In advance of that appointment, will he look at the possibility of providing additional funding from the annual dental clawback?
New Members probably will not know that the hon. Gentleman is a dentist.
I believe that my hon. Friend is the only dentist in the House, and he still practises occasionally. I would be delighted to meet my hon. and experienced Friend to discuss the issues about dentistry that he raises.
General Practitioners: Newcastle
13. What assessment he has made of the consistency and quality of GP services in (a) Newcastle and (b) England. 
In 2016, 85% of patients surveyed across England reported a good overall experience of their GP surgery. In the Newcastle Gateshead CCG, patient satisfaction is even higher than the national average at 88%.
Newcastle has fantastic GPs, but many of my poorest and most vulnerable constituents suffer from GP unavailability and a constant change of providers due to the requirement to re-tender every couple of years to a market that, quite frankly, does not want them because they are too poor or too marginalised to make money from. Will the Minister meet me and my local CCG to find out how we can ensure that those people get the quality and consistency of GP services that they deserve?
I am very happy to do that.
Following the closure of their GP surgery, my constituents in Brownsover have had to make do without one over the past few years. Approvals are in place for a new surgery and it is due to open next summer. Will the Minister confirm that the timeline set out by NHS England will be met?
I will ask NHS England, but if that is what it has told my hon. Friend, that is what will happen.
Mental Health Services
14. What plans he has to improve the integration of mental health services for young people and adults. 
We are investing a record £1.4 billion in children’s mental health services. The transition from children’s services to adult services can cause distress, so NHS England has prioritised transitions when offering financial incentives for improvements. We will consider that in the forthcoming Green Paper.
I thank the Minister for that answer. There is a growing crisis in young people’s mental health in Plymouth and the far south-west. Despite 75% of mental health problems starting before the age of 18, only 8% of funding is allocated to young people. Will the Minister consider ring-fencing that young people’s mental health spending so that the funding gets to where it is needed?
The hon. Gentleman makes a good point. We have to balance the need to give CCGs the flexibility to dedicate funding and prioritise in their own way. We have been told by mental health professionals that the targets for physical health are more rigorous than those for mental health. We need to keep that under review, but we have imposed additional targets, which are being met.
I commend the Government for their work on mental health over the past few years, but when the Department of Health publishes its Green Paper, jointly with the Department for Education, may I urge the Minister to focus on the evidence of what works for young people and children, which is rigorous early intervention, often with enduring psychotherapeutic interventions? Can she reassure me that the Green Paper will look at evidence on what actually works for young people?
I can give my hon. Friend that assurance. Indeed, the Care Quality Commission is undertaking a thematic review to see what works. He is right to identify early intervention as key but, as the hon. Member for Plymouth, Sutton and Devonport (Luke Pollard) highlighted, there is a need to consider the transition as well.
The right hon. Member for North Norfolk (Norman Lamb) is not exactly standing; he is more perched like a panther about to pounce.
Thank you for the encouragement, Mr Speaker.
I have been alerted to an online posting yesterday on the social network Nextdoor by the father of a teenager who suffered awful trauma witnessing the horror at Grenfell Tower. He was after therapy for his daughter. Clearly there is an absolute need to ensure that everyone who may be in need knows how to get such therapy. What are the Government doing to ensure that everyone does know? Also, what are they doing to ensure that there is sufficient funding locally so that mental health services can provide for what will clearly be ongoing needs?
I thank the right hon. Gentleman for his question. I would be grateful to receive more details so that we can make sure that such support is going where it is needed. I advise him that, certainly in the case of the too-frequent disasters that we have had recently, we have been relying on more intervention on the ground. In our work on mental health first aid we are prioritising exactly those areas.
15. What steps are being taken to ensure that NHS Improvement provides timely and effective support to health communities to deliver consistently high-quality care. 
NHS Improvement offers tailored support to the organisations it oversees, particularly those that have gone into special measures as a result of a Care Quality Commission review. The Department, of course, has responsibility for holding NHS Improvement to account, and it does that through me.
Northern Lincolnshire and Goole NHS Foundation Trust is in special measures for both financial and quality reasons, but the support given to date by NHSI has been neither timely nor effective. What are the Government going to do about that?
We are clearly disappointed that Northern Lincolnshire and Goole NHS Foundation Trust has gone back into special measures. It is one of a very small number of trusts that have emerged from special measures and then reverted, so this is something in which we are taking a lot of interest. NHS Improvement has appointed an improvement director and is in the process of arranging for a nearby buddy trust to provide some support. I assure the hon. Gentleman that the Department is receiving weekly updates.
T1. If he will make a statement on his departmental responsibilities. 
Yesterday I updated the House on the action that we are taking to address delayed discharges from hospitals in advance of the winter. Since February, there has been a record decrease in delayed discharges, but faster progress is still needed to free up beds for the sickest patients and to reduce pressure on A&Es. Yesterday we therefore set out further measures to support the NHS and local government to reduce delays, including specific reductions required in all local areas, a prospective review of next year’s social care funding for poorly performing local authorities, and immediate CQC reviews in the worst-performing areas.
The latest figures from the British Medical Association show a huge rise in the number of patients with mental health conditions who are being sent hundreds of miles away from home for treatment. Is not any talk of parity of esteem meaningless unless and until patients can access the support they need close to home?
I completely agree with the hon. Lady that that is a very important issue. It is particularly important because people with mental health conditions need regular visits from their friends and family to help them to get over a crisis. Indeed, their chances of getting discharged and being able to go home are much higher when they are nearer home. She will be aware that we have a commitment to eliminate all out-of-area placements for children by 2020, and we are making big efforts with adults as well.
T4. Leicester and Leicestershire MPs, irrespective of party and led by the hon. Member for Leicester West (Liz Kendall), are united with local people, patients and medical professionals in opposition to NHS England’s badly thought out and, frankly, wrong proposals to close Glenfield hospital’s children’s heart unit. Can my right hon. Friend reassure me that he continues to appreciate the strength of feeling on this issue and that he will ensure that the eventual decision reflects the responses received to the consultation? 
My hon. Friend and other Leicestershire MPs have made their views very clear to me. I hosted a number of them, from both sides of the House, to discuss this issue. He is aware that the public consultation on congenital heart disease services continues until 17 July. Obviously, we will take all the comments made into account when we come to the conclusions from that report.
Today is the sixth anniversary of the publication of the Dilnot commission’s report on the funding of social care. In those six years, Ministers have legislated for a cap and a floor on care costs, and then abandoned those measures. They brought forward disastrous proposals in their manifesto for what became known as the “dementia tax”, and they appear to have abandoned those measures, too. Will the Secretary of State confirm that those policies have indeed been abandoned? Will he tell me, and more than 1 million people with unmet care needs, when he expects to have some new proposals for reform?
I have great respect for the hon. Lady, because she campaigns consistently on this issue, but I do not think that what she says is a fair reflection of what has happened. In the last year of the previous Labour Government, 45,000 people had to sell their home to pay for their care costs, whereas this Government have made it the law that no one has to sell their home. There is more work to do, but we have made important progress and will continue to do so.
T5. Nothing is more important than that people can access a GP when they need one. With that in mind, will the Minister join me in welcoming the move made by South Tees clinical commissioning group to enable 90,000 more appointments a year to be generated for people in Middlesbrough, Redcar and Cleveland by ensuring that appointments are available on evenings, weekends and bank holidays? 
I do indeed welcome that. Improvements to GP access in the NHS in South Tees have been put in place. Patients in Middlesbrough, Redcar and Cleveland can now benefit from accessing GP appointments at a time that is convenient for them, seven days a week—that is exactly as it should be.
T2. With the Scottish Government now committed to a soft opt-out system for organ donation similar to that implemented in Wales in 2015, is it not time that the UK Government followed the lead of the Welsh and Scottish Governments by introducing a similar system south of the border? 
There is a lot of merit in the opt-out system that has been developed in Wales for some time and is now happening in Scotland. We are looking closely at the evidence, but we have a lot of sympathy with this. If the system does lead to an increase in organ donations, it is certainly something we would want to pursue here.
T6. One-year cancer survival rates are now at a record high of 70%, but does the Minister agree that we should and can go further by improving early diagnosis and screening? 
Yes. Progress is really encouraging, and I am sure that Members on both sides of the House will have been encouraged to see today’s press coverage about the chief medical officer’s independent report on genomics—the age of precision medicine is truly here. The NHS has always been at the forefront of new technologies, and so it must be with this; we are determined that it will be.
T3. Would a Minister be willing to meet the all-party group on blood donation after it has been reconvened next week and would they be able to provide an update on the work of the Advisory Committee on the Safety of Blood, Tissues and Organs in respect of lifting or easing the deferral period for gay men who want to donate blood? 
I would be happy to agree to such a meeting, and I know this issue has support on both sides of the House.
T8. Last week I met doctors and nurses at the Friarage, an excellent small hospital serving a rural population spread over 1,000 square miles. Will my right hon. Friend urge South Tees Hospitals NHS Foundation Trust to do everything it can to ensure the continued provision of emergency care clinicians and anaesthetists at this vital local hospital? 
I am aware that my hon. Friend has taken a strong interest in the number of consultants and anaesthetists available at the Friarage hospital. I will be happy to meet him to discuss his concerns in person.
T7. At the height of the recent election campaign, NHS England took forward plans to merge, in effect, six south London CCGs, including Greenwich CCG, under one single chief officer. Does the Minister agree that that would be a retrograde step, not only in terms of local accountability, but at a time when primary care has been devolved downwards and all the emphasis is on collaboration and integration at a local borough level? 
I think the answer is that this varies from area to area. The CCGs grew up organically following the Health and Social Care Act 2012. Some parts of the country are discovering that the groups can be more effective if they combine forces, but these things have to be decided locally.
In addition to the Government’s welcome focus on mental health first aid, may we have equal focus on mental health keep fit, looking particularly at the Mental Health Foundation’s 10 pointers, so that we can all keep our mental health in good condition?
As ever, my hon. Friend makes an important point. I think that every child should leave school as knowledgeable about how to remain mentally resilient as about how to be physically healthy.
T9. What recent assessment has the Secretary of State made of the financial sustainability of Coventry and Rugby clinical commissioning group? 
Like all clinical commissioning groups, Coventry and Rugby CCG is under a great deal of pressure, but our view is that, given the recent funding increases, it should be entirely possible for it to be sustainable.
May I return the Minister’s attention to the issues facing Northern Lincolnshire and Goole NHS Foundation Trust? My constituents are worried that both Grimsby and Scunthorpe hospitals are in special measures for the second time in as many years. Will he meet me and neighbouring MPs to discuss the situation?
I am more than happy to meet my hon. Friend, but he should be confident that we have put in place a substantial support package, including a buddy relationship with another trust and special teams from NHS Improvement, to turn the situation around.
T10. What action does the Secretary of State intend to take to address the link between suicide and socioeconomic deprivation highlighted in the Samaritans’ “Dying from inequality” report as he seeks to reduce the suicide rate by 10% by 2020? 
We will look carefully at the Samaritans’ report, as we always do with what the Samaritans say. I think the signs are that our policies are having an impact and reducing suicide rates significantly, but suicide remains the biggest cause of death among men under 50.
Funding our national health service to meet the needs of UK residents is one proposition; funding an international health service open to the world is another proposition entirely. Are there any indications that advance charging for non-emergency treatment for overseas patients is putting more money into our NHS?
My hon. Friend is a doughty campaigner for ensuring that non-resident visitors to this country contribute for healthcare received here. We put in place a number of measures to enhance the appropriate charging structures and increased the funding received by the NHS from £89 million to £289 million in 2015-16. We expect similar action to result in a further increase.
NHS Property Services has just signed a £1 million lease on a central London location. May I suggest that other properties were available? Would the Secretary of State like me to inquire in my constituency, where NHS Property Services increased Knowle West Health Park’s rent threefold? Better value for the taxpayer is available.
I will be happy to look into the matter if the hon. Lady sends me the details.
I know that Ministers share my passion for ensuring that a bereavement suite is attached to every maternity unit in the country. What steps can the Government take to make that a reality?
I congratulate my hon. Friend on his dedicated work. The Government understand the importance of bereaved parents having a dedicated place where they can be cared for and not hear other babies crying. We have funded better bereavement spaces in nearly 40 hospitals and continue to work with Sands—the stillbirth and neonatal death charity—to see what more we can do to improve provision.
It is always quite interesting to study the habits of colleagues. The hon. Member for Feltham and Heston (Seema Malhotra) has perambulated from one side of the Chamber to the other; nevertheless, she is here and I suppose we should hear her. No? The hon. Lady had a question on the Order Paper. Your opportunity is now—get in there!
During the election campaign, a lady in my constituency told me that she had had to wait nearly four hours for an ambulance to arrive at her home to help her off the floor. Does the Secretary of State have confidence in the ambulance service in London and other regions where targets have been consistently missed? Will he now look at extra resources for the ambulance service across the country, which is so urgently needed by all of our constituents?
If I may say so, that was a brilliant recovery. The hon. Lady is absolutely right to focus her attention on the performance of ambulance services. They are under pressure. They are hitting around 71% for their category A calls, and the target is to hit 75%. However, there are some bigger issues with the way those targets work, which we are looking at. Her ambulance service has just had a Care Quality Commission inspection.
As a result of the capped expenditure process, the wider Devon sustainability and transformation plan is being asked to make £78 million of savings at short notice—within the next nine months. Does the Secretary of State share my concern about the impact on patients, the short timeframe and the undermining of savings already agreed by the STP? Will he meet me to discuss this matter and the wider CEP?
I am more than happy to meet my hon. Friend. The principle behind the capped expenditure process is that we should have fairness between patients in different parts of the country. We should not see patients in one part of the country disadvantaged because the NHS has overspent in their neighbouring area, but the way in which we implement the process must be sensitive and fair. We must ensure that we get it right.
What advice would the Secretary of State give to my constituents who receive their urgent care from Virgin Care, and are told that wounds should be dressed only once and that, in the event that they need to re-attend, they should purchase further dressings from the local chemist? Free at the point of delivery?
I suggest that the hon. Lady gets in touch with the details. What I would say is that when care is not satisfactory—whether it is delivered by the public sector or the independent sector—we have an independent inspection regime to root out the problems.
I was delighted to hear that, in answer to my hon. Friend the Member for Boston and Skegness (Matt Warman), the Minister was positive about the progress of genome screening. On a recent visit to Nottingham University, I saw similar techniques applied to Alzheimer’s research. Will he back using the process for that, as well as for cancer diagnosis and treatment?
The chief medical officer’s report—I am sure that my hon. Friend will read it in due course—is clear that this is an exciting new innovation in medicine. We will tackle cancer first, but there is real potential for applying it to rare diseases and the other disease that she mentioned.
Several hon. Members rose—
Order. We must now move on.