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House of Commons Hansard
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Oral Answers to Questions
29 October 2019
Volume 667

Health and Social Care

The Secretary of State was asked—

Hearing Aids

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1. What steps he is taking to increase access to hearing aids. [900193]

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In 2018, the National Institute for Health and Care Excellence issued new guidance called “Hearing loss in adults: assessment and management”, which aims to improve hearing loss services, including the provision of hearing aids. The guidance brings together evidence, standards, guidance and case studies to encourage best practice across England.

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Does my hon. Friend agree that we in England have been cutting waiting times for hearing aids by using private companies such as Specsavers, and that that demonstrates a huge difference between privatising the NHS, which this Conservative party would never, ever support, and using private companies to provide a first-rate health service free at the point of use?

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My hon. Friend hits the nail on the head. We are absolutely committed to the principle of an NHS that is free at the point of use, but the NHS has, under successive Governments, commissioned care from the private sector to ensure that patients receive the treatment that they need as quickly, safely and near to home as possible. All NHS healthcare, irrespective of how it is provided, must be of the highest possible quality and improve outcomes.

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When the Government published their action plan on hearing loss in 2015, it was widely welcomed across the deaf community, as well as in the House, but there is now just a sense in the deaf community that NHS England’s commitment to the action plan is somehow waning. Will the Minister confirm that the Government are still fully committed to the action plan and will also encourage NHS England to carry on?

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Yes absolutely; I can give the hon. Gentleman that clear reassurance, and I thank him for his work as chair of the all-party group on deafness.

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The Minister will recall that in the loneliness strategy we showcased Action on Hearing Loss’s “Hear to Meet” befriending service, which connects those with hearing impairments to share experiences. Alongside the work that the Department is doing to provide good-quality hearing aids, what more is it doing to recognise that those with hearing loss, especially children, can be among the most lonely in society?

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I thank my hon. Friend for that question. She is absolutely right to highlight the fact that any form of disability can cause social isolation and loneliness, but hearing loss and deafness can do so almost more than anything else. I pay massive tribute to the incredible work that she did as Minister for sport and civil society to further this. I am a keen member of the inter-ministerial group on hearing loss, which does so much to further that aim and aspiration.

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North Staffordshire clinical commissioning group is the only CCG in the country to restrict hearing aids. It is about to launch its consultation to ensure that all my constituents can get hearing aids when they need them. Does the Minister agree that it should be compliant with NICE guidelines?

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The hon. Lady is absolutely to raise that. CCGs are responsible for the commissioning of NHS audiology services, including the provision of hearing aids. We expect all CCGs to have regard to the NICE clinical guidance when commissioning services for their local population.

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With the Sheffield Children’s Hospital last night, I was reminded again that in childhood, dreams are made and die are cast, and through our senses, we come to terms with the world around us. As Dickens said, the best of all stories is a child’s story. Sometimes those stories are not happy ones initially, and deaf children in particular struggle and suffer as they come to terms with the world about them. Will the Minister ensure that every deaf child in Lincolnshire has not only an education, health and care plan, but all the innovations and technology that allow them to live their life to the full and cast a future as glorious as any of ours?

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I certainly could not have put that more articulately than my right hon. Friend did, and he is absolutely right. In 2018, the Government provided contracts worth more than £25 million to help children with special educational needs and disability to access the right support. The Department for Education is reviewing the SEND commitment within that Department, but we are supporting it to do that in the Department of Health and Social Care to ensure that children get the care and support and educational support plans that they need.

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We all noted the reference to Dickens; I am glad that the right hon. Gentleman’s record of literary and philosophical allusions continues apace.

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I thank the Minister for the response so far. Will she outline what discussions have taken place with independent groups such as Specsavers, which does excellent work providing wider access to NHS-funded tests and hearing aids, with special reference to more rural areas?

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The hon. Gentleman is right to raise this. As I said in my first answer, it is important that we can work collaboratively with organisations in the private sector and across the NHS to make sure that patients, wherever they are in the country, in urban or rural areas, can access the right care and support when they need it.

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If the Minister and other Members want to find out how to provide a phenomenal audiology service, they should come to Dudley and visit the clinical CCG buildings at Brierley Hill. It is an amazing service. When I was referred to them for a hearing aid, I could not believe the service. You ring up and say “When can I come in?”, and they say “When would you like to come in?” “Could I come in tomorrow?” “What time would you like to arrive?”—no waiting lists, an absolutely phenomenal service. I was worried—

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I call the Minister.

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I was worried that I was getting special treatment because I was the MP, but I was not; it is just an absolutely fantastic service, and I want to commend the brilliant men and women who provide it. It would be great if the Minister came to see them.

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I don’t know about you, Mr Speaker, but I could listen to the hon. Gentleman talk all day. He is absolutely right to commend the wonderful services provided by the team in Dudley. I would be more than happy to visit at any time.

Epsom and St Helier University Hospitals NHS Trust

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2. How much capital funding he plans to allocate to Epsom and St Helier University Hospitals NHS Trust in each of the next three years. [900194]

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In addition to business-as-usual capital budgets, I am delighted that, as the right hon. Gentleman will be aware, his hospital trust will benefit from a significant part of the £2.7 billion capital funding under the health infrastructure plan—HIP 1—our deeply ambitious hospital building programme.

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I thank the Minister for that. I obviously welcome the announcement—I, local residents, councillors and indeed the hon. Member for Mitcham and Morden (Siobhain McDonagh) have been campaigning on this for many years—but does he remember that in 2015 there was £219 million available for St Helier Hospital, which was then deleted from the Budget by the incoming Conservative Government? Can he reassure me that this commitment to St Helier will last beyond 9, 10, 11 or 12 December, or the date of the next general election?

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The Government’s commitment is clear. While no Government can bind a future Government, our commitment is very clear, so my advice to the right hon. Gentleman’s constituents is to vote Conservative.

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I would like to correct the record, in that my predecessor, Paul Burstow, mentioned before the 2015 election that he regretted the withdrawal of that money.

Does the Minister agree that, in giving us the money that we need for the Epsom and St Helier Trust, it is right to reward a plan that finally will save St Helier without using it as a political football and will improve health outcomes in a brand-new building that we can be proud to have in Sutton?

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My hon. Friend is a doughty champion for his constituents and his trust, and he is absolutely right.

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Not just a champion but doughty!

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This plan could see two A&Es reduced to one and two maternity units reduced to one. Have the Government taken into account the need for extra capital funding for both St George’s and Croydon university trust should St Helier place this new hospital on the Sutton Hospital site?

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The hon. Lady will know that the plans that will be brought forward will be clinically led and delivered and constructed by the trust itself, so I would encourage her to engage with the trust and with neighbouring trusts, but surely she would welcome this significant investment by the Government in her health infrastructure.

Cystic Fibrosis Drugs

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3. What steps he is taking to help ensure access to Orkambi on the NHS. [900195]

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4. What progress has been made in enabling the provision of Orkambi on the NHS. [900196]

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18. What progress he has made on increasing access to drugs to treat cystic fibrosis. [900210]

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I am delighted that a deal has been agreed to provide Orkambi and other cystic fibrosis drugs on the NHS. This deal is great value for the NHS and backed by the National Institute for Health and Care Excellence, but crucially it will improve thousands of lives. My heartfelt thanks go out to many campaigners from right across the House who have pushed this agenda but especially to the Cystic Fibrosis Trust and the patients who, along with their families, have bravely campaigned against this devastating disease. I am thrilled that we can make this progress.

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It may have taken a few years, but I warmly welcome the Secretary of State’s announcement and congratulate him on it. I echo his congratulations to all the campaigners, particularly my hon. Friend the Member for Dudley North (Ian Austin), who has led much of the campaign.

Ten per cent. of cystic fibrosis sufferers are still waiting for approval for another critical combination therapy, called Elexacaftor. Can the Secretary of State reassure me that eligible patients will not have to wait so long for that to be approved?

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Of course I would have liked the deal to happen sooner, but I am glad that the company has now committed itself to engage properly in the normal processes which mean that we obtain drugs nearly as fast as any country in the world. This result—this deal—shows that the system is working to get cutting-edge drugs into the NHS at good value for the NHS pound.

I join the hon. Gentleman in paying tribute to the hon. Member for Dudley North (Ian Austin). I also pay tribute to the hon. Member for Bristol East (Kerry McCarthy), and to other Members in all parts of the House who have campaigned on this issue. It is great to have made some progress.

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I am obviously delighted by this news, and the Secretary of State will know how delighted my family were, because when the news broke I showed him the family WhatsApp with lots of exclamation marks and happy smiley-face emojis. As I have told him, my constituent Jake Ogborne, an 18-year-old boy, was in a similar situation earlier this year when he thought that he had been approved for the drug Spinraza—there is a an online video of him having a cake and a celebration—but then he found that according to the small print he was not eligible. I want his family to be as happy as my family are now, and I hope very much that the Secretary of State will be able to look into his case.

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Absolutely. I pay tribute to the hon. Lady, who raised that case with me last night and gave me advance warning that she would raise it in the House today. I shall be happy to ensure that the relevant member of the team meets her with her constituent, if appropriate, so that we can get to the bottom of this.

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I want to associate myself with the thanks to all the campaigners who worked so hard to ensure that these drugs would be available in England as well as Scotland. I never doubted that my Government would press and press, and I am delighted that the Secretary of State’s Government have followed suit. However, there are still great Brexit uncertainties. Given that people fought for so long, what reassurances can the Secretary of State give those who will obtain these life-saving drugs that they will be possible, affordable and sustainable?

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The agreement that the hon. Lady’s Government—the UK Government—reached with Vertex means that this drug will be available in Wales and Northern Ireland as well. It is true that Scotland chose to go it alone and as a result has not received such good value for money, but what really matters is that the drug is now available throughout the United Kingdom.

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Will the Secretary of State pay tribute to campaigners in my constituency such as Matthew Dixon-Dyer, who campaigned very strongly and lobbied me very effectively? Will he also illuminate the House on how, in future, we can have smoother access to drugs such as Orkambi on the NHS?

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My hon. Friend has campaigned long and hard and has talked to me an awful lot about how important it has been to obtain Orkambi and the other cystic fibrosis drugs that will save lives, and I pay tribute to his campaigning. As I have said, we now have a system that allows access to drugs for the NHS at some of the best value in the world, and that system is working. It is clearly getting the drugs that are needed into the NHS, and I think that we should all get behind it.

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Children and their families throughout the UK will be saying a huge thank you for Orkambi. Will my right hon. Friend now turn his attention to phenylketonuria, or PKU, and the drug Kuvan, so that children like my constituent Cait, who is now 11, do not need to wait any longer?

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I can assure my hon. Friend, who has campaigned long and hard on the issue of access to Kuvan, that we are working on that as well. I hope very much that we can come to a positive conclusion.

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The system did finally work, but did it not take far too long, and is it not time to introduce transparency into this opaque system, particularly when the Americans are waiting to pounce on our pharmaceutical industry?

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The NHS is off the table in trade talks and pharmaceutical pricing is off the table, and transparency over pharmaceutical pricing would not benefit this country at all because we get the best deals in the world because we can keep them confidential, so it is a slight surprise to hear a Labour Member argue for what would effectively lead to higher prices for drugs in the NHS. Instead, we will protect the NHS.

Genomics

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5. What recent assessment he has made of the merits of using genomics in healthcare. [900197]

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We are world leading in genomics and should celebrate that. A recent trial at Addenbrooke’s Hospital in Cambridge provided whole genome sequencing, identifying underlying genetic conditions for babies and children in intensive care. As a result, three quarters of those young patients received changes to their care. The NHS genomic service is working to embed genomics in routine healthcare. Later this year, the national genomic healthcare strategy will set out the ambitious programme for the next 10 years.

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With increasing direct-to-consumer genomic testing by private companies, can my hon. Friend advise what assessment has been made of the potential impact of self-referrals on NHS services?

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Patients who need a genomic test from the national genomic test directory will be referred to the NHS genomic medicine service. However, I recognise that some patients may contact their GP for advice after taking a commercial test. NHS England is working with partners to ensure that GPs receive training to help them respond correctly. Public Health England and the National Screening Committee have also published guidance on private screening.

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Health service professionals in the Black Country are concerned that the removal of local funding for in-house molecular testing for cancer in April in favour of regional genomic laboratory hubs could in certain circumstances cause delays in diagnosis and be more expensive. Will the Minister look at this again in order to refine the processes to address these particular issues?

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Clinicians should be in charge of the process, and I have been assured that the change, using genomic testing, is better for patients and better for outcomes, but I would of course be happy to meet the hon. Gentleman and discuss it further.

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I commend the Minister for the progressive approach the Government have taken to genomics, but for a large number of genetic diseases the symptoms do not manifest themselves until after developmental damage has been done. Will the Government consider whether we should extend genomic testing to all neonates—all newborns—at some point in the future?

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The Government are very open to such an approach. Genomics is transformative, and the early detection of disease means that we can treat patients from birth better and more efficiently.

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Surely all this must be put in the context of the Topol review, with so much innovation and not just in genomics? There is so much innovation going on in the health service, but we have to make sure that there are well-managed and efficient hospital trusts running these programmes. Many are not like Huddersfield and are not up to speed, and we have to get hospitals up to speed in using the new technologies.

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I totally agree with the hon. Gentleman, and my constituency neighbour, the Secretary of State, is totally on this programme.

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In January, the Secretary of State announced that genomic testing would be provided in NHS England to healthy subjects for a few hundred pounds. This ill-advised plan, which would have widened health inequalities, seems to have gone quiet, so can the Minister confirm that the Government no longer plan to sell genetic testing and genomic testing in NHS England?

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As the hon. Lady knows, because we have worked together on this agenda, it is never about selling the product; it is about better patient care and ensuring that we get technology to the patient as speedily as we can for better and appropriate diagnosis.

Bedrolite

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6. What recent assessment he has made of the effectiveness of Bedrolite in treating (a) multiple sclerosis and (b) other neurological conditions. [900198]

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We have changed the law so that specialist doctors on the GMC’s specialist register can now prescribe cannabis-based products. I have asked the NHS to undertake a rapid review of how this is working, and my Department is now working with delivery partners to implement the report’s recommendations.

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I thank my right hon. Friend for his answer, and for his work in this area, but leaving the decision to prescribe cannabis for medical use to individual doctors while NICE is saying that more evidence is needed risks the inertia that has led the MS Society to conclude that not a single person has yet benefited from the legalisation of cannabis for medical use, except those who are able to pay up to £1,000 a month. Will my right hon. Friend meet the MS Society and me to discuss more ways of accelerating the uptake of Bedrolite among patients who have a reasonable expectation of benefiting from it?

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I am very happy to meet my hon. Friend and colleagues from the MS Society. She is right to say that we need to ensure we get the evidence that the clinicians understandably want, and in fact we have committed public funds, through the National Institute for Health Research, to establish clinical trials to develop that evidence base.

End-of-life Care

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7. What steps he is taking to support end-of-life care. [900199]

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We are absolutely committed to supporting end-of-life care, not only through £4.5 billion-worth of investment in primary and community services but through providing an additional £25 million to palliative care and hospices in 2019-20. Today, I am in a position to announce how the geographical spending of that money will be allocated, and I will be putting the regional breakdown in the Libraries of both Houses this afternoon.

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What are the Government doing to better resource support for children’s palliative care, including addressing the shortage of specialist doctors and hospice nurses needed to care for children with life-limiting conditions?

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We care passionately about the way in which children’s palliative care is delivered. That is why we have increased the children’s hospice grant from £12 million this year to £25 million in 2023-24. We have also seen a nearly 50% increase in doctors working in palliative care medicine since 2010, but the interim NHS people plan will set out actions to meet the challenges of workforce supply and demand.

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Last week in the Queen’s Speech debate, I mentioned a constituent of mine, Liz, who had declined the offer of palliative radiotherapy treatment simply because it would involve a four-hour round trip to get from the Lakes to Preston. Does the Minister agree that it is wrong for cancer patients to be forced to choose shorter lives because they cannot cope physically with the longer journeys?

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The hon. Gentleman is absolutely right to raise this matter, and I know that he is meeting the Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar), shortly to discuss the details of that individual case. More broadly, the long-term planned commitment to spend that additional £4.5 billion- worth of investment in primary and community health services will definitely help those services to be delivered much closer to people’s homes.

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Hospice in the Weald is building the UK’s first cottage hospice, and I viewed it on Friday. It allows family members to care for and stay with their loved ones until the end of their life, and it is absolutely fantastic. The cottage hospice is looking for a Minister to come and open it. I know that there is an election coming, but will a Minister from the winning Front Bench come and do that honour for us in East Sussex?

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I am grateful to my hon. Friend for mentioning that brilliant initiative. I think we will probably be falling over ourselves to volunteer to do the honours, but I would be very happy to put myself forward for that.

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Not least due to the charm and courtesy of the hon. Member for Bexhill and Battle (Huw Merriman), quite apart from the magnificent facility that he has just been busily championing.

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The Minister will know that her colleague, the Justice Secretary, has declined to proceed with a call for evidence on the sensitive issue of assisted dying. Would it not be appropriate for her Department to gather evidence from the professional bodies involved in end-of-life care, to ensure that legislation is evidence-led?

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You will know as well as everyone in the House, Mr Speaker, that that is a sensitive matter on which Members have contrasting views. The right hon. Gentleman is right to continue to raise the issue, but the legislation surrounding it continues to lie with the Ministry of Justice.

Mental Health Services

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8. What steps he is taking to ensure the adequate long-term provision of mental health services. [900200]

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20. What steps he is taking to ensure the adequate long-term provision of mental health services. [900213]

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By 2023, an additional £2.3 billion a year will flow into mental health services across England. Our long-term plan for that increased investment will ensure that more adults, children and young people than ever before are able to get mental health support when they need it. Increased funding will also support further improvements in quality of care and patient experience.

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I welcome my hon. Friend to her position. My right hon. Friend the Secretary of State will be more than familiar with the long-running problems at the Norfolk and Suffolk NHS Foundation Trust, which is our county’s main mental health trust. There is a huge effort to try to improve it, but I know from constituency cases that significant problems still exist. Will Ministers update us on what progress they think has been made at NSFT?

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My hon. Friend works tirelessly on his constituents’ behalf. In fact, I think I am meeting some of his constituents tomorrow. I will look into the issues he raises, but the trust has been working since May 2018 on delivering the immediate improvements suggested by the Care Quality Commission, and leadership support has been provided by East London NHS Foundation Trust. I promise to look into the situation to see where the trust is at this point and what improvements have been made, and I may have that information to feed back to him tomorrow.

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I welcome the Minister’s recent announcement of greater support for people affected by the suicide of a loved one, but what form will that additional support actually take?

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It goes without saying that anyone affected by a friend or family member taking their own life will be absolutely devastated. We made an announcement at the weekend of nearly £1 million of funding to target 10 areas to help to provide assistance and support to the bereaved. We will assess those 10 sites to see what is delivered and how it works, and we will hopefully be able to roll the scheme out across the UK in the future.

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I refer the House to my entry in the Register of Members’ Financial Interests. The time in a woman’s life when she is most likely to struggle with her mental health is when she is pregnant or shortly after delivery, but half of all women with depression during that period say that their problem remains unidentified by the NHS. Does the Minister think that it is time for all women to get a postnatal check from their GP as part of the GP contract?

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We are looking into that. Perinatal support is provided to women across the UK. We have been pushing this from the Department. The hon. Gentleman is absolutely right that this is a time in a woman’s life when she may suffer from poor mental health or a mental health condition that is directly related to her pregnancy, and that is when women need support most. We are looking into this, we are pushing this and we are looking into providing that, hopefully as part of the GP contract.

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People outside the House will have listened to the Minister’s warm words, yet we know that still far too many people right across our country are having to travel hundreds of miles to access services. Young people having to travel 300 miles to get a bed is unacceptable. Will the Minister tell us whether the investment she outlined will be ring fenced, because it has not been thus far? Will she also be investing specifically in young people’s mental health services?

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That is a big question because it covers two areas. This Government have invested £2.3 billion in mental health services, a huge amount of which is to go into salaries, to deliver community health services where they are needed: close to patients and to their relatives and families. It is also to provide community health teams and support teams in schools for young people. Clinical commissioning groups are under an obligation to provide those mental health services with the set funding. If the hon. Lady would like to meet to hear more about that, I will be happy to discuss it with her.

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As this is your last Health questions, Mr Speaker, may I thank you for your many years of campaigning for speech and language therapy for children? It has given great hope to many families in a situation similar to your own.

On the issue of early intervention, given that half of all mental health conditions are established before the age of 14, does the Minister, who is passionate about this, agree that mental health provision in schools is essential? Will she update the House on progress towards the 2023 objective of a quarter of schools having a mental health lead?

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I thank my right hon. Friend for his question and for his work as Secretary of State. He was the longest-serving Secretary of State for Health ever, and he is passionately interested in this subject, too. Yes, we are on track—in fact, we are more than on track—to meet our objective of 25% of schools being covered by a school mental health support team by 2023-24.

The school mental health support teams have been launched in trailblazer areas, and I visited one a few weeks ago at Springwest Academy in Hounslow to see the amazing work the teams are doing with young children. The teams are teaching coping strategies and identifying mental health problems as they arise very early in life, which helps children to deal with those mental health problems now and into adulthood. We are on track and we hope to meet that objective.

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Last week it was reported that a 16-year-old boy in Milton Keynes tragically died by suicide. His referral to mental health services was rejected because he did not meet the threshold as his mental health problems were not deemed severe enough. This is deeply shocking, and it is clear that too many children are going without the support they need. Will the Minister now match Labour’s commitment to invest in children’s mental health services and to ensure that every secondary school has access to a trained mental health professional?

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Obviously I cannot comment on an individual case, but what I can say is that the NICE guidelines on assessment for suicide were recently sent out to A&E departments to ensure that people who present with mental health problems are treated holistically and looked at in the round to assess whether they are a suicide risk.

We are investing £2.3 billion in mental health services—more than invested by any previous Government—and a huge amount of that is going towards children and young people. I hope cases such as the one highlighted by the hon. Lady will be a thing of the past. We have turned a corner. We are rolling out these mental health teams and, in the last year alone, 3,000 more people are working with young people and young adults. We have the new training scheme and the school mental health support teams. There is more to be done, but I hope such stories will become a thing of the past.[Official Report, 5 November 2019, Vol. 667, c. 8MC.]

Prescription Costs: Health Outcomes

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9. What recent assessment he has made of the effect of prescription costs on the health outcomes of people with chronic illnesses. [900201]

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Extensive arrangements are in place to help people to afford national health service prescriptions. Those include a broad range of prescription charge exemptions, for which someone with a chronic illness may qualify.

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I think the Minister is being too complacent. The chronic illnesses list has not been updated for years, and I have had complaints from Mr E with coeliac disease, Mrs L with multiple sclerosis and Mr A with cystic fibrosis—he is taking up to 50 tablets a day. With each item costing £9, can the Minister not see how much hardship this is putting on people?

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There have been NHS prescription charges in England for decades, and successive Governments have concluded that patients who can afford it should pay prescription charges in order to contribute to the running of the NHS, but a huge number of exemptions are in place and mean that, in England, 89% of NHS prescription items dispensed in the community are currently provided free of charge. People on low incomes who do not qualify for an exemption will be eligible through the NHS low-income scheme.

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Prescriptions not only include pharmaceuticals, so I congratulate the Secretary of State on the launch of a national academy for social prescribing, which he pushed through with his own energy and enthusiasm. Prescribing alternative treatments such as art therapy and speech and language therapy can have a massive impact on people’s mental health and on many other ailments. This Department has undertaken a revolutionary step, and I wholeheartedly congratulate him and all his Ministers.

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The right hon. Gentleman plays down his role in this agenda; he has been a great champion for social prescribing. All of us in the Department’s Front-Bench team have met people for whom social prescribing has been life changing; it has totally changed the way they are able to deal with their symptoms and illnesses. It really is a massive game changer.

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But of course modesty is the right hon. Gentleman’s middle name.

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And humility.

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Indeed.

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With one in three arthritis sufferers missing out on at least one prescription due to cost, what can the Minister say to the pensioner in Barnsley who has had their pension cut, lost their local bus service and now lost out on the treatment that enables them to simply walk down the street? Is it not time the Government matched Labour’s promise, and invested in pensions, services and free prescriptions on the NHS?

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I simply say to the hon. Lady that people over the age of 60 qualify for free prescriptions.

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Too many patients cut back on their prescribed medicines or go without them altogether because they simply cannot afford to pay prescription charges. Research by University College London indicates that this non-adherence to prescribing regimes costs the NHS £500 million more in complex treatments and hospitalisation. Prescription charges are a tax on sickness that disproportionately burdens those who have chronic illnesses and those on low incomes. Does the Minister agree that it is high time we brought an end to these charges, which fly in the face of the principle of an NHS free at the point of delivery?

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I suppose I should probably have declared an interest in this issue, because I am severely asthmatic and I do not get free prescriptions, but then again I do not think I should. There is a prescription exemption system designed specifically to assist people who are most likely to need support in paying for prescriptions: people on low incomes or in full-time education; the over-60s; people living with many long-term conditions; an d people with an increased risk of illness, such as pregnant women. That is why 89% of prescriptions are dispensed without charge.

Cancer Diagnosis and Treatment

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10. What steps he is taking to improve cancer (a) diagnosis and (b) treatment. [900202]

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Cancer survival rates are, thankfully, at a record high. Last year, the NHS carried out 53 million diagnostic tests, which is 53% higher than the number carried out in 2010, but we need to do more. Our aim is to diagnose three quarters of all cancers early, so that 55,000 more people each year survive cancer for another five years. To achieve that, we are radically overhauling screening programmes to improve access and uptake, investing £200 million in diagnostic equipment and accelerating the adoption of the most innovative cancer treatments.

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Bowel cancer claims 16,000 lives a year, which is 45 every day, yet just 55% of people in Dudley take up bowel cancer screening. What are the Government doing to ensure that more people take up this life-saving cancer screening?

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I thank my hon. Friend for all the work he does to make sure people are aware of cancer screening and taking it up. Diagnosing bowel cancer early is vital if we are to beat this disease. We have committed to lowering the age of bowel cancer screening from 60 to 50 and we rolled out the fit bowel screening test in June. It is easier to use and is expected to improve uptake by 70% in towns like Dudley. Sir Mike Richards’ screening review sets out important recommendations, using prioritisation of evidence-based incentives. We will set out our plan for implementing it next year, so that people can access screening more accessibly—in car parks or wherever else it suits their lifestyle—and we can save more lives.

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Access to screening is a function of people’s poverty. For example, in Newcastle, cervical screening rates vary from 85% to 23%. A Macmillan Cancer Support report said clearly that we need to have access to screening in the places where people are, particularly for those who are running two jobs and so on. What is the Minister specifically doing to make screening available where people are?

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I agree with the hon. Lady on this. The Richards review and working through the recommendations will enable us to put more screening in places where people can access it. The Eve Appeal, specifically directed at cervical cancer, is looking to put screening in workplaces and so on, but anybody who is worried must get tested.

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The Secretary of State is absolutely right in his intent to put the one-year cancer survival metric at the very heart of the cancer strategy, to encourage earlier diagnosis, which the all-party parliamentary group on cancer has long campaigned for. Will the Government ensure that adequate funding is attached to the metric, so that we can finally start closing the gap on international survival rates?

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I thank my hon. Friend for all his work leading the all-party parliamentary group on cancer. We are putting more money into diagnostic tests, which means that there will be more than 7.9 million more tests. Making sure that we have the correct data on survivability, in which the one-year test is an important metric, is part of that programme.

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In the past year, more than 34,000 cancer patients have waited beyond two months for treatment. Every single waiting time measure for cancer has worsened in the past year. Surely, the Minister should be ashamed that so many more cancer patients are waiting longer for treatment.

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I probably know as well as most that waiting for a cancer diagnosis is traumatic and that it needs to be done as speedily as possible. There is nothing more frightening than that wait, so what have we done? In 2018, 2.2 million people were seen by a specialist for suspected cancer—that is more than 1.2 million more people per annum since 2010. Getting to the specialist an individual needs as quickly as possible is what this Government are focused on, and that is why we have put so much emphasis on having specialist clinical nurses in the cancer workforce. We will carry on making cancer a priority.

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But the problem is that that is not happening, is it? Cancer patients are waiting longer for treatment. In recent weeks, we have had an avalanche of hospital board papers blaming understaffing and George Osborne’s pension tax changes for the deterioration in waiting time standards. The Prime Minister promised to fix Osborne’s pension tax mess. How many more patients need to be added to the waiting list before it is fixed?

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The guidance for doctors’ pensions was changed last month. As I said, making sure that everybody can access a GP as soon as they are worried and then get to a specialist as soon as possible is our top priority, and making sure we have a broad-based cancer workforce is part of that plan. Delivering these things, as well as rapid diagnostic centres with £200 million in new machinery, is how we are going to do it.

PrEP

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11. What steps he is taking to establish a national programme for PrEP by April 2020. [900203]

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We have expanded access to PrEP—pre-exposure prophylaxis—so that everyone who needs it should have access. Thousands more places remain available on the trial. We are working closely with the NHS, Public Health England and local authorities, who have to play their part, to plan for a seamless transition from the trial to routine commissioning from April next year.

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The Secretary of State gave a personal commitment that the PrEP trial would be extended. He has failed to meet that commitment, and men have contracted HIV as a direct result of the Government’s failure. What faith can people who need PrEP and organisations such as the Terrence Higgins Trust, the NHS and councils have that the Government’s national programme will be ready and able to meet the demand that exists?

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This is an important issue and I care very much about getting the roll-out right. I chastise the hon. Gentleman slightly for his tone. The Minister met the Terrence Higgins Trust yesterday. It agrees with the approach that we are taking. The roll-out from a trial to routine commissioning will happen in April. There are some gaps where local authorities need to do more, but from an NHS perspective, there are thousands more places available on the trial. If the hon. Gentleman feels strongly about the issue, as I do, he should be working with us to get local authorities to do their part, because the NHS is doing its part.

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May I congratulate the Secretary of State on setting the 2030 target on HIV infections? Access to PrEP is vital for reducing new infections, but access to healthcare professional time is also critical. Does he therefore agree with me and the trust that we must do everything to remove the funding and logistical obstacles that are discouraging clinics from filling the many places that are now available on the trial?

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I wholeheartedly agree with my right hon. Friend, who is absolutely spot on about this, but there is more that we need to do in ensuring that the health inequalities of people who are homosexual or LGBT are reduced across the board. We have a whole plan to make that happen. She played an important part in government, and I will rest at nothing to ensure that we address these problems, but we should not engage in the sort of scaremongering that we have heard from the Opposition.

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I hear what the Secretary of State has said, but data from the British Association for Sexual Health and HIV have shown that nine gay and bisexual men in Greater Manchester were diagnosed with HIV while waiting to access the PrEP trial. This is likely to be just the tip of the iceberg in terms of the number of people who have acquired HIV because they could not access the trial. He will agree that this is totally unacceptable and goes against the Government’s own commitment to eradicate HIV by 2030, so does he think that PrEP should be routinely commissioned before the trial ends in September 2020 and will he commit now to that happening?

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We are switching to routine commissioning from April. It is a deep frustration of mine that some local authorities are not putting in place the necessary measures. I will look into Manchester in particular; I did not know about that example. I personally set the goal of our being HIV-free by 2030. I am delighted that, with the support of my right hon. Friend the Member for Portsmouth North (Penny Mordaunt) when she was the Minister for Equalities, we have made the progress that we have. I have absolutely no doubt that there is further road to travel and that we should all come together in support of equalities in health provision, especially in this area. I look forward to working with the hon. Lady and all those who are on the side of trying to make this change happen.

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I call Tommy Sheppard. Where is young Sheppard? [Interruption.] He has withdrawn. I was not advised of that. Never mind, he is a most active beaver in the Chamber in normal circumstances. It does not matter that he is not here, because Mr Andrew Rosindell is.

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Speak for Romford!

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Yes, speak for Romford. Well done.

Seven-day-a-week NHS Services

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13. What progress his Department has made on providing NHS services seven days a week. [900205]

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Everyone now has easier and more convenient access to GP services, including appointments in the evenings and at weekends. There are also substantial improvement programmes in place related to seven-day hospital services set out in the NHS long-term plan, including hospitals with major A&E departments providing same-day emergency care services 12 hours a day, seven days a week, by the end of 2019-20.

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I thank the Minister for her reply, but I am increasingly concerned that my constituents in Romford often have to wait three weeks or even longer for routine appointments with their GPs. What action are the Government taking to ensure that such long waiting times are reduced and preferably eliminated altogether?

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I thank my hon. Friend for that question. Just over 40% of all booked appointments take place on the same day with GPs. However, it is important to recognise that many patients will be appropriately booking ahead as part of the ongoing plan for long-term conditions. The new GP contract will see billions of pounds in extra investment for improved access to GPs, expanded services at local practices and longer appointments for patients who need them. NHS England is working with stakeholders and is undertaking a national review of access to general practice services.

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With more than 5 million people across England unable to book an appointment with a GP outside working hours, many of our constituents have had to wait two or three weeks to get an appointment. With the loss of 1,600 full-time GPs since 2015 and billions of pounds in cuts since 2010, does the Minister realise that the NHS is certainly not safe with the Conservative party, and that is what the British people think?

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I simply do not recognise the scenario that the hon. Lady has just articulated. There is access to GP practices throughout England outside of working hours.

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21. I am delighted to ask the Minister, who is my constituency neighbour, a question. Will the efforts to get more work through a seven-day NHS mean an extra effort to improve the take-up of the flu vaccine this year, not least for those suffering from lung diseases such as chronic obstructive pulmonary disease and asthma? About 50% of people with those conditions did not get the vaccine or did not take up the opportunity to do so last year. Will that be improved this year? What steps are the Government taking to ensure that those individuals and the people who support them get the necessary flu vaccine this year? [900214]

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It is a delight to take a question in my first Health questions from my right hon. Friend and constituency neighbour. If he pops into Shefford pharmacy, I am sure that Jamil will give him a flu vaccine as he walks through the door because Jamil does not require anybody to wait; anyone who wants a vaccine can have one—think pharmacy first. We are also ahead on flu vaccines for pensioners compared with last year. As my right hon. Friend articulated, it is crucial that those in the at-risk groups are vaccinated first to protect themselves this winter. We are targeting patients through the “Help Us, Help You” campaign, which highlights the impact of flu on those who are most at risk, and we are ahead of our targets from last year.

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Order. We are running late, but I will take a one-sentence question from Gareth Thomas.

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The three walk-in centres that provide a seven-day-a-week service in my constituency are closed or closing. Why?

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I did not hear the hon. Gentleman’s question in full, but I would be happy to meet him afterwards to talk about the matter in more detail.

Topical Questions

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T1. If he will make a statement on his departmental responsibilities. [900218]

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Since the last Health questions, we have announced 20 hospital upgrades; 40 new hospitals; £200 million for cancer diagnosis kit; £250 million for the NHSX artificial intelligence lab; a social prescribing academy, as mentioned by my right hon. Friend the Member for Wantage (Mr Vaizey); the launch of the “Every Mind Matters” public mental health campaign; a landmark agreement so that cystic fibrosis drugs, including Orkambi, can be available on the NHS; and the firm commitment from the Prime Minister that in any trade talks after Brexit, the NHS is—and always will be—off the table.

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There were 1.2 million hospital admissions related to alcohol consumption in England in 2017-18—3% up on the previous year. Hospital admissions due to alcohol-related liver disease have increased by 43% in the last 10 years, and alcohol problems now cost the NHS an estimated £3.5 billion every year in England alone. Why have the Government not properly recognised the enormous and growing scale of the country’s alcohol-related health problems, and why have they failed to bring forward serious and effective measures to address them?

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The prevention Green Paper that we published in the summer specifically addresses what is needed. The effort that we put into supporting those who are hospitalised through their abuse of alcohol needs to be enhanced, and there is an enormous amount of effort under way to make that happen.

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T8. Does the Minister agree that the latest data on the soft drinks industry levy is encouraging and a positive step in the campaign to improve health, particularly of young people? [900225]

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Absolutely; I thank my right hon. Friend for putting it so eloquently. This just shows what can be achieved. We have seen great results from the soft drinks industry levy. The average sugar content of drinks subject to the levy decreased by 28.8% between 2015 and 2018, so we have been able to make significant investments in activity and healthy eating in schools.

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Mr Speaker, as this is the last time that we will have Health questions with you in the Chair, I want to thank you for being a fantastic Speaker—particularly through your support for Back Benchers and ensuring that we can be heard through urgent questions.

Last week, we found that the number of people receiving publicly-funded social care has fallen by 15,000 in the past year. We know that 95 people a day die while waiting for care and that cuts of £7.7 billion have been made from social care budgets since 2010. Older and disabled people are paying the price. Labour has set out our plans to deliver free personal care for people aged over 65 who need it. We are providing dignity in old age. When will the Secretary of State give people the dignity and care they deserve, and bring forward the Government’s plans for social care?

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The hon. Lady will be aware that the Queen’s Speech announced a Bill to tackle the cost of adult social care. She will also know that the Prime Minister said on the steps of Downing Street that the Government will set out plans to fix the social care crisis once and for all. We need to get through Brexit, and Labour Members need to vote for the methods that will help us to deliver that, because we can then get on to the things in life that really matter, such as ensuring that no one will ever have to use their home to pay for their care.

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T9. I thank the Secretary of State very much for agreeing to increase the amount awarded to the Alex—Alexandra Hospital—to begin essential improvement works that the whole community in Redditch have been campaigning for for a very long time. Can he tell my constituents when we will finally see shovels in the ground? [900226]

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We will see shovels in the ground, I very much hope, from next year. I pay tribute to my hon. Friend, who has campaigned endlessly for these improvements to the hospital in Redditch. There is no better supporter of Redditch than her. She has badgered me endlessly, met me formally and bumped into me on the campaign. Every time I see her, she says, “Can we have the improvement to the hospital?” and the answer is yes.

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The Secretary of State says that the NHS is not on the table, but President Trump and his trade officials have been very clear that they will seek to more than double drug prices, driving up the bill from £18 billion to £45 billion a year. What discussions is the Secretary of State having, and does he accept that this is why devolved Governments must have input in trade deals?

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The NHS is not on the table in any trade deal. Medicine pricing and drugs pricing is not on the table in a trade deal. Let me bring the hon. Lady’s attention to this quotation from the former US trade general counsel, Stephen Vaughn, who said that if the UK really is determined to make no changes at all on pharmaceuticals, we can absolutely hold that position and that that has nothing to do with them. Quite right —we do hold that position; they are off the table.

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I welcome the announcement of Royal Preston Hospital being included in the hospital upgrades programme, but what plans does the Minister have for Blackpool Victoria Hospital, where services such as opthalmics are now over capacity and could do with some additional investment?

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As Members will know, my hon. Friend spoke only last week about his local hospital in Blackpool and the challenges it faces. It is absolutely clear that we need not only to get leadership right there but to continue to invest in it. I believe that I am already meeting him to discuss exactly that.

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T2. With your indulgence, Mr Speaker, can I follow on from my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), our Front-Bench spokes- person, and say that you have been a fantastic Speaker? You and I first got together on the Trade and Industry Committee about 20 years ago, and I recall, before you became Speaker, suggesting to you that you might want to stand for Speaker—I bet you have forgotten that one. Anyway, I wish you and your family all the best for the future. You have always been very fair and very helpful to me, and I think you will be missed in this Chamber, despite what your opponents say. I will come on to more serious matters now. We were promised by the previous Chancellor that the doctors’ pensions tax would be sorted out. He said that he was in negotiations, but this has been raised repeatedly and nothing has happened so far. Doctors are not putting in overtime, patients are suffering and the NHS could be in meltdown this winter. What is the Secretary of State going to do about it? [900219]

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Getting this right is incredibly important. The change in the guidance last month allows every single NHS trust to introduce the flexibilities, immediately, to ensure that doctors can do the work and the overtime they need, get paid properly for it and not get penalised through the impact on the pensions system. That change came in at the start of last month. I will write to the hon. Gentleman with the details, so that he can tell all doctors that these flexibilities are available so that they can do the work that they need to.

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Earlier this year, the Secretary of State spoke about the importance of introducing new financing mechanisms to develop and deploy drugs and vaccines to tackle antimicrobial resistance. Will he update us on that, please?

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Yes. In January, with my hon. Friend’s support, we launched the five-year plan to tackle antimicrobial resistance. We have now taken that to a global level; this is a global problem. We have appointed Dame Sally Davies, who recently stood down as the chief medical officer, to be our AMR tsar so that she can continue the drive both domestically and around the world.

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T3. Why, under a Conservative Government, was Airedale Hospital’s £22 million bid for renewal of the ward block turned down? Is it not time that the Government adopted the suggestion of NHS Providers of a far larger multi-year capital programme for the NHS, with decisions based on need? [900220]

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The hon. Gentleman will be pleased to hear that that is exactly what we have done with the health infrastructure plan, which involves multi-year capital funding settlements and investment in our hospitals. I am happy to discuss separately the specific example he raises.

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There are more than 1.5 million people in Hertfordshire and Bedfordshire, and they have no access to a radiotherapy facility in either county. Will the Minister agree to bring cancer care closer to people’s homes and join the campaign to establish a satellite radiotherapy unit in Stevenage?

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My hon. Friend is a strong local champion for his constituents in Stevenage, particularly on that issue, in which he is joined by my right hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald), who is sitting next to him. He is right to highlight the importance of easy access to such facilities. I am happy to meet him and my right hon. and learned Friend to discuss that.

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T4. After almost a decade of ideological Tory austerity and underfunding of our NHS, A&E waiting times at Bradford Royal Infirmary have soared, with one in four patients admitted last winter waiting longer than the four-hour target. Patients in Bradford deserve better than being left to suffer in A&E departments and in the back of ambulances. Will the Minister meet me to discuss emergency funding for Bradford NHS services, to avoid another winter crisis? [900221]

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We are putting record amounts of funding into the NHS across the country, including in Bradford. If the people of Bradford get their election—if Labour Members vote for it—and they want to know what is the best thing to do to support long-term investment in the NHS, I can tell them that it is to support the only true party of the NHS: the Conservatives.

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I note the recent announcement of the roll-out of the electronic prescription service. How will that benefit my constituents? When will it be rolled out, and how can my constituents use it to support their local community pharmacy?

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Preferably in a sentence—Jo Churchill.

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Digitising the process by using electronic prescribing will save the national health service up to £300 million, freeing up vital time for GPs and pharmacists to spend with their patients. It will start on 19 November.

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Splendid.

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T5. The Government have finally completed their consultation on mandatory fortification of flour with folic acid. When can we finally expect to see that eminently sensible policy implemented? [900222]

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That was part of the prevention Green Paper. We have the consultation responses, which we will assess and come forward with proposals.

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There is still too much reliance on body mass index as an indicator of good health in sufferers of eating disorders. Will the Secretary of State get behind the “Dump the Scales” campaign and meet the indomitable campaigner Hope Virgo, to ensure that GPs realise there is more to eating disorders than just weight?

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I thank my right hon. Friend for her question. The National Institute for Health and Care Excellence guidelines state clearly that GPs should not use BMI as the sole indicator for treatment. I have just met the eating disorder charity Beat to discuss how we approach eating disorders. With the £2.3 billion that we have invested in mental health services, we have made a commitment that any young person presenting with an acute eating disorder will be seen within one week, and others within four weeks.

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T6. The right to challenge decisions about care and support is fundamental, and the system for doing that must be fair and consistent across all local authorities. Will the Secretary of State make it his policy to introduce a statutory social care appeals process for the decisions made about an individual’s care and support? [900223]

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That is an incredibly important matter. It was addressed in the Care Act 2014, but I am happy to look at any proposals, because it is important that we get fair treatment right across the country.

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I ask Members for one-sentence questions from now on.

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Does the Health Secretary agree with the joint report produced by the Housing, Communities and Local Government Committee and the Health and Social Care Committee that the best way to fund adult social care is through a social care premium?

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The joint report was excellent.

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T7. My constituent Karen Gray will begin a hunger strike on Friday because she still cannot get cannabis oil on an NHS prescription despite the fact that, since her son started using it, he has had no seizures. It is costing the family £1,300 a month. When will the Secretary of State commit to making this available to the people he promised it to? [900224]

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As we discussed in the answer to an earlier question, I have both decriminalised the use of cannabis oil and introduced the National Institute for Health Research clinical trials. However, individual rules about prescriptions have to be for individual clinicians, and when it comes to funding it in Scotland, that has to be a matter for the Scottish NHS.

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Will the Secretary of State look at making greater use of chiropractors and osteopaths in support of orthopaedic surgeons?

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How could I say no as my wife was an osteopath? I understand very strongly the importance and value of those professions.

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T10. The Royal College of Surgeons reports today that 61% of consultant surgeons have been told not to take up waiting list time reduction initiatives over the winter because of the NHS tax trap. Will the Secretary of State please engage with the Treasury and appeal to it to sort this out before waiting lists are exacerbated over the winter months? [900227]

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I am of course engaged with the Treasury on this, but I would also say that these flexibilities are available right across the country and they must be used by trusts.

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We are all grateful to the national health service, but I know that the right hon. Member for Old Bexley and Sidcup (James Brokenshire) has spoken movingly of the particular debt of gratitude he owes to the institution.

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I am delighted to echo that again in the context of the fact that next month, November, is Lung Cancer Awareness Month. I ask my right hon. Friend to commend the Roy Castle Lung Cancer Foundation and all those who are highlighting the signs of this disease to save lives, quite literally, because of the need for early diagnosis. Equally, could he update the House on the lung health checks programme, which is targeted screening that could quite literally save lives from this terrible disease?

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Along with my right hon. Friend, I pay tribute to the Roy Castle Lung Cancer Foundation, but also to all the charities that work in the cancer space and do the most tremendous work on awareness raising, because it is only by awareness raising that we can actually get earlier diagnoses and beat this disease. We are looking very seriously at what my right hon. Friend suggests.

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May I thank you, Mr Speaker, for all the support you have given to Select Committees during your time in the Chair?

After a long period of engagement with patients, staff and partner organisations, the NHS has come up with a clear set of recommendations to the Government and Parliament for the legislative reforms it needs. I hope all political parties are listening to that. Will the Secretary of State confirm that he will accept all its recommendations, including the one that recommends scrapping section 75 of the Health and Social Care Act 2012 and other provisions, which would end wasteful contracting rounds in the NHS?

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I want to pay tribute to the hon. Lady for the work that she, her Health Committee and all its members have done on this legislation. I think that the legislation proposed by the NHS—with the support of the Select Committee, which will of course scrutinise it further—is an important step forward. I am delighted that Her Majesty committed in the Queen’s Speech to legislation on the NHS, of which these proposals will be the basis.

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Haslemere in my constituency has a busy minor injuries unit, used by 8,000 people a year, which is currently threatened with closure. Given that that would be catastrophic for the town of Haslemere and for the Royal Surrey A&E in Guildford, will the Secretary of State listen to the residents of Haslemere and agree not to close this vital facility?

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My predecessor, my right hon. Friend, is an assiduous campaigner for South West Surrey. There is no better spokesman for South West Surrey than my right hon. Friend. He has raised this issue with me in private over recent weeks since these concerns were raised. I have in turn raised it with the chief executive of the NHS, and I can confirm that the walk-in centre will stay open.

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The primary care mental health service in York is not being cut; it is being scrapped. Will the Secretary of State urgently meet me to save this service?

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I am happy to help and to meet the hon. Lady to talk about that. No primary care mental health services should be cutting given the amount of funding we are putting in, but I am happy to meet and discuss it with her.

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I must say to the hon. Member for Southend West (Sir David Amess) that my kids think he is a great bloke because he made an effort to go and talk to them at my party last week. He will always be a hero in their eyes.

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Does my right hon. Friend the Secretary of State share my concern that a highly paid health executive has been made redundant by Southend clinical commissioning group, given £200,000 and then employed somewhere else in the organisation? Disgraceful.

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Today is the first time I have heard of this. National health service redundancy terms were capped at £160,000 in April 2015. We consulted on bringing that down to £95,000 and we have introduced powers in primary legislation to claw back contractual redundancy payments when someone returns to any public sector job within 12 months. I will raise the individual case with the NHS to ensure that taxpayers’ money is being used as well as possible.

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Will the Secretary of State speak to his colleagues in the Home Office and get them to allow Glasgow City health and social care partnership to open a supervised drug consumption room in my constituency and get vulnerable people into a service that will keep them alive?

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We currently have no plans to change the law on drug consumption rooms. We support a range of evidence-based approaches to reducing the health-related harms associated with drug misuse. I keenly await the summit in Glasgow, which will focus on tackling problem drug use and bring together the experts we need. Dame Carol Black’s report is out in the next few weeks, but putting better resources into treatment and recovery is vital and I urge the Scottish Government to invest.

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Will the Secretary of State visit Wycombe Hospital to discuss the future of our increasingly tired 1960s tower block?

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I am absolutely happy to look at that. We have put in place the health infrastructure plan to ensure that there is a long-term plan for replacing ailing hospitals. That includes the ability to make new proposals that were not announced in the first round. I am happy to visit Wycombe, which is a beautiful town.

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The Government have repeatedly turned down plans for both a new health centre in Maghull and a new walk-in centre in Southport. Is not electing a Labour Government the only way my constituents and those of Members across the House will get the new facilities they so badly need?

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On the contrary. I was in Southport last month and I saw the fantastic staff and what they do. I was able to talk to them about the improvements that we are planning in Southport. People in Southport and across the country know that unless we have a strong economy we cannot fund a strong NHS. The Labour party’s plans for the economy would sink it. Only with a strong Conservative Government can we have a properly funded NHS.

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I say to the right hon. Member for Rayleigh and Wickford (Mr Francois) that when we stood against each other in Conservative student politics in 1986, I was the candidate of the right and he was the candidate of the left. Some things change over the years.

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Mr Speaker, you won. Although we have not agreed on everything in the 18 years I have been in the House, I say most earnestly, from one midget to another, that I wish you a long and happy retirement.

Following the question of my hon. Friend the Member for Southend West (Sir David Amess), I point out that the individual he mentioned moved from being the accountable officer of the Southend CCG to the accountable officer of the Thurrock CCG. It was a sideways move for which he trousered a fifth of a million pounds of public money, which should have been spent on patients. Do not just cap the payment, sir, make him pay it back.

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Again, we have the powers in primary legislation to claw back contractual redundancy payments. Nobody is keener to ensure the careful expenditure of taxpayers’ money than my right hon. Friend. The matter has been raised very powerfully by the voices of Essex in this question time.

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I am sorry, but we have way overrun. Demand exceeds supply on these occasions—by the way, that is true in the health service under Governments of both colours—but we will take one more question.

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I was very distressed to learn last week that a higher than average number of people in Hull are having foot amputations, partly because of diabetic foot ulcers and despite excellent work by the vascular department. The message from that department is that it is underfunded, under-resourced and in desperate need of an infrastructure upgrade to its theatre. Time is running out, so instead of asking the Secretary of State to meet me, will he just act very quickly to give it the funding it needs to stop unnecessary amputations happening in Hull?

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We have the largest infrastructure investment programme in a generation and I am very happy to look at the specific request from Hull to ensure it gets the infrastructure it needs.