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House of Commons Hansard
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Oral Answers to Questions
10 October 2017
Volume 629

Health

The Secretary of State was asked—

Mental Health Workforce

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1. What recent steps he has taken to increase the size of the mental health workforce. [901005]

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Today is World Mental Health Day and the whole House will want to congratulate Time2Change on its 10th anniversary and the remarkable change in attitudes towards mental illness that it has helped to bring about. Our mental health workforce has increased by 30,000 since 2010 and another 21,000 posts are planned. [Official Report, 16 October 2017, Vol. 629, c. 4MC.]

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On World Mental Health Day, I congratulate the Secretary of State on the work he has done, especially for children. We have had 42% more children receiving care for eating disorders and over 21,000 more children have received access to mental health provision. What targets does the Secretary of State have to help to improve such provision?

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Our plans envisage treating another 70,000 children every year by 2020-21, but that is still not enough. It will take us from one in four children needing help to one in three. That is why we are publishing a Green Paper on child and adolescent mental health.

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One of the staffing shortages is actually in children and young people’s services. In County Durham in my constituency, the waiting time for autism diagnosis is two years. I have raised this with the mental health trust and NHS England, but the problem seems to be with the clinical commissioning group. What can the Secretary of State do to ensure that the extra money that he has pledged to put into the service actually gets to the service?

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I would like to thank the hon. Gentleman for speaking out about mental health, like so many colleagues in this House, which makes a massive difference to the Time2Change campaign. It is unacceptable for someone to be waiting that long, and I do not want to stand here and defend it. I will certainly look into the individual case that the hon. Gentleman raises, but the fact is that many Members will know of similar cases. The money is starting to get through to the frontline. It is not just money, though; it is also capacity, and having trained mental health therapists—nurses; psychiatrists—and that is why we are boosting their training, too.

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As someone who is married to an NHS psychiatrist, may I start by paying tribute to all those volunteers, carers and professionals working in mental health on World Mental Health Day? Has the Secretary of State seen today’s briefing by the Children’s Commissioner, highlighting the vital importance of prevention and early intervention? Will he set out what steps he is taking to support a growing workforce—volunteers and professionals—working in prevention and early intervention?

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My hon. Friend is absolutely right. I am aware of the report that she talks about. We know that half of mental health conditions become established before the age of 14, which is why early intervention is so important. In July, I announced an expansion in the mental health workforce—another 21,000 posts. A number of those will be in children’s mental health, to address the issues she raises.

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The Secretary of State may know that because of a reduction in the number of mental health clinicians in Cumbria, the Cumbria Partnership NHS Foundation Trust has now chosen to end consultant psychiatric call-out care from 8 pm to 9 am. It would have started last week, but it is going to start in the next two or three weeks. That means, as I am sure he is aware, that it will not be possible to section people under the Mental Health Acts between those hours unless they are within an NHS facility. People in police stations, people in care homes and people at A&E departments will not be—

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Order. If the hon. Gentleman wants to make an application for an Adjournment debate, he can do that on a subsequent occasion. I think we have got the gravamen of his question.

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The question is: does the Secretary of State agree that that is not an appropriate use of resources, and will he provide the resources that are needed?

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The hon. Gentleman raises a very serious issue. I will not go into it in detail now, but I will certainly look into it closely and get back to him, if I may. Obviously it is very important.

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23. On World Mental Health Day, may I also welcome the progress the Government have made? We are doing all that we can to make changes. However, too many patients in my constituency, particularly younger patients, have to travel out of Eastleigh for the treatment they need, especially given the challenges facing Southern Health. Will the Secretary of State outline what he will be doing to right this wrong? [901029]

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My hon. Friend is right to draw attention to the issues around Southern Health, which will have directly affected a number of her constituents. That organisation is being turned around. However, she is also right to say that too many people are travelling out of area for their treatment. We have record numbers of children’s beds commissioned, but in the end this is about the capacity of the system of trained psychiatrists, psychologists and therapists, which was why we announced the extra 21,000 posts.

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On World Mental Health Day, may I thank my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) for wearing yellow for #HelloYellow on behalf of our team?

The Secretary of State’s claim that thousands of extra mental health staff will be appointed by 2021 is fanciful unless he tells us how they will be funded. Today, the Care Quality Commission reports that mental health services are struggling to staff wards safely. We have also learned recently that two out of five mental health staff have been abused or attacked by patients in the past year. Most blame staff shortages for that violence. Rather than telling us about recruiting for 2021, what is the Secretary of State going to do today to protect staff from violence? [Official Report, 16 October 2017, Vol. 629, c. 4MC.]

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Let me tell the hon. Lady what has happened in mental health. Some 30,000 more people are working in mental health today than when her Government left office—a 5.8% increase in clinical staff. On top of that —she asked about money—we have committed an extra £1 billion a year by 2021 so that we can employ even more people. We are the first Government to admit that where we are now is not good enough. We want to be the best in the world; that is why we are investing to deliver that.

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21. Parental conflict is recognised as a key cause of children’s mental health problems. What is the Department doing to address that, and will Ministers be willing to meet a group of colleagues who supported the “Manifesto to Strengthen Families”? Its policy proposals seek to discuss how strengthening families can address children’s mental health problems. [901027]

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My hon. Friend is absolutely right. Children who come from troubled or chaotic family backgrounds are far more likely to have mental health issues. I am more than happy to meet her and to feed her thoughts into our mental health Green Paper.

Nursing

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2. What steps he is taking to broaden routes into nursing. [901006]

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Developing new routes into nursing is a priority for my Department, which was why last week I announced plans to train 12,500 new nursing associates through the apprentice route in the next two years and to increase the number of nurses we train by 25%—the biggest increase in the history of the NHS.

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I welcome the fact that there are currently record numbers of nurses working in the NHS, but what is the Secretary of State doing to provide assurances to hospitals, such as the Alex in my constituency, that have faced issues with recruitment and retention? I very much welcome the new routes into nursing, including degree apprenticeships. What further actions does he propose to take?

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My hon. Friend is absolutely right to raise this issue. The Alex is going through a difficult period and I know that as the local MP she is giving it a lot of support. The fact is that in 2014 we turned down 37,000 applicants to nurse degree courses. That is why we think that we need to do much, much better in training a number of people who would make brilliant nurses. That was why we announced the big increase last week, which will help the Alex and many other hospitals.

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University admissions departments have reported an 8% fall in the number of people accepted on to nursing courses this autumn, so the situation is getting worse, not better as the Secretary of State claims. What contingency does he have in place, in the event that we crash out of the European Union, to address a further haemorrhaging of European Union staff from the NHS, and when will he review his disastrous decision to abolish nurse bursaries, which has had such a negative impact?

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Let us be clear: we took the difficult decision on nurse bursaries precisely so that we could have the biggest expansion in nurse training places we have ever had. When we had the higher education reforms in 2011, which the right hon. Gentleman’s party opposed, we also saw a drop in initial applications, but then we saw them soaring to record levels. That is what we want to happen with nurses, because we need more nurses for the Royal Devon and Exeter, and all the hospitals that serve our constituents.

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I welcome the apprenticeship route and the associate nurse route into nursing because living on a bursary of £400 a month is no fun, believe me. However, will the Secretary of State look at nurse training so that when nurses qualify they are able to take on courses such as venepuncture and cannulation as soon as possible? Many student nurses and newly qualified nurses are frustrated that they cannot be used in those roles.

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I will certainly look into that. Of course, my hon. Friend understands this issue better than many in this House. The really exciting change is that it will now be possible for healthcare assistants who could make fantastic nurses to progress to being nurses without needing to take out student loans because they will be able to carry on earning while they learn. That will open up big opportunities for many people.

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Although we support moves to broaden access to nursing, these measures are effectively an admission that the scrapping of bursaries has been a disaster, but whatever recruitment strategies there are, the Government need to improve retention. The Royal College of Nursing recently reported that half of nurses surveyed said that

“staff shortages are compromising…care”.

What steps are the Government taking to ensure that nurses can do their jobs properly right now?

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The hon. Gentleman is right to bring that up. One thing we can do a lot better is to improve the opportunities for flexible working. We have announced that we will be making new flexible working arrangements available to all NHS staff during this Parliament. We are also expanding programmes to encourage people who may have left the profession to come back into nursing.

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I think everyone would welcome an expansion of nurse training places, but the Council of Deans of Health stated in June that no new extra places had been funded either in universities or, crucially, in hospitals, where 50% of the course is carried out. Will the Secretary of State clarify when that funding will be made available?

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Next year.

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Obviously we know that it takes quite some time to train a nurse, and one in 10 posts in England is vacant—that is twice the rate we face in Scotland. We also know that there is a 51% increase in nurses leaving the profession, a 96% drop in those coming from the European Union, and a limit on the use of agency staff, so where does the Secretary of State expect NHS England to find the 40,000 nurses it needs right now?

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Let me just remind the hon. Lady that there are 11,300 more nurses on our wards than there were just four years ago, so we are increasing the number of nurses in the NHS. She mentions what is happening in Scotland. I gently remind her that nearly double the proportion of patients are waiting too long for their operations in Scotland as in England.

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17. The Secretary of State will know that the University of Gloucestershire recently introduced courses for both the higher apprenticeships scheme as a pilot project and for nursing degrees. These have been incredibly popular in my constituency and around the county of Gloucestershire. Does he support our bid to have a university technical college that will provide pathways for people into health and care, working closely with all NHS organisations? [901022]

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I support all universities that are trying to move into offering more courses that can help me to ensure that we have enough staff for the NHS. I am sure that the University of Gloucestershire’s bid will be powerful, but I am aware that other hon. Members are supporting bids from their own constituency—including, I have to say, that of the University of Surrey, which puts me in a somewhat difficult position.

Myopic Choroidal Neovascularisation: Eylea

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3. What his policy is on making Eylea available as a treatment for myopic choroidal neovascularisation. [901007]

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The National Institute for Health and Care Excellence is developing guidance on the use of Eylea for the treatment of myopic CNV. NICE has published draft guidance for appeal that recommends use of the drug subject to a patient access scheme that makes it available to the NHS at a discounted price. NICE expects to publish final guidance this November.

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NICE needs to get a move on, because these drugs have been available to patients in Scotland and Wales, but patients in England will be going blind in the meantime.

Some people are told that their eyesight is too good to be treated, but by the time it has declined, they are told that nothing can be done to help. Will the Secretary of State meet my constituent, Elaine Shaw, who has been campaigning on the issue, the Macular Society and the Royal National Institute of Blind People so that we can discuss how to prevent people from facing an increased and unacceptable risk of preventable sight loss?

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Obviously I would be deeply concerned if patients were losing their sight due to treatment not happening in a timely way. Dudley clinical commissioning group tells me that it has already made funding available for Eylea following consideration of the NICE evidence summary issued in June 2016. This is the first drug that we have appraised through the new fast-track process for treatments that demonstrate clear cost-effectiveness. Patients will have routine access to Eylea from 1 December should the guidance remain unchanged. Of course, I would be happy to meet the hon. Gentleman and his constituent.

Transvaginal Mesh Implants

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4. What discussions he has had with the Medicines and Healthcare Products Regulatory Agency on transvaginal mesh implants. [901008]

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My colleague, Lord O’Shaughnessy, met the MHRA on 27 September to discuss this very important issue. The Department will have further discussions with NHS England on the support given to patients who have suffered due to this procedure and has asked the regulator to work with the clinical community to assess the associated risks and whether alternative treatments offer better outcomes for patients.

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Thousands of women across the country, including my constituent Elaine Holmes, the co-founder of the Scottish Mesh Survivors group, have to live with the catastrophic consequences of transvaginal mesh implants. With health regulators across the globe now waking up to the scandal and issuing alerts or deregistering mesh devices, will Ministers join me in urging the MHRA immediately to reclassify this damaging procedure as high risk?

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I thank my hon. Friend for his work in this area. I fully sympathise with anyone who has suffered complications as a result of these devices, but we do not currently have enough evidence to warrant our asking the MHRA to reclassify these procedures, and this is a view shared by other regulators across the world. I can advise him, however, that the National Institute for Health and Care Excellence strongly recommends that mesh implants not be routinely offered for the first surgical intervention on prolapse. That guidance is being updated—publication is due at the start of the new year—and will include an overarching document that looks in depth at the devices and the conditions surrounding the need for them, as well as the treatment of complications, to support better health outcomes.

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A constituent came to my surgery to explain how this has impacted on her life. It is truly harrowing. I understand that NHS England has set up 17 regional teams to look into this. I want to be able to assure my constituent that the voice of women and how this is impacting them on will be considered. I would be grateful if the Minister could respond so that we might understand what the future holds.

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I am absolutely aware that many women experience substantial side effects and complications following this procedure. Equally, however, many women also experience considerable relief from symptoms. We need a good review of the evidence to make sure that we adopt this procedure only when it fully suits women and that women understand the risks associated with the procedure. But I fully sympathise with the hon. Lady’s constituent.

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It is deeply worrying, though, that this procedure was introduced with so little evidence to support it. I think we all have to agree it has led to unacceptable complication rates for certain products. Will the Minister heed the words of Professor Heneghan and hold a public inquiry into the numbers of women adversely affected and why the safety of so many women was disregarded?

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I say again that many women have received relief from their symptoms following this procedure, but we need more evidence before we can properly review it, so it is important that we allow NICE to undertake its work so that we can take a clear view. Any procedure comes with risk—no surgery is without it—but obviously the more evidence we can gather, the better we can advise women of those risks.

Five Year Forward View for Mental Health

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5. What plans he has for the implementation of the NHS’s five year forward view for mental health. [901010]

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14. What plans he has for the implementation of the NHS’s Five Year Forward View for Mental Health. [901019]

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We are making good progress on the implementation of the five year forward view for mental health. We have published a workforce plan and invested more money than ever before, and we are providing care to 120,000 more people this year compared with 2013.

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The charity Mind recently produced a report called “Feel better outside, feel better inside”, which advocated the benefits of eco-therapy—using activities such as gardening, farming and exercise. The National Garden Scheme has also produced a publication on this. Is the treatment being utilised within the NHS?

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I thank my hon. Friend for her work in this area. Yes, I can give her that assurance. It is welcome that local authorities and clinical commissioning groups are considering innovative approaches concentrating on wellbeing, as well as acute services, and eco-therapy is part of that agenda.

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I am sure that you, Mr Speaker, and the rest of the House will send their condolences to the family and friends of Rebecca Nevin, a constituent of mine who died aged 32 after many years of poor mental health and an addiction to alcohol. Her father, Stephen, like many parents of adult sufferers of poor mental health, felt largely excluded by health professionals. Does my hon. Friend agree that we need health systems and workers who maintain patient confidentiality while recognising and acting on the genuine concerns of parents of adults?

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I am sure that we are all very sorry to hear of the death of my right hon. Friend’s constituent, and we send our condolences to her family. It is extremely difficult to balance patients’ right to confidentiality with the needs and requests of their families, and we will study any recommendations that emerge from the coroner’s investigation.

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I heard what the Secretary of State said about funding earlier, and what the Minister said a moment before. However, I sent freedom of information requests to every CCG in the country, and found for the second successive year that more than half of them are not increasing the proportion of their budgets that they spend on mental health. That flies in the face of a commitment made by the Secretary of State at the Dispatch Box, and it flies in the face of the spirit of the Five Year Forward View for Mental Health. On World Mental Health Day, will the Minister, along with the Secretary of State, commit herself to ensuring that we ring-fence the money that they say is available for mental health?

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On World Mental Health Day, I can confirm that we are spending £574 million more on mental health this year. It remains our principle that decisions should be made locally by CCGs, but we have very clear expectations of them, and they will be held to account via inspections.

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The ‘Five Year Forward View’ suggested that the Government accepted the case for comprehensive maximum waiting time standards in mental health to match those in physical health. Given that children throughout the country are routinely waiting for months to start their treatment, may I ask what progress the Government are making with the introduction of a maximum waiting time standard for children’s mental health?

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The right hon. Gentleman has raised an excellent point. Our Green Paper on children and young people’s mental health will address exactly those issues. We have made clear that we will tackle mental health through early intervention, and early intervention for children and young people is central to that.

NHS Staffing Levels

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6. What recent assessment he has made of trends in staffing levels in the NHS. [901011]

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Not only has the number of nurses on our wards increased by more than 11,000 since May 2010, as my right hon. Friend the Secretary of State mentioned earlier, but the NHS has nearly 11,300 more doctors, over 2,700 more paramedics, over 26,000 more supporters for clinical staff, and 5,700 fewer administrators. However, we recognise the pressures on staff from increasing demand. That is why last year my right hon. Friend announced a 25% increase in the number of doctors in training, and why last week he announced a 25% record increase in the number of nursing training places.

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Huddersfield Royal Infirmary, which is in my constituency, is currently facing plans for a downgrading that would result in the loss of 500 hard-working professionals. Is it too much to ask for the Minister, or the Secretary of State, to visit the hospital, as I have requested, before those hard-working trained professionals are lost, and can he assure me—and my constituents—that those cuts, and the pressures on nearby hospitals, will not jeopardise the safety of patients?

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Order. There is a growing tendency for colleagues to ask two questions rather than one, which is not fair on other colleagues who are trying to get in. Forgive me, but the questions are too long, and frequently the answers are as well.

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I will try to keep this answer short, Mr Speaker.

As the hon. Lady will know, the local joint health overview and scrutiny committee has referred those proposals to the Secretary of State, and it would not be appropriate for me to visit the hospital while the referral is in progress.

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On the subject of vital NHS staff, will the Minister join me in congratulating the thousands of community pharmacists on their daily commitment and professionalism? Will he confirm, once and for all, that he has no intention of downgrading their role and putting patients at risk? Surely he agrees that the Prime Minister would have been well advised to seek a cough remedy from a qualified community pharmacist rather than relying on an unqualified Chancellor of the Exchequer.

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As the hon. Lady will know, we have inserted payment for extra activity into the contract for community pharmacists because we want more activities to take place in community pharmacies. For example, many flu vaccinations throughout the country are now being carried out by pharmacists.

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I thank the Minister for the recent meeting that he had with me and other colleagues about Grimsby Hospital, which is in special measures. It was clear from a recent meeting I had with the chief executive that staff vacancies are one of the biggest problems preventing the hospital from getting out of special measures. What additional support can the Department offer in order to get the hospital back on track?

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I was pleased to welcome my hon. Friend to a meeting a few days ago to discuss the situation, together with his Opposition constituency neighbours. One of the things that we will be looking at in the coming weeks is the allocation of the new doctor training places. As part of the criteria, we will be looking to ensure that some of those places are allocated to areas where it is difficult to recruit, such as rural and coastal areas.

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The Minister has visited Kettering General Hospital and knows the wonderful work that the doctors and nurses there do. The problem that the hospital faces, however, is that too few of the doctors and nurses are full-time permanent members of staff, and too many locums are being hired, at great expense to the hospital budget. What is my hon. Friend’s advice for Kettering hospital on tackling the issue?

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When I visited Kettering General Hospital we discussed excessive agency staff costs. One of the measures announced last week by my right hon. Friend the Secretary of State was a drive to invest more in both regional and local bank agencies within the NHS so that we can reduce the reliance on more expensive agency staff.

End-of-Life Care

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7. What steps his Department is taking to improve end-of-life care. [901012]

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By 2020 we want significantly to improve patient choice in end-of-life care. The Government’s end-of-life care commitment sets out exactly what everyone should expect. In September we published a report on the good progress that we have made over the first year.

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The End of Life Care Coalition has said that it remains deeply concerned about the enduring gap in resources for community-based health and social care services. Meanwhile, Together for Short Lives continues to highlight the unacceptable postcode lottery faced by 40,000 children with life-limiting conditions. What is the Minister doing to ensure that all clinical commissioning groups and sustainability and transformation partnerships will meet the Government’s requirements in full for both children and adults by 2020?

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I thank the hon. Lady for her question, and I know that she, through her role on the all-party parliamentary group for children who need palliative care, will continue to hold me to account on these commitments. We did look at the work undertaken by Together for Short Lives to improve end-of-life care for children, which does require special attention—she is quite right to raise that. NHS England recently co-hosted a policy summit with Together for Short Lives, and I will be meeting it next week to discuss that further. We are also engaging local sustainability and transformation partnerships to support planning for end-of-life care, and helping all trusts to develop and improve their services. This work is ongoing, but it remains a key priority.

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When it comes to baby loss, the end of life can often be sudden and unexpected. In this Baby Loss Awareness Week, will the Minister join me in welcoming the launch of the national bereavement care pathway, and pay tribute to Sands, baby loss organisations and charities, the APPG and the former Care Quality Minister, Ben Gummer, who did so much to make it happen?

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I am of course happy to join my hon. Friend in congratulating those organisations and thank him for all the work that he has done. The 11 pilots launched only last month are very much down to his work and that of hon. Members across the House, who have done so much over the past year to raise awareness of the issue.

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Many people would prefer to die at home, but that is actually very difficult to achieve, not only because of the lack of support for Macmillan nurses, for example, but because, frankly, of the reluctance of the authorities to effect a speedy transition to a home base. What can the Government now do to ensure that dying at home is a real option?

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The hon. Gentleman is quite right: many people would elect to die at home, if the opportunity were available. We need to ensure provision to allow people to do that, if that is their choice, because we should be supporting people to honour their choices at the end of their lives, and it enables us to treat more people in hospitals and hospices.

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Hospices, such as Treetops Hospice Care in my constituency, provide outstanding end-of-life care. Although these services benefit from generous charitable donations that enable them to operate on a day-to-day basis, what more can the Government do to help support hospices when capital investment is needed to improve the current setting of new build?

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One of the strengths of our hospice movement is that it relies heavily on charitable donations, which shows that people are generous and that they want to support good, locally focused care. However, CCGs should look at where they can support hospices with their care costs, and we will certainly consider including that in the end-of-life care programme.

Public Sector Pay Cap: NHS Staffing Levels

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8. What assessment he has made of the effect of the public sector pay cap on staffing levels in the NHS. [901013]

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11. What assessment he has made of the effect of the public sector pay cap on staffing levels in the NHS. [901016]

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NHS staff do a fantastic job in tough circumstances, and pay restraint has been challenging for many of them. However, given the financial pressures, it is also true that the NHS would not have been able to recruit an additional 30,000 staff since May 2010 without the cap.

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The NHS is short of 3,500 midwives and 40,000 nurses. What proportion of those numbers does the Secretary of State put down to the public sector pay cap?

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As I said in my previous answer, without pay restraint we would not have 11,300 more doctors in the NHS and 11,300 more nurses on our wards. The hon. Gentleman will know that we recognise that it was not sustainable to carry on with the 1% rise going forward, which is why we have been given the leeway to have more flexible negotiations next year.

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Hospital wards and GP surgeries are chronically understaffed, and the knock-on effect is that waiting lists are spiralling out of control. Is it not in the best interests of patients to scrap the pay cap so that the NHS can be run with the relevant number of staff in place?

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I welcome what I think is my first question from the hon. Lady, and I can give her some good news: the pay cap has been scrapped.

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In the work that I have done in hospitals, staff have told me that they are most unhappy about too much reliance on temporary staff, rota gaps and not feeling valued, as opposed to issues around pay. The latter—not feeling valued—often goes hand in hand with poor management practices. What is my right hon. Friend doing about those causes of staff unhappiness?

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My hon. Friend, who has a lot of experience of working in the NHS, is absolutely right. The new Care Quality Commission inspection regime is designed precisely to identify good, strong leadership, because that has the best impact on staff and, through that, the best impact on patients.

Drug Treatment Services

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9. What assessment he has made of the advice of the Advisory Council on the Misuse of Drugs on the level of funding for drug treatment services. [901014]

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We thank the ACMD for its report, and we take its advice seriously. Discussions will happen across Government, and we will respond fully in due course in the usual way.

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The ACMD says:

“England had built a world class drug treatment system… This system is now being dismantled due to reductions in resources.”

More than 100 local authorities have had to reduce spending on addiction services this year as a result of Government cuts. Will that reduction in addiction treatment budgets not just cost the NHS more in the long term?

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The Government are already investing £16 billion in public health services over the spending review period. We made it a condition of the public health grant that local authorities have regard to the need to improve the take-up and outcomes of their drug and alcohol services. Local authorities are best placed to make those decisions. The investment in effective services means that the average waiting time is just three days and, according to our monitoring systems, treatment outcomes in Greater Manchester are generally better than or in line with the rest of England.

Mental Health: Education

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10. What discussions he has had with the Secretary of State for Education on promoting improved education in schools and youth settings to tackle the stigma associated with mental health. [901015]

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Ahead of our autumn Green Paper on children and young people’s mental health, we are having productive discussions with the Department for Education on the vital role that schools can play in tackling both mental health problems and the stigma surrounding them.

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The YMCA and NHS’s #IAMWHOLE campaign, which was launched this morning, shows that young people seeking help are often dismissed by those around them, largely due to a lack of understanding of mental health difficulties. Will the Secretary of State meet the YMCA to discuss what can be done to combat the stigma?

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I am more than happy to meet the YMCA. I also want to point out the amazing work done by the “Time2Change” campaign. I was at an event to mark its 10th anniversary, and I heard from young people who have spoken up about their mental health conditions, which takes a lot of courage. Things are changing, and we can draw a lot of hope from what is happening on the ground.

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Family doctors undertake such work, but why have only a quarter of them had any formal training in mental health?

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My right hon. Friend is absolutely right to point out that a GP is often the first point of contact for many people. What are we doing? Three thousand mental health professionals will be seconded to GP surgeries over the next few years to give GPs the back-up they need in that area.

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Not for the first time, I implore the right hon. Member for New Forest West (Sir Desmond Swayne) to issue to colleagues his textbook on succinct questions.

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Since the demand for children and youth mental health services far outstrips supply, will the Secretary of State consider diverting resources to voluntary bodies, such as the admirable Off The Record in my constituency, which have a much lower threshold for referral?

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We will look at the role of voluntary organisations, and I totally agree with the right hon. Gentleman that they have an incredibly important role to play. We must also consider the role of schools, because teachers are extremely enthusiastic to do more around mental health. I think that if we give them more support there is a lot more they could do.

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The Secretary of State will know that when it comes to physical health and stigma, the Department will react right away. Do the Government now recognise the importance of treating mental health with equal status to physical health?

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We absolutely recognise that and we have legislated for it. The children and mental health Green Paper will take further steps in that direction.

Bournville Gardens Health and Community Medical Centre

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12. What progress has been made on the Bournville gardens health and community medical centre project in Birmingham. [901017]

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The building of the new health and wellbeing centre is supported by NHS England for funding in principle through the estates and technology transformation fund, subject to due diligence checks including a value for money exercise.

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That is fine, but is it not the case that although approval was given by the NHS technology and transformation fund last autumn, NHS England has spent the past 18 months negotiating new procedures for the premises cost directions? The delays in those procedures are jeopardising things such as that health and wellbeing centre. Is it not time that Ministers stepped in to ensure that projects on which everyone agrees can be approved under existing regulations and should not have to wait for the renegotiations?

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The hon. Gentleman is right that NHS England has been negotiating changes to the premises cost directions, which govern how we manage premises costs for general practitioners, but that is not the reason for the delay. We are working through the detail of the content of the scheme and it is not yet at the point of seeking approval. At the end of the day, this is public money and I think that the hon. Gentleman and everybody in this House would expect me to make sure that things are done properly.

Congenital Heart Services: North-West

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13. What recent assessment he has made of the adequacy of provision of congenital heart services in the north-west. [901018]

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As the hon. Lady knows, the adult congenital heart disease service provided in Manchester has been included in the long-standing clinical assessment of CHD services undertaken by NHS England, which is now reviewing the more than 7,500 responses to the public consultation, which ended in July. The adult CHD service in Manchester was suspended by the trust in June, when the only CHD surgeon left. Hospitals in Leeds and Newcastle continue to deliver level 1 care and paediatric CHD services continue to be provided by Alder Hey Children’s Hospital in Liverpool.

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Is not the truth behind what happened that Ministers and NHS England prejudged the review and therefore left services untenable and unviable in Manchester? There are no level 1 adult congenital heart services anywhere in the north-west and patients are having to travel to Leeds and Newcastle for the treatment. Will the Minister apologise today to those patients for this botched review, which has left patients with a great deal of uncertainty and has meant that they have had to travel huge distances?

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I am sure that the hon. Lady will not want to confuse her patients by suggesting that relying on a single surgeon for prolonged periods is necessarily in their best interests. The facilities that remain in Central Manchester University Hospitals NHS Foundation Trust are intended to remain and include CHD outpatient services for adults and children. Level 2 services also continue to be provided in Manchester.

Unmet Social Care Needs

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15. What estimate he has made of the number of people living with unmet social care needs. [901020]

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By passing the Care Act 2014, this Government established a national eligibility threshold that defines the care needs that local authorities are required to meet. This eliminates the postcode lottery of eligibility across England. Social care continues to be a key priority for this Government. That is why local authorities in England will receive an additional £2 billion for social care over the next three years. In the longer term, we are committed to establishing adult social care on a fair and more sustainable basis.

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Age UK estimates that nearly 1.2 million older people have unmet care needs. After the Government dropped their disastrous dementia tax policy during the general election, all they can offer people is yet another consultation. In the words of the hon. Member for Totnes (Dr Wollaston), the Chair of the Health Committee, is it not time the Government just got “on with it”?

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I do not recognise Age UK’s assessment of unmet need. As I said, the requirements are enshrined in statute and local authorities should be held to that. In response to the hon. Lady’s final point, let me say that we are getting on with it, but we need a real cultural change in how we tackle these issues. There is a long-term issue to address in the fact that we are all living longer. This is not just going to need a sticking plaster; we will need to take the public with us. So this is not just another consultation; it is a vehicle for making sure that we as a society tackle this issue once and for all.

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The Royal Cornwall Hospitals NHS Trust was put into special measures last week, but delayed discharge caused by unmet social care needs contributes to the pressure in the trust. I welcome the £12 million that was awarded to the council this April to address that, but what more can the Minister do to help to relieve the pressure? Will he meet me and my Cornish colleagues to discuss the healthcare challenges faced in Cornwall and on Scilly?

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My right hon. Friend the Secretary of State has visited twice in the past year, and the Minister of State, Department of Health, my hon. Friend the Member for Ludlow (Mr Dunne) is more than willing to meet my hon. Friend next week, with other colleagues.

Clinical Commissioning Groups and Local Authorities

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16. What assessment he has made of the level of co-operation between clinical commissioning groups and local authorities. [901021]

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The Government want and expect strong relationships and joint working between the NHS and local authorities to make a success of STPs. They are meant to be a one-system solution.

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The London Borough of Bromley has had considerable success in joint working with its clinical commissioning group, through joint appointments, a multi-agency use of funding and a complete sign-up from the council, but we are concerned that reorganisation may detract from this operation at the local level. Will the Minister agree to meet me to discuss Bromley’s proposals to build on the success it has had so far?

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We are confident that we have some of the best STP leaders in place. I was looking last night at the figures for south-east London, and I saw that my hon. Friend’s local STP is highly rated, both on leadership and overall. I was thinking about him in the gym last night and I thought he might say what he did, so let me say that I am very happy to meet him and to broker a meeting between him and the NHS.

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It is interesting to hear about the thoughts of the hon. Gentleman when he is on the treadmill or the exercise bike—it is always useful to have a bit of additional information.

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20. Despite co-operation between the CCG and the local authority, we have had severe rationing and cuts and a seriously underfunded mental health service: the funding formula is seriously failing the health economy in York. In particular, the capped expenditure process will make it far, far worse. Instead of just slashing budgets, will the Secretary of State meet me to understand York’s health economy and to put real solutions in place? [901026]

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I am always happy to meet Members, including the hon. Lady in order to talk about York. As the shadow Secretary of State said, the STP proposals are not about Tory cuts; they are about redesigning services in the local area. So I am happy to meet her to talk about her area.

Topical Questions

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T1. If he will make a statement on his departmental responsibilities. [900887]

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This week is Baby Loss Awareness Week, and the whole House will want to mark the tragedy faced by too many parents every year by redoubling our efforts to reduce avoidable baby death and harm. I am pleased to tell the House that to mark World Mental Health Day today the entire Cabinet was this morning briefed by two of the country’s leading mental health experts, Poppy Jaman and Professor Sir Simon Wessely, on our plans announced today to roll out mental health first aid to 1 million people in England.

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Can the Secretary of State tell us what progress has been made regarding an inquiry into the contaminated blood scandal?

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I can absolutely tell the hon. Gentleman the answer to that: we have been making very important progress with families over the summer; and we have decided the shape of the inquiry and the leadership of the inquiry and all the factors around the terms of reference need to be decided in close consultation with the affected families. So we are keen to get on as quickly as possible, but we have made some progress in understanding their wishes.

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T4. Oesophageal cancer is one of the most aggressive cancers with some of the lowest survival rates. Early symptoms are frequently masked with over-the-counter heartburn remedies. Will the Secretary of State consider meeting manufacturers and charities such as Barrett’s Wessex in my Southampton, Itchen constituency to develop a clear warning on packaging to encourage regular users of heartburn remedies to seek medical advice about their condition? [900890]

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I thank one of my constituency neighbours for that question. Improving outcomes for all cancers is one of my main priorities in this job. I visited the Christie hospital in Manchester last week to see the progress being made on the proton beam therapy facility there. I know Barratt’s Wessex in my hon. Friend’s constituency, as it also does work with some of my constituents. We must do better on these rarer cancers with poor outcomes. I will look at what BW does exactly.

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Order. I gently remind Ministers that answers from the Front Bench must be very brief during topical questions, because many other colleagues are waiting to contribute and I do not want to disappoint them, as that would be unfair.

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Can the Secretary of State tell us how many elective operations he expects to be cancelled by 31 December?

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What I can tell the hon. Gentleman is that every year over Christmas time, when we know that hospitals will be busy, we suspend elective care in particularly busy places. That is how we keep patients safe.

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I am grateful to the Secretary of State for his answer, but already more than 80,000 elective operations have been cancelled. That is an increase on the past year. A&E attendance is up on the past year, bed occupancy is higher than last year and the Care Quality Commission has today warned that the NHS is straining at the seams. Winter is coming. Last week, the Tory party made spending commitments worth £15 billion, but not 1p extra for the NHS, so will the NHS fare worse or better than last year this winter, or are we set for another winter crisis made in Downing Street?

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What the CQC actually said this morning is that the majority of health and care systems across the NHS are providing good or outstanding quality; that the safety of care is going up; and that performance is improving. None the less, the hon. Gentleman is right that we are always concerned about winter. Let me tell him the new things that are happening this year to help prepare the NHS: £1 billion more going into the social care system in the most recent Budget; a £100 million capital programme for A&E departments; 2,400 beds being freed up; and an increasing number of clinicians at 111 call centres. A lot is happening, but, overall, let me remind him that our NHS is seeing 1,800 more people every single day within four hours—that is something to celebrate.

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T7. The Minister will be aware that clinical commissioning groups and the London region are currently consulting on changes to governance and commissioning arrangements. Given the positive words already said about arrangements in Bromley, will my right hon. Friend confirm that no changes of any kind will undermine the accountability at a local level, or the ability to commission locally in Bromley? [900893]

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I can confirm that because the legal accountability, whatever co-operation arrangements are made, will stay exactly the same.

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T2. My hospital trust tells me that there are no open or distance learning courses available anywhere to train new nurses. Considering the number of local people who are keen to be trained and the barriers that face them, will the Secretary of State agree to have a chinwag with me to solve this problem in Bassetlaw? [900888]

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That is a very attractive offer, and I am always happy to have a chinwag with the hon. Gentleman. Last week, we announced something that I hope will resolve that, which is that we are looking at holding nurse training courses on-site in hospital and community sites so that experienced healthcare assistants do not have to go to a higher education institution to do their training.

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T9. The last Labour Government downgraded Frenchay hospital in my constituency. My constituents and I have been waiting for several years for the much-needed and much-promised community hospital. What action are the Government taking to ensure that that finally happens? [900895]

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My hon. Friend is a doughty campaigner for Frenchay hospital and keeps it uppermost in our minds. The way in which we are looking at the pattern of health provision for the next period is through the STP process, and I encourage him to engage with the STP leadership in his area and make the case for Frenchay hospital.

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T3. The palliative care we provide to terminally ill children is an incredibly serious topic. I want to refer to the point made by the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) and to press the Minister on giving children’s care parity of funding with adult care. Will she follow the example of the Scottish Government and provide parity of funding? [900889]

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As I previously advised the House, I am in conversation with Together for Short Lives to look at how we improve palliative care for children. This clearly raises a different set of circumstances and sensitivities, and it is essential that we do our best for these children.

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Do Ministers have any plans to review the “do not resuscitate” guidance for hospitals? I have a constituent who has such an order placed on him, despite the fact that he has left hospital and is in a care home, it cannot be rescinded and his family have not consented.

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My hon. Friend is right to raise this issue. Certainly, in CQC inspections in the past, the whole issue of “do not resuscitate” orders has been an area of concern. This is something we will very much look at as part of the end of life policy, but I would like to hear more about the case my hon. Friend mentioned, if he would like to write to me.

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T5. Accountable care systems are a systemic change to the way the NHS will be managed and a significant step towards an Americanised care system, so will the Minister explain why NHS England is having a fundamental reorganisation take place under the radar without a national consultation? [900891]

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Accountable care systems are supported by such rabid right wingers as Polly Toynbee, writing in The Guardian, because they are about health systems coming together to co-operate to give the best care for patients. That is what is happening across the NHS, and it is already delivering great results.

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This Friday marks Secondary Breast Cancer Awareness Day. In 2015, the Government recognised that data collection for this type of cancer was not good enough. However, research by Breast Cancer Care shows that less than a third of trusts collect the number of people diagnosed with secondary breast cancer. Will the Minister confirm what actions the Government are taking to ensure that all trusts are collecting this information, given its importance to improving outcomes?

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I thank the co-chair of the all-party group on breast cancer in what is BCAM—Breast Cancer Awareness Month. We must never forget the treatment and support we give to those living with and beyond the cancer diagnosis. We must always remember those living with secondary breast cancer and the work of the third sector—brilliant charities such as Breast Cancer Haven and Breast Cancer Care—so that we can focus on access to a specialist nurse. As my hon. Friend says, the collection of data is critical, and I will be discussing that at my roundtable with some of the main players in the cancer community later this week.

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Will the Minister abolish the patient penalty and scrap hospital car parking charges, which punish both the sick and hard-working NHS staff, as well as causing problems for residents living adjacent to NHS hospitals, such as Peterlee Community Hospital in my constituency?

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I do understand the concerns raised, and all hospitals are under a responsibility to make sure that they have proper arrangements in place for people on low incomes and people who have to visit hospitals regularly.

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Antibiotic resistance is a major threat to humanity. Will the Minister outline the progress we have made in opening up the £50 million global antimicrobial resistance innovation fund to applications?

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I thank my hon. Friend for that. We expect the first launch to be the bilateral UK-China partnership £10 million fund, which we expect to go live early in 2018. Further information on the calls for the remaining £40 million will be announced in due course.

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T10. In the light of the latest statistics from the Office for National Statistics showing a record number of drug-related deaths registered in England and Wales, will the Minister meet members of the drugs, alcohol and justice parliamentary group to discuss this issue and see how it can be addressed? [900896]

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I am very happy to meet the group, and the hon. Lady should contact my office. The Home Office is the lead Department for cross-governmental drugs policy, and we obviously released the new cross-Government drugs strategy earlier this year. However, this cannot all be about drugs services and picking up the pieces after things have gone wrong; it can also be about prevention. We should, as somebody once said at this Dispatch Box, understand a little more and condemn a little less.

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This month is Stoptober, and someone who manages to stop smoking for 28 days is five times more likely to quit for good. Legislation is obviously part of this, but perhaps the Minister could update us on what more could be done.

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At the last health oral questions, I committed to publishing the new tobacco control plan. I did that on 18 July. We have had a lot of legislation, from this and the previous Government. It is Stoptober, and there has never been a better time to quit. We now need to take that legislation, work with the control plan the Government have published and work it through local authorities and smoking cessation services, because my hon. Friend is absolutely right that where buddying services are used, we have better outcomes.

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There is a crisis in mental health staffing levels. Does the Secretary of State accept that today, throughout the country, there are 2,000 fewer mental health nurses than there were when he took charge five years ago?

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What I accept is that we have 30,000 more professionals working in mental health than when my Government came into office. There has been a decline in the number of mental health nurses, but we have in place plans to train 8,000 more mental health nurses, and that will make a big difference.[Official Report, 17 October 2017, Vol. 629, c. 6MC.]

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The Gloucestershire Hospitals NHS Foundation Trust capital expenditure bid would fund a 24-hour urgent care service, and it would also increase bed capacity and improve hospital performance in Gloucester and Cheltenham, to the benefit of patients throughout the county. When do Ministers expect to announce the results of the bid? Will they take this particular bid into careful consideration?

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I am aware that, under the Gloucestershire STP, a proposal has been submitted for capital funding to support plans to improve the clinical environment for patients and staff at the Gloucestershire Royal Hospital. I am afraid that my hon. Friend will have to join me in awaiting the Chancellor’s announcement in the Budget as to whether there will be a second phase of capital funding for STPs. If there is any funding, it will be allocated thereafter.

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GPs in my constituency tell me that because of changes to personal data rules they will no longer be able to charge for providing reports for private insurance and legal claims. Will Ministers update the House on the situation? What assessment has been made of how GPs will cope with the additional costs they will face?

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I am happy to look into that matter and write to the hon. Lady.

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If nurses or other NHS staff are awarded a pay rise above the current pay cap, will the Government fund that pay rise fully, or will they require it to be met by cuts in patient services?

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That is something I cannot answer right now, because the latitude that the Chancellor has given me with respect to the negotiation of future pay rises is partly linked to productivity improvements that we will negotiate at the same time. The fact is, though, that we do have that flexibility, and I hope we can get a win-win as a result.

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May I take the Secretary of State back to the issue of nursing associates? Given that evidence shows that for every 25 patients for whom a professionally qualified nurse is replaced by a non-nurse, mortality on an average ward rises by 21%, how comfortable is he with reports that hospitals in Lincolnshire and Leicester are using nursing associates to plug gaps in the nursing workforce?

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The hon. Lady should be very careful before talking down nurse associates. They do a fantastic job, they are trained, they are helping our NHS and they are welcomed by their nursing colleagues.

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Under this Government, there has been an unprecedented fall in the number of nurses: the NHS is short of 40,000 nurses and more than 6,000 have gone since 2010, under this Conservative Government. When will the Secretary of State acknowledge that he is failing the NHS and failing patients, and when will he do something about it?

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With respect, I really think the hon. Gentleman needs to get his facts right. The number of nurses has gone up, not down, since this Government have been in office. The number of nurses in our hospitals has gone up by more than 11,000, because this Government are supporting safer care in all our hospitals.

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The number of unfilled nursing posts in London is now more than 10,000—whatever the Secretary of State’s figures say, it is more than 10,000. When will they be filled?

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When we have put through the biggest increase in nurse training places in the history of the NHS—the 25% increase that I announced last week.

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Suicide is the most common cause of death for men under the age of 45, and men are significantly less likely than women to seek support from loved ones or medical professionals when they have mental health problems. How can services be better targeted at men to encourage them to seek help more quickly and thereby reduce misery?

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This is a very important issue and the hon. Lady is right to raise it. The Time to Change campaign has said that this year it will focus on men, specifically to try to address the issues she mentioned. We are rolling out crisis plans throughout the country to make sure we are better able to reach people who reach out to us.

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What reassurance can the Secretary of State give to the Amplify youth project in Northwich in my constituency that timely and improved access to mental health services will be provided?

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We have said that by 2020-21 we want to be treating an extra 70,000 young people every year, but the truth is that that is still not enough. We need to bring down waiting times much more dramatically, which is why we are doing a lot of work across Government and we have a Green Paper coming out shortly.

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Newly released NHS guidance makes it clear that walk-in services can have a future as part of urgent treatment centres. Does the Secretary of State agree with me and thousands of patients in Bury North that Bury walk-in centre can, should and must stay open and that Bury CCG should ensure this when it concludes its review?

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Current plans by NHS England to look at the urgent and emergency care pathways include creating 150 urgent treatment centres by the end of this year. I am happy for the hon. Gentleman to write to me about Bury and will respond in due course.

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Is the Secretary of State aware that there is widespread support in the House for his Government’s commitment to enact the principle of deemed consent for organ donation? He knows from a previous meeting that my private Member’s Bill is due for its Second Reading early in the new year. Will he therefore agree to an early meeting now, so that we can co-ordinate the two and see how to advance his intentions? I know that my hon. Friend the Member for Barnsley Central (Dan Jarvis) will be with me again and, with the Secretary of State’s commitment to this, we look forward to an early meeting.

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I very much enjoyed our previous meeting, which was not so very long ago. I hope the hon. Gentleman is happy that we have made good progress since that meeting, with the Prime Minister announcing that we will start a consultation, but I am always happy to see him and his colleague the hon. Member for Barnsley Central (Dan Jarvis).

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The Secretary of State will be aware that he and he alone has responsibilities under the Health and Social Care Act 2012 to deal with referrals from local authorities of clinical commissioning group decisions. Almost a year ago, Stoke-on-Trent City Council and Staffordshire County Council referred a matter to the Minister regarding the closure of community care beds. To date we have had no response. Letters from me and my hon. Friend the Member for Stoke-on-Trent North (Ruth Smeeth) have gone unanswered. When will we get a response? Is this a case of wilful indifference towards his responsibilities or just ignorance of the Act?

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May I apologise to the hon. Gentleman if he has not had a prompt reply to any letters to me or my Department? I will look into the issue that he raises and ensure that he gets a rapid response.

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Yesterday the private ambulance service that provided non-urgent patient transport at Bedford hospital ceased trading, leaving the East of England Ambulance Service NHS Trust to pick up the pieces. Will the Minister order an inquiry to establish what went wrong, and does he agree that using private companies to run key services for our NHS is simply not working?

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The hon. Gentleman will be aware that private and independent providers of patient transport services provide services all across the country and support the ambulance services in that work. I will look into the case that he raises in relation to Bedford and write to him.

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All of the local dementia and rehabilitation beds in my rural constituency of High Peak are earmarked for closure. In some cases, patients and their families will have to travel 25 miles across the moors to Chesterfield. Given the importance of staff being able to work with families to support patients to return home, will the Minister agree to look again at such decisions, which make this work practically impossible?

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The hon. Lady will be aware that the STP plans being considered for her area include providing more services in the community by community nurses and other nurses in our community hospitals being reassigned, which will allow them to undertake care for more patients than they can at present within community hospitals.

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Order. I am sorry, but we must move on. Demand invariably tends to exceed supply.