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being read for the third time. Objection taken. What today?

:00:00.:00:00.

Tuesday, 21st of February. Thank you. Order! Order! Under this

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Government, yesterday I announced that we are going further with

:00:25.:00:38.

upfront ID checks for elective care. We wish to recharge the cost of

:00:39.:00:46.

their home country. We welcome this crackdown on the abuse of our

:00:47.:00:50.

National Health Service, but at this time we are struggling to find money

:00:51.:00:57.

for care elderly people. We cannot afford to provide a free national

:00:58.:01:05.

health service. It's a national not an international health service and

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I was this appointed as the comments from the opposition, saying that the

:01:12.:01:17.

money this would raise is a drop in the ocean. 500 million pounds,

:01:18.:01:24.

enough to finance 5000 GPs enough for everyone's constituents in this

:01:25.:01:31.

House. Whenever there are disastrous figures, isn't it a coincidence when

:01:32.:01:42.

the Government renounces away as cracking down on health tourism. It

:01:43.:01:46.

is chronically underfunded and this Government is doing nothing about

:01:47.:01:51.

it. I'll tell you what we're doing about underfunding. We are raising

:01:52.:01:58.

three times more than he was a health Minister of through

:01:59.:02:04.

international visitors. Mr Speaker, given the Government's stated

:02:05.:02:11.

objectives, could be Secretary of State set out for those who have

:02:12.:02:18.

severe injury mental illness and who are homeless, who are unlikely to

:02:19.:02:21.

have the required documentation, how is the Secretary of states going to

:02:22.:02:31.

implement this to them? We have good evidence from hospitals like the one

:02:32.:02:36.

in Peterborough where they introduced ID checks for elective

:02:37.:02:40.

care and they have seen no evidence that people who need care are being

:02:41.:02:49.

denied it. It's making sure that we abide with the fundamental principle

:02:50.:02:55.

of fairness that people who don't have a NHS through their taxes

:02:56.:03:09.

should be providing. We've just heard that the CC G is changing its

:03:10.:03:16.

constitution, excluding GPs, changing the nature of it. This is

:03:17.:03:24.

under resourced, and are stressed and asking to do something else like

:03:25.:03:44.

this, it won't cope. I had the extra money we raise from international

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visitors -- I hope that. We'll continue to fund the NHS. See if you

:03:56.:04:02.

travel to America, you have to have medical insurance, won't that be one

:04:03.:04:06.

of the requirements for people coming into the country to have

:04:07.:04:12.

medical insurance? We did look at this extremely carefully and what we

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concluded was that you don't have to have medical insurance if you go to

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countries like America, and we don't insist on it because of our tourist

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industry head. We decided it would be better for people who are getting

:04:31.:04:36.

visas here to pay a surcharge. It's raising several hundred million

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pounds for our NHS. I have always supported a view that we aren't

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running an international health service, but could be Secretary of

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State direct his energies stopping the wastage going on elsewhere in

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the NHS when highly skilled surgeons and teams have to wait to operate

:05:02.:05:04.

because there isn't a bed for their patients. How much is that wasting

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because of the chronic underfunding this Government has produced? These

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accusations would have a little bit more credibility if Labour were

:05:20.:05:24.

promising any extra money for an NHS, however they were committing to

:05:25.:05:37.

?5.5 billion less. My Hons friends will be when polio was eradicated in

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the 1980s, however 85% of sufferers can develop post polio syndrome.

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This involves increased referrals. 93% of people are unaware of PPS. A

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low awareness in the NHS and among GPs leaves patients waiting up to

:06:15.:06:20.

six years for a diagnosis. Will the Government agreed to fund a campaign

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for this? I congratulate him for the work he does for the British Polio

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Charity and I agree it's difficult to diagnose as there is no

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definitive test and symptoms are vague. There are guidelines from the

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Fellowship to make is aware of these conditions. Having noted there is no

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tests, can the Minister outline what information is available to medical

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professionals to make sure that the symptoms are collectively collated?

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As I said, the symptoms are vague and the fact is there is no

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definitive test but as my honourable friend pointed out, the awareness

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amongst GPs isn't as high as it might be. We need is guidelines plus

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the help of the British Polio Fellowship for better education. I

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will answer three and ten together. In the last four years, 31 trusts

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have been put into special measures, one in ten are NHS Trust. Out of

:07:40.:07:45.

those, 16 have come out and I bank those from Addenbrooke's hospital

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which came out last month. A safer and more caring NHS for the

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3 million patients and the staff there can be streamed it proud of

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what they have achieved. Bolton hospital has also come out after

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extreme hard work, so there is now a surplus which is being reinvested

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into patients, so will my right honourable friend joining in when I

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thank staff for their hard work. It's a fantastic example of what is

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possible in very challenging circumstances, and I feel that staff

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should be proud. On average, staff go on to recruit new doctors and

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nurses and see improvement. The Secretary of State is right to

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congratulate those hospitals, but we still need to reduce the pressure is

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on A E. That could be through increasing care in rural hubs. The

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money spent in Ely, minor injuries unit is money well spent, will he

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agreed? I know that my honourable friend campaigns and cares for her

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local health services. We know how important that is at Ely, and they

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are setting up some public engagement meetings. I want to

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reassure her that there will be a formal consultation if there are any

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changes. The self congratulatory tone of the Health Secretary is

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astonishing. In the last year, the numbers of people waiting longer

:09:50.:09:54.

than four hours in A E has gone up by 63%. The numbers waiting on

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trolleys have gone up by percent, and the number of discharges has

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gone up. While we won hospitals in special measures to be improving,

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what are the answers to these urgent problems affecting the NHS across

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the board? I will tell her. 130 more people starting cancer treatment

:10:22.:10:29.

every single day. 2.5 thousand being seen in accident and emergency

:10:30.:10:33.

within four hours. 5000 more operations every single day. None of

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which would be possible if we cut the

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The trust has been taken out of special measures in spite of the

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growth of people with mental health problems dying from things like

:10:51.:10:54.

suicide, avoidable deaths. Panorama has shown in 33 trusts, the number

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of avoidable deaths has doubled in the last three years, with a real

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terms cut of ?150 million. What specific measures is he taking to

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tackle the problem of avoidable deaths? We have committed, the Prime

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Minister affirmed this commitment last month, to spend ?1 billion more

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every year on mental health services but we recognise it is not just

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about money, it is about having proper suicide prevention plans and

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we have updated that and making sure we properly across the NHS

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investigate avoidable deaths and learn from them and that is why

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following the tragedy of what happened with Southern health we

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have started a new programme, the first of its kind, whereby every

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trust will publish on a quarterly basis its number of deaths. A year

:11:49.:11:54.

ago in East Sussex the trust was rated inadequate. Thanks to the hard

:11:55.:11:58.

work of the staff, the hospitals are now good in many measures albeit

:11:59.:12:04.

further improvements are needed. Can he thank the staff and would he

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agree we need to talk up our successes as well as recognising

:12:10.:12:13.

challenges? I absolutely will join him in doing that and I think it is

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really important, contrary to what the former Shadow Health Secretary

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says, that we praise NHS staff. There is a lot of pressure

:12:22.:12:27.

everywhere in the NHS and praising NHS staff is not being self

:12:28.:12:31.

congratulatory, it is recognising when a good job is being done.

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Further to the very important questions, members might have seen

:12:39.:12:42.

that Panorama programme and it was shocking and disgusting and I'm

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ashamed to live in a country where in past year there has been 1000

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more unexpected deaths. That is not a reflection of a country that cares

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equally about mental health as physical health. In spite of what he

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just told us, the money he talks about is not getting to where it is

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needed. What will you do to insure that no person in our country should

:13:05.:13:11.

lose their life because they have a mental health condition which is not

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treated properly? I agree, there is a huge amount we need to do to

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improve mental health provision. Let me also say a huge amount has been

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done and is being done. We are now seeing 1400 more people every day

:13:27.:13:29.

with mental health conditions, we are committing huge amounts of extra

:13:30.:13:32.

money into mental health provision and we are becoming a global leader.

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Certainly according to the person who is in charge of the Royal

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College of psychiatrists. We have to support the efforts happening in the

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NHS because we are one of the best in the world. Last month the Prime

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Minister made a major speech in which she made it clear in proving

:13:57.:14:01.

children and young people's mental health is a major priority for this

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government. My department will work with the Department for Education to

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publish an ambitious green paper outlining the plans before the end

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of the year. I am grateful. Would my right honourable friend agree that

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as well as providing mental health support in schools and colleges,

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community hospitals because of their locality, status and scale could

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often provide a very useful forum for providing these vital services?

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I am pleased he raises that point because when we discuss mental

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health, we talk about the services provided by mental health trusts and

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we do not give enough credit to the work done in primary care in

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community hospitals and by GPs who have a very important role as the

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first point of contact. He is absolutely right to make that point.

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Will the green paper look at the role educational psychologists could

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play, not only in providing support and assistance to young people with

:15:06.:15:10.

mental health problems, but also looking at preventative work? Cuts

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in local authority budgets have meant the service has become quite

:15:15.:15:18.

fragmented but it should be practical ways in which it could be

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improved to help young people with mental health problems. She is

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absolutely right. As we have looked into this issue, we have realised

:15:28.:15:33.

that there are two issues when it comes to improving children and

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young people's mental health, improving access to specialist care

:15:38.:15:40.

for people who need it and prevention. It is the work that can

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be done by teachers within schools, training people in mental health

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first aid, making a huge difference and we want to make sure we do them

:15:49.:15:54.

both. I welcome the Secretary of State's focus on child and

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adolescent mental health gap but what is he going to do about out of

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area transfers which too often sees children in beds due and red, 300

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miles away from their home? -- mental health care. I thank him for

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his continuing campaigning on mental health issues and he is right it is

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completely unacceptable, not least because if we want a child to get

:16:24.:16:27.

better quickly, the more visits from friends and family they can have,

:16:28.:16:30.

the better. The faster they will recuperate. We have commissioned 56

:16:31.:16:38.

more beds. The total number is a record 1142. We are determined to

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end out of area treatments by the end of the parliament. No one will

:16:45.:16:47.

disagree with what he has said but it is not going to help people in

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Dudley at a house which faces closure this year for the want of

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what is quite a small amount of money. Will he look at this

:17:00.:17:04.

personally and do everything he can to help this really valuable

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facility open? It is closing because... Dudley is losing 20% of

:17:07.:17:17.

its funding compared with just 1% in Surrey which he represents. Dudley

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CCG has seen its funding go up and on top of that we are asking all

:17:24.:17:27.

CCGs to increase the proportion they spend on mental health. I'm happy

:17:28.:17:33.

look into the situation. I would be very disappointed if within Dudley

:17:34.:17:36.

we're not seeing increasing resources going into mental health

:17:37.:17:41.

provision. Could he say a little more about how children's mental

:17:42.:17:45.

health services can work more closely with schools and the

:17:46.:17:48.

education system war broadly? Absolutely, very happy to do that --

:17:49.:17:55.

more broadly. Very interesting innovation going on in many parts of

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the country. I visited a school where there is a worker based

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full-time in the school and it had a transformational effect, the

:18:07.:18:08.

teachers always had someone they knew they could talk to, their

:18:09.:18:11.

understanding of mental health improved, this is what we want to

:18:12.:18:19.

encourage. Further to that, what persuasiveness is the Minister

:18:20.:18:21.

bringing to bear in the education system, particularly in primary

:18:22.:18:25.

schools, where on occasions very young people have had such a

:18:26.:18:30.

diagnosis and problems have been created within the school

:18:31.:18:35.

environment? This is a very important issue because as he knows,

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half of all mental health conditions are diagnosed before or become

:18:40.:18:45.

established before people of 14 and the sooner we catch them, the better

:18:46.:18:49.

the chance of giving someone a full cure. We need to find a way whereby

:18:50.:18:54.

there is some mental health expertise in every primary school so

:18:55.:18:57.

that we can head off some of these terrible problems. Last night the

:18:58.:19:10.

Panorama programme showed mental health is not funded properly. Cuts

:19:11.:19:15.

led to amenity teams being disbanded, loss of staff and loss of

:19:16.:19:19.

inpatient psychiatry beds. Most disturbing of all, parents talking

:19:20.:19:23.

of what happens to their children when they are denied support in a

:19:24.:19:28.

crisis, self harming or suicidal, no inpatient beds. One parent called it

:19:29.:19:33.

a living nightmare. We do not need warm words, we need action to make

:19:34.:19:39.

sure mental health services are properly funded and staffed. Let me

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tell her what action is happening this year. The proportion of CCG

:19:45.:19:50.

budgets being assigned to mental health is increasing from 12.5% up

:19:51.:19:58.

to 13.1% which is an increase of ?342 million. It is action happening

:19:59.:20:03.

today because this covenant is funding our NHS. Number five, Mr

:20:04.:20:12.

Speaker. The Government recognises the value of surrogacy in helping

:20:13.:20:15.

people who cannot have children create a family. Legislation is now

:20:16.:20:19.

over 30 years old and in view of changes in society it is time for an

:20:20.:20:24.

independent review. We have asked the Law Commission to include a

:20:25.:20:28.

project on surrogacy for 2017 to 2019. The Minister will be aware of

:20:29.:20:36.

the work by my constituent who I pay tribute to today. I welcome the

:20:37.:20:39.

Minister's answer but I wonder whether I could ask very

:20:40.:20:43.

specifically about the remedial order for the situation on single

:20:44.:20:46.

parents which my constituent is waiting for? My honourable friend

:20:47.:20:52.

has raised this very difficult case with me and my sympathies go to his

:20:53.:20:56.

constituent. He is right that High Court has made a judgment about the

:20:57.:21:01.

current provisions and the Government is obliged to act within

:21:02.:21:05.

a reasonable timescale so we will be bringing forward irremediable order

:21:06.:21:08.

this spring. I am pressing for this to happen but I'm in the hands of

:21:09.:21:11.

the business managers and I will keep the House updated. And my

:21:12.:21:22.

honourable friend. Number six. The Robert Naylor's report on the NHS

:21:23.:21:27.

will be published shortly. In developing his recommendations, he

:21:28.:21:30.

has worked with leaders across the NHS and this will ensure his

:21:31.:21:34.

recommendations are informed by the salability and transformational

:21:35.:21:40.

plans and will help support successful delivery --

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sustainability. I look forward to the report. It has been shortly for

:21:44.:21:47.

a while. My constituency is exactly the sort of community-based model we

:21:48.:21:54.

should promote. Promoting good health and assisting recovery after

:21:55.:21:58.

medical treatment. NHS property services mean it has a threefold

:21:59.:22:04.

increase in its bill, what assurances can the Government give

:22:05.:22:08.

that the report will ensure cooperation on estates planning so

:22:09.:22:11.

that my constituents who rely on the health part's contribution can face

:22:12.:22:17.

the future with confidence? We have accepted one of the recommendations

:22:18.:22:22.

from Robert Naylor ahead of the report publication which is looking

:22:23.:22:26.

to bring together NHS property services with other estate services

:22:27.:22:30.

and with regard to allocations being given to the CCG, I can tell the

:22:31.:22:35.

honourable lady the Department of Health has provided ?127 million of

:22:36.:22:46.

funding to CCGs. In looking at the estate plan and the transformation

:22:47.:22:49.

plan, will the Minister in short travel arrangements between

:22:50.:22:52.

different sites are taken into account? -- ensure. For health care

:22:53.:22:57.

professionals, patients and visitors. I am grateful to my

:22:58.:23:05.

honourable friend who has consistently shown concern about

:23:06.:23:09.

arrangements in Essex went as we look at potential reconfiguration of

:23:10.:23:14.

urgent and emergency care arrangements and ensuring good

:23:15.:23:20.

access to AMD macro is vital as it is everywhere of -- AMD macro. In

:23:21.:23:26.

Leicester the CCG is proposing to close a walk-in centre and moving it

:23:27.:23:31.

to another part in Leicester. It then becomes a drive-in centre. Does

:23:32.:23:37.

he agree it is important local people are consulted fully on these

:23:38.:23:46.

proposals? Of course as he knows, service reconfiguration requires

:23:47.:23:49.

public consultation. I'm not sure whether the walk-in centre qualifies

:23:50.:23:53.

but I am happy to look at it. A number were established under the

:23:54.:23:56.

previous government in a random way and they need to be located more

:23:57.:24:01.

appropriately for the local people. Would my noble friend agree with me

:24:02.:24:08.

that the driving force of SDPs is to improve and enhance patient care for

:24:09.:24:13.

our constituents? -- my honourable friend. With regard to the mid-Essex

:24:14.:24:23.

SDP, no proposal put forward involves any closure of accident and

:24:24.:24:29.

emergency and far from downgrading the existing AMD macro it is about

:24:30.:24:38.

upgrading the quality of care for my constituents? -- accident and

:24:39.:24:44.

emergency departments. The success regime for mid-Essex is looking at

:24:45.:24:48.

the configurations of the three existing accident and emergencys

:24:49.:24:54.

each of whom may develop their own speciality and none will close.

:24:55.:25:01.

Analysis of the SDPs this week found that a substantial number of

:25:02.:25:04.

departments across the country could be closed or downgraded over the

:25:05.:25:11.

next four years, and approached the royal college described as alarming.

:25:12.:25:14.

We have seen the images over the last month of departments

:25:15.:25:16.

overflowing and stretched to the limits so surely now is not the time

:25:17.:25:20.

to get rid of them. Can he pledged today that the numbers of accident

:25:21.:25:24.

and emergency beds will not reduce below the current level? He is right

:25:25.:25:32.

to point out that the SDPs are looking at providing more integrated

:25:33.:25:35.

care across localities. And there are a number of indicative proposals

:25:36.:25:40.

which will have to be worked through. NHS England at the moment

:25:41.:25:45.

are reviewing each of the SDPs and they will be presented to the

:25:46.:25:49.

department for their consideration in the coming weeks and months.

:25:50.:25:54.

Regarding bed closures, I gently remind the honourable gentleman that

:25:55.:25:57.

in the last six years of the previous Labour government, over

:25:58.:26:01.

25,000 beds were closed across the NHS in the first six years since

:26:02.:26:06.

2010, fewer than were closed by discovered than its predecessor.

:26:07.:26:14.

Minister moment. With permission, I will answer questions seven and 15

:26:15.:26:25.

together. The relationship between health and social care budget is

:26:26.:26:29.

complex. Recent study by the University of Kent shows that for

:26:30.:26:34.

every pound spent, hospital closure falls by 30 to 35%. We will be aware

:26:35.:26:40.

that there is an increasing delays over transfers of care over the last

:26:41.:26:45.

two years. This has meant more hospital beds are unavailable. Our

:26:46.:26:51.

best estimate is around 0.7% of total NHS bed capacity due to the

:26:52.:27:00.

increase in social care delays. It's quite amazing that the Minister

:27:01.:27:04.

stands up and accept that there is a crisis in the NHS caused by social

:27:05.:27:16.

care. It has been reduced to washing, feeding and toileting our

:27:17.:27:21.

elderly people. Crisis in social care, where people are being left

:27:22.:27:28.

with the most complex care because of staffing levels... Order! We must

:27:29.:27:43.

have one question. No comfort for our elderly people. I say to them

:27:44.:27:58.

it's not too late. Can you bring forward the ?700 million... Order!

:27:59.:28:21.

Order!. I say to the lady we have a lot to get through. Leadership Grid

:28:22.:28:35.

and best practice are important. Social care delays occurred in 24

:28:36.:28:42.

local authorities. Many others have burst virtually none. I visited

:28:43.:28:50.

Saint Helens, the honourable lady's own constituencies. They have

:28:51.:28:54.

achieved some of the best outcomes in the country. I'm sure she will

:28:55.:29:03.

agree with me in congratulating those in charge. There had been cuts

:29:04.:29:10.

in Rochdale, piling the pressure onto our social budget. The 2%

:29:11.:29:16.

preset loanee raise 4.2 million which is a drop in the ocean of the

:29:17.:29:24.

deficit of ?80 million. There's a increase in delayed discharges. I

:29:25.:29:31.

call upon the Minister to bring in the better care of so that our

:29:32.:29:38.

social care services can cope now. As a direct answer, it will be

:29:39.:29:48.

allocated in a way so that it will address real need which is what we

:29:49.:29:53.

will be doing for the remainder of this Parliament, starting from

:29:54.:29:57.

April. What I would say is that we spend in this country more on adult

:29:58.:30:03.

social care and Germany, Canada and Italy. It's very important that we

:30:04.:30:09.

also spend it well. It's very good to hear my honourable friend's

:30:10.:30:18.

research from Kent earlier. NHS and Social Services are working closer

:30:19.:30:24.

together than ever before but there is still further to go. Does my

:30:25.:30:29.

honourable friend agree with me that's important to overcome the

:30:30.:30:33.

barriers between Social Services and NHS so that they function more as

:30:34.:30:37.

one system so that patients get the sort of they need in the right

:30:38.:30:46.

place. Minister. She raises a good point about the vanguard in Kent,

:30:47.:30:50.

and I visited that care home vanguard in Sutton where they've

:30:51.:30:56.

achieved a 20% reduction in A E admissions, with better integration.

:30:57.:31:06.

If the Minister sought BBC News last night he may have seen the pressure

:31:07.:31:12.

in the Blackburn emergency department. It's down to Burnley's

:31:13.:31:20.

other hospital being closed down. What else can we do to reduce the

:31:21.:31:30.

pressure? Two thirds of all delayed transfers of care are as a

:31:31.:31:38.

consequence of internal NHS issues, and not that and councils. I think

:31:39.:31:44.

the relationship with Blackburn and Burnley is part of that. Recent

:31:45.:31:55.

figures in South words has 150 out of 184 delayed discharges. Sir David

:31:56.:32:01.

Alton has said hospital overcrowding at Salford Royal is a cousin the

:32:02.:32:06.

hospital's inability to transfer patients to and alternative care

:32:07.:32:11.

setting and changes to social care are urgently required. We've had

:32:12.:32:17.

cuts of 40% to our budget in local council since 2010, but Salford

:32:18.:32:23.

Royal is now providing social care rather than the council. I know that

:32:24.:32:30.

the help secretary respects Sir David, does he accept his view about

:32:31.:32:37.

funding changes will he continue to find reasons to blame for his

:32:38.:32:45.

Government's cuts? We respect Sir David Dalton and might I remind the

:32:46.:32:52.

honourable lady that she stood for Parliament under the slogan Not A

:32:53.:32:59.

Penny More. What I will say is in Manchester that there is an

:33:00.:33:02.

opportunity through the devolution deal to integrate social care and

:33:03.:33:12.

the NHS and I expect them to do so. Best trend data comes from the GP -

:33:13.:33:29.

patient survey which collates feedback of over 2 million patients

:33:30.:33:37.

I annually. 92% of patients found their appointments to be convenient,

:33:38.:33:40.

a slight increase from previous results. 86% rated their experience

:33:41.:33:51.

with a GP surgery as good. There was a 30% rise in waiting times in 2016.

:33:52.:33:57.

One of the key concerns raised by constituents, when I speak to local

:33:58.:34:03.

GPs, one of the key pressures they are facing is the failing social

:34:04.:34:07.

care system. So he knows those answers he gave a minute ago don't

:34:08.:34:14.

address them. Will he commit to something meaningful? Those answers

:34:15.:34:22.

are from a GP patient survey, but I do accept, and the Government

:34:23.:34:26.

accepts that we need more GPs in this country. They are important in

:34:27.:34:33.

the NHS and by 2020 we have plans to have a further 5000 doctors working

:34:34.:34:38.

in primary care. We also intend to add to that pharmacist, clinical

:34:39.:34:43.

pharmacists and mental health therapist and that will be part of

:34:44.:34:49.

the solution. It's not just the need for GPs, but surely what is required

:34:50.:34:55.

is for GPs should work at weekends and they should be included in their

:34:56.:34:59.

assessments for demand, working together in groups. The Government

:35:00.:35:08.

is committed to having seven-day appointments with GPs eight AM- 8pm.

:35:09.:35:18.

We want to roll that out in London. The other plan is to have GPs

:35:19.:35:24.

working smarter in hubs which labels them to spread and include services

:35:25.:35:30.

such as pharmacy, physios and social care in that integrated hub. In a

:35:31.:35:38.

survey I conducted in Enfield North, 58% agree it is difficult to get an

:35:39.:35:43.

appointment. Now the Royal College of GPs has calculated that Enfield

:35:44.:35:52.

need 84 more GPs by 2020, but in fact, between now and 2014, we've

:35:53.:36:02.

lost for GPs. What is he going to do that if these 5000 GPs appear by

:36:03.:36:11.

2020 that Enfield will get those GPs that it needs? As I said earlier, we

:36:12.:36:17.

will have 5000 doctors working in 2020, a chunk of those will be able

:36:18.:36:25.

to work across the country, and Enfield will see its share. The

:36:26.:36:30.

point is that the Honourable Lady makes our correct. Collaboration is

:36:31.:36:40.

also important. How far have we got spending the billion pounds

:36:41.:36:44.

earmarked by the Chancellor for this surgery is and does he share our

:36:45.:36:58.

vision of more polyclinics. There is more spend in the community and as a

:36:59.:37:02.

proportion, an increase in the amount of money the NHS has going

:37:03.:37:09.

into primary care. Part of that will be polyclinics and state clinics

:37:10.:37:15.

generally. What you find with the vanguard is when you put together

:37:16.:37:21.

groups of 50,000 patients in a GP hubs, the quality of care increases

:37:22.:37:26.

dramatically and we are going to excel rate that. The challenges

:37:27.:37:36.

facing our health system are grave so we need to uptake technologies

:37:37.:37:42.

for patient outcomes that meets those challenges, so by capitalising

:37:43.:37:47.

on advances in genomic, data, digital health and Informatics,

:37:48.:37:53.

there should be access to cost-effective, new products. It's

:37:54.:38:01.

vital that we endeavour to ensure the NHS gets better value for money

:38:02.:38:05.

for the drugs bill so we can get more innovative products to patients

:38:06.:38:11.

more quickly. De she also agree that there is much more work to be done

:38:12.:38:18.

alongside the accelerated access review and the forthcoming life

:38:19.:38:21.

sciences strategy to achieve this objective? I completely agree with

:38:22.:38:29.

my friends. Medicines is one of the highest spendings, and it's

:38:30.:38:34.

important that NHS gets best value. I was glad to have supported our

:38:35.:38:39.

recent ill on medicine and medicine supplies. This means we can prevent

:38:40.:38:45.

unjustified price rises from brand medicines. Ensuring cost effective

:38:46.:38:54.

prescribing behaviour. When will this be published and will it

:38:55.:39:01.

include how to improve patient access to molecular diagnostics? We

:39:02.:39:04.

are working hard on that exact point. As the Health Secretary is

:39:05.:39:16.

aware, my constituents Abby Longfellow is suffering from a rare

:39:17.:39:21.

disease. What was Government do to ensure access for people with

:39:22.:39:32.

ultra-rare diseases such as Abbey? We are trying to do with

:39:33.:39:38.

technologies for rare diseases, and the implementations which has 51

:39:39.:39:42.

commitments to be implemented by 2024 improving the lives of

:39:43.:39:47.

constituents exactly like my honourable friend's. Cheap

:39:48.:40:16.

it is cheap feeding awareness week. -- tube.

:40:17.:40:32.

Scientists are warning for the first time that resistance to malaria may

:40:33.:40:38.

be increasing, can the Minister outlined what further steps have

:40:39.:40:45.

been taken to deal with and he microbe I'll resistance in the next

:40:46.:40:57.

few years. We are trying to work with international partners to deal

:40:58.:40:58.

with a range of Question 11, Mr Speaker. We are

:40:59.:41:14.

determined we will improve access to cost-effective innovative medicines

:41:15.:41:20.

including breast cancer drugs which is why we introduced the Cancer

:41:21.:41:26.

Drugs Fund. She will know that cost-effective is not an easy thing

:41:27.:41:34.

to decide and many women will not get access to the breast cancer

:41:35.:41:38.

drugs they need unless there is a review of how we assess cost

:41:39.:41:44.

effectiveness or how Nice assess it. Will she support an independent

:41:45.:41:47.

review of those processors and will she have something to say about

:41:48.:41:54.

off-take and cancer drugs? -- off patent. We have debated this in the

:41:55.:41:58.

House and it is worth looking at our record. The Cancer Drugs Fund has

:41:59.:42:03.

helped 95,000 people access drugs and Nice has approved three breast

:42:04.:42:09.

cancer drugs, while there are others it has not yet. It is important

:42:10.:42:14.

politicians do not intervene in this debate as these are very difficult

:42:15.:42:21.

decisions which will always find challenging issues in the situation

:42:22.:42:27.

where the NHS has a finite budget. If the member was standing, I would

:42:28.:42:37.

call him, but if he isn't, I went. He is, so I will. I'm delighted to

:42:38.:42:43.

stand. Thank you. Even there is no General Hospital in my constituency

:42:44.:42:46.

and a large number of my constituents have to travel many

:42:47.:42:51.

miles for cancer treatment, what discussions has my right honourable

:42:52.:42:53.

friend had with the Welsh Government to persuade them to fund mobile

:42:54.:42:58.

cancer treatments? We have continual discussions with the Welsh

:42:59.:43:02.

Government to make sure these issues are under review and I will

:43:03.:43:05.

definitely write to the honourable gentleman about this issue and I

:43:06.:43:08.

will also be happy to meet with him about this, if you would like to

:43:09.:43:14.

discuss it further. Would the Minister agree that there is no one

:43:15.:43:19.

subject we have discussed here today that would not be improved by the

:43:20.:43:23.

better transfer of patient data and could she tell me how the department

:43:24.:43:26.

is working towards linking social care with the GPs, mental health,

:43:27.:43:34.

innovation, cancer drugs in order to understand where we can best target

:43:35.:43:37.

patient outcomes and spend our resources? My honourable friend is

:43:38.:43:43.

very well aware because of her leading role with the Private

:43:44.:43:48.

Members' Bill which she is bringing forward that we are working very

:43:49.:43:51.

hard to improve the connection of patient data and in particular

:43:52.:43:57.

through the role of the national data guardian and the safeguarding

:43:58.:44:00.

rules which will make sure we not only protect patient data more

:44:01.:44:05.

effectively but we are able going forward to share it in an effective

:44:06.:44:09.

way which improves patient care. I would like to make further progress

:44:10.:44:14.

with questions from backbenchers. Question number 12. Developing a

:44:15.:44:21.

variety of routes into nursing is a priority to reflect the local

:44:22.:44:24.

population served by nurses. That is why we have developed the new

:44:25.:44:30.

nursing associate role and nursing degree apprenticeships which are

:44:31.:44:34.

opening up routes into the profession for thousands of people

:44:35.:44:37.

from all backgrounds and allowing employers to grow their own

:44:38.:44:41.

workforce locally. Will the Minister inform the House if there are plans

:44:42.:44:45.

to roll out the associate role to include Wiltshire and enable new

:44:46.:44:50.

nursing degree apprentice schemes to be offered in larger further

:44:51.:44:52.

education colleges so that counties like Wiltshire which have no

:44:53.:44:57.

university can provide them? We have announced the first 1000 nursing

:44:58.:45:06.

associates. I visited in Romford the hospital with the first very

:45:07.:45:09.

enthusiastic group of nursing associates. We have announced a

:45:10.:45:14.

second wave of 2000 associate roles. I regret Wiltshire I do believe has

:45:15.:45:19.

any of those. They can bid for more in the future. When the Secretary of

:45:20.:45:27.

State scrapped the nursing bursary, he claimed his reforms would lead to

:45:28.:45:30.

an increase in nursing applications will stop last week figures from

:45:31.:45:34.

Ucas showed there has been a drop in nursing applications of 23%. A

:45:35.:45:38.

worrying trend when the demands of Brexit will need we need more

:45:39.:45:44.

home-grown nurses. Will he scrapped this disastrous policy or give

:45:45.:45:49.

Greater Manchester ability to opt out and reinstate the nursing

:45:50.:45:53.

bursary? I would urge the right honourable member not to indulge in

:45:54.:46:00.

scaremongering about the number of nurses... There are people applying

:46:01.:46:05.

to become nurses. That on more than two applications from individuals

:46:06.:46:09.

for the nursing places on offer to start next August. The number of

:46:10.:46:14.

applications from EU nationals which has gone down significantly, he

:46:15.:46:18.

needs to be careful in interpreting these figures this early, it

:46:19.:46:21.

coincided with the introduction of the language tests for EU nationals.

:46:22.:46:29.

Surely with the reduction of 23% in applications are English and nursing

:46:30.:46:32.

schools, the minister might want to actually look again at the policy.

:46:33.:46:38.

There has been a significant drop, 90% drop, in EU nationals. With one

:46:39.:46:44.

in ten nursing vacancies in NHS England and a cap on agency, who

:46:45.:46:47.

exactly does the Minister think should staff the NHS? I gently say

:46:48.:46:53.

to the honourable lady there are 51,000 nurses in training at present

:46:54.:46:57.

and the number of applications through Ucas bus far suggests there

:46:58.:47:03.

will be more than two applicants for each place and as I have just said,

:47:04.:47:08.

the reduction in application forms requested by EU nationals has come

:47:09.:47:12.

down coinciding with the introduction of a language test.

:47:13.:47:20.

Language test applications was over 3500 last January, so the reduction

:47:21.:47:24.

after language tests was from that to 1300. In December, there were

:47:25.:47:29.

only 101 applications. This cannot all be blamed on the language test.

:47:30.:47:33.

What is he going to do to protect nursing numbers? There are over

:47:34.:47:42.

13,000 more nurses working in the NHS today than in May, 2010. The

:47:43.:47:45.

introduction of the language test came into effect from July of last

:47:46.:47:52.

year and since then, the applicants have been somewhat steady. It is

:47:53.:47:56.

down very significantly but that is because frankly we have had

:47:57.:47:59.

applications from nurses from EU countries that have not been able to

:48:00.:48:05.

prosper language test. The national standard is to be expected 85% of

:48:06.:48:10.

cancer referrals to receive initial treatment within two months of

:48:11.:48:16.

urgent referrals. For cancer overall, most recent data indicates

:48:17.:48:20.

we achieved 82%. For prostate cancer, 78%. The lower figure for

:48:21.:48:26.

prostate cancer is because of the pathways being more complex than

:48:27.:48:31.

average. I'm disappointed in the figures but at least they are

:48:32.:48:34.

available. When I asked this last month, the information was not

:48:35.:48:38.

available. Nor was it available about the number of vacancies for

:48:39.:48:44.

prostate cancer surgeons, no information about training,

:48:45.:48:47.

equipment used, because this information is not collected

:48:48.:48:52.

centrally, I am told. When will the department collect adequate

:48:53.:48:54.

information to run a health service properly? There is more information

:48:55.:49:05.

published on cancer I CCG since the back end of last year than at any

:49:06.:49:10.

time in the history of the NHS. He is right to say that prostate cancer

:49:11.:49:15.

is grouped with other cancers in general and that is the type of

:49:16.:49:22.

surgeons employed, the facts are this government is incredibly

:49:23.:49:24.

transparent in terms of information published on cancer. Last Saturday

:49:25.:49:31.

was world cancer day and the theme was unity and I am still wearing my

:49:32.:49:36.

band with pride. We must do all we can to beat cancer yet the

:49:37.:49:40.

Government is coming to the three-year anniversary of not

:49:41.:49:46.

meeting the 62 day waiting target. Treatment quickly after diagnosis is

:49:47.:49:50.

crucial for all cancers. Will the Minister outlined what he is doing

:49:51.:49:54.

to ensure this target is once again met so that patients received timely

:49:55.:50:00.

treatment? The volume has increased greatly, something like 2000 more

:50:01.:50:04.

being diagnosed every day. She is right, of the eight cancer standards

:50:05.:50:09.

we judge ourselves against, we meet seven under 62 day one has not been

:50:10.:50:16.

met. The cancer strategy put out a pathway and we have invested in the

:50:17.:50:19.

early diagnosis component of that and 200 million in terms of early

:50:20.:50:27.

diagnosis and 31-day or clear or being referred for treatment. That

:50:28.:50:30.

is the pathway to meeting the 62 days. It is an important indicator

:50:31.:50:38.

and we need to do better. We know that a strong primary care system is

:50:39.:50:42.

the bedrock of the NHS which is why I'm pleased to announce today NHS

:50:43.:50:46.

England will publish the new GP contract agreed by the Government,

:50:47.:50:51.

NHS England and the BMA which will see almost ?240 million extra

:50:52.:50:57.

invested in GP services, require GPs to establish whether overseas

:50:58.:51:02.

visitors are eligible for free care and improve access for patients by

:51:03.:51:06.

removing extra funding if GPs readily close for afternoons in the

:51:07.:51:11.

working week. Would the Secretary of State consider putting a GP in every

:51:12.:51:19.

A department so that they could triage patients not so ill and

:51:20.:51:22.

advise them to go home and see their own GP on another occasion? She is

:51:23.:51:27.

right to say that it is the proxy that all A is space available

:51:28.:51:34.

should do that -- the policy. The hospitals that do it are the most

:51:35.:51:39.

successful results wise, not least the one that pioneered that model.

:51:40.:51:47.

We have seen 4000 people with urgent operations cancelled, 18,000 people

:51:48.:51:52.

a week in January waiting on trolleys in corridors, nine out of

:51:53.:51:57.

ten hospitals overcrowded and unsafe levels. Even in the local paper, I

:51:58.:52:03.

read his local hospital had to put patients in the gym overnight. Does

:52:04.:52:07.

he agree with the Prime Minister that the crisis facing our NHS is to

:52:08.:52:15.

a small number of incidents? The NHS is under pressure but we never get

:52:16.:52:19.

from the honourable gentleman any solutions. Our solution is 600 more

:52:20.:52:25.

A consultants since 2010, 2000 more paramedics, 2500 more people

:52:26.:52:32.

being seen within four hours everyday. His solution at the last

:52:33.:52:35.

election was to cut the NHS budget by 1.3 billion. His solution has

:52:36.:52:41.

been to blame everybody else but never take responsibility himself.

:52:42.:52:46.

Can I ask the Secretary of State what he is going to do about the

:52:47.:52:50.

crisis we are facing in staffing? Last week we learned half of junior

:52:51.:52:55.

doctors are abandoning specialist training, we have heard already

:52:56.:52:58.

applications for nursing degrees are down by a quarter following the

:52:59.:53:05.

axing of the student bursary, shortage of midwives. I know he has

:53:06.:53:09.

been in US and he will try to give us alternative facts, but when will

:53:10.:53:16.

he deal with the staffing crisis? Let us look at the reality instead

:53:17.:53:21.

of his rhetoric. In his own trust in Leicester, there are 246 more nurses

:53:22.:53:28.

than in 2010 and 330 more doctors. 185 more patients seen in A

:53:29.:53:35.

everyday. Next year a new emergency floor will open at the Leicester

:53:36.:53:38.

while infirmary because we are backing the NHS instead of cutting

:53:39.:53:44.

its budget -- Royal Infirmary. The recently produced council survival

:53:45.:53:52.

rate indicator is a beacon of light. What will come the Government do to

:53:53.:53:58.

hold underperforming CCGs to account for this outcome indicator given

:53:59.:54:02.

that we are still failing to catch up with international averages when

:54:03.:54:08.

it comes to survival rates? He is right to say that we now published

:54:09.:54:12.

one year survival rates for every CCG in the country and I agree with

:54:13.:54:17.

him that it is a beacon of light and a transformative step. It shows

:54:18.:54:22.

differences between the best and the worst of over 10% which is

:54:23.:54:26.

unacceptable. The transparency itself will bring improvements but

:54:27.:54:30.

we have also recently established 16 cancer alliances whose job it is to

:54:31.:54:35.

roll out best practice and investigate poor performance. Can

:54:36.:54:44.

the Minister update the House about NHS litigation costs which rocketed

:54:45.:54:52.

last year? Are they under control? It is a very big concern and the

:54:53.:54:57.

only way in the long run to reduce the litigation costs is to have

:54:58.:55:01.

safer care and that is why this covenant has prioritised safety in

:55:02.:55:04.

everything we do. -- this government. If a patient in the eyes

:55:05.:55:11.

suffers a stroke, they have a far better chance of recovery if they

:55:12.:55:19.

get quick treatment. -- in Cornwall. What is the Government doing to

:55:20.:55:24.

ensure that there will be a national stroke strategy? The current stroke

:55:25.:55:30.

strategy was produced in 2007 and our priority is to implement it

:55:31.:55:40.

fully. I would prefer to have detailed implementation plans and

:55:41.:55:43.

not more strategies. The issue he refers to is there are a great deal

:55:44.:55:48.

of differences in performance across the country, in particular access to

:55:49.:55:52.

speech and language therapy and we need to achieve better. My

:55:53.:56:02.

constituents, they have been through lengthy processes for Beth Allen to

:56:03.:56:11.

access treatment for muscular dystrophy and thankfully he is now

:56:12.:56:15.

receiving the treatment. What action is the Government taking to increase

:56:16.:56:20.

the capacity of the medicines and health care products as the result

:56:21.:56:28.

of the UK leaving the EU and most importantly, will the Secretary of

:56:29.:56:33.

State agreed to meet with muscular dystrophy UK?

:56:34.:56:38.

I would like to pay tribute to the work of the charity the art

:56:39.:56:45.

honourable gentleman mentioned. It does important work and I have

:56:46.:56:51.

sympathy for the KC mentioned. The UK rare diseases strategy has 51

:56:52.:56:57.

recommendations which are being driven through the NHS and improving

:56:58.:57:03.

life chances that patients with rare diseases, and our genomics

:57:04.:57:13.

department is bringing improvements so that people with rare diseases

:57:14.:57:19.

can receive treatment quicker. People in Lancashire will be pleased

:57:20.:57:23.

that the emergency services in Shirley in Chorley had been

:57:24.:57:35.

reopened. I recognise there's a lot that's gone in to reopening that in

:57:36.:57:42.

Chorley and I'm delighted ID work done by the Deputy Speaker and the

:57:43.:57:47.

honourable member for South Rebel. Last year, hospital trusts were

:57:48.:57:52.

advised to raise bed budget to revive resources funding. Does he

:57:53.:57:58.

think this is a good idea what advice is he giving officials

:57:59.:58:03.

issued? It's not a sustainable position to have to do that. They

:58:04.:58:09.

were pressures on the front line and that had to happen, but I recognise

:58:10.:58:18.

that budget Capitals are important. Young people with anxiety can find

:58:19.:58:20.

themselves out of school and sidelined. Are there any ways to

:58:21.:58:28.

reach out to these young people's futures that we mustn't give up on?

:58:29.:58:35.

3% of schoolchildren had severe anxiety, but we also know that if we

:58:36.:58:40.

treat them quickly we can often cure the condition and it doesn't come

:58:41.:58:44.

back, so he is right, we have to be as imagine it as possible. I have

:58:45.:58:51.

two report back to a constituent awaiting treatment is that the

:58:52.:58:58.

waiting time for his clinic is to use. People with mental ill-health

:58:59.:59:10.

have the right to access to treatment. Why can't this be dealt

:59:11.:59:21.

with by the honourable gentleman? We are spending at least ?1 billion

:59:22.:59:29.

more per year then his Government. This year we will be implementing

:59:30.:59:35.

maximum times for eating disorders, but we are also trying to put

:59:36.:59:41.

pathways to all illnesses and I agree that that waiting time is

:59:42.:59:51.

matched to long. Some GP practices across Lancashire have started

:59:52.:59:54.

publishing benumbed bar of missed appointments. When will he look at

:59:55.:00:04.

giving GPs the powers to charge those who missed their GP

:00:05.:00:08.

appointments in Lancashire? I have sympathy for those who are

:00:09.:00:12.

frustrated about that. I've said before my objection to that is not

:00:13.:00:17.

one of principle but whether it's practical to do it. Perhaps it's

:00:18.:00:21.

something that GPs can decide at a local level. The Health Secretary

:00:22.:00:29.

there was a small number of NHS during this winter. I would like to

:00:30.:00:35.

know what he calls small. There are a large number in my constituency

:00:36.:00:40.

alone. I would like him to visit my local hospital and see for himself

:00:41.:00:43.

as the Shadow Health Secretary will do later this week. I don't think

:00:44.:00:55.

our debates helped by her taking my comments out of context. I was

:00:56.:01:00.

talking about eight specific week when we talked about a small number

:01:01.:01:05.

of incidents that the pressure is recognised across the NHS which is

:01:06.:01:11.

why this Government is backing NHS with record funding. Slow payments

:01:12.:01:18.

for relatively small sums by NHS providers has caused a health clinic

:01:19.:01:25.

to close in my area. Will he impose strict guidelines for timely

:01:26.:01:33.

Caymans? My honourable friend will be aware there is a 30 day advisory

:01:34.:01:51.

strategy for NHS departments -- NHS providers to pay within 30 days.

:01:52.:02:00.

Adolescent mental training -- health training positions are unfilled. How

:02:01.:02:08.

does the Government plan on dealing with these recruitment issues? We

:02:09.:02:16.

have said we will recruit the brightest and the best. I have a

:02:17.:02:31.

constituent who has breast cancer and cannot access drugs. I will meet

:02:32.:02:42.

with my friend on a difficult case. What's has been done about

:02:43.:02:47.

increasing nurses' pay? Many of them have expertise and qualifications?

:02:48.:02:57.

As the honourable lady will be aware, relevant bodies are due to

:02:58.:03:00.

make their recommendations this week and we will look at those closely.

:03:01.:03:17.

North Hampshire, what's reassuring scan the Minister give that GP

:03:18.:03:22.

services will keep up with housing growth happening in the area? I can

:03:23.:03:28.

reassure him we take that into account when we give out funding for

:03:29.:03:34.

private care, but it depends on a strong economy and this is something

:03:35.:03:37.

that the Government will always do the NHS. These secretary for state

:03:38.:03:44.

of communities and

:03:45.:03:45.

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