Health Questions House of Commons

Good morning and welcome to BBC Parliament's live coverage of the

House of Commons. MPs will be hearing a statement from David

Cameron on the outcome of the G 0 summit in Turkey and the latest on

the terrorist attacks in Paris. Jeremy Corbyn will be replyhng. He

has come under criticism after telling the BBC he doesn't does not

support a shoot to kill polhcy. There is continued debate of the

Cities and Local Government Devolution Bill. This devolves power

sound budgets to local budgdts under the control of a directly elected

mayor. Join me for a round-tp of the day in both Houses of Parli`ment at

11pm tonight. First, questions to the Health Secretary, Jeremx Hunt

and his ministerial team. Order order. What questions to thd

Secretary of State for Health. We are determined to ensure people with

learning disabilities live independent lives with bettdr care

and improved outcomes. Taking together big response to thd no

voice and heard no right ignored consultation and the care programme,

steps are to protect rights, strength of choice and meet physical

and mental health needs by default. I would like to thank my honourable

friend for his answer. My constituency are making an

application to open a free school for autistic children. How does he

feel that schools such as this could help education for children with

autism? I thank my honourable friend for the question. Autism is a

growing area of identified special educational needs at which requires

a range of provision to meet the diverse needs of the power of pure

elation. While it will be inappropriate for me to comlent

where it is needed, a speci`l free school can and to the local

provision in providing spechalist places and expertise that c`n be

shared widely. The all-partx group on Spectrum disorders took dvidence

on the link between alcohol consumed by mothers in pregnancy and growing

incidences of learning disability and autism. In Canada, this has been

widely known and the Canadi`n Government has invested heavily in

raising awareness. When can we expect the same in this country I

think the syndrome to which the honourable gentleman draws `ttention

is well known here as well. I understand from my honourable friend

the Minister for Public health, that there will be a consultation in

relation to this and new guhdelines and response. The all-party group is

right to draw attention to this and anything that can protect women

during pregnancy and their children is of benefit to all. I havd one

family in my constituency where three of the form youngsters have

autism. We look at the works of the local authorities where thex are not

working closely enough with the mother who has one idea abott how

she would like a youngster to be educated and the local authority,

which seems for cost reasons alone, simply not working with the parent

and would like to see her prosecutors rather than working with

her? I meet on a regular basis with families and others who havd had

young people and older people in the system where there is a difference

of opinion about what might be done. Some of the stories are

distressing. Families will sometimes feel people have not listendd to

them, but they can be -- thdre can be difficult clashes of opinion I

know it is a perpetual issud. The important thing is to listen to

those closest to a particul`r problem and that is likely to be the

best way forward, even if there is a difference of opinion. If pdople

feel they are listened to, there is an opportunity to explore what can

be done. The autism numbers in Northern Ireland growing but it

seems clear to me that therd is three departments that have a

responsibility. Health, education and employment. We need to lake sure

autistic children have the opportunity through their hdalth to

be prepared for education and employment. Does the Ministdr have a

strategy that takes all thrde of those Government departments on

board and Dessie share that with other regions of the UK and Northern

Ireland? -- does he share. Xes, I couldn't put it better. We have not

as -- and autism programme which provides an opportunity to look at

the Government strategy. It contains many different elements but in

relation to work, we have sdt out a challenge to halve what is the

disability employment gap bdcause we know more people with disabhlities

want to take the chance of working and it has to be done in thd right

way. Things like the autism insurance board give a chance for

families to be involved right across the areas where there might expect a

fund assistance. By 2020, all patients admitted to hospit`l in an

emergency will have access to the same level of consultant assessment

and diagnostic tests which dveryday they admitted. With evidencd

suggesting that mortality r`tes at weekends, there is an incre`sed

risk, does he recognise the importance of getting right to the

proposal for a new emergencx hospital in the and Bournemouth area

and ensuring Barack specialhst consultants 24/7. -- ensuring there

are specialist consultants 24/7 The clinical standards say anyone

admitted to hospital in an dmergency should be assessed by a consultant

without -- within 14 hours `nd across every day of the week and all

specialties. That only happdns in one in eight of our hospitals and

that is why it is so import`nt to get this right. York no longer has a

seven-day service or a one-day service in our hospital. Totally

avoidable. Will he agreed to meet with me and to an independent

enquiry so mental health patients are not put at risk again and we can

have a full service before 2020 I know the Minister of State has been

looking at this issue and is willing to talk to her about it. Thdre has

been alternative provision lade and she is right to make sure hdr

constituents have access to urgent emergency care seven days a week.

Will my right honourable frhend agree that hospital services do not

mean full services in every hospital and if we are to achieve our

ambition of driving our accdss weekend deaths down, we havd to look

at concentrating services in regional centres. In addition, make

sure we network among smalldr hospitals where they exist. He

speaks very wisely on this hssue. This is not about making sure every

hospital is providing every service seven days a week. It is making sure

in an emergency situation, people have access to the care that they

need. High dependency patients are reviewed twice a day, even `t the

weekends by consultants and that is something that only happens across

all specialties in one in 20 of our hospitals, which is why it hs

important to get this right. What assessment has the department made

of the impact of reduced A and what assessment has that made on the

implementation of a seven-d`y work plan? I am not sure what shd is

referring to. We are not reducing A ours. We have invested hn 2 00

more consultants and five ydars ago and we need to support strong A E

departments as much as posshble Over the weekend, we learned of the

close links between the leadership of the BMA and the party upset. They

are more interested in putthng their own political agenda forward and

security -- fans during thehr members. Can he shall be th`t they

will hold their nerve and ddliver the seven-day NHS to make it more

safer for our patients? I c`n give her that assurance. This is

essential for the constituents of all honourable members of the House

they are sitting on and this Government will always stand on the

side of patients. The week `nd mortality rates are not accdptable

and that is why we are doing something about it. Given the

pressures on the NHS, we ard a long way from the vision the Secretary of

State wants to get to. When he agree that there are thousands of care

workers of Indian origin is -- who are trained in the NHS but xou have

set the language bar so high that they are excluded from doing so

Will he look again at the tdst? I would like to commend the

contribution made by NHS front line workers of Indian orange in --

origin. I do think it is re`lly important that people speak good

English if they are going to be providing care in the NHS. Hn terms

of clinical safety, there are real issues when the standard of English

isn't high enough. We have ` lot of fantastic support from Eric -- from

immigrants who do a great job on the NHS front line but good English is a

prerequisite. The Government is determined to invest in diagnostic

testing in primary care. Di`gnostics are key to 21st-century NHS and that

is why we have set up the mddical technology strategy group which I

chair. We set up the cancer strategy task force, the Access fund and new

models of care programme. Wd are looking to accelerate these in the

system and to the genomics programme, we are investing in

molecular diagnostics which will shape the future. Point of care

testing could reduce the nulber of prescriptions for antibiotics and

contribute to the UK's strategy and save the NHS millions of potnds each

year. Ahead of my adjournment debate next Monday on this issue, with the

Minister agree to look at this type of testing as a way of saving the

NHS money and provide an appropriate patient treatment?

We are committed to tackling antimicrobial resistance and the

reducing of antibiotic percdption is part of that. We have a grotp

looking at improved diagnostic services in relation to that. It has

already identified what diagnostics are in use and what new technologies

are on the horizon, including the point of care testing. My honourable

friend is looking forward to responding to herd debate on Monday

to set up more of that detahl. The Government has done a good job of

getting one year cancer survival rates into the DNA of the NHS as a

means of encouraging CCGs to promote earlier diagnosis, cancer's magic

key. We need to make sure that we do not just have diagnostic testing at

my recap but we also increase referral rates and improve `wareness

campaigns as a means of enstring that we save those thousands of lies

that only does the lost -- boast thousands of lives that are lost

through late diagnosis will stop I pray to be to do his work through

this on the -- aye -- I pay tribute to his work on the task force for

this. They have said that ndw guidelines on clear ambitions and

standards for how quickly p`tients should be referred for diagnostics.

There is good news. Compared to 2009-10, more diagnostics wdre used

but we have more work to do. Every person lost to suicide is a tragedy.

We continue to reduce suicide rates by working with the NHS comlunity

and the voluntary sector. I want us to be more ambitious about suicide

prevention. In Rochdale, suhcides have gone up by 25% since 2010. The

rate is 11.8% against an avdrage in England for 8.9%. We have a much

higher rate of male suicide. If the Government continued to get their

be more and more needless ddaths. be more and more needless ddaths.

Are they going to fund ment`l health services properly? Mental hdalth

services is just part of wh`t we intend to do. More money is going

into mental health. I will lention some other things as well. He is

right in terms of male suichde. Men are three times more likely to

commit suicide than women, `nd it is also a particular course thd concern

amongst young men. Our national suicide rates remain politically

low-income Harrison with others But it has been rising and I am worried.

I'm interested in this theory of zero suicide, more work to try and

ensure that suicide is not seem as inevitable and more work in detail

with particular affected colmunity. 'S particularly affected

communities. And the work wd're doing with young people, ushng

I'm interested in this area and we I'm interested in this area and we

will have a debate on it later this week. As my right honourabld friend

just said, we will indeed bd having a debate on this matter latdr this

week, on Thursday, in Westmhnster Hall. It will be the first time that

we have been able to mark International men's day and consider

this issue of male suicide hn more detail. It will give us the

opportunity to look at why ht is that the proportion of male deaths

to female deaths has increased steadily since 1981. I am grateful

to my honourable friend for raising the subject and of course the

forthcoming debate. It does deserve to be looked at extremely c`refully.

They should be neither complacency nor sensitivity about it. Wd need to

look at what can be done. I have spoken to people who have h`d these

tragedies in the family, and I am meeting this afternoon a gentleman

well-known for having been hnvolved in a suicide prevention inchdent.

The more people are prepared to talk about things that might cause

suicide, the work we are dohng to reduce stigma and find placds for

people to talk about things, the more the better. It is something we

can give higher profile to ` -- and do more work on. Mr Speaker, last

week, another report, this one from the King's fund, one of eight health

system that is under pressure. Under this government's watch, just 1 % of

patients feel that they havd received appropriate care in a

crisis. We know that the nulber of mental health nurses has dropped and

increasing numbness of people are having to travel hundreds of miles

for a bed. But action for the minister take to turn his rhetoric

into reality? Firstly, the lore we are looking at these issues, and

this is across parties, it ht is important. We have made strhdes

during the last government `nd in this one. We are investing lore

money English into mental hdalth. This was the first covenant to

introduce access and waiting times for mental health to try and put it

on a parity with other condhtions that have not been that way before.

We'll now be looking to makd sure that the money that goes in

nationally is used locally hn order to provide assistance and to make

sure that money that is put in for local use is used locally. There are

other areas to look at and celebrate. We are world leaders in

the access to psychological therapy, we want to build on those

things, we know it is a service that has lacked in the past and that is

why we are so determined to do much more about it and I think that is

the view of the whole house, that we should be doing more about this and

carefully to what the minister had carefully to what the minister had

to say but I reinforce the point that in this country, the sticide

rate is going up, not down, and it is a national scandal that we need

to address. If I can return to his point about prevention which he

referred to in his answer, the Government have confirmed that it

will be making a ?200 million cut to local public health grants. This is

a political decision, it will not save money and, apart from the

devastating human price, it will cost our NHS and local authorities

more as they deal with both physical and mental ill-health that could

have been prevented. How can the Minister justify this? Firstly,

?1.25 billion is going to create new ?1.25 billion is going to create new

people's mental health servhces people's mental health servhces

during the course of the parliament. That is not a commitment th`t the

honourable lady's party madd before the general election. There is more

being done in schools to provide a better base for mental health. We

have appointed a minister focusing on mental health in schools. Public

budgets are affected like everyone else's budgets, it is of thd

pressures that are there. Those pressures in the NHS were mdt by

their commitments, which were not made by the honourable lady or her

party. When she is asking for more money to be spent, we are fhnding

it. It is important that we take the position that we have to do as much

as we can with what we have got but mental health services are loving

forward and we should look `t the opportunity to say that and welcome

what has been done. We have provided the resources in a way which her

party did not. Question fivd, Mr Speaker. Mr Speaker, it is for NHS

Trusts locally to set the ldvel of parking. My local trust has just

increased parking charges at Dewsbury and did you charges for

drivers with disabilities. They claim this is due to the judges from

government. Is it right that people who are ill or in need of mddical

attention or their loved onds are being penalised in this way? I say

to the honourable lady that the financial settlement from government

is more generous than the one promised at the last election by her

party. It is committing ?10 billion over the next few years. I would ask

her trust to look at the savings suggested by Lord Carter, where he

is identified considerable savings that could be made. If they feel

they need to increase car p`rking charges, they should refer to the

guidance that makes clear that should be concessions for blue badge

holders. Clearly, hospital parking charges are too high in the UK and

he will agree that might right honourable friend, the membdr for

Harlow, made an amazing campaign in the last parliament to reduce the

charges. Will he confirm his commitment to reducing car parking

charges? The principles that the Department published is that charges

should be proportionate and fair and should be set at a level so that

people can be assured that there is a car parking space. The problem

with free parking is that there are not spaces for carers and for the

sick turning up. Clearly, hospitals should exercise judgment in making

sure that carers and people on frequent visits should get `

discounted rate so it is not any betterment to access to fred health

care. Hospitals have recently imposed charges for blue badge

holders. Constituents have told me that as a result they will struggle

to attend their appointments. The trust admitted that they have not

considered the impact of thd admission rate. It could add a

financial burden on the vulnerable and it will deny them access to the

care they need to mark the honourable lady raises a surprising

point is -- in that the hospital did not think of the impact. Disabled

driver should get concessionary rates and charges sometimes need to

be higher for disabled -- to allow for disabled drivers. The trust

should have thought of that. Question other six, Mr Speaker. Mr

Speaker, the Department is looking at a whole number of fronts at how

it can improve medical outcomes It is introducing a seven-day NHS and

by looking at the number of consultants and doctors to lake sure

we can improve medical outcomes across the service. I welcole the

Government's commitment to hmproving outcomes of patients admittdd at

weekends. Seven-day services are needed not just in hospitals but

also in primary care, the community care, social care is, and in mental

health services. All my honourable friend advise on what steps are

being taken to make sure th`t seven-day services are being made

available where they are nedded The point is well made. A seven,day NHS

will only work if it works `cross all areas of care, that is why it is

part of the wider vision th`t we have in the NHS to see a local

integration of care and health services. I would urge her to look,

when it is published, at th`t Sir Bruce Keogh's report on the social

care. It envisaged is a scenario where they receive the corrdct

attention and therefore thex are not going to hospital and can bd dealt

with in Trinity care -- comlunity care situations. There was ` Bill

which would have provided bdtter clinical outcomes by making drugs

more available. There was an alternative pathway that thdy

government could be considering that you said what that will be My

honourable friend, who is ftlly committed to the ambition which is

Bill proposed, feels that the mechanisms do not work but has set

up a working party to ensurd that the ambition can be taken forward. I

know he would welcome the ftll engagement of the honourabld

gentleman in order to make sure it happens. If we are to improve

patient clinical outcomes, surely we need to look more at patient

experiences. shouldn't now that the Society of homoeopathic is regulated

by the professional standards authority, we spent more th`n an

paltry ?100,000" homoeopathhc medicine in the NHS? The

Department's position, desphte repeated questioning from mx

honourable friend, is consistent and remains the same. Repetition is not

Commons! 80% of end of life patients Commons! 80% of end of life patients

died in hospital, where is 80% of life patients want to die at home,

assisted by the hospice movdment was that I have discovered that the GPs

are taking the end of life box on the framework form, but that

information is not being automatically passed to loc`l

hospices. What can the Department do about that?

Clinical outcomes can only be assessed in a complete sensd a

complete sense of it includds end of life care for those that thdre is no

clinical outcome. If that is what is happening in his area, it is

unacceptable. I would point him in my direction of the work thd

Government is doing. The kind of bureaucratic model which he has

identified each. -- would not happen any further. The project Genomics

England, launched, we are the first organisation to commit to sdquence

and we combine with patient records to unlock NHS and UK leadership in

the emerging field of genomhc medicine. I am delighted to report

we have 5000 patients fully sequenced and the centre is set up.

2500 researchers are in bold -- involved in the project and NHS

England are setting the standard on genomic medicine. Would the Minister

agree with me that the world's leading Genomics England will

deliver personalised and patient centred revolution to modern health

care by combining the talent of global companies such as alongside

UK based companies. Not onlx to the benefits of patients with c`ncer and

other rare diseases but to the vitality of our NHS and through jobs

and innovation come to the strength of our economy. I pay tribute to the

work of the small company in Cambridge who are doing

extraordinary work. I opened a globe all company and as well as the

research in the UK, NHS England is leading genomic medicine is across

the whole of the UK, not just in the Cambridge, Oxford London trhangle.

We bring genomic diagnostics to the benefit of everyone. In the case of

Lila Richards, she was saved from leukaemia by genomic, what `dvice

can he give on this pioneerhng work? Genomic editing is a suite of

technology emerging through genomic. We are supporting those tools and

technologies and through thd accelerated Access review, we are

looking to harness those breakthroughs to support new

treatments and new flexibilhty for NICE and other treatments. H would

like to take questions eight and nine together. Junior doctors are

the backbone of the NHS and it is highly regrettable that the union

has let them down by refusing to negotiate a new contract th`t would

be better the doctors, sick of the patients and is delivered the

seven-day were once. Can I thank my right honourable friend for that

answer but has he had an opportunity to speak to medical schools about

the new contract with junior doctors, especially the Penhnsula

medical School in my constituency? NHS employers are in regular

discussions with the medical schools Council which represents thd

Peninsular Medical School and we do think although the training of

doctors is not the specific contractual dispute that is in the

headlines, this is something where we could make improvements `nd we

want to use this opportunitx to work with medical schools and thd Royal

colleges to see if we can bring back some of the continuity of trading

that used to be an important feature of junior doctor's training. The

person that has let the junhor doctors down is none other than the

Secretary of State himself. It is insulting to those doctors to imply

that they are not already working seven days and will he listdn to the

professionals both the junior doctors and their senior

counterparts who support thdm and drop this threat to impose the

contact, so meaningful talks can take place? What was she sax to her

constituents who are not getting the standard of care that they need to

get seven days a week? Is she going to stand side-by-side with them or

with a union that has risen -- misrepresented the Government's

position. There are no preconditions to any talks except that if we fail

to make progress on the crucial issue of seven-day reform, we

reserve the right to implemdnt a manifesto commitment. That has to be

the way forward and I urge the BMA to negotiate rather than gr`ndstand

so we can get the right answer for everyone. I am concerned about the

impact on patient care if these three days of industrial action will

go ahead. What offence -- advanced preparation is going ahead to a job

patient safety and are therd any preconditions that can act `s

barriers that the BMA have to agree to before negotiations can take

place? I can give her that reassurance. There are no

preconditions and I have wrhtten to the BMA to reiterate the pohnt. If

we fail to make progress, wd have to implement manifesto commitmdnts We

are willing to talk about everything. I agree with her that it

is going to be difficult to avoid harm to patients during these three

days of industrial action. The delaying of cancer clinic mdans

somebody will a later diagnosis delaying a hip operation, these will

be hard to avoid and impact on patients and I would urge the BMA to

listen to the Royal colleges and others. It is 40 years sincd the

last junior doctor's strike. Does the Secretary of State perh`ps, with

the ballot tomorrow, regret the ad agonistic approach he took before

the summer to float for -- vote against these doctors rather than

working with them to reach ` stronger emergency seven-dax

service? Let me say to her, I don't know what she thinks is ant`gonistic

about having reasonable discussions with doctors the three years to try

and solve the problem of seven-day care. That ended with a BMA after

two and a half years, walking away from negotiations last October. We

made a manifesto commitment that whatever seven-day NHS do the right

and the patients and were shmply ask the BMA to sit round the table and

talk to us about it and I'm confident we can find a solttion. In

July, claiming that senior doctors didn't work as 95 was maybe felt to

be antagonistic. Contrary to the figures quoted by the honourable

member for Dudley North last Monday, the A figures that NHS England are

5% below those in Scotland. The disappointing figures beford we even

get into winter or face a work to rule and the presence of eyd

watering deficits, how does the Secretary of State plan to support

hospital trusts through this winter? Could I ask her to correct for the

record her a wholly untrue statements that I ever said that

doctors don't work outside 8-to 5. That is exactly the kind of

inflammatory comments that lake the contest -- that make the current

situation worse than it needs to be. I have always work and -- I have

always recognised the work that doctors do what we can but we have

less cover at weekends and that means mortality rates are hhgher

than they should be. With rdgard to A performance, we are takhng

measures to say -- to make sure the NHS is prepared for the winter.

Unnecessary avoidable industrial action by the BMA will make it

worse. Will my right honour`ble friend agree with me that the failed

attempt by the BMA to get an injunction against the GMC to stop

them issuing guidance as to how doctors should behave responsibly

towards patients if there w`s to be a strike, undermines the BM@'s

claimed that it is putting patient safety first? Can my right

honourable friend assure thhs house that the BMA will have no vdto over

a seven-day NHS which was a manifesto commitment of ours and

what the vast majority of pdople in this country want? I would like to

thank my right honourable friend. He championed the cause of pathents

when he was a Health Ministdr and we must continue to do the right thing

patients, which is also the wedding the doctors. It is inexplic`ble that

the BMA should guide the GMC on issuing guidance to doctors about

their professional responsibilities. The most hmportant

thing is whatever the disagreements, we should keep patients safd. I am

sure both sides of the Housd to appreciate the excellent work done

by all staff within our NHS which at a time of unprecedented str`in

relies more than ever on thd goodwill of its employees to keep

going. We have to support and value our staff, not criticise thdm and

provide them by disagreement. Calling junior doctors militant is

not the way to end a disputd and we have heard more of the same matter

at this morning. Industrial action is or was the last resort when

negotiations have failed. Does the Secretary of State accept

responsibility for that failure I accept total responsibility for

doing the right thing to save patient's lives. I have to say

anyone who is a hold of this office will be doing wholly the wrong thing

if they were to try and brush under the carpet six academic studies we

have had in the last five ydars that says we have higher mortality rates

at weekends than you should expect. This Government is on the shde of

the patients and this Government will do something about that. I am

aware there is an increased risk of a recessive genetic conditions in

both that occurs as a result of first cousin marriages. It hs a

complex issue and stop experience health professionals used m`terials

and they have some specialist clinicians in my honourable

friend's areas that are looking at this important issue. Given the

severe medical conditions that are caused by first cousin marrhages,

isn't it time the Government considered the only proper solution

to this which is outlawing first cousin marriages in this cotntry?

Such a change in the law wotldn t be for the Department of Health. Let me

reply to the point about localised challenges. He might be intdrested

to know in May 2012, there was a major conference on this issue ads

leads Town hall with groups drawn from across the area he represents.

We look at these issues. I have written to the Public health

director Byford as skiing about what they are doing locally to address

this and I suggest that it will be useful of my honourable fridnd to

follow-up on that and I will be interested to how that convdrsation

goes. Of education in England, working with NHS England, is charged

with ensuring there is suffhcient staff with the right skill lix to

support the delivery of the improving access to psychological

therapy programme. An annual workforce monitors this. Eight -

plans for 2015/16 to train additional individuals, 25% increase

on last year. As well as providing adequate numbers of high qu`lity

specialised staff, given thd prevalence of mental health issues

in our society, is it not ilportant that general awareness is r`ised

from mental health issues and the available treatments amongst all

medical professionals and GPs and what future steps could the

Government take to improve training? There is particular ways to do this.

First, to enhance GP training and work is going on to do that.

Secondly, continuing development where RCGP and health education in

England are combining to make sure there is a good range of materials

for clinicians and others to improve skills in this area. I would like to

group this with question 16. We are looking to work to improve the life

chances of children. Tackling the real cause of child poverty and to

improve the prospects for the next generation. That involves t`king a

broad approach to improving poor health, tackling health

inequalities. We embedded that within the law and tackling

inequalities but the wider causes worklessness -- wider coursds are

being addressed at the moment. We have record numbers of people in

work and a dramatic drop in the number of children living in

workless households. That goes to the heart of some of the broader

drivers of ill health and poverty. I'm pleased the Government has

accepted there was a link bdtween poverty and poor health outcomes.

They will know there is widdspread concern that the proposed changes to

the tax credits regime will result in greater poverty, which whll cause

poor health outcomes and maple pressure on the NHS. Could H ask if

the Department will consider putting in place mechanisms to monitor the

effect of the tax credit ch`nges on demands in the National Health

Service? We do far more than monitor issues like health inequalities We

are taking action to deal whth them. The heart of my portfolio is

entirely comprised of tacklhng health inequalities in our nation to

give a couple of examples. The expanded troubles families ,-

troubled families programme, the partnership where we support some of

the most vulnerable young p`rents in the earliest years of their

children's lives. These programmes at the greatest impact on otr most

disadvantaged communities. What I am trying to do is act on health

inequalities and the issues that he raises are matters for other

departments. I want to give the House this reassurance. This is core

business but the Government, improving the life chances of all of

our children. An interesting answer but not the

answer to the question that my honourable friend related. There is

a clear indication that although there is a strong link betwden

poverty and poor health, th`t link is not inevitable and should not be

allowed to become inevitabld. What will the Government do with this

policy so that that link cannot be broken? I have given examplds of

what the governorate is doing to tackle health inequalities hn our

nation. I will give another example of a practical aspect, tobacco, the

burden of disease that it brings false is proportionately on pork

amenities. On top of the action we have taken with standardised

packaging and smoking in cars with children, at the heart of that

strategy has got to be effective action to look at the areas in which

tobacco falls most heavily, that is in disadvantaged communities. There

are a range of ways in which we are taking practical action to close

those gaps in health outcomds. Question 13.

Those affected by the contalinated blood tragedy are entitled to

receive DWP fuel winter paylents if they meet the criteria. It hs worth

me explaining for the House that separate to that, the progr`mmes of

support, the bodies that actually put support in place for thd

affected individuals also provide some winter payments, and those two,

if they are getting something from the bodies, does not includd them

getting a deed of EP winter payment if they meet those criteria. They

are two different schemes. With the UK governorate dragging its feet on

the ?25 million transitional compensation payments for those in

receipt of infected blood products, receipt of infected blood products,

will they now make a firm commitment to supporting these patients through

this winter and then get on with the business of giving a just and

lasting settlement? I have had conversations with my opposhte

numbers in Scotland, as he knows. I was written to about this. We're

looking at wider scheme of form I have also shown that my offhcials

are talking to the other devolved administrations about this `s we

move forward to a better solution to this tragedy. Number 14. Thd

governorate is committed to transforming care for everyone. My

right honourable friend's own area has in place another of initiatives

such as the community treatlent team and intensive rehabilitation service

which is rated highly in her local community. My right honourable

friend will be aware that elderly people deteriorate rapidly `nd lose

their independence skills when they are admitted into hospital. What

discussions have been held with local authorities to ensure that

their is an adequate supply of care is to ensure older people to remain

in their homes whenever possible? I meet regularly, as does the

Department, with our partners providing social care, a new

strategy has been launched to look particularly at how to make sure

more carers are provided in the home environment. My right honourable

friend is right to raise thhs. There is a report about the care collapse

on a residential care systel, which is in crisis. It is faced whth an

unsustainable combination of declining funding, rising ddmand for

services and increasing liabilities. A ?1 billion funding gap will result

in loss of 37,000 care beds, and that is bigger than the Southern

Cross collapse. The most likely outcome is that those older people

will end up in hospital. Can the Minister tell us what he is doing to

protect the care sector frol catastrophic collapse? As the House

is aware, social care is a latter of great importance as we head towards

the spending review round. We are aware of pressures in the sxstem,

and there are always contingency plans looking at whether thdre may

be any particular problems. We're working hard with the care

Association in order to improve the quality of care provided in the

sector itself, but my right honourable friend the Secretary of

State has asked experts to look at inner qualities in the care home

sector to see if we are abld to meet the challenges. Once again, if

challenges require more mondy, which they always seem to do from the

honourable lady's position, she does not come up with any ideas of how to

come up with that money. It is our challenge to meet those challenges

within our aims. I know the House will also like my reassurance that

following the tragic events in Paris, we can regulate revidw and

stress test the NHS's preparedness for responding rapidly to tdrrorist

attacks, and I have written to my French counterpart to offer our

solidarity and support. Just after the election, the Health Secretary

called childhood obesity a national scandal. He put tackling he`lth and

inequalities as one of his key priorities. Can the Minister explain

how a flat rate cut in publhc health grants across all areas, in spite of

specific health challenges, and a predicted cut of three main pounds

in my constituency, due to the reformulation, how can this help you

achieve your mission? Can I say to her that we have to find

efficiencies in every part of the NHS, and we are asking the public

health world to find the sale efficiencies as we are asking

hospitals and GPs surgeries and other parts of the NHS, but that

should not be at the expensd of service. I agree about childhood

obesity and we'll be announcing some important plans shortly. Wh`t we

need at topical questions is short enquiries without preamble hf we are

to make progress. Let's be led by Fiona Bruce. This is alcohol

awareness week. In Scotland, drink-driving offences have dropped

in the last 70 months of a lower limit being introduced. In light of

this, is the Mr's Department looking at the implications of revidwing the

drink-drive limit as part of its review. I thank my honourable friend

for that question and tacklhng drink-driving remains a priority for

the Government. We will be interested to see a robust

evaluation of the change to the Scottish drink-drive limit.

Obviously, some of the issuds are for the Department of Transport and

we'll be looking at that and I'll be interested in the evidence. On

Sunday, independent experts at the Kings fund, the Trust and The Health

Foundation had this to say `bout the coming winter. Expect the

inevitable, more old people living on well, unsupported and misery

more people dying on lengthdning waiting lists and a crisis hn

Accident and Emergency. Are they all wrong? They are right about the

pressures on the NHS, which is why we are investing ?5.5 billion more

in the NHS than the party opposite promised. Those pressures whll be

made a lot worse by the forthcoming strike, so will she clear up once

and for all, that she condelned the strike? Yes or no? Mr Speakdr, let's

be clear. If junior doctors do vote for industrial action, therd will be

one person to blame, and th`t person is the Health Secretary. Mr Speaker,

what the Health Secretary does not want to admit is that NHS ftnding

isn't keeping pace with dem`nd and that, over the last five ye`rs, his

government's deep cuts to social care have left the NHS bleeding Can

the Health Secretary guaranteed that every penny of them money hhs

Department set aside for implemented now postponed cap on care costs will

go directly into funding social care? Mr Speaker, that is the

difference. She follows the unions, I lead the NHS. When Labour had a

big choice whether to support one for patients who desperatelx need

better weekend care, they chose political expediency, and the whole

country noticed. Saint Cathdrine's Hospice provides outstanding end of

life care but receives little funding in bed to the national rate.

Will the Minister encourage CCG 's to expand their funding? NHS England

is looking at a more transp`rent, clear funding advice for CCGs. I

would encourage her CCG to look at that and compare themselves to a

Dale, which put themselves `t the centre of the work they do to help

patients. Myself and my colleagues support his comments about the

atrocities in France at the weekend. I would like to ask him of the

assistant he has made of how problems are contributing toward the

problem with recruiting nursing staff in London in the NHS? It is a

serious problem and people find it hard to live nearby to the hospital

where they work on the parthcular where housing is very expensive and

this is an issue we are looking at closely. Could the Secretarx of

State assure me that the NHS funding review, which is currently tnder

way, will deliver a fair formula for my constituents that many other

across York and North Yorkshire by putting age and morality, some of

the biggest drivers, at the heart of this review? The clinical commission

formula, I can assure him that morbidity is taken into account It

is or is a matter for local decision and discretion. Can the Health

Secretary explain how cutting ? 00 million from pub health Budget is

consistent with the emphasis on prevention as put forward in the

five-year public review? I have already explained, but I wotld ask

the Labour Party held they committed ?5.5 billion less? Some of our GPs

surgeries are finding it hard to attract new GPs. What plan does the

Government have to train new GPs in areas where it difficult to recruit?

We are very colleges of the pressures on general practice and on

the pressures of ensuring there are enough GPs available. The

Government's plans are for 4000 more GPs to be working by 2020. Ht is

supported by efforts to makd sure medical schools are doing anything

they can to make sure gener`l practice is more attractive.

According to Public Health Dngland, in the most deprived areas hn

Bradford, life expectancy is 9. years lower for men at eight years

lower for women. It demonstrates that there are clear health

inequalities in urban areas in Bradford. The governor's attack on

the poor make this issue worse. Can the Minister tell me what the

Government is doing to tackle these inequalities to give people a

Bradford the quality of lifd they deserve? The honourable gentleman

will be aware of the answer I gave earlier to other questions. There is

a wide range of aspects of the public health work that the governed

is taking forward that attacks that very issue. The inequality that

falls on some community is. I gave examples, the family nurse

partnership, more widely, for example, the universal health

visitor programme which has moved into commissioning by local

government. It has signific`nt elements within it to support

families in disadvantaged alenities. For the avoidance of doubt, please

with the Secretary of State repeat again that he will enter into

completely open-minded, negotiations with the BMA, because the ptblic

needs to see this. We'll be doing everything we can to avoid `

damaging dispute for patients. We do reserve the right to incremdnt our

manifesto commitment to sevdn-day reforms if we failed to makd

progress in those negotiations. Right now, in the interest of

patients, the right thing to do is to sit around the table and talk

rather than to refuse to negotiate and go ahead with the strikds.

Rochdale infirmary has dementia help which helps the local peopld. Will

he meet me there to see how it can be shared more widely? I am happy to

do that and we have made progress in tackling dementia. There ard great

examples across the country but we can still do a lot better and we

need to concentrate not just on dementia diagnosis but on the

quality of care we give people when they have a diagnosis. Could the

Health Secretary outline will be available to patients over the

winter. Norfolk hospital has declared an alert last week. We are

preparing for this winter whth unprecedented scales. We ard

learning from the experiencds of last some power -- Samantha would be

support provided through thd winter to ensure we deal with the

additional challenges that `re being thrown in the way of hospit`ls

across the country by the jtnior doctors in their industrial action

they are taking. Is the Secretary of State doing everything he c`n to

ensure we secure extra dedicated investment in mental health at the

Spending Review? To introduce the same access rights as everyone

else, it requires hard cash and I am sure he will agree that we have to

end this outrageous discrimhnation against those who suffer from mental

ill-health. I congratulate him on his time given who is sitting on the

bench right now. We will put extra resources into the NHS and will make

sure we increase the proportion of those resources are going to mental

health and I would like to congratulate him on his award last

week on mental health, which was extremely well deserved. St`tement,

the Prime Minister. With permission, I would like to make a statdment on

the terrorist attack in Parhs and the G20 in Turkey this weekdnd. On

Paris, the Home