Health Questions House of Commons


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

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Elliott. Number one, Mr Spe`ker I call the Minister Nicola Bl`ckwood.

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NICE recommends exercise schemes for those who are at risk of ill health.

:00:30.:00:40.

Our GP physical activity ch`mpion programme has taught health care

:00:41.:00:45.

professionals to provide advice on physical activity in the te`m

:00:46.:00:52.

examinations. In the north-dast only 33% of adults participate in weekly

:00:53.:00:57.

sports. 30% in London. This has a knock-on effect on people throughout

:00:58.:01:04.

their lives. What is the government doing to address these geographic

:01:05.:01:11.

health inequalities. The honourable lady is right to raise this

:01:12.:01:16.

question. Inactivity costs Dngland ?7.4 billion a year and regtlar

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physical activity reduces the risk of developing many health conditions

:01:21.:01:30.

from between 20 and 40%. It can reduce the risk of cancer. Hn

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addition to BGP programme, we have secured funding from sport Dngland

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to highlight a module with lidwives, mental health practitioners and

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there will be a pilot to embed this project in practising nurses, but it

:01:55.:01:59.

will be up to local areas to make the best of these programmes. On the

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behaviour part of the questhon, what can the Minister do to addrdss the

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overconsumption of painkilldrs? The honourable gentleman has rahsed an

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important issue about drug `nd Apple on this use which is why we have

:02:20.:02:25.

prioritised this is one of the local statutory requirements. We have

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given ?16 billion to local health authorities for Public health

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delivery and we will expect them to prioritise this. Mrs Sharon Hodgson.

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Lep of physical activity contributes to obesity and weight today's help

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questions falling onto world obesity day, it is vital we commit our

:02:53.:02:57.

efforts to reversing rising obesity levels in the UK. An opporttne

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moment would have been the childhood obesity plan published over the

:03:04.:03:07.

summer, but sadly it did not go far enough. Will the Minister ensured

:03:08.:03:13.

this plan is realised as a preventative strategy to ch`nge

:03:14.:03:19.

behaviours and help make thd next-generation healthier than the

:03:20.:03:24.

last? Can I congratulate thd honourable lady on her role. We are

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proud of the childhood obeshty plan. It is based on the best evidence

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that is available and will lake a real difference to obesity rates in

:03:38.:03:42.

this country. The government is consulting on the soft drinks levy.

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We must now work hard to make sure we are delivering on that. We are

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proud because this is a world leading plan. Johnny Mercer. Number

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two Mr Speaker. Mr David Mowat. Limit has gone further and faster in

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terms of help and social care integration. The integrated fun they

:04:12.:04:17.

have set includes housing and leisure as well as housing ,- help

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and care. I will be happy to visit to see how the fund is workhng in

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practice. Innovative steps have been taken to look at the inequalities in

:04:34.:04:45.

Devon. There is a shortfall. Will be MP work with the relevant agencies

:04:46.:04:51.

to address these inequalitids? The honourable member refers to the

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timing lion that can exist between target and funding. When I visit I

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will be happy to meet with stakeholders and to congrattlate

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health and social care leaddrship in the progress they have made with the

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fund and the above average satisfactory ratings that h`ve been

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achieved in Plymouth. When he is in Devon will he meet patients, grids

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and NHS staff who are very worried about the proposals under the

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government's successor regile which includes the closure of manx

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hospitals? Does he accept that while it may make sense to integr`te and

:05:37.:05:41.

move money from beds and buhldings to better care for people in their

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homes, against a backdrop of massive cuts in social care budgets, that is

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simply not going to be deliverable. To answer the question, yes, I would

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be happy to meet in that context. In terms of the success regime, it is a

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transfer of resources from community hospitals to care at home and

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domiciliary care. That is not necessarily the wrong thing to do,

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but it must be done right and I am happy to meet. I welcome grdater

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integration, but there are grave concerns about the effects of cuts

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to social care on the NHS. What we are seeing is more and more patient

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spending greater time in more expensive settings in hospital when

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they could be better looked after in their own homes or communitx, but it

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is such to social -- cuts to social care that makes that imposshble Can

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the minister explained the damage that the cuts has made? Sochal care

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funding is tight, but it is true to say that those parts of the country

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that do the best in this regard do it where they have integratdd health

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and social care effectively. In terms of the budget there is some

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disparity amongst different health authorities. Something like a

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quarter of health authoritids this year have increased the budget this

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year. The scientific evidence for the low risk alcohol guidelhnes are

:07:21.:07:28.

available on the government website. There was public consultation to

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make sure the advice was as clear and usable as possible. We received

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1019 responses. Does the Minister not agree that the Chief Medical

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Officer should highlight thdse benefits more? For many people

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drinking alcohol is part of the normal social lives and we `re

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perfectly clear that these guidelines are advisory. Thdy are in

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place to help people make informed decisions about how they drhnk and

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to decide whether they want to take less risks with the drinking. I

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would like to point out that Rochdale has more than double the

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number of admissions to hospital where alcohol is a factor than other

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authorities in England. Can the Minister assure the house that

:08:35.:08:36.

public health guidance regarding drinking is advisory? They `re

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intended to give the best possible advice and put the evidence in one

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place so that people can make the best decisions regarding drhnking.

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Could she have a word with her colleagues in DC jee who prdside

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over a system where profitable wanted pubs are being demolhshed and

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supermarkets built on the shte against the wishes of the community?

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We are very clear that soci`l drinking is not the target of these

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low risk guidelines. I'm very happy to meet and discuss this with

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colleagues. Sadly very few people are aware of the link betwedn our

:09:53.:09:56.

coal consumption and obesitx and the long-term impacts of life lhmiting

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diseases. To make sure obeshty is integral to the guidelines, will be

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Minister put tackling adult and childhood obesity even highdr up the

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agenda? The honourable lady is right to raise the hidden risks of alcohol

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consumption which is exactlx why a widespread and analysis of the

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evidence was conducted throtgh this guideline exercise and she hs right

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to say that obesity should be a top priority for the government. We will

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analyse her question and look into it. Thank you, Mr Speaker. 003

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hospital PFI schemes reach financial close between 1997 and 2010,

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creating liabilities for thd NHS of ?77 billion. Three Legacy PF the --

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PFI schemes have been signed recently and one has been shgned

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under the new model work ?243 million. Except for some of the

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earlier schemes, ownership of the hospital reverts to the NHS at the

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end of the contract, but at the end of this the NHS has the

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Ever techively the figures will mean even more debt for the next

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generation. Will the Governlent commit to abandon the PFI idiotic

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scheme. No more PFI one or two, just abandon it, minister? I know the

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honourable gentleman has a consistent track record in opposing

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PFI, even when the vast majority of the schemes were put under contract

:11:56.:11:58.

under the Government of which he was a member, so I'm not going to take

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any lectures from the honourable gentleman about how to deal with

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PFI. And we will continue to use the new stricter terms as and when

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appropriate. Thank you, very much. I nothce no

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indecision there. The National Audit Office concluded that the PFI

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contract for the Norfolk Norwich Hospital was a bad deal for the

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taxpayer and NHS, yet last xear Octagon Health Care sunk further

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into the red. Would the minhster consider making an approach to

:12:38.:12:43.

Octagon to help confront thd enormous financial black hole this

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Trust faces? Well, we have provided access for seven of the worst

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affected Trusts with obligations under PFI signed as I've indicated

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earlier to some 1.5 billion of a support fund to help with this. I'm

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not sure off the top of my head whether Norfolk is one of these I

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suspect it's not. I would bd happy to talk to him about this. Rather

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than hissing the honourable gentleman's hopes inapproprhately,

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many of these schemes are too costly to divert resource to pay off in

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their absence. Number five, Mr Speaker.

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Mr Speaker, the five-year forward view will be delivered throtgh

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sustainability and transforlation plans which are currently bding

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developed by Clinical Commissioning Groups in collaboration with local

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authorities and providers. NHS England expects that all SDPs will

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be published, though in somd areas, discussions are already takhng

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place. I'm most grateful. In Wycombe I'm led to understand we should

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expect no dramatic changes `nd possibly no publication of `

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strategic plan. Would my right honourable friend agree with me that

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public confidence would be luch enhanced by the clear artictlation

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in public of a strategy for meeting the five-year forward view. I would

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agree with the honourable mdmber and I'll drive and give a clear`nce --

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try and give a clear answer. NHS England have said all 44 pl`ns will

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be published shortly. For those that have not done so, it will t`ke place

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at the end of the formal chdckpoint we view at the end of Octobdr. Areas

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are working to different tile scale bus they'll all be published by the

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end of November. For the avoidance of doubt, this includes the SDP for

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Bucks, Oxford and Berkshire West. Thank you, Mr Speaker. The NHS

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five-year forward view calldd for radical upgrade in interevens and

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public health. How does the minister square that with the Governlent s

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subsequent cuts to public hdalth, including ?200 million in-ydar cuts

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and further subsequent cuts expected by 2020? Mr Speaker, the SDP process

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is trying to upgrade our provision in terms of public health, cancer

:15:07.:15:11.

outcomes and mental health. Part of what every SDP will be expected to

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provide will be an assessment of the local priorities in public health

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and the timetable for progrdss towards that.

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Mr Speaker, Wantage community Hospital has recently closed because

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of a threat of Legionnaire's disease and it will not re-open unthl we

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have finally concluded constltation on the sustainability consultation

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plan, if it re-opens at all. This consultation has been delaydd,

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naturally worrying my consthtuents. I hope you will join with md in

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urging Oxfordshire to get on with this plan so we can have a

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reasonable discussion. Mr Speaker, I will join with the

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Right Honourable member in doing that. I'm not familiar with the

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specifics of the Wantage case but it doesn't sound right that thhs is an

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ongoing thing that's not fixed quickly. Could I congratulate the

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minister on his appointment to the frontbench, as well as that of the

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honourable lady from Abingdon. I'm sure they'll do a terrific job in

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

:16:15.:16:20.

local CCGs are just not providing information on reventive work for

:16:21.:16:24.

dyke knees. -- preventative work for diabetes. Will he confirm there ll

:16:25.:16:30.

be reference to diabetes once these plans have been published? H will

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confirm that. There is a national diabetic plan. He'll be aware of

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that. Diabetes is one of a number of long-term conditions that the plans

:16:40.:16:45.

are charged to actually delhver improvements in and it would not be

:16:46.:16:49.

acceptable for a plan to be signed off or completed unless progress in

:16:50.:16:54.

diabetes has been made. Looking at new treatment options and

:16:55.:16:59.

the forward view, so will hd consider the example of the NHS

:17:00.:17:03.

Trust in South Wales which treats 1.5 million cancer patients every

:17:04.:17:10.

year and is now using reflexology, reiki healing, aromatherapy and

:17:11.:17:14.

breathing relaxation technipues to alleviate anxiety, pain and side

:17:15.:17:20.

effects and symptoms. If thhs was more widely spread, cost savings and

:17:21.:17:25.

patient satisfaction would hncrease. Mr Speaker, the SDP process is

:17:26.:17:29.

locally led, not led from the centre. I would expect though that a

:17:30.:17:35.

clinical judgment of the type that were referred to would be m`de if

:17:36.:17:40.

they can be confirmed on thd basis of scientific trial-based evidence.

:17:41.:17:49.

Central to the aim of the fhve-year forward plan for the mace is a

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sustainable Health Service hn which all patients receive the right care

:17:54.:17:57.

at the right time in the right place. With that in mind, c`n the

:17:58.:18:01.

minister tell me what action he s taken to address the problel of

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delayed hospital discharges which have risen by 20% so far thhs year?

:18:07.:18:13.

This amounts to an addition`l 9 6 people every day condemned to stay

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in hospital longer than is ledically necessary. May I welcome her to her

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post also and wish her luck in the new job. In terms of delayed

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discharges, there has been `n increase in England over thd last

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year. A part of that increase, only a part of it, is due to difficulties

:18:35.:18:38.

in the integration between social care and the NHS, a large p`rt of it

:18:39.:18:44.

is also within the NHS itself. But it's not uniform across loc`l

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authorities and indeed many local authorities are improving in this

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regard. What is very clear hs that those that are making the most

:18:54.:18:56.

progress most quickly are those that have gone furthest in integrating

:18:57.:19:07.

social care and health care. Thank you, Mr Speaker.

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Mr Speaker, the Department of Health has commissioned three separate

:19:14.:19:17.

reviews on the diagnosis, treatment and transmission of lime disease.

:19:18.:19:21.

The work will be carried out by the epicentre of University College it

:19:22.:19:26.

will be clinically driven evidence-based and the work will be

:19:27.:19:31.

published late 2017. I'm delighted the Government is looking into this

:19:32.:19:34.

serious important disease, but as the reviews progress, thous`nds of

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people contract lime Des each year, particularly in areas like Wiltshire

:19:40.:19:42.

and potentially receive inadequate treatment. Can the minister look

:19:43.:19:51.

into speeding up a the revidws - Lyme disease. We need to go as fast

:19:52.:19:55.

as possible but we are workhng with research teams. The work is to be

:19:56.:20:00.

trial based and needs to be as definitive as possible. In the

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meantime, early diagnosis is the key way to make progress, public health

:20:06.:20:08.

England continues to work whth GPs and the public on this.

:20:09.:20:17.

Thank you, Mr Speaker. My mother recently died of motor neurone

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disease. There are 13 sufferers per 10,000 people. Will the minhster

:20:22.:20:35.

PROBLEM WITH SOUND. I'll be happy to meet with the

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member on that subject. THE SPEAKER: Extremely gratdful to

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the Minister for His response to that matter.

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Bearing in mind that the cases of lime disease have quadrupled in the

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last 12 years, some in my own constituency, what has been done

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with the devolved assemblies of Great Britain and Northern Hreland

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to have a wide strategy in place, UK-wise, which addresses thhs trend

:20:59.:21:02.

and provides effective diagnosis on the treatment? The principal thing

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we need to do is to have an innovative approach to it.

:21:15.:21:25.

I agree with my right honourable friend that this is an important

:21:26.:21:33.

area where the Lord in his report identified potential annual savings

:21:34.:21:38.

of ?700 million through redtcing procurement performance between

:21:39.:21:42.

providers. We have announced a first tranche of 12 standardised products

:21:43.:21:47.

for all NHS providers to usd in order to boost procurement volumes

:21:48.:21:50.

and use economies of scale to secure lower prices. These initial

:21:51.:21:54.

products, including commodity items like gloves and needles, cover 100

:21:55.:21:58.

million worth of Trust spending and we expect to achieve savings of up

:21:59.:22:03.

to 25%. Innovative private sector stppliers

:22:04.:22:07.

have successfully partnered with the NHS from its inception and ht's

:22:08.:22:11.

quite right for that relationship to be sustainable, that they mtst make

:22:12.:22:15.

a profit. But does the minister agree with me that rogue colpanies

:22:16.:22:20.

who exploit the NHS's lack of commercial expertise could be named

:22:21.:22:23.

and shamed because they are making a lot of money at the taxpayers'

:22:24.:22:29.

expense. We believe the right approach to secure procuremdnt

:22:30.:22:32.

savings is to take advantagd of the immense amount of data that's

:22:33.:22:36.

available across the NHS and that's why we've set up the purchase price

:22:37.:22:42.

benchmarking indebltion tool where to date more than ?8 billion of

:22:43.:22:49.

expenditure covering over 30 million separate procurement transactions

:22:50.:22:53.

has been collated, is going to be analysed, and we'll use that

:22:54.:22:57.

information judiciously to save the taxpayer money. That's the right way

:22:58.:23:00.

to start, rather than naming and shaming.

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Can I urge the minister when thinking about national procurement,

:23:05.:23:08.

national commissioning, to look at some of those national strategies

:23:09.:23:12.

that can underpin them? For example, why we need to renew the national

:23:13.:23:18.

stroke strategy, 100,000 people a year suffer from a stroke and we

:23:19.:23:24.

have nearly a million peopld in this country living with having had a

:23:25.:23:28.

stroke and yet they care very much about the rehabilitation services

:23:29.:23:31.

and other services too. THE SPEAKER: The minister's

:23:32.:23:34.

challenge is to relate that very important matter to tell qu`litily

:23:35.:23:37.

important matter that happens to be the subject of the question which is

:23:38.:23:42.

procurement. Minister? I'm grateful to you for drawing the attention of

:23:43.:23:45.

the honourable gentleman to the fact that this topic is about

:23:46.:23:49.

procurement. I think he is right to highlight the fact that we have

:23:50.:23:55.

looked at an acute heart trdatment strategy and we are creating centres

:23:56.:24:00.

of excellent across the country to ensure that if people suffer from an

:24:01.:24:05.

acute heart incident, a stroke in particular, that they are treated by

:24:06.:24:09.

the specialists who'll give them best prospects for recovery.

:24:10.:24:16.

THE SPEAKER: Secretary of State In the last four years, 29 Trusts have

:24:17.:24:21.

been put into special measures, more than one in ten of all NHS Trusts,

:24:22.:24:27.

of those 12 have come out h`ving demonstrated improvements in safety

:24:28.:24:31.

and quality and 1300 doctors and 4,200 more nurses are working in

:24:32.:24:35.

Trusts that have been put into special measures.

:24:36.:24:38.

The Secretary of State will be aware that the previous hospital hn my

:24:39.:24:42.

constituency's now come out of special measures because he visited

:24:43.:24:47.

last year. They made excelldnt progress, not least in bringing in

:24:48.:24:52.

lists for in patients and also numerous measures to transform the

:24:53.:24:55.

out-patients department. Will he join me in paying tribute to all the

:24:56.:25:00.

staff at the hospital, parthcularly the Chief Executive and the chairman

:25:01.:25:03.

for the excellent progress that s been made? I'm very happy to do that

:25:04.:25:08.

and I very much enjoyed my visit to the QE with him a couple of years

:25:09.:25:15.

ago. I think it's a good ex`mple of how Trusts can be transformdd when

:25:16.:25:24.

they go into special measurds. They've opened a laporoscophc unit,

:25:25.:25:28.

they have got 72 more nurses and this is a good example to m`ny other

:25:29.:25:33.

Trusts that are currently in special measures that it can be a ttrning

:25:34.:25:36.

point for the benefits of p`tients and staff.

:25:37.:25:45.

So many trusts are still in a financial mess. To solve it we need

:25:46.:25:53.

more funding and also funding for councils to occur as well. What is

:25:54.:25:58.

the secretary of state doing to fight for more funding so wd can do

:25:59.:26:03.

with these problems properlx? He will have noticed that last year in

:26:04.:26:08.

the spending review the NHS got the biggest funding increase of any

:26:09.:26:11.

government department. We committed to the NHS's open plan which asked

:26:12.:26:22.

for ?10 billion more per and in real terms, but I don't disagree with him

:26:23.:26:26.

that there are still very rdal financial problems in the NHS and

:26:27.:26:31.

social care system. The trusts that are delivering the highest standards

:26:32.:26:35.

of care or so have the lowest deficits. Delivering unsaid care is

:26:36.:26:42.

one of the most expensive things you can do and that's why this hs so

:26:43.:26:49.

important. We'll be Secretary of State joined me in congratulating

:26:50.:26:57.

all staff at the auto contr`st just four years after it was deeled at

:26:58.:27:02.

risk and it is now in the top percentage of trusts. I think the

:27:03.:27:08.

staff at Orton have done a fantastic job. I congratulate them and thank

:27:09.:27:15.

him for his work in supporthng them. In my own area of Calderdald and

:27:16.:27:19.

Huddersfield there is a dre`dful situation caused because of the

:27:20.:27:24.

clinical commissioning group and the way it procures. He has had a

:27:25.:27:34.

petition about the closure of A E. Will he please intervene because the

:27:35.:27:42.

competence of local CCG 's hs not up to the job. I would say to him that

:27:43.:27:50.

there is a mechanism by which these issues do end up on my desk. It has

:27:51.:27:55.

to be reviewed by overview `nd scrutiny committees from local

:27:56.:28:00.

councils and then I get the recommendation, but I will look at

:28:01.:28:03.

it closely if that process hs followed. Due to rapid incrdase in

:28:04.:28:17.

population, there was a planned new health centre. Is he expecthng clear

:28:18.:28:32.

and timely plans? Absolutelx. One of the main purpose of SDP is to make

:28:33.:28:37.

sure we deliver our Cancer plan which will see us introducing a

:28:38.:28:41.

four-week maximum waiting thme between GP referral and ulthmate

:28:42.:28:48.

diagnosis. That will save up to 30,000 lives a year and will be a

:28:49.:28:56.

big priority for each SDP. Lr Speaker, I joined the secretary of

:28:57.:29:02.

state in praising all who work in the NHS. We are encouraging people

:29:03.:29:08.

to become doctors, nurses and supports the. Last week there was a

:29:09.:29:19.

commitment to encourage 25% more doctors into the NHS on top of the

:29:20.:29:24.

6000 or the trend. Does the Minister agree that the

:29:25.:29:42.

rising agency costs point to a recruitment crisis and will you make

:29:43.:29:46.

a statement of a house outlhning his plans to address this crisis? We do

:29:47.:29:51.

recognise absolutely that the bills for agency staff have becomd

:29:52.:29:54.

unsustainable and that is why we have taken deliberate action,

:29:55.:29:59.

including introducing price caps on hourly rates last November `nd that

:30:00.:30:03.

is having a significant imp`ct in reducing agency costs. Year to date,

:30:04.:30:10.

agency costs are some ?550 lillion less than they were last job. Can I

:30:11.:30:18.

work the announcement about the increase in medical spaces `nd can I

:30:19.:30:23.

ask what plans the department has to ensure there is sufficient clinical

:30:24.:30:26.

training places for those mddical students? I can reassure my

:30:27.:30:33.

honourable friend that therd is considerable excess demand to train

:30:34.:30:40.

to become a coalition in thhs country from UK-based students. Only

:30:41.:30:45.

some half of those who applhed to train in medical schools ard

:30:46.:30:48.

accepted at present and therefore we are confident that there will be

:30:49.:30:53.

plenty of take-up of these dxtra places and regarding clinic`l

:30:54.:30:57.

placements, we are in discussions with the universities, colldges and

:30:58.:31:00.

teaching hospitals to ensurd that they are made available. Mr Speaker,

:31:01.:31:07.

I welcome the 25% expansion in medical student places, but reject

:31:08.:31:11.

tying this to the elimination of 25% of overseas doctors who currently

:31:12.:31:18.

work in our NHS. The secret`ry of State must know that with 10% of

:31:19.:31:23.

posts unfilled and ever rishng patient demand, we will alw`ys need

:31:24.:31:27.

international graduates in the future. Does he not recognise that

:31:28.:31:31.

he is creating unrealistic expectations and conflict whth his

:31:32.:31:36.

British only medical servicd ideal? I'm grateful to the honourable lady

:31:37.:31:44.

for giving me the opportunity to stop this scaremongering whhch is

:31:45.:31:48.

undoubtedly unsettling many of the very valuable doctors, nursds and

:31:49.:31:52.

other foreign nationals providing vital services to the NHS. The

:31:53.:31:56.

announcement last week was `bout adding more doctors to be trained

:31:57.:32:02.

who are UK-based. We are not changing any of the present

:32:03.:32:06.

arrangements regarding international students being trained here, or

:32:07.:32:14.

doctors and nurses working here With one in ten posts unfilled right

:32:15.:32:18.

now, how does the Minister dxpect with the rhetoric that was tsed last

:32:19.:32:23.

week that we will even retahn let alone attract foreign doctors the

:32:24.:32:30.

fill those posts? No, there was no rhetoric used regarding the valuable

:32:31.:32:42.

contribution by a foreign n`tionals to our health service that remains

:32:43.:32:53.

the case. Staff shortages c`use a temporary closure of Granth`m A E.

:32:54.:33:05.

Will the state of -- will the Secretary of State meet with me and

:33:06.:33:16.

Jody Clarke, a local coordinator? I understand that my right honourable

:33:17.:33:20.

friend has already committed to me to enable me to say to the

:33:21.:33:24.

honourable gentleman he does intend to meeting with campaigners in due

:33:25.:33:32.

course. The minister says there was no rhetoric scaremongering last

:33:33.:33:36.

week. How do you explain to the house what the Prime Ministdr said

:33:37.:33:39.

when she said there will be staff here from overseas in that hnterim

:33:40.:33:43.

period until the further nulber of British doctors can be trained and

:33:44.:33:53.

come on our hospitals. What did she mean and what can we expect next?

:33:54.:33:59.

Ambulances plastered with go home stickers? I hope he will usd more

:34:00.:34:09.

measured language rather th`n spreading this kind of inappropriate

:34:10.:34:15.

rumour. The interim period referred to was the period during whhch the

:34:16.:34:19.

doctors will be trained. We won t get new doctors coming under this

:34:20.:34:25.

increase allocation until 2023 and during that time clearly we will

:34:26.:34:30.

need to use all measures to ensure we feel these spaces that I

:34:31.:34:32.

acknowledge we have across our hospitals. I appreciate the

:34:33.:34:39.

Minister's warm welcome and I am looking forward to shadowing the

:34:40.:34:53.

secretary of State, but the remark about, it should be directed to the

:34:54.:35:00.

Prime Minister. Post Brexit, given there are concerns that these powers

:35:01.:35:03.

that go far enough, can you tell us what steps he will be taking to

:35:04.:35:08.

ensure that no staff from the EU will lose their jobs? And whll the

:35:09.:35:16.

NHS post Brexit still be able to recruit from the EU if necessary.

:35:17.:35:28.

Minister. Health ministers `re insuring that the 53,000 people from

:35:29.:35:36.

the EU working within the NHS have secure posts. Although we h`ve

:35:37.:35:42.

vacancy rates, we have 7800 more consultants employed in the NHS than

:35:43.:35:48.

there were in May 20 ten. Wd have 8500 more doctors than in M`y 2 10

:35:49.:35:54.

and over 10,500 more nurses working on our wards. We have gone through a

:35:55.:35:59.

consistent policy of recruiting more people to work in the NHS under this

:36:00.:36:09.

government. The independent cancer task force highlighted in a report

:36:10.:36:15.

saving lives, averting costs that identified cost savings in darly

:36:16.:36:29.

diagnosis, especially in:, rectal and ovarian cancer. In welcoming the

:36:30.:36:38.

Minister to his post may I highlight evidence to show that early

:36:39.:36:44.

diagnosis offers substantial savings. Colon cancer stage while

:36:45.:36:56.

cost ?3000 to treat. Stage forecasts ?12,000 to treat. Can we colmission

:36:57.:37:01.

a study to look at this bec`use it requires further detail on behalf of

:37:02.:37:08.

the taxpayer. We agree that early diagnosis says lies and can lead to

:37:09.:37:13.

cost savings and just as an example, we know now that GB revivals are up

:37:14.:37:23.

by 91% since 2010. -- GP. Wd are beginning to see the results of

:37:24.:37:29.

early diagnosis coming throtgh. In terms of a further study, both

:37:30.:37:34.

Public Health England and McMillan have commissioned studies on

:37:35.:37:39.

modelling, one element of which will be the costing of early diagnosis.

:37:40.:37:48.

We look forward to the findhngs GPs play a role in the early di`gnosis

:37:49.:37:57.

of cancer. In Sunderland we were the most underfunded. Can the Mhnister

:37:58.:38:01.

set out how he make sure th`t we train more family doctors and that

:38:02.:38:05.

they are encouraged to work in areas where there is an acute shortage? We

:38:06.:38:14.

are training 3250 extra GPs every year. We have a target to h`ve 000

:38:15.:38:20.

additional doctors working hn general practice by 2020. Btt as

:38:21.:38:27.

well as new GPs we need to do better with retention and that means

:38:28.:38:31.

keeping the GP population wd have. There are a number of steps that are

:38:32.:38:36.

being taken to do that. With reference to Sunderland, thdre is a

:38:37.:38:41.

bursary scheme that is aimed at attracting GPs to areas which they

:38:42.:38:54.

may not wish to necessarily work in. In 2010 target was set to m`ke 20

:38:55.:39:01.

billion worth of efficiency savings by 2015 to free up money to treat

:39:02.:39:13.

patients and for new technology Under inspirational leadership, the

:39:14.:39:19.

NHS broadly delivered on thhs challenge, recording savings of

:39:20.:39:23.

?19.4 billion. Will of the savings have been reinvested into an NHS --

:39:24.:39:32.

into NHS front line services. Would he confirmed that the achievements

:39:33.:39:37.

of those savings was done through greater efficiency and effectiveness

:39:38.:39:41.

in the delivery of care and that also in cutting out waste whthin the

:39:42.:39:49.

NHS between 2002 and 2007? @nd can you confirm that the benefit of this

:39:50.:39:55.

achievement to the NHS is that not a single penny of those savings goes

:39:56.:40:02.

back to the Treasury, but is reinvested in the NHS and front line

:40:03.:40:08.

services? Well, my right honourable friend has managed to include

:40:09.:40:14.

several questions in his impressive supplementary. I can confirl that

:40:15.:40:17.

much of the ways that took place in the years he cited relate to

:40:18.:40:23.

projects of the previous Labour government which they themsdlves

:40:24.:40:27.

then cancelled, such as the IT project. I can also confirm that

:40:28.:40:31.

savings generated within thd NHS are kept within the NHS and Lord Carter,

:40:32.:40:38.

whose report I referred to darlier, has identified some ?5 billhon worth

:40:39.:40:43.

of efficiency savings that we have two deliver within this Parliament.

:40:44.:40:47.

That is a distinction to be drawn between realistic targets and

:40:48.:40:54.

systematic underfunding. Silon Stephens said last month th`t for

:40:55.:40:57.

three of the five years we did not get what we asked for. It w`s also

:40:58.:41:01.

said that there is a huge g`p coming. Cheers and chief exdcutives

:41:02.:41:07.

on the front line say they can't make things add up any longdr. The

:41:08.:41:13.

government says the NHS gets all it asks for. Those running the NHS say

:41:14.:41:16.

something different. The honourable gentleman stood on a

:41:17.:41:23.

manifesto 18 months ago in which his party were not prepared to commit

:41:24.:41:27.

the funding which this partx was prepared to do. They committed 5.5

:41:28.:41:33.

billion, we committed ?8 billion and have put in ?10 billion.

:41:34.:41:41.

Tragically suicide is the bhggest single cause of death for mdn under

:41:42.:41:45.

50. We have 13 suicide everx single day of which three quarters are men.

:41:46.:41:49.

We are currently reviewing the strategy to make sure we le`ve no

:41:50.:41:55.

stone unturned in trying to reduce the totally unacceptable levels of

:41:56.:42:00.

these tragedies. Yesterday larked the launch of the mental he`lth

:42:01.:42:08.

awareness and suicide intervention called, it takes balls to t`lk. It's

:42:09.:42:12.

targeted at male dominated sporting venues aiming to direct men to

:42:13.:42:17.

support when they need it in order to promote positive mental health

:42:18.:42:20.

and reduce the incident of lale suicide. With suicide being the

:42:21.:42:25.

single most common cause of death, in men under 45, would the linister

:42:26.:42:30.

take the opportunity to welcome and support this important new campaign?

:42:31.:42:34.

I'm happy to do just that and I would like to thank her for bringing

:42:35.:42:38.

up this very, very important difficult issue. We are makhng

:42:39.:42:42.

progress in reducing suicidd rates but we can do an awful lot better.

:42:43.:42:47.

The thing that troubles me lost is that nearly three quarters of people

:42:48.:42:51.

who kill themselves have had no contact with specialist NHS mental

:42:52.:42:55.

Health Services in the prevhous year even though in many cases wd do know

:42:56.:42:59.

who they are because sadly lost of them have tried before. I'm very

:43:00.:43:04.

happy to commend the, it takes balls to talk, campaign and she m`y want

:43:05.:43:10.

to put them in touch with the sports and mental health charter, `nother

:43:11.:43:14.

scheme aimed to use sport to help boost the psychological well-being

:43:15.:43:18.

of men. A recent survey showed one hn four

:43:19.:43:22.

members of the emergency services experience mental health problems

:43:23.:43:26.

and a number experience suicidal thoughts. What is he doing to

:43:27.:43:33.

protect our vital paramedics and other ambulance staff and ensure

:43:34.:43:38.

they get the support they nded in dealing with absolutely app`lling

:43:39.:43:42.

situations? Well, again, I thank her for raising that and she'll be

:43:43.:43:46.

pleased to know that the NHS has introduced a scheme backed with

:43:47.:43:51.

funding to encourage NHS Trtsts to look after the mental well-being of

:43:52.:43:55.

their own staff. I would particularly like to pay trhbute to

:43:56.:43:59.

the courage of people who work in the Air Ambulance service bdcause

:44:00.:44:03.

they see day in day out somd of the most difficult and distresshng

:44:04.:44:05.

cases. They have to cope with that pressure when they take it home

:44:06.:44:09.

every day and I think we all salute them. Mr Speaker, every pathent

:44:10.:44:18.

discharged from hospital into a care home should have a care plan or

:44:19.:44:22.

discharge assessment. This should include a clear assessment of the

:44:23.:44:29.

needs covering transport, c`rers, GP notification, medication and, where

:44:30.:44:37.

necessary, clothing requirelents. I think thank the Minister for His

:44:38.:44:41.

response. There are cases of elderly and vulnerable people being

:44:42.:44:44.

discharged from hospital straight into care homes, often without any

:44:45.:44:49.

basic personal effects or clothing, whether that's because their family

:44:50.:44:52.

can't or aren't willing to supply them. Does the minister recognise

:44:53.:44:55.

this and what can the Government do to tackle it?

:44:56.:45:00.

Mr Speaker, as I said earlidr, there is a national process or in terms of

:45:01.:45:06.

this care plan where the falily is not able or won't provide stpport,

:45:07.:45:10.

typically the voluntary sector is asked to. If that doesn't work, Mr

:45:11.:45:16.

Speaker, local authorities `re able to increase the personal expense

:45:17.:45:20.

allowance to provide clothing. I'm interested to hear the cases that

:45:21.:45:23.

he's talking about in his constituency and I'll be very happy

:45:24.:45:27.

to understand better and talk to him about why it's failed there.

:45:28.:45:32.

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

:45:33.:45:40.

questions. Secretary of State? Last week aannounced plans to make the

:45:41.:45:46.

NHS sufficient with doctors. We recognise the brilliant work done by

:45:47.:45:49.

the overseas doctors that work in the NHS and have made it cldar

:45:50.:45:54.

whether or not they are frol the EU, we wish that work to continte

:45:55.:45:58.

post-Brexit. As the fifth l`rgest economy, Britain should be training

:45:59.:46:07.

all the doctors we need. Whhle there'll always be benefits for

:46:08.:46:16.

overseas doctors, we need to collaborate and have both. Our local

:46:17.:46:27.

health centre. Can we take ` coordinated approach to movd the

:46:28.:46:30.

health centre forward? I think I can do better than that

:46:31.:46:33.

because I think I've said I'm prepared to go to the health centre.

:46:34.:46:38.

I remember visiting the thornibly community hospital during the

:46:39.:46:41.

general election campaign and had a very good visit then. I unddrstand

:46:42.:46:46.

what they are trying to to `t the health centre and they are right to

:46:47.:46:51.

think we can improve better by thinking outside the hospit`l Health

:46:52.:46:54.

Services? Can I ask the Secretary of State to look into the creation of a

:46:55.:46:59.

sideways move for a Chief Executive of a Trust cricketised for ,-

:47:00.:47:02.

criticised for failing to investigate patient deaths. Six

:47:03.:47:07.

weeks after this special recruitment exercise by Southern health, cattery

:47:08.:47:12.

that Percy has resigned with a substantial 12-month salary pay off,

:47:13.:47:15.

signed off by the Department of Health and the Treasury. Thd

:47:16.:47:21.

campaign group, justice for LB, has called this utterly disgracdful and

:47:22.:47:24.

I agree. Will the Secretary of State investigate?

:47:25.:47:28.

Well, can I agree with the honourable lady that the wax this

:47:29.:47:33.

case was handled was by no leans satisfactory and I think thd truth

:47:34.:47:39.

is that it did take some tile to establish precisely what had gone

:47:40.:47:44.

wrong at Southern Health, as this House knows because we did `n urgent

:47:45.:47:47.

question at the time I think it was. There was a real issue about the

:47:48.:47:51.

failure to investigate unexplained deaths. I don't think the NHS

:47:52.:47:54.

handled this as well as it should, but we do have much more

:47:55.:47:58.

transparency and I think we do now not have a situation where people go

:47:59.:48:02.

on and get other jobs in thd NHS which is what has happen sod off

:48:03.:48:05.

none the past. Thank you, Mr Speaker. May H ask

:48:06.:48:09.

what the Government will be doing to scrutinise and assist the London

:48:10.:48:19.

ambulance service which has had an appalling, consistently bad call out

:48:20.:48:25.

record for category A situations? London ambulance service is in

:48:26.:48:28.

special measures and haar for some time. I visited this summer and am

:48:29.:48:33.

pleased to be able to confirm that some ?63 million of additional

:48:34.:48:36.

funding has been provided to the ambulance service since Aprhl 2 15

:48:37.:48:41.

and the service is starting to make significant inroads in incrdasing

:48:42.:48:44.

the number of paramed I belheves available on call, some 250 more

:48:45.:48:49.

have been added in the last couple of years. Last October, the then

:48:50.:48:53.

Health Minister confirmed that in terms of NHS dental provision, my

:48:54.:48:57.

constituency fell far below the national average. In fact this is

:48:58.:49:01.

one of the worst in the country Nothing has changed since then,

:49:02.:49:05.

unfortunately. Does the Secretary of State believe it's acceptable that

:49:06.:49:08.

my constituents and many of whom are children, are unable to get an NHS

:49:09.:49:11.

dentist? THE SPEAKER: Minister? Mr Speaker,

:49:12.:49:16.

it's clearly unacceptable if the situation that the honourable lady

:49:17.:49:19.

sets out is the case and I'll be happy to meet with her and work with

:49:20.:49:23.

her to take the action that we need to to make things better. Thank you,

:49:24.:49:28.

Mr Speaker. The Government's provided welcomed increased funding

:49:29.:49:32.

for mental health support, xet this does not appear to be reachhng my

:49:33.:49:35.

constituency effectively, particularly for children and there

:49:36.:49:41.

are concerns that the Millb`nk unit near Macclesfield may close. Will

:49:42.:49:44.

the minister look into thesd concerns? I'm very happy to do that

:49:45.:49:47.

and she's absolutely right to highlight the fact that the

:49:48.:49:51.

provision in mental Health Services to children is one of the bhggest

:49:52.:49:54.

weak spots in NHS provision today and it's an area we are putting a

:49:55.:49:58.

big focus on but I'm happy to talk to her about this.

:49:59.:50:01.

Thank you very much, Mr Spe`ker I know this is a devolved matter but

:50:02.:50:04.

look forward to the union all working together. In Northern

:50:05.:50:08.

Ireland, the Health Service is in crisis and on cancer, just `n

:50:09.:50:14.

example, 6.7 of those with breast cancer are being called in to be

:50:15.:50:23.

checked within 14 days, not 100 , so 6.7%, yet we have 392,000 pdople on

:50:24.:50:28.

the waiting list. Will the Secretary of State for Health meet with us to

:50:29.:50:35.

find a better way forward? Lr Speaker, we'll be working together

:50:36.:50:40.

to defeat cancer and the ond thing we know about defeating cancer is

:50:41.:50:44.

that the best way of doing ht is early diagnosis. We have had a lot

:50:45.:50:48.

of progress in that in Engl`nd, but there's a lot further to go. Of

:50:49.:50:52.

course I would be willing to talk to the devolved administration about

:50:53.:50:55.

what they can learn from us and perhaps vice versa.

:50:56.:50:59.

Can I ask the Secretary of State to look again at the decision not to

:51:00.:51:03.

fund second stem cell transplants for adults and children with blood

:51:04.:51:07.

cancers given there's significant clinical evidence of their benefit

:51:08.:51:10.

for those who relapse. Don't just take my word for it, take it from

:51:11.:51:15.

the Ant any Nolan Trust and the 36 specialist who is've written to the

:51:16.:51:18.

Secretary of State asking hhm to review this decision? This hs a very

:51:19.:51:24.

difficult area, Mr Speaker. Decisions on priority are clinically

:51:25.:51:27.

driven and must continue to be based on peer review day too. The most

:51:28.:51:31.

recent review determined th`t less than one third of second tr`nsplants

:51:32.:51:35.

would result in survival after five years. That is the reason that it

:51:36.:51:40.

was not funded. There will however be a further review next April and

:51:41.:51:44.

to the extent that the data is changed, there'll be a new

:51:45.:51:50.

evaluation at that time. The Park medical centre in Whitney

:51:51.:51:54.

faces closure. Patients will be dispersed a long way into other

:51:55.:51:58.

practices in this area wherd already one in four wait over a week to see

:51:59.:52:05.

their GP. Duncan Enright, L`bour's candidate in the by-election in

:52:06.:52:12.

Witney is campaigning to save the medical centre. Will the Secretary

:52:13.:52:17.

of State reward his campaign with a save your today? What the

:52:18.:52:23.

Conservative candidate done, we ll be saying very clearly, is that

:52:24.:52:26.

because of the extra funding by this Government, we are aiming to put

:52:27.:52:30.

5,000 more doctors working hn general practice by the end of

:52:31.:52:33.

Parliament, something that wouldn't have been possible with the increase

:52:34.:52:36.

of less than half promised by Labour.

:52:37.:52:40.

Thank you, Mr Speaker. As mhnisters will be aware, this week is baby

:52:41.:52:46.

loss awareness week. Access to Ne-Yo natal cots and transport services

:52:47.:52:50.

are a vital part of the card of premature and sick babies. What

:52:51.:52:54.

reassurances and assurances can my right honourable friend givd me that

:52:55.:52:57.

his department is continuing to review the findings of the Bliss

:52:58.:53:01.

report and when can we expect to hear more? I'm grateful to ly right

:53:02.:53:07.

honourable friend for raising Baby Loss awareness week. I'm sure she'll

:53:08.:53:12.

participate with others in the debate in the backbench comlittee

:53:13.:53:17.

later this week. The better births review of independent maternity

:53:18.:53:21.

review mad a number of recommendations, including Ne-Yo

:53:22.:53:24.

natal critical care. We are studying the recommendations and are due to

:53:25.:53:27.

report initial findings frol work in December.

:53:28.:53:30.

Thank you, Mr Speaker. I listened very closely to the Secretary of

:53:31.:53:33.

State before and his comments on mental health. He stood at that

:53:34.:53:37.

despatch box on 9th December and said that CCGs are are commhtted to

:53:38.:53:41.

increasing the proportion of their funding that goes into ment`l

:53:42.:53:48.

health. My research shows that 7% of CCGs are reducing. Yet another

:53:49.:53:53.

broken promise, when can we have real equality from this Govdrnment

:53:54.:53:57.

for mental health? I'll tell you what this Government's tone, we have

:53:58.:54:02.

legislated for parity of esteem on mental health, we are treathng 400

:54:03.:54:08.

more people every day for mdntal health conditions than six xears ago

:54:09.:54:11.

and we'll have a new plan that will see more people treated by 2020

:54:12.:54:15.

include ago transformation of CAMHS. That's possible because we `re

:54:16.:54:18.

putting extra money into thd NHS which her party refused to do.

:54:19.:54:21.

Does manufacture agree with me that the Government has a moral

:54:22.:54:25.

obligation to end the raid on poorer countries for their skilled doctors

:54:26.:54:29.

and nurses and make our NHS recruitment more self-sufficient? He

:54:30.:54:33.

is absolutery right to say that and I find it extraordinary that the

:54:34.:54:38.

party opposite said that our plan to train more doctors was nonsdnse We

:54:39.:54:42.

currently have 80 doctors in the NHS from Sri Lanka, 600 from Nigeria,

:54:43.:54:47.

400 from Sudan, 200 from My`nmar, they are doing a brilliant job, I

:54:48.:54:50.

want them to continue doing that, but we have to ask ourselves whether

:54:51.:54:55.

it's ethical for us to conthnue to recruit doctors from much poorer

:54:56.:54:58.

countries that really need their skills. I was really alarmed to see

:54:59.:55:03.

NHS chiefs warning that hospitals in England are on the brink of collapse

:55:04.:55:08.

at the weekend. I read it at the weekend, I must clarify. Is the

:55:09.:55:12.

Government's intention to ctt the public supply of health card in

:55:13.:55:15.

order to create demand for private health care systems or will the

:55:16.:55:19.

Government give it the inithal funds it needs? Let me remind the

:55:20.:55:23.

honourable lady that the party that introduced the most outsourcing to

:55:24.:55:27.

the private sector was her own Labour Government under the previous

:55:28.:55:32.

health Secretary tear Alan Lilburn. Our view is we should be nettral as

:55:33.:55:36.

to whether local doctors decide to commission their care from the

:55:37.:55:39.

public or private sector. Wd want the best care for patients. I

:55:40.:55:44.

welcome last week's NHS eye report that there are now sufficient staff

:55:45.:55:47.

at Chorley and South Ribble hospitals and the A department can

:55:48.:55:52.

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

:55:53.:55:55.

next year. Can the minister reassure me that he'll work with me `nd

:55:56.:55:58.

others to oblige the Trust to open as soon as possible?

:55:59.:56:04.

The honourable lady has been a champion of Chorley, along with a

:56:05.:56:12.

number member -- another melber of this house. I know them at local MPs

:56:13.:56:19.

yesterday. I am happy to work with her was welcoming the reopening of

:56:20.:56:34.

A and hope it can be brought forward. STDs are led locally -

:56:35.:56:54.

STPs are led locally. My local hospital has been downgraded. What

:56:55.:57:02.

has the Minister got to say to love loved ones of families who lay lose

:57:03.:57:12.

people? The NHS will need freedom to collaborate integrate and mdrge

:57:13.:57:16.

across divides. That came from the 2015 Labour manifesto. The SDP

:57:17.:57:21.

process is designed to have better care, better health and productivity

:57:22.:57:28.

as well. We should be critical friends to the process in that we

:57:29.:57:36.

all want a better NHS service. Telford's brand-new women and

:57:37.:57:42.

children's centre should be closed and moved to a more affluent area

:57:43.:57:46.

where help is better than the national average. The confidence of

:57:47.:57:52.

local people has been lost. We'll be secretary of State intervend and

:57:53.:57:57.

make sure that health care practitioners fulfil their legal

:57:58.:58:01.

duties? I would like to thank her for standing up for her

:58:02.:58:04.

constituents. She will agred that this has to be a local mattdr led by

:58:05.:58:08.

clinicians locally, but she can be reassured that we are always

:58:09.:58:13.

watching what has happened to make sure people are following dte

:58:14.:58:17.

process and the results of `ny changes that are proposed bdnefit

:58:18.:58:22.

patients as they are intenddd to do. I will watch carefully what is

:58:23.:58:26.

happening in Telford in Shropshire. About half a dozen times in the last

:58:27.:58:31.

hour the Secretary of State has been bragging about the extra money

:58:32.:58:36.

putting into the National Sdrvice. Why is it then that Bolsover

:58:37.:58:42.

hospital is due to close, including many that have been referred to Why

:58:43.:58:49.

is it that the neighbouring hospitals in countless

:58:50.:58:51.

constituencies in Derbyshird will be closing? Why doesn't he use some of

:58:52.:58:58.

that money to save the double shot hospitals? The extra money we are

:58:59.:59:02.

putting into the NHS is going into better cancer care, GP provhsion,

:59:03.:59:10.

mental health care. It means we can support our hospitals better. We

:59:11.:59:15.

will continue to have with our ageing population great dem`nd for

:59:16.:59:18.

hospital care, but the best way to relieve pressure is to invest in

:59:19.:59:23.

better outer hospitals which has not been done familiars. General

:59:24.:59:29.

hospitals are treating an increasing number of patients, but despite

:59:30.:59:37.

being in an area of rapid growth, the funding for the local groups is

:59:38.:59:45.

amongst the worst in the cotntry. What can Her Majesty's government do

:59:46.:59:51.

to correct this? I'm happy to look at this funding issue. I know

:59:52.:59:54.

Kettering Hospital is under a great deal of pressure. The one thing they

:59:55.:59:58.

can perhaps do to relieve the financial pressures is to look at

:59:59.:00:01.

the amount of agency and locum staff they employ. As with many hospitals,

:00:02.:00:07.

there are savings to be madd in ways that improve rather than decrease

:00:08.:00:13.

the quality of clinical card. The public 's accounts committed has

:00:14.:00:16.

questioned the Department of Health and NHS England on the NHS `ccounts

:00:17.:00:23.

this year, following the colments by the controller and auditor General.

:00:24.:00:27.

It's clear that SDPs are thd only plans on the table. Will thd

:00:28.:00:34.

secretary of state make it clear that he will deliver them and if he

:00:35.:00:40.

can't, what is plan B? I don't recognise the picture she p`ints

:00:41.:00:45.

about opposition to SDPs. What we need to do is make sure we have good

:00:46.:00:50.

plans that will deliver better care for NHS parents by bringing together

:00:51.:00:53.

and integrating the health `nd social care system and improving out

:00:54.:01:00.

of hospital plans. Whilst wd are in a period where the planned

:01:01.:01:04.

unpublished, there is a degree of uncertainty that we will do

:01:05.:01:08.

everything to alleviate, but the plans are important for the future

:01:09.:01:15.

of the NHS and has our full support. There is concern around Paignton

:01:16.:01:35.

hospital. We need to know what will replace the provisions that will be

:01:36.:01:45.

cut? I hosted a meeting for a number of colleagues who are concerned

:01:46.:01:50.

about health in Devon and h`ppy to continue to engage with colleagues

:01:51.:01:56.

across the country. Two years ago Nottingham University Hospital trust

:01:57.:01:57.

privatised support services, including cleaning, handing them

:01:58.:02:03.

over to a company in an effort to save money. Since then therd have

:02:04.:02:08.

been shortages of equipment, staff and an appalling decline in

:02:09.:02:13.

standards of cleanliness. Whll he condemned Karelian for putthng

:02:14.:02:16.

patients at risk and one warmly ensure that hospital servicds in

:02:17.:02:25.

Nottingham are properly funded? The decision about whether to ottsource

:02:26.:02:31.

services must be a matter for local hospitals, but I know that hospital

:02:32.:02:38.

has been struggling. If the contract is not working and the qualhty is

:02:39.:02:42.

not right, I expect the hospital to change it, but it is their decision.

:02:43.:02:51.

Demand has exceeded supply, we must now move on. I kept the honourable

:02:52.:02:57.

lady waiting for a moment. Babies are due sense of anticipation. Point

:02:58.:03:08.

of order. Thank you, Mr Spe`ker It is frustrating to hear ministers and

:03:09.:03:11.

some backbenchers continually refer to this government investing or

:03:12.:03:21.

intending to invest ?10 billion into the NHS. I sit on the house select

:03:22.:03:26.

committee and I would just like to read you the following extr`ct from

:03:27.:03:31.

a report. Last year's spendhng review announced the NHS wotld

:03:32.:03:39.

receive an additional 8.4 bhllion by 2021, was previous spending review

:03:40.:03:42.

is defined health spending `s the whole of the Department of Health

:03:43.:03:46.

budget, the 2015

:03:47.:03:47.

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