Health Questions House of Commons

Order, order. Questions to the Secretary of State for Health. Mr

Johnny Mercer. The local authority public health grant is ring fenced

and must be spent in published grand conditions set by the Government.

Local authority chief execs and directors are required to cdrtify

that Grant spenders in mind that these conditions. England ftrther

review spent information and local authorities spend against the grant

is subject to an external atdit as well. In my city of Plymouth in

2014/15, we have seen ?47 pdr head. In Portsmouth, they received ?7 and

in Kensington and Chelsea, ht is ?136. I understand this is ` legacy

issue and the Government is committed to closing it. I cannot

stress how important it is to speed this up. How do they plan to achieve

this? The current situation is grossly unfair to my constituents.

My honourable friend is a rdal champion the public of his community

and I do applaud him for th`t. We have had conversations about this

issue. There are historic differences which I am conscious of

that exist. They arise from historical PCT spending priorities.

We have made progress in addressing this but we are looking in terms of

allocations of range -- across a range of factors including

inequalities and they will be announced shortly. I have offered

the Chief Executive of publhc England who will be happy to talk

with him and that remains an offer open to him. The NHS forward view

states the future of millions of children come the sustainabhlity and

the Emmett -- of the NHS and the economic stability of Britahn need

and rely on a upgrading public health. How can he explain how the

cuts in public health help to achieve this objective? The

challenge on being serious `bout prevention is about the enthre

health care system. Public health grants have had to absorb some of

that fiscal challenge. Dealhng with the problems we inherited at the

beginning of the Coalition Government. Despite that, local

authorities will have ?16 bhllion over the spending review period in

public health grounds alone that is not the only way we invest hn

prevention. I have seen somd of the great work going on on my vhsits to

work with local authorities and I'm confident of the great things they

can do that money. Given thd report that has been out today frol the

commission into mental health provision and mental health

treatments, can the Minister provide any assurance about the equhtable

treatment of physical and mdntal health to ensure that there is equal

allocation of funds? There hs a great deal of attention in this area

and there has been more beds commission. We are looking seriously

at our Tobacco strategy. Right at the heart of that is a concdrn for

the inequity between mental health and when it comes to smoking levels.

I want to give that assurance level that we are looking at how we can do

more for those who suffer whth mental health. Access to

contraception is not only a fundamental right, but it is also a

cost-effective public health intervention. With every ?1 spent on

contraception, it saves the NHS in ?11. However, this Government is

presiding over savage cuts to public health services with ?40 million

predicted to be cut from sexual health services this financhal year

alone. Is this what the Minhster means by saying that her Government

is serious about prevention? Why doesn't she finally admit that these

cuts not only make no financial sense, but also potentially putting

the nation's health at risk also. I reject that analysis. On thd matter

of sexual health services ddcisions on public health or a matter of

priority and they are mandated by legislation to commission open

sexual health. We'll sing a great deal of innovation around the

country in terms of how people do this. There was a good example in

Leeds of people redesigning services to enable people to access sexual

health. The Shadow minister, the question goes unanswered on how much

they would have invested in the NHS. The question that was never answered

at the general election. On prevention alone, the public health

grant is not everything. In the next financial year alone, the Ddpartment

will spend ?320 million on vaccines. We have introduced to world firsts.

The child flu programme and the meningitis immunisation programme.

This Government is investing in prevention and investing in our NHS.

With permission, I would like to take questions two, nine and will

together. 11 out of 27 hosphtals have not existed special me`sures

have demonstrated sustainable improvements in quality of care

Trusts put into special measures having recruited 1089 more doctors

and 4442 more nurses with one estimate saying this has reduced

mortality rates by 450 lives a year. I thank him for that answer.

Following the recent CQC report at Medway Hospital, the staff, the new

chief executives are working hard to turn around a long and deep problem

at the hospital. What furthdr support can the Government offered

to turn it around and out of special measures? I think the Secretary of

State and his department for the sport they have given so far. -

thank. This hospital has bedn through a very difficult patch. I

had a meeting about Medway Hospital yesterday. Over the last five years,

we have 106 more doctors and 26 more nurses in the trust. We havd a link

with guys and Saint Thomases and it is beginning to bear fruit. We have

to deal with this quickly and deliver safer care for his

constituents. My right honotrable friend will know of some of the

terrible problems that we h`ve experienced in Shropshire whth

regards to the CCG's and thd trust on the future fit programme over

services in Shropshire. Roy`l Shrewsbury Hospital covers ` huge

area, not just Shropshire btt the whole of mid Wales. Will he do

everything possible to support me and the residents of Shrewsbury come

to guarantee that A services remain at the Royal Shrewsbtry

Hospital? I would like to thank him for his campaigning for the Royal

Shrewsbury. Nobody can do more than he has done for it. I would

encourage him to engage with the programme carefully. In the end it

is incredibly important that we get the right hands of the patidnts and

he has been supportive of this process. Like him, I would like to

see it concluded rather sooner than later. Could the Secretary of State

set out for my constituents in Worcestershire, what the impact of

the trust being put into spdcial measures is likely to have this year

and what improvements they can expect when the trust exits special

measures? The advantage of the special measures programme hs we

tend to make much faster progress in turning round hospitals in

difficulty and did happen in previous years. He will know in his

local trust in the last fivd years, we have nearly 50 more doctors and

more than 100 more nurses. We are making progress but need to do it

much faster. That hospital will have my full support in dealing with

these problems quickly. Walsall NHS Trust has been placed into special

measures. What immediate action can the Secretary of State take to

ensure their Manor Hospital can recruit the vital staff in

paediatrics and A for the long-term in fall employed staff?

One of the things that can put hospitals into special is if the

proportion of stuff coming from agencies is too high becausd they

cannot offer the continuity of care. In terms of full-time doctors, there

is an extra 83 at Walsall c`re NHS Trust and 422 full-time nurses. An

improvement director started this week and we are looking to find a

bloody hospital. Where we h`ve turned round hospitals the fastest,

we found if they have a partner hospital, it has the biggest effect.

Despite having a football tdam that is talk, Leicester's hospit`ls are

in need of urgent assistancd. The worry for Leicester is they slip

into special measures come especially with regard to A What

steps can he take to ensure our hospitals are performing as well as

Leicester City football club? We want them to be as outstandhng as

Leicester City football club, but we do recognise there is a way to go.

There is pressure in the A departments which my honour`ble

friend has acknowledged in ` house and we are looking carefullx to do

what we can to support them. They are going to be one of the first

trusts in the country to offer full seven-day services from March 2 17.

There are some important improvements happening but we will

be doing everything we can to make sure they happen quickly.

My trust is not in special leasures, it is in trouble and we looked like

losing our A if we follow the recommendations of the CCG. Will you

agree with me that when hospitals get into trouble, trusts get into

trouble, it is usually becatse of poor? Management? There are some

things we need to do differdntly. Managers need longer in thehr post.

If the average tenure of an executive is only around ten years

then inevitably their horizons are short-term and we need to ghve them

time to turn around their organisations. The latest trust to

get an outstanding measure, the Park Hill Hospital, the chief exdcutive

has been there for 26 years and I think there is a connection. If we

make sure they have the resources, and where there are problems we

identify them quickly and ghve them support before things turn hnto a

crisis. Barking hay ring and Redbridge trust is working dxtremely

hard to improve services, and has had some considerable success but

despite there being 250 spare care home beds in the London Borough of

hay ring, there are a large number of rail and elderly patients in

hospital who are no longer clinically ill. Has any resdarch

being done into the reasons for the late discharge and how much does

patient choice play a part hn that? It can unfortunately sometiles play

apart, but the biggest way to tackle the problem is to have bettdr

coordination between what the local authorities do, this easy gdes do

and what the trusts do, and that is not only a problem in her trust but

also around the NHS. -- Havdring. The CCG found there had been

significant progress in the last inspection, more doctors and nurses

and an excellent chief execttive and I'm confident for the futurd. 1

trusts across the country are currently in special measurds. Nine

in ten hospitals are failing to achieve their own safe staffing

plans and waiting time targdts are being missed so often that failure

is now becoming the norm. Does the Health Secretary think that that

might explain why the king's fund survey yesterday found satisfaction

in the NHS increased by eight percentage points in 2015, the

largest increase since the survey began in 1980 three? I think she

might want to look more cardfully at that report before turning ht into a

political football begins on page six it says that satisfaction rates

in Wales, run by her party, are six percentage points lower than in

England. I will tell her wh`t is happening with the regime of special

measures, we being honest about the problems and sorting them ott rather

than sweeping them under thd carpet which is the problem we had with

mid-Staffordshire, Morecambd Bay and a whole range of hospitals. We are

putting more money in, treating more people in, and public confidence in

the safe the dignity of the care they get is at record levels. It is

clear the Health Secretary doesn't want to talk about his record in

England. His own backbenchers are queueing up to tell him abott

problems in their own NHS. Hn Medway, Shropshire, but he does not

understand the extent of thd problem. Let's return to thd public.

Satisfaction with the NHS h`s fallen by five percentage points, this up

by 8%, satisfaction with GP services is the lowest rate ever recorded.

Satisfaction with A at 53$. We know the Health Secretary h`s lost

the confidence with doctors, isn't this the clearest sign that he has

lost confidence in patients two What's my backbenchers are pueueing

up to say is, thank you for sorting out problems that Labour swdpt under

the carpet for years and ye`rs and years. Professor Brian Jarm`n, what

did he say about the Departlent of Health under the last Labour

government? EZ it was a denhal machine. All the problems h`ppening

in hospitals was swept under carpet and not dealt with. What is

happening in this government is to mark -- he said. 100 more pdople

treated for cancer, 2000 more people treated at A departments, 400

more operations, record doctors and nurses, save NHS than ever. We are

proud to be the party the NHS stop -- a safe NHS. The results of the

last GP patients' survey showed that 91% gets convenient appointlents.

84% who were not able to get an appointment or a convenient

appointment indicated they went to the A The same survey indicated

that one in four people are now waiting more than one week to see

their GP. There is a staggering 1 million people heading off to A E

because they cannot get an appointment with their GP. Ht is a

total meltdown. What is the Minister doing about it? 40 million lore

appointments are available for GPs than in the past. The government's

commitments to track one GB access to ?175 million is being invested to

test improved and innovativd access to GP services. 57 schemes, 250

practices, and by March, next year, 18 million patients will have

benefited from improved accdss and change at local levels. That is what

we are doing about it. The Linister will be aware that despite great

improvements in cancer care under this government and the previous

government, one in five, more than 20% of cancer patients are first

diagnosed as late as A C`n he give an assurance that the

government's brokers will bd on one-year's survival rates as a means

of driving forward survival rate will remain a key indicator for the

government? You raise a serhous issue. Assuming the earliest

diagnosis of cancer is very important to the government,

obviously important to patidnts We are publishing the statistics on

early detection through the CCG in order to improve transparency

further because this transp`rency is the government has shown actually

drives improvements in performance. Canada minister advise me on how the

government is going to tackle urgently safety of care at North

Middlesex Hospital A, following revelations that a patient died in

December 2015 after being forced to wait an unacceptable amount of time

in A? -- can the Minister. The honourable lady gives an ex`mple of

why it is so important to sdek to improve care and quality of care in

A, why it is so important to keep transparency going. It is one of the

reasons why we have a new inspection regime, designed to highlight these

things. 1250 new doctors in A over the last five years will also make a

difference to quality of care and improvement but you are right to

highlight this. The NHS does not do everything right but what is

important is we value what hs done, the bustard majority of stuff, but

when things go wrong, we sax so examine it and learn lessons. - the

vast majority. Of 25 absencds in Leicestershire before Christmas 16

were queueing outside Leicester Royal Infirmary to dischargd people.

I have written to the Secretary of State about this issue, gritty

update me and the House on what measures are being taken? -, could

he. The issue with ambulancds and care is the variation in qu`lity and

it is important to ensure local leadership addresses these problems

that are handed differently in various places. It is right to raise

this and I am sure he has r`ised it with his local trust, local

Ambulance Trust, as well as the hospital, to see how there can be

better facilitation of patidnts going in and being dischargdd, so

ambulances are not needed. The health and safety care information

Centre has shown 124,000 patients waited more than 12 hours after

arrival in A in comparison to 1700 in Scotland. This number has doubled

since 2013. The Royal College of Emergency Medicine has expl`ined

these tend to be the sickest patients and this delay is

associated with increased mortality, so how does the Minister and

Secretary of State plan to hmprove this performance? I have to tell the

honourable lady that I did notice patient satisfaction with A was

lower in Scotland than Engl`nd which indicates we all have probldms to

deal with in relation to thhs area. It is correct to continue otr

progress in increasing resotrces throughout the health service and

A, and improve the transp`rency and ability of people to sed what is

happening and going on. Unacceptable weights are not part of what we want

to see from the NHS and that is why there is a determination to drive

them down and make sure pathents in England have the best quality

information about what is h`ppening in their NHS and they continue to

drive efficiency in improvelent -- waits. They have not been ptblished

since November. The doctors required to look after patients are @

specialist. There is a problem with retaining A specialist and

trainees because they worked a higher proportion of unsoci`ble

hours. These are exactly thd hours that will be less rewarded hn the

new contract. In the future, how does the secretary of state plan to

recruit and retain doctors of emergency measures to the -,

medicine? The new contract which is under negotiation at the molent the

majority of which has been `greed with junior doctors, I'd contract

designed to replace the failures in the old contract which everxbody

knew needed to be corrected, writes the basis for the profession for the

future, to deal with some of the issues the honourable lady lentions,

and it is a matter of great concern that negotiations should continue,

there should be no strike tomorrow, and this pattern gets a chance to

work. It might assist the House to mention the Independent health care

commission for North West London was made up of five Labour councils and

chaired by Michael Mansfield QC and in terms of the assessment of the

findings for the commission, I can put it no better than the ldad

medical for the Shaping Healthier Future project who said the

unanimous conclusion was th`t the report offered no substanti`l

evidence or credible altern`tive that would lead to better ottcomes

for our patients above the dxisting plans we have in place, and I concur

with that judgment. Last July the Minister held a meeting with MPs and

agreed information on review of hospital services will be shared. We

understand plan B will be considered which will move services to Charing

Cross but will retain a mothball existing buildings rather than

redevelopment. Can we see ctrrent plans? We had a constructivd

meeting, and I think it is time to move on. There is a grave d`nger of

the honourable gentleman appearing to be like one of those soldiers

discovered on a Pacific isl`nd after the Second World War, he is still

fighting the old war. If only he was! Some of the reasons for costs

escalating within projects of the NHS is because of the const`nt

challenge and delay. Shaping a Healthier Future has clinic`l

consensus across north-west London. This will save many lives e`ch year.

It is time to get on with this project. The report heavily features

Ealing Hospital where a radhographer blew the whistle on consult`nts

taking funds and extra paymdnts and now she is jobless. She will soon be

homeless. Will the Minister urgently look into her place because despite

a plethora of reports, this government does not seem to be doing

anything for higher? I don't think that is fair. In fact, the secretary

of state has met the commission in question and the Francis review

recommendations as we have `dopted them make it clear that thex have a

right to speak out, and we would want everybody to speak out on

behalf of patient safety. The trust reported a deficit of 6

billion for this financial xear with 75% reporting another deficht which

is why we launched the Cartdr efficiency programme, hospitals can

save ?5 billion annually by making sensible improvements. Mr Speaker

almost every acute trust will be in deficits including Saint Helens

which covers my constituencx, the fact is the Government has been slow

in dealing with a cause which is the employment of agency staff. Also it

continues to put up the tarhff which is based on efficiency savings when

hospitals like Saint Helens are struggling to make greater

efficiency, will he look at this again? I think you should ghve a

slightly more complete picttre of this hospital comparative fhve years

ago. 7000 more CT and MRI scans When it comes to deficits wd are

tackling the agency staff issue and that happen because agencies were

responding to the France of support and rightly they said they wanted to

stuff up quickly but in a sustainable basis. If we were

putting ?5 billion less into the NHS as he stood for at the last

election, the problems would be worse. Does my right honour`ble

friend not agree that the rtnning costs very from 105-195 per square

metre which was highlighted by Lord Carter is wholly unacceptable and

would he also agree the concept of a model hospital has great merit? My

honourable friend knows abott these from his own clinical background and

he is right. We are now doing the most ambitious programme anxwhere in

the world to identify the cost that hospitals are playing from @pril we

will be collecting the cost for the hundred most use products in the

NHS, that information will be shared and we are the biggest purchaser of

health care equipment in thd world and we should be paying the lowest

prices. The largest hospital trust in the UK is set to run up 035 and

in pounds in deficits, this would be the greatest ever overspend in the

NHS, when will the Minister except this austerity driven crisis facing

the NHS? -- accept it is a stretch to say this is an austerity driven

problem when next year we h`ve the six biggest increase for funding in

the NHS in its entire 70 ye`r history. There are severe problems

and we will tackle the deficit and we will make sure we includd patient

safety and patient care. Thd staff of the University Hospital of North

Midlands entrusted the care of County Hospital in Stafford and

Stowe has done a great job hn improving quality of care and

bringing down the deficit, Willie ensure a long-term approach is taken

to the finance of the trust to ensure we don't make rapid decisions

which could could deliver rdsults in difficult situations in the future

-- will he. The trick when we reduce deficit is to take a strategic

approach to deficits and cost reduction and not to make short term

sacrifices which harm patients. That is why at the weekend we announced a

?4.2 billion IT investment programme that will mean doctors and nurses

spend less time to form a more times with patients. Number six please

stop white by 2020. Everyond will be to get a GP appointment in dvenings

and weekends. By March this year a third of the country, 18 million

people will have benefited from improved services. There is

currently a concern for GPs in my constituency of Eastleigh which has

left so if it can delay is `n patient is getting nonurgent

appointments. Will the Secrdtary of State promotes more agile working

structures for GPs, especially women, this was highlighted when CCG

is fighter for retaining extra GPs? I know West Ham Shih CCG is

providing extra space and c`pacity to take on more trainees and across

the country we want five dozen more doctors by the end of this

Parliament, this is the biggest increase in GPs in the history of

the NHS. It builds on the extra 1700 GPs we have working in 2010. It does

take too long to see a GP and we are committed to sorting it out and The

Record investment will make that possible. Why can the Mac -, why can

medical centre will close in March in my constituency leaving 2000

people needing to find a new GP This means it is impossible to have

a prompt GP appointment let alone register, can the Secretary of State

ensure he will coordinate whth NHS England to manage the situation

appropriately and all they can to assist each of my constituents

affected especially the vulnerable and elderly to get access to new GP

as soon as possible. I am h`ppy to do that. She is right to make those

points and the vulnerable pdople with long-term conditions is the

area where we need to see the biggest supports to GPs bec`use it

is strengthening the abilitx to proactively keep people out of

hospitals to keep costs down. In Rochester we are facing the closure

of two single Hannah GP practices due to a retirement and a stspension

with no long-term replacement. Would my right honourable friend `t wired

what steps he has taken to laintain appropriate access to local GPs I'm

absolutely prepared to do that and I've met a number of GPs her area,

what's we are doing is reversing the historic underfunding for gdneral

practices with an increase hn more than 4% a year in funding going into

primary care and general pr`ctice. That'll give hope to the profession.

Northern Ireland, when it comes to accessing GPs you need to h`ve GPs,

25% of GPs are over 55 years of age, that is going to get worse, what

steps have been taken to tr`in more GPs to ensure they then stax within

the NHS and not going oversdas with better wages and conditions? We have

plans to have 5000 more doctors working in general practice, we need

to increase the number of GPs going into general practices by 3000 every

year, I'm very happy to liahse with the province on this. Against the

peers and against the press, Victoria Atkins. Thank you Lr

Speaker I must mention the team is led by my honourable friend from

Ealing North and Hayward and Middleton. Question seven please.

Can I join you in offering congratulations for her success

Tackling the integration is crucial to avoiding unnecessary hospital

admissions, providing better for the elderly and easing the pressure for

an ageing population. That hs why we have setup the better care fund

have set a ?5.3 billion increase, this is why my friend the h`s

announced a social capri set which will raise two billion and we have a

five-year forward view with integrated care plans and ndw.. I

hope notwithstanding his excitement he didn't mention that this was

grouped with question 16 and she didn't the deed is done. In areas

with a high proportion of rdsidence, home aids and adaptations c`n help

people live longer in their homes which benefit them and can help to

ease pressure on the NHS and social care services, what steps of the

Government taking to boost this kind of support? My honourable friend

makes an excellent point. The disabled facilities Grant is a

primary mechanism for helping the disabled. Currently I am honoured to

announce it has been increased which will fund 85,000 adaptations. In a

recent study carried out by the sea QC, a survey found that there was no

notable improvement on ment`l health services outside of hospitals. Can I

asked the minister what steps are being taken to rectify this? It is

writes the crisis resolution home treatment teams were critichsed in

the recent reports. That is why the Prime Minister announced in January

we are providing an extra ?400 million funding for those tdens and

it is why in the mandate NHS England have to improve crisis treatment in

all areas. The decision to slash funding to local authorities was

disastrous for adult social care as they were warned at the timd, will

the Minister accept that thd social care precept which the Government

are allowing councillors to raise will raise the most money in those

councils which have the highest council tax base, not necessarily in

those which are the greatest need? I would be concerned if it is true. We

are facing an exploding dem`nd and at the risk of sounding likd a Monty

Python sketch, what has the Government done apart from fully

funding the NHS five year vhew with 3.5 billion and driving health

devolution and 4 billion he`lth technology, we are funding the

integration in a way the last Labour government did not do. Mr Speaker

that is really not true. Government ministers residing over the

hollowing out of social card because they are funding far short of what

is needed. ?4.6 billion has really been cut and the gap is growing at

?700 million a year. The prdset you have been talking about will raise

?400 million a year, the better care fund doesn't start until next year

when it starts at 105 million. Simon Stephens has called this unresolved

business, when will the Minhster when will all the ministers face up

to the fact this does not add up? The question would be more capable

of being capable of taken sdrious if the party opposite had ideas. Over

the next ten years a 22% increase in over 65 is, a number of people over

75 the rise 90%, we are fachng extraordinary challenges whhch is

why we have announced the bdtter care fund. And why we are driving

devolution which allows loc`l health leaders to integrate. If it was as

easy as members opposite sahd then they would have done in the of

office. The NHS choice survdy which has been carried out in its current

form for the past two years shows the proportion of patients who said

they recalled being offered a choice of hospital or clinic is at 40% in

2015 up from 30% in 2014. The figure at the minister left out was that it

was 50% when Labour left power in 2010. How does you explain this very

worrying fall in the proportion of patients being given a choice? Will

he reaffirm that choice is ` legal right under the NHS Constitttion and

fully acknowledge that the introduction of choice was `nd has

been a major driver in improving NHS performance across? The fact the

right now wouldn't and missdd out was that was a different survey and

the figures are not, double. I agree that choice was important and we

should do more and I would like to take this opportunity if I lay

congratulate the team at his hospital which has been awarded

good, the first in the south-west to be rated as such. Patients needing

mental health services don't get to choose where they receive their care

as highlighted in the commission on acute adult psychiatric ports which

was published today. It says the whole system has suffered from an

attrition in funding in recdnt years, it highlights poor qtality of

care, inadequate staffing and low morale, it describes the situation

as potentially dangerous. Whll the Minister now accept his govdrnment

has let vulnerable people down and Willie implement the recommdndations

in full to put the serious situation right? We have just received a

report and it is a good report, NHS England are working on the

recommendations and I would remind her it is this government which has

put mental health on an equ`l esteem within the NHS within the

constitution for the first time The position front and say it is

meaningless but if it were, why did they not do it when they were in

office? We have done it for the first time and are acting on it not

just in terms of the constitution but the funding which is gohng up in

real terms. The CCG expects to publish hts

internal review by the end of February. The independent rdview is

expected to be completed by the middle of the month. The monitor is

assessing the project from the providers' perspective and will

reveal findings soon. The United clear contract in temperature was an

attempt to join up disintegrated services. Now we seem to have a

series of disintegrated revhews What is needed is a overarching

review that looks at the role of NHS England and the role of an Lonitor,

the strategic project team `nd the ministers. When will we get that

review? As I have indicated, there are reviews going on which concern

the responsibilities of each individual part but there is no

doubt that this was a seriots matter and a serious failure, which raises

serious concerns. We want to know what went on as much as the

honourable member. Once the reviews have been completed, I will be happy

to talk to the honourable gdntleman about the consequences of those

reviews. I call the victorious team leader, Mr Stephen Pound. Qtestion

11, Mr Speaker. Mr Speaker ht is my considerable honour to respond to

the honourable gentleman in his victorious mode. Community pharmacy

is a vital part of the NHS. We want to see a high-quality community

pharmacy service properly integrated into primary care and public health

and the proposed changes will help us in conjunction with the pharmacy

profession to do just that. I am grateful to the Minister for that

question. The result was a place for him in our team next year although

we are actually taking trials over the next few weeks. -- therd is

always a place. Will he accdpt that community pharmacists are of great

and growing importance to otr constituents, providing an

increasing range of health care and advice in accessible High Street

locations. What message does the Minister have for these dedhcated

professionals who are now fdaring for their future due to the

uncertainty arising from thd announcement of a 6% cut in funding

for the NHS pharmacy servicd? I am grateful to the honourable

gentleman. The message is that community pharmacy does and is doing

an extraordinary and import`nt job but it will change. In 2013, the

Royal pharmaceutical servicd, any publication said that the

traditional model of communhty pharmacy needs to change because of

economic austerity, increashng use of automated technology to tndertake

expensing, and the use of online prescribing. It pointed to the

massive potential of communhty pharmacists to do more and sees

pharmacy as ideally placed to play a crucial role in the new moddls of

care. With the consultation going on, there was a great futurd for

pharmacies, but like so much else, it will be different. Number 13 Mr

Speaker. The UK continues to play a global leadership role on -, roll on

antimicrobial resistance. Wd created the Fleming fund to help poorer

countries tackle drug resistance and we are promoting action. Our review

is helping to galvanise global awareness. I welcome that answer.

Antibiotic resistance is ond of the biggest challenges for glob`l

health, making routine oper`tions impossible with in ten or 14 years.

I welcome the government's `ction on this. Antibiotic research UK is the

world's first organisation set up to tackle this. Thank you. I wdlcome

the fact that my my honourable friend is becoming a champion for

this important international agenda. I am aware of the work of the

charity he mentions. I belidve they have had some contact with the

Department already and I am happy to look at the issue he mentions. I

don't make decisions on the sort of issues but I'm happy to it `nd meet

with him. UK health and medhcal research projects benefit htgely

from EU funding with the UK at the top of the table for approvdd

grants. This funding is vit`l if we are to tackle global health

challenges. Does the Ministdr accented that pulling Britahn out of

the EU may have a detriment`l impact on the UK's role as a world leader

in health and development? H can give the House the reassurance that

the funds she mentions are protected by the Spending Review. Mr Simon

Burns. Number 14. NHS England advises that in Chelmsford, there

are 1927 patients, slightly lower than the mid Essex clinical

commissioning area. Eight of the practices have been inspectdd and

seven were rated good with one outstanding. Does the Minister think

it is possible that the NHS review of the PMS scheme to ensure that

good and innovative work is promoted by PMS as example five by Sttherland

Lodge surgery can be sustained? I hope so. And I appreciate the

honourable gentleman's visit to my office yesterday with members of

that surgery and also present lives of the NHS. The ?1.4 million release

from PMS in Essex will be rdinvested within the area but it is ilportant

that there is an opportunitx for all practices to bid for that money so

that some of the work already done under PMS, if it is still ndeded,

gets the chance to continue and certainly with services ratdd

outstanding. If the Secretary of State... Number one. Number one

Significant progress has bedn made in our negotiations on a new

contract with junior doctors but the agreement has not been reached on

the issue of Saturday play despite assurances from the BMA.

Regrettably, 2884 operations have been cancelled ahead of tomorrow's

industrial action which will affect all nonemergency services. H urge

the BMA to put the interests of patients first and reconsiddr their

refusal to negotiate. At PMPs in February of 2014, I raised with the

Prime Minister might serious concerns about the bullying culture

at Liverpool community trust. I understand that the enquiry into

parts of this is complete so I will ask the Secretary of State, in the

spirit of honouring his stated commitment to openness and

transparency, to ensure that report is available from the 23rd of

February. I will happily look into that matter and I know my honourable

friend has had a roundtable on bullying and harassment and can I

thank her for raising it because over the last decade, none of us

should be proud of this, but the number of NHS staff suffering from

bullying and harassment has gone up from 14% to 22%. We need to make it

easier for doctors and nursds to speak out without worrying `bout

being bullied and harassed. Demand always exceeds supply here. We need

short questions and short answers. I'm sure the Minister will dnjoy me

in congratulating the surgery in Bath for being ranked among the top

ten GP practices in the country Does the Minister agree with me that

patient satisfaction will increase if patients have a choice of where

they are treated? Yes, it whll, and that is another reason why we are

hoping to have 5000 more doctors working in general practice and 5000

more health professionals expanding the primary care service by 202 . It

has been reported that a potential deal on the junior doctor contract

was put to the government which would resolve concerns without

costing any more money and `voiding the industrial action tomorrow. A

source close to the negotiation told the newspaper that one person who

would not agree was the Health Secretary. Even though the NHS

employers and health teams thought this was a solution, he said no Let

me ask the Health Secretary a direct question, as the government at any

point rejected a cost neutr`l proposal from the BMA on thd junior

doctor contract, yes or no? The only reason that we do not have `

solution on the junior doctors is because in December on the one

outstanding issue, about Saturday play, the BMA said they would

negotiate but last month sahd they would refuse to negotiate. Hf they

are prepared to negotiate and be flexible, so are we. What is

noticeable is that despite 3000 cancelled operations, no-ond in the

Labour Party is condemning these strikes. Can my honourable friend

update us on the progress of decriminalisation of dispensaries

for pharmacists. I'm aware of my honourable friend's keen interest in

the rebalancing programme and dispensing errors. We are committed

to making this change. Therd are a number of measures related to this

in a section 60 order and ghven that timetable, it is likely the order

will be laid in the Westminster and Scottish parliaments in the autumn.

The Secretary of State will be aware that there is currently a

recruitment for junior doctors for the DWP. They are offering ?72, 00 a

year, up to twice the salarx they would get in the health service Is

he concerned this will result in inexperienced medical staff making

judgments that will relate to people's livelihoods and also is he

not concerned that this will result in a drain in staff resourcds out of

the NHS and out of general health care for the public? What I would

say to the honourable gentldman is that as a result of the changes this

government has made on welf`re reform, we have 2 million more

people in work. We have half a million fewer households whdre

nobody works, and part of that is making important reforms, including

making assessments of peopld in the benefits system. Everyone should

welcome that. Comparative rdsearch has shown that proton therapy is as

effective as radiotherapy for certain cancers but with less side

effects. Does the government accept the use of comparative eviddnce in

deciding the availability of emerging treatments on the NHS such

as proton therapy? I will rdflect on the wider point that my honourable

friend makes but the House will be keen to know that we are investing

in building two proton beam therapy facilities in Manchester and London.

Work has already started. That is a ?250 million project on the first

facility will become operathonal in 2018. Could the secretary of state

provide an update on efforts and contingencies to combat these Zika

virus. Effort is being coordinated with all the administrations,

including Scotland. Yes, thhs is something that the government is

taking seriously and we havd got under active review. Up-to-date

medical guidance has been c`scaded to the NHS in England and the UK is

at the forefront of some of the world's response. We are a lajor

fund of the WHO and we are investing, we have people on the

ground in Brazil in particular. I can assure him that we are

maintaining close links with the devolved administrations at the

official level and I am verx happy to speak to colleagues. We take it

seriously, keeping those links alive. As the Minister seen the

comments of Angus Dalglish, reported in the papers today, which suggested

that EU rules are forcing us to spend billions of pounds trdating

health tourists and preventhng us from undertaking important clinical

trials? Has he made any assdssment of the comments made by Professor

Dalglish? This government h`s made huge assessment of the cost of

overseas people using the NHS, and we think there is ?500 millhon of

recoverable costs that we do not currently recover. When it comes to

the EU, the biggest problem we have is that we are able to recl`im the

costs of people visiting thd UK but we do not do it as much as we should

because the systems are not as efficient as they need to bd. And we

are sorting that out. Despite the prevalence of pancakes in P`rliament

today, I am pleased to be asking a food related question. It is

concerning a recent opinion poll by Diabetes UK which showed th`t 7 % of

British adults think that food and drink manufacturers should reduce

the amount of fat and sugar in their products. Does the Minister support

introducing mandatory targets for industry to reform the food, and

help people drink more -- e`t more healthily and will that forl part of

their strategy going forward? We have made considerable progress on

this area in the last Parli`ment, under the responsibility de`l. We

have always said there is more to do and the challenge to industry

remains. We will be saying lore about that when we published the

childhood obesity strategy hn due course.

The midwife led unit in my constituency of world and is key to

the high quality of passion in maternity care. Last year this get

100% -- scored 100% satisfaction, can the Government outlines plan

critically given this weeks launch of the safe of the campaign. These

have increased in number whhch is a greater advantage to more choice, I

hope the next review will m`p out the future of maternity services and

show what midwife led units would do within the NHS and I'm excited and I

know she be too. Ministers will be aware by a call for concertdd action

to promote and protect breast-feeding, will he meet with me

and these organisations to discuss with these proposals further? I m

aware of the Lancet review `nd it makes important points. It hs of

note that in Scotland and W`les and Northern Ireland progress h`s been

made where we should get a copy in England. We have made progrdss but

there is a considerable difference between rich and poor we nedd to

fix. I'm pleased to support the NSPCC it is time campaign to ensure

children who have been victhms of abuse receive ongoing support.

Cannot seek assurances from the Government that this initiative will

be actively helped? Thank you Mr Speaker, yes indeed we support the

initiative and our work looking after those children who nedd extra

care, especially in relation to health and emotional needs hs being

helped by local authorities and vulnerabilities are certainly a

matter of great concern. Ovdr 1 million elderly people can laintain

independence, what discussions are being made to ensure the allowance

will be left at the same level? This consultation is ongoing. Thdre is

now a committee to look at ` range of issues, the actual details has

not been finalised but it is a matter of concern and discussion

between departments. In askhng about mental health can I remind the House

that I am married to an NHS forensic scientists, can I ask whethdr the

Government has looked careftlly at the report today from the

independent commission in ilproving mental health services, and in

particular they are finding nationally there is an inaddquate

level of provision for the lost severe ill patients and can the

Government sets out what me`sures they will take to make sure we

really do see progress and hmprove access? Can I thank my honotrable

friend for this and thank the Royal College of psychiatry for the work

on the commission of launch Nigel crisp which we have supporthve. The

report and the recommendation has only just comfort it goes in the

direction the Government is still going, we want to reduce out of area

placements and the NHS is working on this team moved to a definitive

target to reduce that and hopefully eventually scrap it. I was hn Hull

looking at problems and the recommendations on waiting times are

important. This area has bedn undervalued and is under grdater

scrutiny now and there is more investment going into the

Government. The reports will help this in relation today. I whll call

the honourable gentleman if his question consist of one sentence. A

Leeds we have pressure on acute services, will the secretarx of

state... Bell was, Mr Speakdr,. . While the CCG provides the loney? I

am happy to look at that. Wd will come to points of order but not yet.

By refusing to condemn the junior doctors strike, the lady opposite

has shown she shows little regard for patient safety, that shd

repeated condemnation for the strike which will endanger patient safety

and can he Kante... Guarantde a contract for better patient care? I

think that was a reaction. The party opposite are saying if a negotiated

settlement can not be reachdd then we should not impose a new contract,

in other words we should give up on a seven day care for the most

honourable patients, there was a time when the Labour Party tsed to

speak up for vulnerable pathents but now it is clear that unions matter

more than patient. Demand is so high, last but not least. The

pharmacy budget comes in in October in the next financial year can the

Minister say what the fall cuts will be in a full financial year?

Negotiations are ongoing with the pharmaceutical services, thd amounts

that have been set up cover this financial year and settlements are

moved from year to year so that discussion is ongoing, the future

for pharmacy is very good and will be different, there is a grdat

future bright for high-stredt shops, shops and areas where we nedd the

bottle so an improvement in services and health care, improper c`re, in

primary homes around the