Health Questions House of Commons


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Good morning. Welcome to live coverage of the Commons. Today's

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debate is reaction to last week's budget. At the start of the debate

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the Chancellor of the Exchequer George Osborne will be making a

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resolute offence of his budget, following the turmoil that followed,

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the resignation of Iain Duncan Smith, and the resulting drop in

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changes to disability benefits. Join me for a round-up of the day in both

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Houses of Parliament at 11pm tonight. First, questions to the

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Secretary of State for health, Jeremy Hunt, and his ministerial

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team. The first question is from the Conservative Andrew Stevenson,

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concerning cancer survival rates. Order. Questions to the Secretary of

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State for health. Ministers Jane Ellison. Before I answer the

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question, may I start by saying that the thoughts of the houses are with

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the people in Brussels today. Shocking events. We will do all we

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can to support. With your permission I will take questions one and 11

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together. Cancer survival rates are at a record high, and we are on

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track to save more lives. But we know we need to strive to be better.

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Independent cancer task force report was published last summer,

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recommending improvements across the pathway, setting out recommendations

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which will be further survival rates. Can I associate myself with

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her comments about the terrorist outrage in Brussels. As she may be

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aware, a Cancer foundation has been fundraising for chemotherapy unit in

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my constituency. Due to the huge generosity of residents, they have

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raised 90,000 of their target of 100,000. Would she join me in

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congratulating them and encouraging the residents to meet their full

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target? It is a delight to associate myself with the support for this

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group. Those near Cancer foundation support world-class cancer treatment

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throughout Lancashire and Cumbria, and 4000 treatments are delivered

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every year at Burnley Cosby to, and the new unit will be a benefit to

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cancer patients. -- Burnley hospital. Is there anything further

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my honourable friend can do to incentivise NHS trusts to replace

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linear accelerators over ten years old, which would allow more patients

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to access cutting-edge radiotherapy techniques? This is one of the areas

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covered by the cancer task force. It is an important matter. The national

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cancer director is leading on task force implementation, and that

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replacement is based on improvements across the pathway, and that can

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only be done because we are putting the money into the NHS that we need

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to achieve those world-class outcomes. 38,000 people are

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diagnosed with a blood cancer every year then the UK but very few people

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are familiar with the term blood cancer. Patients have expressed

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concern that a lack of awareness has an impact throughout the patient

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journey, from confusion and uncertainty at diagnosis, to being

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unaware of the organisations that provide support and care that they

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need. Can the Minister say what more the government can do to tackle this

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lack of awareness to improve outcomes and survival rates are all

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patients affected ID 137 types of blood cancer? -- by the 137 types.

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She is right to bring this to the House. Joining up these cancers is

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the approach that the implementation team are looking at. I had a recent

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conversation with the director, and NHS representatives, discussing how

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we can get the joined up approach. That is that the heart of the

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recommendation. We will be taking this forward for all those reasons.

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Cancer Research UK has said that cancer waiting times have now been

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missed so many times that failure has become the norm. Does the

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Minister agree that failure to tackle this is undoing the good work

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of the last 15 years in terms of survival rates? We are dealing with

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a greater number of people. More people are being diagnosed these

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days. For example last year, GPs referred nearly half a million more

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patients to see a cancer specialist, an increase of 51%. When it comes to

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waiting lists we want to make sure everyone is seen. Government have

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committed more money on diagnostics, for example. We expect the NHS to

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look urgently act dips and local performance to make sure nations get

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access to treatment as soon as possible. Will the Minister join me

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in welcoming the government announcement of funding for a new

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radiotherapy machine which will improve cancer survival rates for

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patients of my constituency? Absolutely. My honourable friend

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highlights again where we are investing, upgrading machines, where

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we are and the effort and the people and resources in, to make sure we

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can achieve those world-class cancer outcomes. We are on course for a

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record outcomes in terms of patients surviving ten years beyond

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diagnosis, but we always want to do better, so I do applaud local

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efforts, as she highlighted. I would like to reiterate what the Minister

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said. I am sure my honourable friends would agree that our

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thoughts quite to everyone in Brussels. Can the Minister informed

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the House what consideration has been given to bringing Powell cancer

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screening age into line of that of Scotland, 50 rather than 60,

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following the debate on this subject? -- bowel. We had a

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tremendous debate, which demonstrated how many people were

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interested in the subject. In response, in England we have the

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bowel Scope screening programme and the bowel cancer programme, which

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complemented each other, and the impact of that is that we can really

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make a huge impact. I went into more detail on my response to the debate,

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but I think that is the key to identifying more people and

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preventing them dying from this disease. I have received many

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representations on the effect of liberties safeguards, including the

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impact on health and care budgets. The honourable lady is a respected

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choice on the safeguards, and there is ongoing work to address it. It is

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costing Stockport Council 1.2 million this year for deprivation of

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liberty assessments as a result of the Cheshire West judgment. Not 1p

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provides social care. This is unsustainable at a time when budgets

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are under pressure and something needs to be done now. We cannot wait

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for the Law Commission. With the Minister consider scrapping costly

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automatic annual assessments? I will happily look at anything that might

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help. We are caught in this process of trying to deal with a court

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judgment and the issues surrounding mental capacity issues, which are

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serious and cannot be changed quickly. We are now close to hearing

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the Law Commission's post-consultation proposals. Inmate,

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they will oblige the analysis. I would look at any suggestion that

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could help this practically. When the new legislation is introduced,

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can he confirm it will be simpler to understand, resulting in fewer

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bereaved relative spacing delays when a loved one dies in care? He is

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absolutely right. What has caused the confusion has been a definition

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of loss of liberty and dying in state detention. Whatever the new

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legislation proposed, it has got to meet a much simpler test, and has

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the meat what it says, so it does not get disrupt did in the courts

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again. -- disrupted. Apologies. UK Government takes the issue of

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prevention and I notice that diagnosis of hepatitis seriously.

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Key stakeholders are looking to develop operational delivery

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networks. The Scottish Government provides treatment for all those

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with sensitive hepatitis C, including those infected with

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contaminated blood. This transforms the lives of patients and reduces

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the risk of further infection in the population. Will the Minister

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provide similar access to treatment in England? Well, obviously Nice

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have given guidance on the docks, so the treatment are effective compared

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to what was previously available. The NHS is rolling out its response,

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it has already treated hundreds of people, and there is a commitment to

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treat thousands next year. Look more widely how we can tackle these

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issues, not least in the context of the tragedy of infected blood. What

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discussions has she had with her counterparts in Northern Ireland

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regarding the deduction and eradication of hepatitis C, and does

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she agree it is important we have a strategy that encompasses all of

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Great Britain and Northern Ireland? Absolutely. Looking at all aspects

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of how we eliminate hepatitis C is important, but it should not be

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underestimated what a difficult job this is, largely because a lot of

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people are not aware that they have no symptoms -- they are not aware,

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as they have no symptoms. There is always more we can do.

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Can I start by echoing my honourable friend's thoughts for the people of

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rustles with whom we stand shoulder to shoulder? Turning to question

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number four. In my statement of the house on the 11th of debris I gave

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abroad like -- out line on the new training for doctors and dentists.

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I'm still reviewing the exact terms along with the equality impact

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assessment. When the Secretary of State declared he was imposing the

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contracts and junior doctors last month, he claimed that the support

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of senior NHS leaders was his. As foundation trusts offer their own

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terms how does he envisage enforcing this contract? The fact is that we

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consulted widely with NHS leaders about the terms of the new contract

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and they confirmed that it was fair and reasonable. Any decision to

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proceed with the new contract when it is not possible to have a

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negotiated settlement is inevitably controversial, but what we wanted to

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do was make sure that the terms of the contract, things that

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independent people put there. I think we have done that. And junior

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doctors seek their new contracts, which they will do shortly, they

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will think that we were right to say so. Underlying the dispute about the

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junior doctors is the long-standing problem of morale and the failure to

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pay attention to the experience of junior doctors in training. Can I

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welcome the government decision to launch an independent review and can

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they ask my right honourable friend to give an update on the timing of

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that review? As she speaks with great knowledge about NHS matters,

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she is right that some of the underlying issues are nothing to do

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with contractual terms but to do with the big changes in the way

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training has happened over recent years, in particular the loss of

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camaraderie that was part of the deal for junior doctors in training.

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We would like to see if we could restore some of the things that have

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gone on the wrong direction. We have not yet have the cooperation of the

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BMA in this independent review, led by Doctor Sue Bailey. I hope the

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local operate with this because I think there is a big opportunity to

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sort out long-standing problems. There are currently 4500 trainees in

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the NHS and junior doctors are having to cover these, often having

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to do extensive extra shifts and even having to cover two jobs at the

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same time. It looks as though this will get worse as fewer than half of

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the most junior trainees have applied for ongoing training this

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year. Does the Secretary of State except that this represents a

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serious threat to patient safety? The purpose of these changes is to

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improve patient safety, in particular to deal with the issue

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that we have higher mortality rates for people admitted at weekends than

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we do in the week. Because of the very confrontational approach taken

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by the BMA it has been difficult to negotiate an agreement that we are

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committed to doing the right things. What is right for patients is also

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right for doctors. We have been talking about morale and the biggest

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way to dent the morale of doctors is to prevent them getting the care

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that they want to give to patients. Can I suggest that what is also good

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for doctors is also good for patients and the people who are

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being text that four or five times a day to be asked to do a second shift

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to cover for a junior and a senior post at the same time is not good

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for either. The Secretary of State on the 11th of February said he was

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imposing the contract to bring stability to the NHS. That is not

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exactly gone well. Can I ask what it is but I'm going forward to

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re-establish his relationship with junior doctors and get us back to

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where we are now? With the greatest respect, we are trying to solve a

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problem that in Scotland is being done it. The seven-day NHS with

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mortality rates that are no higher at weekends. There is no plan in

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Scotland to deliver that across the whole NHS and I think than rather

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than sniping she should recognise that in the interests of patient

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safety we do need to take difficult decisions and in the end doctors

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will see this was the right thing for them, as well. Can I say on

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behalf of the opposition, I would like to associate ourselves with the

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comments made by ministers about the tragic events in Brussels and offer

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our condolences and solidarity to the people over there. Yesterday in

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Westminster Hall there was a debate calling on the Health Secretary to

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resume meaningful contract negotiations with the BMA. The

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Health Secretary was not there. If he had been there he would have

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heard his junior minister confirm that since they announced the

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position the government has made no temp two attempt further industrial

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action. They know there is more industrial action coming Dave Ward

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to patients to get off their backsides and do something to

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prevent it? Let me say to the honourable gentleman, the reason

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that we made the decision to proceed with the new contract is because we

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had independent advice that a negotiated settlement was not

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possible and on that basis we decided it was important to have

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certainty for the service by making clear what the new contract is. The

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contract we have decided to do his contract that strikes at the

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midpoint between what the government wanted and what the BMA were asking

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for. It is a better contract for patients and I think the Labour

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Party should support it if there were really on the side of patients.

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The government is committed to delivering the vision set out in

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future in mind and the striving for the major systemwide transformation

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programme working alongside partners in government to improve access to

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high-quality support across the country. Will he join me in

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congratulating the charity Young minds for the important but it does

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in highlighting the challenges young people facing mental health, not

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least from this so far -- so-called dark net and social media? We must

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make sure that the Internet is a positive not negative force in

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tackling mental health challenges for young people? Young minds and a

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range of other partners, the work that they do to ensure that young

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people can information safely is commendable. Children and young

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people and their parents have expressed the need to be able to

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access both high quality and reliable information and support

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online and this was reflected in the future in mind report. We are

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investing with a number of different groups and organisations working on

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applications for young people and it is important that they have access

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to safe material in order to exclude those places rather darker. Walk-in

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centres run by experienced GPs can offer important support of those

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children with mental health problems, yet popular walk-in

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centres that were established by local GPs in my constituency are now

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being put out to tender, putting at risk the leadership and involvement

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by those experienced GPs of the centres. Will the Minister give

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guidance to the NHS procurement authority that walk-in centres

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should be led by local GPs with experience of that area? I look at

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what the red envelopes -- Right Honourable gentleman says. I am not

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responsible for individual commissioning decisions and the

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commissioners will have full regard to the needs of the local population

:20:16.:20:18.

when they are putting these services are out. It is important that access

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is increasingly available or that GPM primary level as well as other

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areas with the government is investing further money. I will have

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a look at what he says. Can the Minister informed the house as to

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what dialogue is maintained between his department and the Department

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for Education to make sure that these issues are signposted as early

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as possible? There is a growing relationship with the Department for

:20:45.:20:47.

Education knife. For the first time we have the Minister responsible for

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mental health in the department. There is a schools champion for

:20:54.:20:57.

mental health limit the other day. We worked very closely together to

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deliver that vision set out in future in mind and we work with the

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Department for Education, there is a ?1 million pilot project to find the

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right people in schools in order to deal with mental health issues. That

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is working across 22 schools. There is much greater recognition now that

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the earlier you can pick up these things the better it is for

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youngsters and their future mental health. Eating disorders in children

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and teenagers cause is life that -- life-threatening health problems and

:21:32.:21:35.

even death. What steps of the Minister taking to enable early

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intervention which result in better prognosis and support closer to

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home? Two things can help the honourable lady. The commitment to

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?30 million a year built in the budgets over the next five years to

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support those with eating disorders in a conference on this last week.

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Also earlier detection on eating disorders. By 2020 we will reckon

:21:58.:22:06.

95% of urgent cases will be seen within a week and routine cases for

:22:07.:22:09.

weeks. There is a recognition of the real dangers -- real danger posed by

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eating disorders and it is important to recognise that. Earlier this

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month school and College leaders reported a large rise in student

:22:20.:22:23.

suffering from anxiety. Two thirds said that they struggled to get

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mental health services for their pupils and of those that have

:22:28.:22:31.

preferred a student the majority rated them for very poor. Despite

:22:32.:22:35.

the Minister was not warm words things are getting worse, not

:22:36.:22:38.

better. Can confirmed today that single penny promised the children's

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mental health will reach those services and that none of this money

:22:44.:22:46.

will be used to plug the gap in hospital budgets? Following long

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conversation between myself, the NHS and the treachery I can indeed give

:22:56.:23:01.

the honourable lady that insurance -- Ashya rents. Every penny pledged

:23:02.:23:07.

in the budget for cans and eating disorders will be spent on

:23:08.:23:10.

children's mental health at the end of this Parliament. It is not fair

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for her to constantly say that nothing is happening. The first lot

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of that money is being spent nine. ?75 million the CCG is, ?75 million

:23:21.:23:29.

for eating disorders, ?15 million for perinatal, ?25 million were

:23:30.:23:32.

other issues involving training. That is money already committed in

:23:33.:23:36.

being spent night. The problem that she relates to our high priority and

:23:37.:23:42.

are being plugged it. By his own admission in response to

:23:43.:23:46.

parliamentary questions he is going to understand this year by ?77

:23:47.:23:50.

million on his pledge to spend ?250 million and will underspend by ?11

:23:51.:23:55.

million on his 15 million plug -- pledged that perinatal mental

:23:56.:24:04.

health. Does he agree with Labour today that every child should

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receive personal social and health education so that young people are

:24:09.:24:10.

equipped with the resilience to better support their mental health?

:24:11.:24:16.

You can't have it both ways, it would seem. I have given a pledge

:24:17.:24:21.

which he asked for in her first question, the ?1.4 billion committed

:24:22.:24:28.

to mental health. It is no wonder that first tranche has not been

:24:29.:24:34.

fully committed. Some money has the rollover. I have made absolutely

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sure that that money will be spent including on perinatal services

:24:39.:24:42.

which will reach a much better pitch them in Whee Kim in the office. That

:24:43.:24:48.

work will be done. In relation... It is not a matter for this department.

:24:49.:24:52.

I fully agree that it is very important that children have this

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information. The pressure caused by social media requires that the

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children have a very modern understanding of personal health and

:25:04.:25:05.

social education and Italy supported. Can I gently point out to

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colleagues that as usual at this stage we have got a lot to get

:25:13.:25:16.

through. We do need to speed up a bit. Question number six. There is a

:25:17.:25:25.

long waiting list of colleagues. Our ground-breaking 100,000 June object

:25:26.:25:30.

and notes by the Prime Minister represents the moonshot of medicine

:25:31.:25:35.

in making the UK's diverse nation on earth this ignores the entire

:25:36.:25:40.

genetic sequence of 100,000 genomes from NHS patients. We are winning

:25:41.:25:52.

international plaudits, and attract ten inward investment. I recently

:25:53.:25:59.

visited a school in Nottingham and saw the great work being carried out

:26:00.:26:05.

there including ground-breaking genomics work. Will the Minister

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outlined the support his department is providing to ensure workers fully

:26:10.:26:13.

funded and expanded to make sure that the East Midlands and the UK

:26:14.:26:18.

continue to be world leaders in the search for treatment and ultimately

:26:19.:26:20.

a cure for Alzheimer's based on our research? Can I started paying

:26:21.:26:25.

tribute to my honourable friend. She had a distinguished scientific

:26:26.:26:30.

career, including setting up in business. She is right to highlight

:26:31.:26:34.

the work at Nottingham University which represents something of an

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East Midlands powerhouse. The Nottingham University Hospital NHS

:26:40.:26:43.

Trust as part of the East of England genomic medicine centres, which is

:26:44.:26:50.

becoming one of our hubs. We are actively supporting research into

:26:51.:26:52.

Alzheimer's in addition to our billion pound a year research

:26:53.:26:58.

project the 100 and 50p -- ?150 million dementia Institute.

:26:59.:27:08.

We remain committed to achieving parity of esteem in mental health.

:27:09.:27:23.

We will work to in the recommendations in

:27:24.:27:40.

the policy. Bidders are concerned that services are ... In my

:27:41.:27:49.

honourable friend's area, an analysis of the impact of the new

:27:50.:27:55.

beds shows that the average distance travelled has improved from 114

:27:56.:28:03.

miles in 2014, 239.9 miles in 2016. But it is not enough to simply

:28:04.:28:06.

provide more beds. We have to provide more community-based

:28:07.:28:16.

treatment. I was delighted that the report endorsed the plan was put

:28:17.:28:26.

forward by myself Under-Secretary of State, so people with mentally ill

:28:27.:28:30.

health have the same rights to treatment in time as others. I was

:28:31.:28:36.

glad the government endorsed the plan, but dismayed that Simon

:28:37.:28:41.

Stevens then confirmed there was no money to implement this. How will he

:28:42.:28:44.

ensure that the comprehensive waiting times standards and

:28:45.:28:51.

implemented? If anything, the questions are getting longer! The

:28:52.:28:58.

question was far too long. Firstly, the first set of waiting times

:28:59.:29:03.

standards, the first ever by a government, are already in place.

:29:04.:29:08.

50% of people experiencing an episode of psychosis will be treated

:29:09.:29:14.

within two weeks. We have to get the database right. The right honourable

:29:15.:29:18.

gentleman will know that we are doing a much greater data trawl, to

:29:19.:29:24.

find clear these waiting times can be set. Progress has been made on

:29:25.:29:45.

many of the key ambitions set out. Transformation plans that cover

:29:46.:29:52.

young people and adults mental health issues,... This month the

:29:53.:29:59.

mental health network representing NHS providers said very little if

:30:00.:30:05.

any of the money promised for child and adolescent mental health has

:30:06.:30:09.

materialised, in some areas are experiencing a cut. He much accept

:30:10.:30:12.

that the efforts in this department in getting the money out the door

:30:13.:30:24.

has been woeful. I did give a list we're the money is currently being

:30:25.:30:30.

spent. I think I can help the honourable lady and gentleman. More

:30:31.:30:35.

has been done to make sure that CCGs deliver what they can in relation to

:30:36.:30:39.

mental health. The figures show that there has been a 3.7 uplifting

:30:40.:30:47.

CCG's, so more transparency and determination to make sure that what

:30:48.:30:52.

they are currently seeing and feeling will become less and less in

:30:53.:31:00.

the future. In 2010 the country faced a deficit that constituted 11%

:31:01.:31:04.

of GDP, so all major political parties committed to plans reducing

:31:05.:31:09.

government spending including on health, as a proportion of GDP.

:31:10.:31:16.

Because of this government's commitment, spending on this will

:31:17.:31:24.

increase over the decade. Former Coalition Minister has written that

:31:25.:31:30.

during the previous government... The health service required an

:31:31.:31:37.

additional ?30 billion. He was allocated only 8 billion by the

:31:38.:31:41.

tragedy. The savage cut, isn't that the root cause of all the problems,

:31:42.:31:50.

and does it not make sense the government should not be cutting

:31:51.:31:55.

this? What he describes as a savage cut was a real terms increase of ?10

:31:56.:32:01.

billion a year. ?5.5 billion more than his party was proposing. Does

:32:02.:32:08.

my right honourable friend agree that as well as focusing on health

:32:09.:32:14.

input and how much we spend on the NHS, it is also important we focus

:32:15.:32:20.

on health outcomes. He is right, which is why I am so proud that

:32:21.:32:24.

under this Conservative Government we have that 27 hospitals into

:32:25.:32:30.

special measures, 11 have come out of special measures, and we are

:32:31.:32:35.

improving standards and quality of care, the number of people being

:32:36.:32:39.

treated across the board, so I put matters, which is what the

:32:40.:32:47.

government will deliver. The Health Secretary may talk a good game when

:32:48.:32:51.

it comes to funding, but the reality in accident and emergency

:32:52.:32:55.

departments and GP surgeries tells a very different story. The whole

:32:56.:33:01.

system is on its knees and the revelations of the former Chief

:33:02.:33:03.

Secretary to the Treasury this weekend confirmed what everyone in

:33:04.:33:08.

the NHS already knew, ?22 billion worth of efficiency savings over the

:33:09.:33:17.

next four years is pure fantasy. So in the interests of transparency,

:33:18.:33:20.

will the Health Secretary now publish the full analysis explaining

:33:21.:33:25.

how NHS England arrived at the figure of 22 billion? Let us look at

:33:26.:33:32.

what the chief of NHS England actually said, not what he is

:33:33.:33:38.

alleged to have done, which he denies. He said that when it came to

:33:39.:33:42.

the Spending Review, the government listened to and actively supported

:33:43.:33:46.

the case for spending, and he could kick-start his plan for the NHS. But

:33:47.:33:52.

it is rather academic because Labour refused to fund his plan at all,

:33:53.:33:55.

which goes to show that when it comes to the NHS, Labour right the

:33:56.:34:01.

speeches, but conservative right the checks. I did not ask the Health

:34:02.:34:08.

Secretary what the chief executive of the NHS said. I asked him to

:34:09.:34:12.

publish the analysis, which lays behind the 22 billion figure. He

:34:13.:34:17.

will not publish that because he knows that the only way to achieve

:34:18.:34:20.

these politically motivated efficiencies is to make cuts to

:34:21.:34:28.

staff and cuts to pay. Truth is, the NHS survives on the goodwill of its

:34:29.:34:32.

staff. And yet this Health Secretary has pushed the goodwill to breaking

:34:33.:34:38.

point. Let me ask him this. How does he expect to improve current

:34:39.:34:44.

services, let alone deliver a seven day NHS with fewer staff and a

:34:45.:34:52.

demoralised workforce? Under this government staff have gone up.

:34:53.:34:56.

11,000 more doctors, 12,000 more nurses, and if she is worried about

:34:57.:35:02.

NHS funding, perhaps she might look in the mirror because in 2010 her

:35:03.:35:07.

party wanted to cut funding to the NHS, in Wales they did cut funding

:35:08.:35:17.

for the NHS, in 2015 and they put in a lot less. The NHS needs more

:35:18.:35:23.

doctors, more nurses, and only the Conservatives can deliver that.

:35:24.:35:32.

Number ten. Mr Speaker, in the Department we assessed staff morale

:35:33.:35:39.

in the NHS using engagement scores from the staff survey, I am

:35:40.:35:41.

delighted to say that the score currently runs at 3.78 out of five,

:35:42.:35:47.

a rise from the 2010 figures when the survey began, when it was at

:35:48.:35:55.

3.68. In the same staff survey it shows that midwives are stressed.

:35:56.:36:01.

90% of them are working extra shifts unnecessarily. There is also the

:36:02.:36:09.

case I have raised of the radiographer who was sacked for

:36:10.:36:16.

exposing bribes at Ealing Hospital. She is yet to have a response, apart

:36:17.:36:21.

from the Francis review, which has yet to be commented anyway. -- to be

:36:22.:36:36.

implemented. She is wrong about the recommendations which are being

:36:37.:36:41.

implemented in full. She should look at the results of the staff survey.

:36:42.:36:47.

The number recommending the trust is a place to receive treatment has

:36:48.:36:52.

gone up. We would like to address the staff survey. This is a balanced

:36:53.:37:02.

and overall positive return from the survey. Can he confirmed that as

:37:03.:37:14.

important as staff morale, in NHS hospitals, patient morale is

:37:15.:37:21.

improving considerably as well? He is right. The returns from the test

:37:22.:37:26.

shall increasing satisfaction from patients of the NHS. How does the

:37:27.:37:32.

Minister think it affects staff morale the year the government's

:37:33.:37:35.

constant refrain of implementing seven-day working, such as the ball

:37:36.:37:43.

-- pathology staff who have offered this for many years? Staff morale

:37:44.:37:51.

has gone up over the past few years. It is not helped when the nature of

:37:52.:37:56.

the junior doctors contract has been misrepresented. If they were to look

:37:57.:38:03.

at this, they would see further improvements in staff morale. Staff

:38:04.:38:08.

morale at upfield Community Hospital is exceptionally high partly due to

:38:09.:38:14.

receiving 100% in recent friends family survey. With he joined me in

:38:15.:38:22.

congratulations and nurses, volunteers and front staff in the

:38:23.:38:29.

hospital? I will happily congratulate the staff. It shows

:38:30.:38:32.

we're good constituency representation reinforces efforts of

:38:33.:38:39.

people in hospitals can improve staff morale. In a recent survey 17%

:38:40.:38:54.

of GPs said the quality of service was becoming unmanageable. Too many

:38:55.:39:00.

patients needing treatment. We now have a decrease in the applications

:39:01.:39:04.

for GP training places, which is one of the last cohorts to be trained by

:39:05.:39:09.

2020. Unless the Minister takes drastic actions to address GP

:39:10.:39:14.

morale, workload and recruitment, patient care will just get worse.

:39:15.:39:23.

What is he going to do? There will be 5000 additional GPs by the end of

:39:24.:39:26.

this Parliament, and that is what she is raising. I am not sure why

:39:27.:39:34.

she is shaking her head. We're also putting a greater proportion of

:39:35.:39:43.

funding into the NHS. And weird increasing the number of GP training

:39:44.:39:47.

places, and we are doing well in ensuring more people are choosing to

:39:48.:39:56.

become general practitioners. Trust split into special members have

:39:57.:40:03.

recruited 4190 more nurses, with one estimate saying this has reduced

:40:04.:40:09.

mortality rates by up to 450 year. In the last six years the north

:40:10.:40:14.

Cumbria trust has had four Chief Executive is, and acquisition going

:40:15.:40:18.

nowhere, a so-called success regime, reporting later than intended. There

:40:19.:40:24.

are clearly tough decisions to be made, and the sooner they are made,

:40:25.:40:28.

the better. Can he undertake to ensure the recommendations of this

:40:29.:40:32.

implemented in full and in a timely manner? I would like to thank him

:40:33.:40:38.

for his consistent campaigning on behalf of his local trust. He is

:40:39.:40:43.

right, there are big issues. He is also right that generally the NHS

:40:44.:40:47.

has two quick turnover of Chief Executive is. They have a new one,

:40:48.:40:53.

who is one of the top-rated health chief executives. Mortality rates

:40:54.:40:58.

are going down. So I will support him and of the way I can to resolve

:40:59.:41:01.

the situation as quickly as possible. Because the Manor Hospital

:41:02.:41:06.

is in special measures, all mothers to be being denied the right of the

:41:07.:41:13.

choice to have their babies here. And the Secretary of State confirmed

:41:14.:41:14.

they are safe staffing levels We have 83 more doctors and 426 more

:41:15.:41:31.

nurses there since 2010. There is a quality improvement plan in place.

:41:32.:41:38.

Can I thank the honourable member for raising this. Mess Ophelia is a

:41:39.:41:46.

terrible disease. The government is completely committed to supporting

:41:47.:41:49.

treatment, prevention and compensation. In the last three

:41:50.:41:52.

months my noble friend has had discussions with interested parties

:41:53.:41:57.

and the Chancellor was able to announce ?5 million of funding for a

:41:58.:42:05.

new research centre. The British Lung foundation has welcomed the ?5

:42:06.:42:10.

million announced. Can the Minister confirm when the funds will be -- be

:42:11.:42:16.

released for the centre and hide the funding will be going forward? We

:42:17.:42:22.

are in active discussions with the various parties and we have received

:42:23.:42:27.

some interesting submissions from the research institutes. We will be

:42:28.:42:32.

looking in the coming weeks of how best to use than ?5 million to build

:42:33.:42:38.

UK leadership in this field. Number 14, please. NHS England is working

:42:39.:42:45.

with muscular dystrophy UK to the bridging the Gap project looking at

:42:46.:42:48.

issues such as the provision of cough assist machines. The number of

:42:49.:42:55.

CCG is have no commission policies for these devices based on a policy

:42:56.:43:06.

developed by Walsall. 21-year-old Freddie Kemp, he had muscular

:43:07.:43:13.

dystrophy, sadly died of cardiac complications. He had been refused

:43:14.:43:19.

permission by his CCG. While the Minister said he is working with UK

:43:20.:43:24.

muscular dystrophy, will he meet with representatives from that

:43:25.:43:28.

organisation to discuss what be done to get CCG is to prioritise these

:43:29.:43:36.

important machines? Of course I will meet any groups concerned with this.

:43:37.:43:42.

The clinical evidence has divided about the efficacy of cough assist

:43:43.:43:46.

machines over manual massage, but this is something that Walsall CCG

:43:47.:43:51.

has sought to resolve. There it is a template that others might wish to

:43:52.:44:02.

follow. Question number 15. NHS England will invest ?2 million over

:44:03.:44:08.

the next two years to run together with Public Health England Hurley

:44:09.:44:11.

implemented test sites which will seek to answer and meaning questions

:44:12.:44:14.

about how clap could be commissioned in the most cost-effective way to

:44:15.:44:18.

reduce HIV and sexually transmitted infections for those at highest

:44:19.:44:25.

risk. Yesterday NHS England scrapped plans for brand trap. Can the

:44:26.:44:30.

Minister Teller said there is anything she can do to put an end to

:44:31.:44:34.

this inconsistent decision-making? That she agree with me that the

:44:35.:44:39.

decision yesterday to stop the roll-out of this drug contradicts

:44:40.:44:46.

the desire to stop HIV? The management team had NHS England did

:44:47.:44:51.

make that decision and I think NHS England recognises that the decision

:44:52.:44:56.

could been taken earlier. There is also recognition the valuable work

:44:57.:45:01.

has taken place. NHS England has undertaken that valuable work. There

:45:02.:45:05.

are important lesson that have been learnt and we don't want to lose

:45:06.:45:09.

that. Neither is a case of working with NHS England and Ph.D. To

:45:10.:45:14.

understand how we can take things forward including learning from the

:45:15.:45:21.

test sites. I share some of the concerns with the honourable member

:45:22.:45:27.

on the roll-out of clap. It is only one tool in HIV prevention. Did the

:45:28.:45:31.

Minister update the house in progress on the HIV prevention

:45:32.:45:38.

innovation fund? He is right to draw the attention of the house to the

:45:39.:45:44.

fact that it is only one part of it, albeit we understand the importance.

:45:45.:45:47.

He is right to mention the innovation fund, which he champions.

:45:48.:45:53.

We have invested up to ?500,000 in new and innovative ways to tackle

:45:54.:45:57.

HIV and some excellent organisations came forward with innovative

:45:58.:46:03.

approaches. We have also established the first national HIV home sampling

:46:04.:46:11.

service. Topical questions. Topical number one, Mr Speaker. The latest

:46:12.:46:13.

performance figures show that challenges the NHS racism problem

:46:14.:46:17.

with extraordinary levels of a man but despite these pressures the

:46:18.:46:23.

government is making good progress in our ambition that NHS care should

:46:24.:46:26.

be the best in the world. Figures from the health foundation showed

:46:27.:46:30.

that the portion of patients being harmed has fallen by over a third in

:46:31.:46:36.

the last three years. MRSA infections have been hath antsy but

:46:37.:46:38.

the sale infections have rocked by a third. The five-year forward

:46:39.:46:46.

Giuseppe NHS would need between eight and ?21 billion from the

:46:47.:46:50.

Treasury extra bite 2021. It got the commitment of eight billion pounds.

:46:51.:46:55.

Can the Secretary of State say when the Stevens plan will be formally

:46:56.:47:00.

reviewed and where in the range of eight up to 21 billion is the real

:47:01.:47:05.

requirement will be fine to lie? We are putting in ?10 billion of

:47:06.:47:11.

additional public money to support the NHS over the next few years.

:47:12.:47:17.

That does mean that we need to find between ?20 billion and ?22 billion

:47:18.:47:22.

of efficiency savings. We will be reviewing the progress of the plan

:47:23.:47:25.

as we go through it. I want to reassure him that they meet the

:47:26.:47:31.

chief executive of NHS England to review the plan every week and we

:47:32.:47:34.

are determined to rule it out as quickly as possible. I would like to

:47:35.:47:39.

express my sadness at the news that two people in my constituency lost

:47:40.:47:42.

their lives in a house fire yesterday. My thoughts are with

:47:43.:47:48.

their family and friends. The Coalition Government legislated for

:47:49.:47:52.

NHS hospitals earn up to 49% of the money from private patients.

:47:53.:47:55.

Hospital and might constituency is highly valued. With the ministers

:47:56.:48:03.

see an increase in the number of NHS veggies for private patients and a

:48:04.:48:07.

decrease used for NHS patients as a sign of success or a sign of

:48:08.:48:13.

failure? The matter of beds is entirely for the trust to decide.

:48:14.:48:17.

NHS patient should always come first. Last decade Crawley Hospital

:48:18.:48:26.

under the Labour government saw its accident and emergency and maternity

:48:27.:48:31.

units ) who's to say that in recent years we have seen the casualties

:48:32.:48:35.

services returning as well as a GP out-of-hours services and greater

:48:36.:48:41.

numbers of beds. Would he join me in congratulating the NHS that in my

:48:42.:48:44.

constituency who worked so hard to deliver these new services? I am

:48:45.:48:50.

delighted to do that and join him in congratulating staff at his

:48:51.:48:59.

constituency. They are seeing 36,509 more people less -- in less than

:49:00.:49:05.

four hours compared to six years ago. They are meeting their targets,

:49:06.:49:15.

so it is a very good performance. Scotland has consistently

:49:16.:49:18.

outperformed all other nations in the UK on a anti-performance over

:49:19.:49:22.

the last year. I think the's performance dropping in every single

:49:23.:49:28.

month since weekly publication was abandoned last July, does the

:49:29.:49:30.

Secretary of State think it is time to return to more frequent analysis

:49:31.:49:35.

and eliminate the obfuscation of the six-week delay in publication? I am

:49:36.:49:41.

somewhat surprised that the complacency in the honourable

:49:42.:49:45.

gentleman's questions after audit Scotland identified in the autumn

:49:46.:49:48.

that performance in seven out of the nine key targets for the Scottish

:49:49.:49:53.

NHS have deteriorated in the last three years. Spending since 2009 has

:49:54.:49:58.

fallen in Scotland as opposed to increasing in England. Spending on

:49:59.:50:03.

private sector dividers is increasing so they should think

:50:04.:50:05.

about that before they criticise what is happening in England. Often

:50:06.:50:13.

successful cardiopulmonary resuscitation involves knowing where

:50:14.:50:16.

the nearest public access to favourite nature is located. In my

:50:17.:50:22.

constituency of Twickenham it is hard to find out exactly where all

:50:23.:50:27.

of these fibril agers are located. Will the Minister as the Department

:50:28.:50:31.

of Health to do a live mapping of public access the fibril agers, and

:50:32.:50:38.

also as that every work face with a first aid point has a clear sign

:50:39.:50:42.

where the nearest the fibril agers is located? This work is already in

:50:43.:50:49.

hand to the British Heart Foundation. I would like to have

:50:50.:50:52.

that last week the Chancellor announced another ?1 million to make

:50:53.:50:55.

public access the fibril agers and CPR training more widely available.

:50:56.:51:01.

Coupled with last year's funding of a million there is over 690 more the

:51:02.:51:08.

fibril agers across England. That mapping work is very important and

:51:09.:51:16.

you are right to raise it. I believe the publication today of the

:51:17.:51:18.

governance review will show that serious harm was caused to patients

:51:19.:51:24.

and staff, that there was such a culture of bullying and harassment

:51:25.:51:28.

even after the Francis Report that the Liverpool community trust is the

:51:29.:51:31.

community equivalent of mid Staffordshire. In the spirit of

:51:32.:51:38.

openness and transparency, will he instigate a public enquiry to

:51:39.:51:42.

establish the full extent of the harm that has been caused to

:51:43.:51:53.

patients and staff? May I commend the honourable member for the brave

:51:54.:51:54.

stand that she has taken on this difficult issue? I will take her

:51:55.:51:56.

concerns very seriously. I want to read the report that has been

:51:57.:52:01.

delivered and I will speak to her as early as possible to establish a

:52:02.:52:04.

local governments and commissioners can take this forward. It is

:52:05.:52:09.

imperative that the NHS has the best possible culture. People should have

:52:10.:52:16.

the freedom to speak up and the whistle. Colchester Hospital,

:52:17.:52:24.

insurance premiums under the clinical negligence scheme at more

:52:25.:52:27.

than double the 11.2 point 2,000,004 years. What steps is the department

:52:28.:52:34.

taking to reduce this figure? The honourable gentleman points the

:52:35.:52:37.

variations across the service, sometimes premiums go up or down in

:52:38.:52:42.

different trusts. I would be happy to speak to him further about what

:52:43.:52:48.

we are doing. Does the Secretary of State agree that this week's public

:52:49.:52:51.

debate around best feeling has been both destructive and condemning for

:52:52.:52:58.

those women who suffer from postnatal depression and struggle to

:52:59.:53:02.

bond emotionally with their children? Do we need to reframe the

:53:03.:53:06.

public debate and reduce rather than reinforce this stigma? As the

:53:07.:53:16.

Minister for mental health services takes forward the increase in

:53:17.:53:19.

funding in perinatal mental health he will be wanting to work with me

:53:20.:53:23.

around breast-feeding rates and the relationship between breast-feeding

:53:24.:53:32.

and mental health. If my honourable friend aware of the agreement struck

:53:33.:53:35.

by President Obama and president Moody of India to collaborate on

:53:36.:53:40.

research and development for traditional medicines for palliative

:53:41.:53:46.

and preventative cancer care? Shouldn't we be aiming for a similar

:53:47.:53:51.

agreement, bearing in mind antimicrobial resistance? It is

:53:52.:53:58.

worth saying that NICE does not recommend homoeopathy for any

:53:59.:54:05.

condition. Antimicrobial resistance, we see increasing studies showing

:54:06.:54:09.

that resistance to common problems is growing and that serves to

:54:10.:54:14.

underline the importance of the responsible stewardship of all drugs

:54:15.:54:17.

and medicines and by the international efforts are so

:54:18.:54:26.

important. Given the latest very worrying reports about goings-on at

:54:27.:54:32.

the office of the health service ombudsman, does the Secretary of

:54:33.:54:34.

State still have confidence in the leadership of this vital regulator?

:54:35.:54:41.

I have expressed my concerns on behalf of patients about some of the

:54:42.:54:44.

things that have been happening there but I respect the fact that it

:54:45.:54:48.

is a matter for this house and not for the government, and in

:54:49.:54:52.

particular for the relevant committee of this house to deal

:54:53.:54:56.

with. I do have concerns and I think it is very important that patients

:54:57.:55:01.

have confidence in the ombudsman because that is the vital

:55:02.:55:04.

independent avenue that they have the challenge NHS trusts when things

:55:05.:55:11.

go wrong. Would my right honourable friend joined me in congratulating

:55:12.:55:15.

the Chief Executive Glenn Burley and the whole team at Warwick Hospital

:55:16.:55:18.

for delivering the new excellent orthopaedic ward? Would he tell the

:55:19.:55:25.

house will support the NHS is being given for similar state-of-the-art

:55:26.:55:31.

facilities across the country? I am delighted to join my honourable

:55:32.:55:34.

friend and congratulation and confirm the announcement in the

:55:35.:55:37.

Autumn Statement that we are committed to ?4.8 billion extra

:55:38.:55:44.

capital neurons year to the 2021, that will include funding for proton

:55:45.:55:48.

beam therapy and major new hospitals, in addition to arm

:55:49.:55:54.

billion pound a year for NHS research and more funds for medical

:55:55.:56:00.

research. The financial year ends next week so can I ask the Secretary

:56:01.:56:04.

of State by then what does he expect the NHS provider budget deficit to

:56:05.:56:12.

be? We know that the deficit is going to be bigger this year and we

:56:13.:56:16.

know there is extreme pressure. Part of the reason for that is because

:56:17.:56:20.

NHS trusts have rightly said that they want to make sure that their

:56:21.:56:23.

water properly staffed in the wake of what happened that mid

:56:24.:56:28.

Staffordshire, but they have done so by using unsustainable agency staff

:56:29.:56:31.

so the most important thing that we need to do is to move the permanent

:56:32.:56:35.

full-time staff rather than agency staff, which are too expensive and

:56:36.:56:40.

not good for care. A number of my constituents are unable to access an

:56:41.:56:45.

NHS dentist. Can I have the Minister to look at the availability of NHS

:56:46.:56:50.

dentists in my constituency and use his good offices to ensure that

:56:51.:56:54.

there is enough capacity for all of my constituents who want to use an

:56:55.:56:58.

NHS dentist to be able to use a good local NHS dentist?

:56:59.:57:02.

overall access to NHS dentistry is good, but it

:57:03.:57:07.

varies from area to area. It is one of the areas that worries us, and we

:57:08.:57:15.

are trying to do more about it. Work is being undertaken to look at

:57:16.:57:18.

issues around NHS dentistry. I have met with a number of honourable

:57:19.:57:23.

members about this. I will monitor the issue closely. Analysis revealed

:57:24.:57:32.

that is not 10 billion that is going to be the increase in real terms to

:57:33.:57:37.

the NHS, but 4.5 and Ian. Will the Health Secretary apologise for

:57:38.:57:43.

misleading not just this House but the public as a whole. The

:57:44.:57:51.

honourable lady mustn't accuse a member of the House of misleading

:57:52.:57:56.

it. If she wishes to insert the word inadvertently, she would spring back

:57:57.:58:01.

into order, which I am sure she would wish to be. Do I take it that

:58:02.:58:07.

the word inadvertently has been inserted? I am happy to insert

:58:08.:58:14.

inadvertently. She may have inadvertently not been listening to

:58:15.:58:20.

previous answers I gave! Let us look at what Simon Stevens, the Chief

:58:21.:58:24.

Executive of the NHS, said about the spending settlement. He said the

:58:25.:58:27.

government listened to two and actively supported the NHS case for

:58:28.:58:34.

public spending. The chair of the health select committee. Following

:58:35.:58:40.

the welcome announcement of a graduated levy on a sugar

:58:41.:58:47.

unsweetened -- sugar unsweetened drinks manufacturers, could she tell

:58:48.:58:52.

us what discussions she is having to speed up the reformulation process,

:58:53.:59:00.

and given the importance of child obesity, with the Department welcome

:59:01.:59:03.

the opportunity to take over leading on this strategy, in order for us to

:59:04.:59:13.

make progress on this vital issue? A number of invitations, some of which

:59:14.:59:19.

I will resist. My honourable friend is right to highlight the importance

:59:20.:59:22.

of this announcement, and obviously it will be a first step into the

:59:23.:59:32.

government's strategy. The Chancellor was right to go ahead

:59:33.:59:35.

with this, to move forward. The burden of childhood obesity falls

:59:36.:59:41.

very heavily on broader communities, and my right honourable friend the

:59:42.:59:43.

Chancellor was right to champion this measure

:59:44.:59:49.

because it will make the most difference in the poor list areas.

:59:50.:59:59.

Families of young boys with muscular dystrophy awaiting for a report.

:00:00.:00:06.

Will be NHS bring funding forward very which we! To recommend is it?

:00:07.:00:16.

We're just going to have to await the decisions I am pleased that my

:00:17.:00:30.

office team based on market shriek in Hednesford will receive dementia

:00:31.:00:35.

friendly training next month. Does the Minister agree we should be

:00:36.:00:38.

encouraging more times to become dementia friendly? We absolutely

:00:39.:00:44.

recognise the work being done in South Staffordshire fantastic work

:00:45.:00:54.

is being done, and I thank her for her support. When will we have a

:00:55.:01:01.

decision on the future of the vaccination programme, will it be

:01:02.:01:06.

clear, and will there be meetings with devolved counterparts? They are

:01:07.:01:15.

two, as he knows, programmes going on.

:01:16.:01:19.

The work will look to report in 2017. We have already got guidance

:01:20.:01:32.

on HPV, and we're looking at it in detail to see how we take it

:01:33.:01:42.

forward. We must now move on. Point of order, Mr Pat McFadden.

:01:43.:01:49.

I wonder if I could ask you if there have in any discussions on the

:01:50.:02:01.

terrible unfolding event in Brussels. We do not know the facts,

:02:02.:02:05.

but a number of innocent people have been killed. We do not yet know if

:02:06.:02:10.

there are any British victims, but there will be many families and just

:02:11.:02:16.

to find news of relatives, and I'm sure all sides of the House

:02:17.:02:17.

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