Health Questions

:00:09. > :00:17.Order, order. Questions to the Secretary of State for Health. Julie

:00:18. > :00:29.Elliott. Number one, Mr Spe`ker I call the Minister Nicola Bl`ckwood.

:00:30. > :00:40.NICE recommends exercise schemes for those who are at risk of ill health.

:00:41. > :00:45.Our GP physical activity ch`mpion programme has taught health care

:00:46. > :00:52.professionals to provide advice on physical activity in the te`m

:00:53. > :00:57.examinations. In the north-dast only 33% of adults participate in weekly

:00:58. > :01:04.sports. 30% in London. This has a knock-on effect on people throughout

:01:05. > :01:11.their lives. What is the government doing to address these geographic

:01:12. > :01:16.health inequalities. The honourable lady is right to raise this

:01:17. > :01:20.question. Inactivity costs Dngland ?7.4 billion a year and regtlar

:01:21. > :01:30.physical activity reduces the risk of developing many health conditions

:01:31. > :01:36.from between 20 and 40%. It can reduce the risk of cancer. Hn

:01:37. > :01:46.addition to BGP programme, we have secured funding from sport Dngland

:01:47. > :01:54.to highlight a module with lidwives, mental health practitioners and

:01:55. > :01:59.there will be a pilot to embed this project in practising nurses, but it

:02:00. > :02:08.will be up to local areas to make the best of these programmes. On the

:02:09. > :02:16.behaviour part of the questhon, what can the Minister do to addrdss the

:02:17. > :02:19.overconsumption of painkilldrs? The honourable gentleman has rahsed an

:02:20. > :02:25.important issue about drug `nd Apple on this use which is why we have

:02:26. > :02:32.prioritised this is one of the local statutory requirements. We have

:02:33. > :02:36.given ?16 billion to local health authorities for Public health

:02:37. > :02:46.delivery and we will expect them to prioritise this. Mrs Sharon Hodgson.

:02:47. > :02:52.Lep of physical activity contributes to obesity and weight today's help

:02:53. > :02:57.questions falling onto world obesity day, it is vital we commit our

:02:58. > :03:03.efforts to reversing rising obesity levels in the UK. An opporttne

:03:04. > :03:07.moment would have been the childhood obesity plan published over the

:03:08. > :03:13.summer, but sadly it did not go far enough. Will the Minister ensured

:03:14. > :03:19.this plan is realised as a preventative strategy to ch`nge

:03:20. > :03:24.behaviours and help make thd next-generation healthier than the

:03:25. > :03:32.last? Can I congratulate thd honourable lady on her role. We are

:03:33. > :03:37.proud of the childhood obeshty plan. It is based on the best evidence

:03:38. > :03:42.that is available and will lake a real difference to obesity rates in

:03:43. > :03:48.this country. The government is consulting on the soft drinks levy.

:03:49. > :03:56.We must now work hard to make sure we are delivering on that. We are

:03:57. > :04:08.proud because this is a world leading plan. Johnny Mercer. Number

:04:09. > :04:11.two Mr Speaker. Mr David Mowat. Limit has gone further and faster in

:04:12. > :04:17.terms of help and social care integration. The integrated fun they

:04:18. > :04:25.have set includes housing and leisure as well as housing ,- help

:04:26. > :04:33.and care. I will be happy to visit to see how the fund is workhng in

:04:34. > :04:45.practice. Innovative steps have been taken to look at the inequalities in

:04:46. > :04:51.Devon. There is a shortfall. Will be MP work with the relevant agencies

:04:52. > :04:58.to address these inequalitids? The honourable member refers to the

:04:59. > :05:03.timing lion that can exist between target and funding. When I visit I

:05:04. > :05:08.will be happy to meet with stakeholders and to congrattlate

:05:09. > :05:13.health and social care leaddrship in the progress they have made with the

:05:14. > :05:17.fund and the above average satisfactory ratings that h`ve been

:05:18. > :05:21.achieved in Plymouth. When he is in Devon will he meet patients, grids

:05:22. > :05:28.and NHS staff who are very worried about the proposals under the

:05:29. > :05:36.government's successor regile which includes the closure of manx

:05:37. > :05:41.hospitals? Does he accept that while it may make sense to integr`te and

:05:42. > :05:45.move money from beds and buhldings to better care for people in their

:05:46. > :05:51.homes, against a backdrop of massive cuts in social care budgets, that is

:05:52. > :05:56.simply not going to be deliverable. To answer the question, yes, I would

:05:57. > :06:01.be happy to meet in that context. In terms of the success regime, it is a

:06:02. > :06:05.transfer of resources from community hospitals to care at home and

:06:06. > :06:09.domiciliary care. That is not necessarily the wrong thing to do,

:06:10. > :06:15.but it must be done right and I am happy to meet. I welcome grdater

:06:16. > :06:20.integration, but there are grave concerns about the effects of cuts

:06:21. > :06:24.to social care on the NHS. What we are seeing is more and more patient

:06:25. > :06:27.spending greater time in more expensive settings in hospital when

:06:28. > :06:34.they could be better looked after in their own homes or communitx, but it

:06:35. > :06:39.is such to social -- cuts to social care that makes that imposshble Can

:06:40. > :06:47.the minister explained the damage that the cuts has made? Sochal care

:06:48. > :06:56.funding is tight, but it is true to say that those parts of the country

:06:57. > :07:00.that do the best in this regard do it where they have integratdd health

:07:01. > :07:05.and social care effectively. In terms of the budget there is some

:07:06. > :07:10.disparity amongst different health authorities. Something like a

:07:11. > :07:20.quarter of health authoritids this year have increased the budget this

:07:21. > :07:28.year. The scientific evidence for the low risk alcohol guidelhnes are

:07:29. > :07:34.available on the government website. There was public consultation to

:07:35. > :07:47.make sure the advice was as clear and usable as possible. We received

:07:48. > :07:50.1019 responses. Does the Minister not agree that the Chief Medical

:07:51. > :07:58.Officer should highlight thdse benefits more? For many people

:07:59. > :08:01.drinking alcohol is part of the normal social lives and we `re

:08:02. > :08:06.perfectly clear that these guidelines are advisory. Thdy are in

:08:07. > :08:10.place to help people make informed decisions about how they drhnk and

:08:11. > :08:22.to decide whether they want to take less risks with the drinking. I

:08:23. > :08:25.would like to point out that Rochdale has more than double the

:08:26. > :08:34.number of admissions to hospital where alcohol is a factor than other

:08:35. > :08:36.authorities in England. Can the Minister assure the house that

:08:37. > :08:58.public health guidance regarding drinking is advisory? They `re

:08:59. > :09:06.intended to give the best possible advice and put the evidence in one

:09:07. > :09:19.place so that people can make the best decisions regarding drhnking.

:09:20. > :09:24.Could she have a word with her colleagues in DC jee who prdside

:09:25. > :09:28.over a system where profitable wanted pubs are being demolhshed and

:09:29. > :09:41.supermarkets built on the shte against the wishes of the community?

:09:42. > :09:45.We are very clear that soci`l drinking is not the target of these

:09:46. > :09:52.low risk guidelines. I'm very happy to meet and discuss this with

:09:53. > :09:56.colleagues. Sadly very few people are aware of the link betwedn our

:09:57. > :10:04.coal consumption and obesitx and the long-term impacts of life lhmiting

:10:05. > :10:14.diseases. To make sure obeshty is integral to the guidelines, will be

:10:15. > :10:20.Minister put tackling adult and childhood obesity even highdr up the

:10:21. > :10:25.agenda? The honourable lady is right to raise the hidden risks of alcohol

:10:26. > :10:30.consumption which is exactlx why a widespread and analysis of the

:10:31. > :10:36.evidence was conducted throtgh this guideline exercise and she hs right

:10:37. > :10:41.to say that obesity should be a top priority for the government. We will

:10:42. > :10:56.analyse her question and look into it. Thank you, Mr Speaker. 003

:10:57. > :11:03.hospital PFI schemes reach financial close between 1997 and 2010,

:11:04. > :11:10.creating liabilities for thd NHS of ?77 billion. Three Legacy PF the --

:11:11. > :11:15.PFI schemes have been signed recently and one has been shgned

:11:16. > :11:21.under the new model work ?243 million. Except for some of the

:11:22. > :11:26.earlier schemes, ownership of the hospital reverts to the NHS at the

:11:27. > :11:33.end of the contract, but at the end of this the NHS has the

:11:34. > :11:39.Ever techively the figures will mean even more debt for the next

:11:40. > :11:45.generation. Will the Governlent commit to abandon the PFI idiotic

:11:46. > :11:50.scheme. No more PFI one or two, just abandon it, minister? I know the

:11:51. > :11:55.honourable gentleman has a consistent track record in opposing

:11:56. > :11:58.PFI, even when the vast majority of the schemes were put under contract

:11:59. > :12:01.under the Government of which he was a member, so I'm not going to take

:12:02. > :12:06.any lectures from the honourable gentleman about how to deal with

:12:07. > :12:12.PFI. And we will continue to use the new stricter terms as and when

:12:13. > :12:19.appropriate. Thank you, very much. I nothce no

:12:20. > :12:23.indecision there. The National Audit Office concluded that the PFI

:12:24. > :12:32.contract for the Norfolk Norwich Hospital was a bad deal for the

:12:33. > :12:37.taxpayer and NHS, yet last xear Octagon Health Care sunk further

:12:38. > :12:43.into the red. Would the minhster consider making an approach to

:12:44. > :12:50.Octagon to help confront thd enormous financial black hole this

:12:51. > :12:55.Trust faces? Well, we have provided access for seven of the worst

:12:56. > :13:01.affected Trusts with obligations under PFI signed as I've indicated

:13:02. > :13:06.earlier to some 1.5 billion of a support fund to help with this. I'm

:13:07. > :13:10.not sure off the top of my head whether Norfolk is one of these I

:13:11. > :13:15.suspect it's not. I would bd happy to talk to him about this. Rather

:13:16. > :13:20.than hissing the honourable gentleman's hopes inapproprhately,

:13:21. > :13:25.many of these schemes are too costly to divert resource to pay off in

:13:26. > :13:32.their absence. Number five, Mr Speaker.

:13:33. > :13:36.Mr Speaker, the five-year forward view will be delivered throtgh

:13:37. > :13:39.sustainability and transforlation plans which are currently bding

:13:40. > :13:44.developed by Clinical Commissioning Groups in collaboration with local

:13:45. > :13:49.authorities and providers. NHS England expects that all SDPs will

:13:50. > :13:53.be published, though in somd areas, discussions are already takhng

:13:54. > :13:57.place. I'm most grateful. In Wycombe I'm led to understand we should

:13:58. > :14:00.expect no dramatic changes `nd possibly no publication of `

:14:01. > :14:04.strategic plan. Would my right honourable friend agree with me that

:14:05. > :14:09.public confidence would be luch enhanced by the clear artictlation

:14:10. > :14:13.in public of a strategy for meeting the five-year forward view. I would

:14:14. > :14:19.agree with the honourable mdmber and I'll drive and give a clear`nce --

:14:20. > :14:24.try and give a clear answer. NHS England have said all 44 pl`ns will

:14:25. > :14:27.be published shortly. For those that have not done so, it will t`ke place

:14:28. > :14:31.at the end of the formal chdckpoint we view at the end of Octobdr. Areas

:14:32. > :14:35.are working to different tile scale bus they'll all be published by the

:14:36. > :14:42.end of November. For the avoidance of doubt, this includes the SDP for

:14:43. > :14:47.Bucks, Oxford and Berkshire West. Thank you, Mr Speaker. The NHS

:14:48. > :14:50.five-year forward view calldd for radical upgrade in interevens and

:14:51. > :14:54.public health. How does the minister square that with the Governlent s

:14:55. > :14:58.subsequent cuts to public hdalth, including ?200 million in-ydar cuts

:14:59. > :15:06.and further subsequent cuts expected by 2020? Mr Speaker, the SDP process

:15:07. > :15:11.is trying to upgrade our provision in terms of public health, cancer

:15:12. > :15:15.outcomes and mental health. Part of what every SDP will be expected to

:15:16. > :15:18.provide will be an assessment of the local priorities in public health

:15:19. > :15:24.and the timetable for progrdss towards that.

:15:25. > :15:27.Mr Speaker, Wantage community Hospital has recently closed because

:15:28. > :15:33.of a threat of Legionnaire's disease and it will not re-open unthl we

:15:34. > :15:38.have finally concluded constltation on the sustainability consultation

:15:39. > :15:41.plan, if it re-opens at all. This consultation has been delaydd,

:15:42. > :15:44.naturally worrying my consthtuents. I hope you will join with md in

:15:45. > :15:47.urging Oxfordshire to get on with this plan so we can have a

:15:48. > :15:51.reasonable discussion. Mr Speaker, I will join with the

:15:52. > :15:56.Right Honourable member in doing that. I'm not familiar with the

:15:57. > :16:01.specifics of the Wantage case but it doesn't sound right that thhs is an

:16:02. > :16:06.ongoing thing that's not fixed quickly. Could I congratulate the

:16:07. > :16:10.minister on his appointment to the frontbench, as well as that of the

:16:11. > :16:14.honourable lady from Abingdon. I'm sure they'll do a terrific job in

:16:15. > :16:20.their post. As a type II di`betic I'm very concerned at the f`ct that

:16:21. > :16:24.local CCGs are just not providing information on reventive work for

:16:25. > :16:30.dyke knees. -- preventative work for diabetes. Will he confirm there ll

:16:31. > :16:34.be reference to diabetes once these plans have been published? H will

:16:35. > :16:39.confirm that. There is a national diabetic plan. He'll be aware of

:16:40. > :16:45.that. Diabetes is one of a number of long-term conditions that the plans

:16:46. > :16:49.are charged to actually delhver improvements in and it would not be

:16:50. > :16:54.acceptable for a plan to be signed off or completed unless progress in

:16:55. > :16:59.diabetes has been made. Looking at new treatment options and

:17:00. > :17:03.the forward view, so will hd consider the example of the NHS

:17:04. > :17:10.Trust in South Wales which treats 1.5 million cancer patients every

:17:11. > :17:14.year and is now using reflexology, reiki healing, aromatherapy and

:17:15. > :17:20.breathing relaxation technipues to alleviate anxiety, pain and side

:17:21. > :17:25.effects and symptoms. If thhs was more widely spread, cost savings and

:17:26. > :17:29.patient satisfaction would hncrease. Mr Speaker, the SDP process is

:17:30. > :17:35.locally led, not led from the centre. I would expect though that a

:17:36. > :17:40.clinical judgment of the type that were referred to would be m`de if

:17:41. > :17:49.they can be confirmed on thd basis of scientific trial-based evidence.

:17:50. > :17:53.Central to the aim of the fhve-year forward plan for the mace is a

:17:54. > :17:57.sustainable Health Service hn which all patients receive the right care

:17:58. > :18:01.at the right time in the right place. With that in mind, c`n the

:18:02. > :18:06.minister tell me what action he s taken to address the problel of

:18:07. > :18:13.delayed hospital discharges which have risen by 20% so far thhs year?

:18:14. > :18:16.This amounts to an addition`l 9 6 people every day condemned to stay

:18:17. > :18:26.in hospital longer than is ledically necessary. May I welcome her to her

:18:27. > :18:31.post also and wish her luck in the new job. In terms of delayed

:18:32. > :18:34.discharges, there has been `n increase in England over thd last

:18:35. > :18:38.year. A part of that increase, only a part of it, is due to difficulties

:18:39. > :18:44.in the integration between social care and the NHS, a large p`rt of it

:18:45. > :18:48.is also within the NHS itself. But it's not uniform across loc`l

:18:49. > :18:53.authorities and indeed many local authorities are improving in this

:18:54. > :18:56.regard. What is very clear hs that those that are making the most

:18:57. > :19:07.progress most quickly are those that have gone furthest in integrating

:19:08. > :19:13.social care and health care. Thank you, Mr Speaker.

:19:14. > :19:17.Mr Speaker, the Department of Health has commissioned three separate

:19:18. > :19:21.reviews on the diagnosis, treatment and transmission of lime disease.

:19:22. > :19:26.The work will be carried out by the epicentre of University College it

:19:27. > :19:31.will be clinically driven evidence-based and the work will be

:19:32. > :19:34.published late 2017. I'm delighted the Government is looking into this

:19:35. > :19:39.serious important disease, but as the reviews progress, thous`nds of

:19:40. > :19:42.people contract lime Des each year, particularly in areas like Wiltshire

:19:43. > :19:51.and potentially receive inadequate treatment. Can the minister look

:19:52. > :19:55.into speeding up a the revidws - Lyme disease. We need to go as fast

:19:56. > :20:00.as possible but we are workhng with research teams. The work is to be

:20:01. > :20:05.trial based and needs to be as definitive as possible. In the

:20:06. > :20:08.meantime, early diagnosis is the key way to make progress, public health

:20:09. > :20:17.England continues to work whth GPs and the public on this.

:20:18. > :20:21.Thank you, Mr Speaker. My mother recently died of motor neurone

:20:22. > :20:35.disease. There are 13 sufferers per 10,000 people. Will the minhster

:20:36. > :20:39.PROBLEM WITH SOUND. I'll be happy to meet with the

:20:40. > :20:42.member on that subject. THE SPEAKER: Extremely gratdful to

:20:43. > :20:48.the Minister for His response to that matter.

:20:49. > :20:52.Bearing in mind that the cases of lime disease have quadrupled in the

:20:53. > :20:54.last 12 years, some in my own constituency, what has been done

:20:55. > :20:58.with the devolved assemblies of Great Britain and Northern Hreland

:20:59. > :21:02.to have a wide strategy in place, UK-wise, which addresses thhs trend

:21:03. > :21:14.and provides effective diagnosis on the treatment? The principal thing

:21:15. > :21:25.we need to do is to have an innovative approach to it.

:21:26. > :21:33.I agree with my right honourable friend that this is an important

:21:34. > :21:38.area where the Lord in his report identified potential annual savings

:21:39. > :21:42.of ?700 million through redtcing procurement performance between

:21:43. > :21:47.providers. We have announced a first tranche of 12 standardised products

:21:48. > :21:50.for all NHS providers to usd in order to boost procurement volumes

:21:51. > :21:54.and use economies of scale to secure lower prices. These initial

:21:55. > :21:58.products, including commodity items like gloves and needles, cover 100

:21:59. > :22:03.million worth of Trust spending and we expect to achieve savings of up

:22:04. > :22:07.to 25%. Innovative private sector stppliers

:22:08. > :22:11.have successfully partnered with the NHS from its inception and ht's

:22:12. > :22:15.quite right for that relationship to be sustainable, that they mtst make

:22:16. > :22:20.a profit. But does the minister agree with me that rogue colpanies

:22:21. > :22:23.who exploit the NHS's lack of commercial expertise could be named

:22:24. > :22:29.and shamed because they are making a lot of money at the taxpayers'

:22:30. > :22:32.expense. We believe the right approach to secure procuremdnt

:22:33. > :22:36.savings is to take advantagd of the immense amount of data that's

:22:37. > :22:42.available across the NHS and that's why we've set up the purchase price

:22:43. > :22:49.benchmarking indebltion tool where to date more than ?8 billion of

:22:50. > :22:53.expenditure covering over 30 million separate procurement transactions

:22:54. > :22:57.has been collated, is going to be analysed, and we'll use that

:22:58. > :23:00.information judiciously to save the taxpayer money. That's the right way

:23:01. > :23:04.to start, rather than naming and shaming.

:23:05. > :23:08.Can I urge the minister when thinking about national procurement,

:23:09. > :23:12.national commissioning, to look at some of those national strategies

:23:13. > :23:18.that can underpin them? For example, why we need to renew the national

:23:19. > :23:24.stroke strategy, 100,000 people a year suffer from a stroke and we

:23:25. > :23:28.have nearly a million peopld in this country living with having had a

:23:29. > :23:31.stroke and yet they care very much about the rehabilitation services

:23:32. > :23:34.and other services too. THE SPEAKER: The minister's

:23:35. > :23:37.challenge is to relate that very important matter to tell qu`litily

:23:38. > :23:42.important matter that happens to be the subject of the question which is

:23:43. > :23:45.procurement. Minister? I'm grateful to you for drawing the attention of

:23:46. > :23:49.the honourable gentleman to the fact that this topic is about

:23:50. > :23:55.procurement. I think he is right to highlight the fact that we have

:23:56. > :24:00.looked at an acute heart trdatment strategy and we are creating centres

:24:01. > :24:05.of excellent across the country to ensure that if people suffer from an

:24:06. > :24:09.acute heart incident, a stroke in particular, that they are treated by

:24:10. > :24:16.the specialists who'll give them best prospects for recovery.

:24:17. > :24:21.THE SPEAKER: Secretary of State In the last four years, 29 Trusts have

:24:22. > :24:27.been put into special measures, more than one in ten of all NHS Trusts,

:24:28. > :24:31.of those 12 have come out h`ving demonstrated improvements in safety

:24:32. > :24:35.and quality and 1300 doctors and 4,200 more nurses are working in

:24:36. > :24:38.Trusts that have been put into special measures.

:24:39. > :24:42.The Secretary of State will be aware that the previous hospital hn my

:24:43. > :24:47.constituency's now come out of special measures because he visited

:24:48. > :24:52.last year. They made excelldnt progress, not least in bringing in

:24:53. > :24:55.lists for in patients and also numerous measures to transform the

:24:56. > :25:00.out-patients department. Will he join me in paying tribute to all the

:25:01. > :25:03.staff at the hospital, parthcularly the Chief Executive and the chairman

:25:04. > :25:08.for the excellent progress that s been made? I'm very happy to do that

:25:09. > :25:15.and I very much enjoyed my visit to the QE with him a couple of years

:25:16. > :25:24.ago. I think it's a good ex`mple of how Trusts can be transformdd when

:25:25. > :25:28.they go into special measurds. They've opened a laporoscophc unit,

:25:29. > :25:33.they have got 72 more nurses and this is a good example to m`ny other

:25:34. > :25:36.Trusts that are currently in special measures that it can be a ttrning

:25:37. > :25:45.point for the benefits of p`tients and staff.

:25:46. > :25:53.So many trusts are still in a financial mess. To solve it we need

:25:54. > :25:58.more funding and also funding for councils to occur as well. What is

:25:59. > :26:03.the secretary of state doing to fight for more funding so wd can do

:26:04. > :26:08.with these problems properlx? He will have noticed that last year in

:26:09. > :26:11.the spending review the NHS got the biggest funding increase of any

:26:12. > :26:22.government department. We committed to the NHS's open plan which asked

:26:23. > :26:26.for ?10 billion more per and in real terms, but I don't disagree with him

:26:27. > :26:31.that there are still very rdal financial problems in the NHS and

:26:32. > :26:35.social care system. The trusts that are delivering the highest standards

:26:36. > :26:42.of care or so have the lowest deficits. Delivering unsaid care is

:26:43. > :26:49.one of the most expensive things you can do and that's why this hs so

:26:50. > :26:57.important. We'll be Secretary of State joined me in congratulating

:26:58. > :27:02.all staff at the auto contr`st just four years after it was deeled at

:27:03. > :27:08.risk and it is now in the top percentage of trusts. I think the

:27:09. > :27:15.staff at Orton have done a fantastic job. I congratulate them and thank

:27:16. > :27:19.him for his work in supporthng them. In my own area of Calderdald and

:27:20. > :27:24.Huddersfield there is a dre`dful situation caused because of the

:27:25. > :27:34.clinical commissioning group and the way it procures. He has had a

:27:35. > :27:42.petition about the closure of A E. Will he please intervene because the

:27:43. > :27:50.competence of local CCG 's hs not up to the job. I would say to him that

:27:51. > :27:55.there is a mechanism by which these issues do end up on my desk. It has

:27:56. > :28:00.to be reviewed by overview `nd scrutiny committees from local

:28:01. > :28:03.councils and then I get the recommendation, but I will look at

:28:04. > :28:17.it closely if that process hs followed. Due to rapid incrdase in

:28:18. > :28:32.population, there was a planned new health centre. Is he expecthng clear

:28:33. > :28:37.and timely plans? Absolutelx. One of the main purpose of SDP is to make

:28:38. > :28:41.sure we deliver our Cancer plan which will see us introducing a

:28:42. > :28:48.four-week maximum waiting thme between GP referral and ulthmate

:28:49. > :28:56.diagnosis. That will save up to 30,000 lives a year and will be a

:28:57. > :29:02.big priority for each SDP. Lr Speaker, I joined the secretary of

:29:03. > :29:08.state in praising all who work in the NHS. We are encouraging people

:29:09. > :29:19.to become doctors, nurses and supports the. Last week there was a

:29:20. > :29:24.commitment to encourage 25% more doctors into the NHS on top of the

:29:25. > :29:42.6000 or the trend. Does the Minister agree that the

:29:43. > :29:46.rising agency costs point to a recruitment crisis and will you make

:29:47. > :29:51.a statement of a house outlhning his plans to address this crisis? We do

:29:52. > :29:54.recognise absolutely that the bills for agency staff have becomd

:29:55. > :29:59.unsustainable and that is why we have taken deliberate action,

:30:00. > :30:03.including introducing price caps on hourly rates last November `nd that

:30:04. > :30:10.is having a significant imp`ct in reducing agency costs. Year to date,

:30:11. > :30:18.agency costs are some ?550 lillion less than they were last job. Can I

:30:19. > :30:23.work the announcement about the increase in medical spaces `nd can I

:30:24. > :30:26.ask what plans the department has to ensure there is sufficient clinical

:30:27. > :30:33.training places for those mddical students? I can reassure my

:30:34. > :30:40.honourable friend that therd is considerable excess demand to train

:30:41. > :30:45.to become a coalition in thhs country from UK-based students. Only

:30:46. > :30:48.some half of those who applhed to train in medical schools ard

:30:49. > :30:53.accepted at present and therefore we are confident that there will be

:30:54. > :30:57.plenty of take-up of these dxtra places and regarding clinic`l

:30:58. > :31:00.placements, we are in discussions with the universities, colldges and

:31:01. > :31:07.teaching hospitals to ensurd that they are made available. Mr Speaker,

:31:08. > :31:11.I welcome the 25% expansion in medical student places, but reject

:31:12. > :31:18.tying this to the elimination of 25% of overseas doctors who currently

:31:19. > :31:23.work in our NHS. The secret`ry of State must know that with 10% of

:31:24. > :31:27.posts unfilled and ever rishng patient demand, we will alw`ys need

:31:28. > :31:31.international graduates in the future. Does he not recognise that

:31:32. > :31:36.he is creating unrealistic expectations and conflict whth his

:31:37. > :31:44.British only medical servicd ideal? I'm grateful to the honourable lady

:31:45. > :31:48.for giving me the opportunity to stop this scaremongering whhch is

:31:49. > :31:52.undoubtedly unsettling many of the very valuable doctors, nursds and

:31:53. > :31:56.other foreign nationals providing vital services to the NHS. The

:31:57. > :32:02.announcement last week was `bout adding more doctors to be trained

:32:03. > :32:06.who are UK-based. We are not changing any of the present

:32:07. > :32:14.arrangements regarding international students being trained here, or

:32:15. > :32:18.doctors and nurses working here With one in ten posts unfilled right

:32:19. > :32:23.now, how does the Minister dxpect with the rhetoric that was tsed last

:32:24. > :32:30.week that we will even retahn let alone attract foreign doctors the

:32:31. > :32:42.fill those posts? No, there was no rhetoric used regarding the valuable

:32:43. > :32:53.contribution by a foreign n`tionals to our health service that remains

:32:54. > :33:05.the case. Staff shortages c`use a temporary closure of Granth`m A E.

:33:06. > :33:16.Will the state of -- will the Secretary of State meet with me and

:33:17. > :33:20.Jody Clarke, a local coordinator? I understand that my right honourable

:33:21. > :33:24.friend has already committed to me to enable me to say to the

:33:25. > :33:32.honourable gentleman he does intend to meeting with campaigners in due

:33:33. > :33:36.course. The minister says there was no rhetoric scaremongering last

:33:37. > :33:39.week. How do you explain to the house what the Prime Ministdr said

:33:40. > :33:43.when she said there will be staff here from overseas in that hnterim

:33:44. > :33:53.period until the further nulber of British doctors can be trained and

:33:54. > :33:59.come on our hospitals. What did she mean and what can we expect next?

:34:00. > :34:09.Ambulances plastered with go home stickers? I hope he will usd more

:34:10. > :34:15.measured language rather th`n spreading this kind of inappropriate

:34:16. > :34:19.rumour. The interim period referred to was the period during whhch the

:34:20. > :34:25.doctors will be trained. We won t get new doctors coming under this

:34:26. > :34:30.increase allocation until 2023 and during that time clearly we will

:34:31. > :34:32.need to use all measures to ensure we feel these spaces that I

:34:33. > :34:39.acknowledge we have across our hospitals. I appreciate the

:34:40. > :34:53.Minister's warm welcome and I am looking forward to shadowing the

:34:54. > :35:00.secretary of State, but the remark about, it should be directed to the

:35:01. > :35:03.Prime Minister. Post Brexit, given there are concerns that these powers

:35:04. > :35:08.that go far enough, can you tell us what steps he will be taking to

:35:09. > :35:16.ensure that no staff from the EU will lose their jobs? And whll the

:35:17. > :35:28.NHS post Brexit still be able to recruit from the EU if necessary.

:35:29. > :35:36.Minister. Health ministers `re insuring that the 53,000 people from

:35:37. > :35:42.the EU working within the NHS have secure posts. Although we h`ve

:35:43. > :35:48.vacancy rates, we have 7800 more consultants employed in the NHS than

:35:49. > :35:54.there were in May 20 ten. Wd have 8500 more doctors than in M`y 2 10

:35:55. > :35:59.and over 10,500 more nurses working on our wards. We have gone through a

:36:00. > :36:09.consistent policy of recruiting more people to work in the NHS under this

:36:10. > :36:15.government. The independent cancer task force highlighted in a report

:36:16. > :36:29.saving lives, averting costs that identified cost savings in darly

:36:30. > :36:38.diagnosis, especially in:, rectal and ovarian cancer. In welcoming the

:36:39. > :36:44.Minister to his post may I highlight evidence to show that early

:36:45. > :36:56.diagnosis offers substantial savings. Colon cancer stage while

:36:57. > :37:01.cost ?3000 to treat. Stage forecasts ?12,000 to treat. Can we colmission

:37:02. > :37:08.a study to look at this bec`use it requires further detail on behalf of

:37:09. > :37:13.the taxpayer. We agree that early diagnosis says lies and can lead to

:37:14. > :37:23.cost savings and just as an example, we know now that GB revivals are up

:37:24. > :37:29.by 91% since 2010. -- GP. Wd are beginning to see the results of

:37:30. > :37:34.early diagnosis coming throtgh. In terms of a further study, both

:37:35. > :37:39.Public Health England and McMillan have commissioned studies on

:37:40. > :37:48.modelling, one element of which will be the costing of early diagnosis.

:37:49. > :37:57.We look forward to the findhngs GPs play a role in the early di`gnosis

:37:58. > :38:01.of cancer. In Sunderland we were the most underfunded. Can the Mhnister

:38:02. > :38:05.set out how he make sure th`t we train more family doctors and that

:38:06. > :38:14.they are encouraged to work in areas where there is an acute shortage? We

:38:15. > :38:20.are training 3250 extra GPs every year. We have a target to h`ve 000

:38:21. > :38:27.additional doctors working hn general practice by 2020. Btt as

:38:28. > :38:31.well as new GPs we need to do better with retention and that means

:38:32. > :38:36.keeping the GP population wd have. There are a number of steps that are

:38:37. > :38:41.being taken to do that. With reference to Sunderland, thdre is a

:38:42. > :38:54.bursary scheme that is aimed at attracting GPs to areas which they

:38:55. > :39:01.may not wish to necessarily work in. In 2010 target was set to m`ke 20

:39:02. > :39:13.billion worth of efficiency savings by 2015 to free up money to treat

:39:14. > :39:19.patients and for new technology Under inspirational leadership, the

:39:20. > :39:23.NHS broadly delivered on thhs challenge, recording savings of

:39:24. > :39:32.?19.4 billion. Will of the savings have been reinvested into an NHS --

:39:33. > :39:37.into NHS front line services. Would he confirmed that the achievements

:39:38. > :39:41.of those savings was done through greater efficiency and effectiveness

:39:42. > :39:49.in the delivery of care and that also in cutting out waste whthin the

:39:50. > :39:55.NHS between 2002 and 2007? @nd can you confirm that the benefit of this

:39:56. > :40:02.achievement to the NHS is that not a single penny of those savings goes

:40:03. > :40:08.back to the Treasury, but is reinvested in the NHS and front line

:40:09. > :40:14.services? Well, my right honourable friend has managed to include

:40:15. > :40:17.several questions in his impressive supplementary. I can confirl that

:40:18. > :40:23.much of the ways that took place in the years he cited relate to

:40:24. > :40:27.projects of the previous Labour government which they themsdlves

:40:28. > :40:31.then cancelled, such as the IT project. I can also confirm that

:40:32. > :40:38.savings generated within thd NHS are kept within the NHS and Lord Carter,

:40:39. > :40:43.whose report I referred to darlier, has identified some ?5 billhon worth

:40:44. > :40:47.of efficiency savings that we have two deliver within this Parliament.

:40:48. > :40:54.That is a distinction to be drawn between realistic targets and

:40:55. > :40:57.systematic underfunding. Silon Stephens said last month th`t for

:40:58. > :41:01.three of the five years we did not get what we asked for. It w`s also

:41:02. > :41:07.said that there is a huge g`p coming. Cheers and chief exdcutives

:41:08. > :41:13.on the front line say they can't make things add up any longdr. The

:41:14. > :41:16.government says the NHS gets all it asks for. Those running the NHS say

:41:17. > :41:23.something different. The honourable gentleman stood on a

:41:24. > :41:27.manifesto 18 months ago in which his party were not prepared to commit

:41:28. > :41:33.the funding which this partx was prepared to do. They committed 5.5

:41:34. > :41:41.billion, we committed ?8 billion and have put in ?10 billion.

:41:42. > :41:45.Tragically suicide is the bhggest single cause of death for mdn under

:41:46. > :41:49.50. We have 13 suicide everx single day of which three quarters are men.

:41:50. > :41:55.We are currently reviewing the strategy to make sure we le`ve no

:41:56. > :42:00.stone unturned in trying to reduce the totally unacceptable levels of

:42:01. > :42:08.these tragedies. Yesterday larked the launch of the mental he`lth

:42:09. > :42:12.awareness and suicide intervention called, it takes balls to t`lk. It's

:42:13. > :42:17.targeted at male dominated sporting venues aiming to direct men to

:42:18. > :42:20.support when they need it in order to promote positive mental health

:42:21. > :42:25.and reduce the incident of lale suicide. With suicide being the

:42:26. > :42:30.single most common cause of death, in men under 45, would the linister

:42:31. > :42:34.take the opportunity to welcome and support this important new campaign?

:42:35. > :42:38.I'm happy to do just that and I would like to thank her for bringing

:42:39. > :42:42.up this very, very important difficult issue. We are makhng

:42:43. > :42:47.progress in reducing suicidd rates but we can do an awful lot better.

:42:48. > :42:51.The thing that troubles me lost is that nearly three quarters of people

:42:52. > :42:55.who kill themselves have had no contact with specialist NHS mental

:42:56. > :42:59.Health Services in the prevhous year even though in many cases wd do know

:43:00. > :43:04.who they are because sadly lost of them have tried before. I'm very

:43:05. > :43:10.happy to commend the, it takes balls to talk, campaign and she m`y want

:43:11. > :43:14.to put them in touch with the sports and mental health charter, `nother

:43:15. > :43:18.scheme aimed to use sport to help boost the psychological well-being

:43:19. > :43:22.of men. A recent survey showed one hn four

:43:23. > :43:26.members of the emergency services experience mental health problems

:43:27. > :43:33.and a number experience suicidal thoughts. What is he doing to

:43:34. > :43:38.protect our vital paramedics and other ambulance staff and ensure

:43:39. > :43:42.they get the support they nded in dealing with absolutely app`lling

:43:43. > :43:46.situations? Well, again, I thank her for raising that and she'll be

:43:47. > :43:51.pleased to know that the NHS has introduced a scheme backed with

:43:52. > :43:55.funding to encourage NHS Trtsts to look after the mental well-being of

:43:56. > :43:59.their own staff. I would particularly like to pay trhbute to

:44:00. > :44:03.the courage of people who work in the Air Ambulance service bdcause

:44:04. > :44:05.they see day in day out somd of the most difficult and distresshng

:44:06. > :44:09.cases. They have to cope with that pressure when they take it home

:44:10. > :44:18.every day and I think we all salute them. Mr Speaker, every pathent

:44:19. > :44:22.discharged from hospital into a care home should have a care plan or

:44:23. > :44:29.discharge assessment. This should include a clear assessment of the

:44:30. > :44:37.needs covering transport, c`rers, GP notification, medication and, where

:44:38. > :44:41.necessary, clothing requirelents. I think thank the Minister for His

:44:42. > :44:44.response. There are cases of elderly and vulnerable people being

:44:45. > :44:49.discharged from hospital straight into care homes, often without any

:44:50. > :44:52.basic personal effects or clothing, whether that's because their family

:44:53. > :44:55.can't or aren't willing to supply them. Does the minister recognise

:44:56. > :45:00.this and what can the Government do to tackle it?

:45:01. > :45:06.Mr Speaker, as I said earlidr, there is a national process or in terms of

:45:07. > :45:10.this care plan where the falily is not able or won't provide stpport,

:45:11. > :45:16.typically the voluntary sector is asked to. If that doesn't work, Mr

:45:17. > :45:20.Speaker, local authorities `re able to increase the personal expense

:45:21. > :45:23.allowance to provide clothing. I'm interested to hear the cases that

:45:24. > :45:27.he's talking about in his constituency and I'll be very happy

:45:28. > :45:32.to understand better and talk to him about why it's failed there.

:45:33. > :45:40.THE SPEAKER: Have a cup of tea with the fella. Luke Hall, topic`l

:45:41. > :45:46.questions. Secretary of State? Last week aannounced plans to make the

:45:47. > :45:49.NHS sufficient with doctors. We recognise the brilliant work done by

:45:50. > :45:54.the overseas doctors that work in the NHS and have made it cldar

:45:55. > :45:58.whether or not they are frol the EU, we wish that work to continte

:45:59. > :46:07.post-Brexit. As the fifth l`rgest economy, Britain should be training

:46:08. > :46:16.all the doctors we need. Whhle there'll always be benefits for

:46:17. > :46:27.overseas doctors, we need to collaborate and have both. Our local

:46:28. > :46:30.health centre. Can we take ` coordinated approach to movd the

:46:31. > :46:33.health centre forward? I think I can do better than that

:46:34. > :46:38.because I think I've said I'm prepared to go to the health centre.

:46:39. > :46:41.I remember visiting the thornibly community hospital during the

:46:42. > :46:46.general election campaign and had a very good visit then. I unddrstand

:46:47. > :46:51.what they are trying to to `t the health centre and they are right to

:46:52. > :46:54.think we can improve better by thinking outside the hospit`l Health

:46:55. > :46:59.Services? Can I ask the Secretary of State to look into the creation of a

:47:00. > :47:02.sideways move for a Chief Executive of a Trust cricketised for ,-

:47:03. > :47:07.criticised for failing to investigate patient deaths. Six

:47:08. > :47:12.weeks after this special recruitment exercise by Southern health, cattery

:47:13. > :47:15.that Percy has resigned with a substantial 12-month salary pay off,

:47:16. > :47:21.signed off by the Department of Health and the Treasury. Thd

:47:22. > :47:24.campaign group, justice for LB, has called this utterly disgracdful and

:47:25. > :47:28.I agree. Will the Secretary of State investigate?

:47:29. > :47:33.Well, can I agree with the honourable lady that the wax this

:47:34. > :47:39.case was handled was by no leans satisfactory and I think thd truth

:47:40. > :47:44.is that it did take some tile to establish precisely what had gone

:47:45. > :47:47.wrong at Southern Health, as this House knows because we did `n urgent

:47:48. > :47:51.question at the time I think it was. There was a real issue about the

:47:52. > :47:54.failure to investigate unexplained deaths. I don't think the NHS

:47:55. > :47:58.handled this as well as it should, but we do have much more

:47:59. > :48:02.transparency and I think we do now not have a situation where people go

:48:03. > :48:05.on and get other jobs in thd NHS which is what has happen sod off

:48:06. > :48:09.none the past. Thank you, Mr Speaker. May H ask

:48:10. > :48:19.what the Government will be doing to scrutinise and assist the London

:48:20. > :48:25.ambulance service which has had an appalling, consistently bad call out

:48:26. > :48:28.record for category A situations? London ambulance service is in

:48:29. > :48:33.special measures and haar for some time. I visited this summer and am

:48:34. > :48:36.pleased to be able to confirm that some ?63 million of additional

:48:37. > :48:41.funding has been provided to the ambulance service since Aprhl 2 15

:48:42. > :48:44.and the service is starting to make significant inroads in incrdasing

:48:45. > :48:49.the number of paramed I belheves available on call, some 250 more

:48:50. > :48:53.have been added in the last couple of years. Last October, the then

:48:54. > :48:57.Health Minister confirmed that in terms of NHS dental provision, my

:48:58. > :49:01.constituency fell far below the national average. In fact this is

:49:02. > :49:05.one of the worst in the country Nothing has changed since then,

:49:06. > :49:08.unfortunately. Does the Secretary of State believe it's acceptable that

:49:09. > :49:11.my constituents and many of whom are children, are unable to get an NHS

:49:12. > :49:16.dentist? THE SPEAKER: Minister? Mr Speaker,

:49:17. > :49:19.it's clearly unacceptable if the situation that the honourable lady

:49:20. > :49:23.sets out is the case and I'll be happy to meet with her and work with

:49:24. > :49:28.her to take the action that we need to to make things better. Thank you,

:49:29. > :49:32.Mr Speaker. The Government's provided welcomed increased funding

:49:33. > :49:35.for mental health support, xet this does not appear to be reachhng my

:49:36. > :49:41.constituency effectively, particularly for children and there

:49:42. > :49:44.are concerns that the Millb`nk unit near Macclesfield may close. Will

:49:45. > :49:47.the minister look into thesd concerns? I'm very happy to do that

:49:48. > :49:51.and she's absolutely right to highlight the fact that the

:49:52. > :49:54.provision in mental Health Services to children is one of the bhggest

:49:55. > :49:58.weak spots in NHS provision today and it's an area we are putting a

:49:59. > :50:01.big focus on but I'm happy to talk to her about this.

:50:02. > :50:04.Thank you very much, Mr Spe`ker I know this is a devolved matter but

:50:05. > :50:08.look forward to the union all working together. In Northern

:50:09. > :50:14.Ireland, the Health Service is in crisis and on cancer, just `n

:50:15. > :50:23.example, 6.7 of those with breast cancer are being called in to be

:50:24. > :50:28.checked within 14 days, not 100 , so 6.7%, yet we have 392,000 pdople on

:50:29. > :50:35.the waiting list. Will the Secretary of State for Health meet with us to

:50:36. > :50:40.find a better way forward? Lr Speaker, we'll be working together

:50:41. > :50:44.to defeat cancer and the ond thing we know about defeating cancer is

:50:45. > :50:48.that the best way of doing ht is early diagnosis. We have had a lot

:50:49. > :50:52.of progress in that in Engl`nd, but there's a lot further to go. Of

:50:53. > :50:55.course I would be willing to talk to the devolved administration about

:50:56. > :50:59.what they can learn from us and perhaps vice versa.

:51:00. > :51:03.Can I ask the Secretary of State to look again at the decision not to

:51:04. > :51:07.fund second stem cell transplants for adults and children with blood

:51:08. > :51:10.cancers given there's significant clinical evidence of their benefit

:51:11. > :51:15.for those who relapse. Don't just take my word for it, take it from

:51:16. > :51:18.the Ant any Nolan Trust and the 36 specialist who is've written to the

:51:19. > :51:24.Secretary of State asking hhm to review this decision? This hs a very

:51:25. > :51:27.difficult area, Mr Speaker. Decisions on priority are clinically

:51:28. > :51:31.driven and must continue to be based on peer review day too. The most

:51:32. > :51:35.recent review determined th`t less than one third of second tr`nsplants

:51:36. > :51:40.would result in survival after five years. That is the reason that it

:51:41. > :51:44.was not funded. There will however be a further review next April and

:51:45. > :51:50.to the extent that the data is changed, there'll be a new

:51:51. > :51:54.evaluation at that time. The Park medical centre in Whitney

:51:55. > :51:58.faces closure. Patients will be dispersed a long way into other

:51:59. > :52:05.practices in this area wherd already one in four wait over a week to see

:52:06. > :52:12.their GP. Duncan Enright, L`bour's candidate in the by-election in

:52:13. > :52:17.Witney is campaigning to save the medical centre. Will the Secretary

:52:18. > :52:23.of State reward his campaign with a save your today? What the

:52:24. > :52:26.Conservative candidate done, we ll be saying very clearly, is that

:52:27. > :52:30.because of the extra funding by this Government, we are aiming to put

:52:31. > :52:33.5,000 more doctors working hn general practice by the end of

:52:34. > :52:36.Parliament, something that wouldn't have been possible with the increase

:52:37. > :52:40.of less than half promised by Labour.

:52:41. > :52:46.Thank you, Mr Speaker. As mhnisters will be aware, this week is baby

:52:47. > :52:50.loss awareness week. Access to Ne-Yo natal cots and transport services

:52:51. > :52:54.are a vital part of the card of premature and sick babies. What

:52:55. > :52:57.reassurances and assurances can my right honourable friend givd me that

:52:58. > :53:01.his department is continuing to review the findings of the Bliss

:53:02. > :53:07.report and when can we expect to hear more? I'm grateful to ly right

:53:08. > :53:12.honourable friend for raising Baby Loss awareness week. I'm sure she'll

:53:13. > :53:17.participate with others in the debate in the backbench comlittee

:53:18. > :53:21.later this week. The better births review of independent maternity

:53:22. > :53:24.review mad a number of recommendations, including Ne-Yo

:53:25. > :53:27.natal critical care. We are studying the recommendations and are due to

:53:28. > :53:30.report initial findings frol work in December.

:53:31. > :53:33.Thank you, Mr Speaker. I listened very closely to the Secretary of

:53:34. > :53:37.State before and his comments on mental health. He stood at that

:53:38. > :53:41.despatch box on 9th December and said that CCGs are are commhtted to

:53:42. > :53:48.increasing the proportion of their funding that goes into ment`l

:53:49. > :53:53.health. My research shows that 7% of CCGs are reducing. Yet another

:53:54. > :53:57.broken promise, when can we have real equality from this Govdrnment

:53:58. > :54:02.for mental health? I'll tell you what this Government's tone, we have

:54:03. > :54:08.legislated for parity of esteem on mental health, we are treathng 400

:54:09. > :54:11.more people every day for mdntal health conditions than six xears ago

:54:12. > :54:15.and we'll have a new plan that will see more people treated by 2020

:54:16. > :54:18.include ago transformation of CAMHS. That's possible because we `re

:54:19. > :54:21.putting extra money into thd NHS which her party refused to do.

:54:22. > :54:25.Does manufacture agree with me that the Government has a moral

:54:26. > :54:29.obligation to end the raid on poorer countries for their skilled doctors

:54:30. > :54:33.and nurses and make our NHS recruitment more self-sufficient? He

:54:34. > :54:38.is absolutery right to say that and I find it extraordinary that the

:54:39. > :54:42.party opposite said that our plan to train more doctors was nonsdnse We

:54:43. > :54:47.currently have 80 doctors in the NHS from Sri Lanka, 600 from Nigeria,

:54:48. > :54:50.400 from Sudan, 200 from My`nmar, they are doing a brilliant job, I

:54:51. > :54:55.want them to continue doing that, but we have to ask ourselves whether

:54:56. > :54:58.it's ethical for us to conthnue to recruit doctors from much poorer

:54:59. > :55:03.countries that really need their skills. I was really alarmed to see

:55:04. > :55:08.NHS chiefs warning that hospitals in England are on the brink of collapse

:55:09. > :55:12.at the weekend. I read it at the weekend, I must clarify. Is the

:55:13. > :55:15.Government's intention to ctt the public supply of health card in

:55:16. > :55:19.order to create demand for private health care systems or will the

:55:20. > :55:23.Government give it the inithal funds it needs? Let me remind the

:55:24. > :55:27.honourable lady that the party that introduced the most outsourcing to

:55:28. > :55:32.the private sector was her own Labour Government under the previous

:55:33. > :55:36.health Secretary tear Alan Lilburn. Our view is we should be nettral as

:55:37. > :55:39.to whether local doctors decide to commission their care from the

:55:40. > :55:44.public or private sector. Wd want the best care for patients. I

:55:45. > :55:47.welcome last week's NHS eye report that there are now sufficient staff

:55:48. > :55:52.at Chorley and South Ribble hospitals and the A department can

:55:53. > :55:55.open. I'm dismayed the Trust is delaying re-opening until J`nuary

:55:56. > :55:58.next year. Can the minister reassure me that he'll work with me `nd

:55:59. > :56:04.others to oblige the Trust to open as soon as possible?

:56:05. > :56:12.The honourable lady has been a champion of Chorley, along with a

:56:13. > :56:19.number member -- another melber of this house. I know them at local MPs

:56:20. > :56:34.yesterday. I am happy to work with her was welcoming the reopening of

:56:35. > :56:54.A and hope it can be brought forward. STDs are led locally -

:56:55. > :57:02.STPs are led locally. My local hospital has been downgraded. What

:57:03. > :57:12.has the Minister got to say to love loved ones of families who lay lose

:57:13. > :57:16.people? The NHS will need freedom to collaborate integrate and mdrge

:57:17. > :57:21.across divides. That came from the 2015 Labour manifesto. The SDP

:57:22. > :57:28.process is designed to have better care, better health and productivity

:57:29. > :57:36.as well. We should be critical friends to the process in that we

:57:37. > :57:42.all want a better NHS service. Telford's brand-new women and

:57:43. > :57:46.children's centre should be closed and moved to a more affluent area

:57:47. > :57:52.where help is better than the national average. The confidence of

:57:53. > :57:57.local people has been lost. We'll be secretary of State intervend and

:57:58. > :58:01.make sure that health care practitioners fulfil their legal

:58:02. > :58:04.duties? I would like to thank her for standing up for her

:58:05. > :58:08.constituents. She will agred that this has to be a local mattdr led by

:58:09. > :58:13.clinicians locally, but she can be reassured that we are always

:58:14. > :58:17.watching what has happened to make sure people are following dte

:58:18. > :58:22.process and the results of `ny changes that are proposed bdnefit

:58:23. > :58:26.patients as they are intenddd to do. I will watch carefully what is

:58:27. > :58:31.happening in Telford in Shropshire. About half a dozen times in the last

:58:32. > :58:36.hour the Secretary of State has been bragging about the extra money

:58:37. > :58:42.putting into the National Sdrvice. Why is it then that Bolsover

:58:43. > :58:49.hospital is due to close, including many that have been referred to Why

:58:50. > :58:51.is it that the neighbouring hospitals in countless

:58:52. > :58:58.constituencies in Derbyshird will be closing? Why doesn't he use some of

:58:59. > :59:02.that money to save the double shot hospitals? The extra money we are

:59:03. > :59:10.putting into the NHS is going into better cancer care, GP provhsion,

:59:11. > :59:15.mental health care. It means we can support our hospitals better. We

:59:16. > :59:18.will continue to have with our ageing population great dem`nd for

:59:19. > :59:23.hospital care, but the best way to relieve pressure is to invest in

:59:24. > :59:29.better outer hospitals which has not been done familiars. General

:59:30. > :59:37.hospitals are treating an increasing number of patients, but despite

:59:38. > :59:45.being in an area of rapid growth, the funding for the local groups is

:59:46. > :59:51.amongst the worst in the cotntry. What can Her Majesty's government do

:59:52. > :59:54.to correct this? I'm happy to look at this funding issue. I know

:59:55. > :59:58.Kettering Hospital is under a great deal of pressure. The one thing they

:59:59. > :00:01.can perhaps do to relieve the financial pressures is to look at

:00:02. > :00:07.the amount of agency and locum staff they employ. As with many hospitals,

:00:08. > :00:13.there are savings to be madd in ways that improve rather than decrease

:00:14. > :00:16.the quality of clinical card. The public 's accounts committed has

:00:17. > :00:23.questioned the Department of Health and NHS England on the NHS `ccounts

:00:24. > :00:27.this year, following the colments by the controller and auditor General.

:00:28. > :00:34.It's clear that SDPs are thd only plans on the table. Will thd

:00:35. > :00:40.secretary of state make it clear that he will deliver them and if he

:00:41. > :00:45.can't, what is plan B? I don't recognise the picture she p`ints

:00:46. > :00:50.about opposition to SDPs. What we need to do is make sure we have good

:00:51. > :00:53.plans that will deliver better care for NHS parents by bringing together

:00:54. > :01:00.and integrating the health `nd social care system and improving out

:01:01. > :01:04.of hospital plans. Whilst wd are in a period where the planned

:01:05. > :01:08.unpublished, there is a degree of uncertainty that we will do

:01:09. > :01:15.everything to alleviate, but the plans are important for the future

:01:16. > :01:35.of the NHS and has our full support. There is concern around Paignton

:01:36. > :01:45.hospital. We need to know what will replace the provisions that will be

:01:46. > :01:50.cut? I hosted a meeting for a number of colleagues who are concerned

:01:51. > :01:56.about health in Devon and h`ppy to continue to engage with colleagues

:01:57. > :01:57.across the country. Two years ago Nottingham University Hospital trust

:01:58. > :02:03.privatised support services, including cleaning, handing them

:02:04. > :02:08.over to a company in an effort to save money. Since then therd have

:02:09. > :02:13.been shortages of equipment, staff and an appalling decline in

:02:14. > :02:16.standards of cleanliness. Whll he condemned Karelian for putthng

:02:17. > :02:25.patients at risk and one warmly ensure that hospital servicds in

:02:26. > :02:31.Nottingham are properly funded? The decision about whether to ottsource

:02:32. > :02:38.services must be a matter for local hospitals, but I know that hospital

:02:39. > :02:42.has been struggling. If the contract is not working and the qualhty is

:02:43. > :02:51.not right, I expect the hospital to change it, but it is their decision.

:02:52. > :02:57.Demand has exceeded supply, we must now move on. I kept the honourable

:02:58. > :03:08.lady waiting for a moment. Babies are due sense of anticipation. Point

:03:09. > :03:11.of order. Thank you, Mr Spe`ker It is frustrating to hear ministers and

:03:12. > :03:21.some backbenchers continually refer to this government investing or

:03:22. > :03:26.intending to invest ?10 billion into the NHS. I sit on the house select

:03:27. > :03:31.committee and I would just like to read you the following extr`ct from

:03:32. > :03:39.a report. Last year's spendhng review announced the NHS wotld

:03:40. > :03:42.receive an additional 8.4 bhllion by 2021, was previous spending review

:03:43. > :03:46.is defined health spending `s the whole of the Department of Health

:03:47. > :03:47.budget, the 2015