Health Questions

:00:00. > :00:09.and his team of ministers. THE SPEAKER: Order. Order. The

:00:10. > :00:14.questions to the Secretary of State for Health.

:00:15. > :00:21.Question one, Mr Speaker. THE SPEAKER: The Secretary of State

:00:22. > :00:24.for Health. As we wish each other a merry Christmas the whole House will

:00:25. > :00:29.also this morning remember the people of Berlin as they face up to

:00:30. > :00:35.yesterday's horrific suspected terrorist attack. Germany and its

:00:36. > :00:38.capital Berlin, are been beacons of freedom and tolerance in modern

:00:39. > :00:44.times and all our thoughts and prayers are with them today.

:00:45. > :00:48.With respect to question one, evidence from all over the world

:00:49. > :00:52.suggests that higher standards of care for patients relates directly

:00:53. > :00:55.to the quality of clinical leadership which is why last month I

:00:56. > :00:58.announced a number of measures to increase the number of doctors and

:00:59. > :01:04.nurses in leadership roles in the NHS.

:01:05. > :01:09.I thank my Right Honourable friend for his response. Clinicians in

:01:10. > :01:14.Telford have been showing real leadership by rejecting a proposal

:01:15. > :01:19.to close a brand-new women and children's unit and elements of our

:01:20. > :01:23.emergency services. The quango responsible for this idea has spent

:01:24. > :01:29.?3 million and taken three years to come up with this proposal which is

:01:30. > :01:34.rejected by local people and local clinicians. Will my honourable

:01:35. > :01:40.friend meet with me and my local colleagues to bring an end to this

:01:41. > :01:46.farce and ensure that this does not continue in limbo any longer?

:01:47. > :01:52.Thank you mrrks speaker. First of all, I do recognise the her of

:01:53. > :01:57.campaigning on this issue in Telford and she speaks for the concerns of

:01:58. > :02:02.many of her own constituents. As she knows, these service changes must be

:02:03. > :02:06.locally driven and they must have the support from local GP

:02:07. > :02:11.commissioners, but she will also know that the actual situation very

:02:12. > :02:14.frustratingly has not led to a consensus between clinicians in

:02:15. > :02:18.different parts of Telford and Shropshire. I agree with her that

:02:19. > :02:22.the process has taken much too long and I'm more than happy to meet her

:02:23. > :02:27.and try and bring the situation to a close as quickly as possible.

:02:28. > :02:32.In a year when the Health Secretary has spent a lot of time knocking

:02:33. > :02:38.clinicians, it is good to hear him speak so positively about them. But

:02:39. > :02:44.can I ask him this - after four years in his own job, what

:02:45. > :02:47.responsibility does he accept for the lack of suitably qualified

:02:48. > :02:52.individuals, not just clinicians, who are prepared to take on the top

:02:53. > :02:58.jobs in the NHS on a permanent basis? Well, I will tell the

:02:59. > :03:01.honourable lady what I take responsibility for, more doctors and

:03:02. > :03:08.more nurses and more funding than ever before in the history of the

:03:09. > :03:13.NHS. But we know that the highest standards are often achieved when

:03:14. > :03:20.there is strong clinical leadership. Only 54% of managers are clinicians

:03:21. > :03:24.in this country compared to 74% in Canada and 94% in Sweden and that's

:03:25. > :03:28.why it is right we do everything we can to encourage more clinicians

:03:29. > :03:32.into leadership roles. Does the Secretary of State agree that the

:03:33. > :03:36.clinical leadership involved in the getting it right first time

:03:37. > :03:40.initiative is important, not only as it will save ?1.5 billion which

:03:41. > :03:45.could be put back into patient care, but because patients will be in less

:03:46. > :03:48.pain and end up having less operations and some of them will

:03:49. > :03:55.even survive treatment which they wouldn't otherwise have done?

:03:56. > :03:59.He is absolutely right and I want to thank him for bringing Professor Tim

:04:00. > :04:04.Bricks to see me to explain how superb this programme is. Infection

:04:05. > :04:08.rates for orthopaedic surgery vary between one in 20 patients in some

:04:09. > :04:11.trusts to one in 500 in other trusts and getting this right can transform

:04:12. > :04:16.care for patients and save money at the same time.

:04:17. > :04:20.Can I associate myself with his comments about my one-time home,

:04:21. > :04:24.Berlin? Will he accept that we have the best clinical leaders anywhere

:04:25. > :04:29.in the world in this country and the challenge facing the NHS is not one

:04:30. > :04:33.of clinical leadership or the dedicational skill of staff, it is

:04:34. > :04:41.the chronic under funding by this Conservative Government? We do

:04:42. > :04:45.indeed have superb clinical leaders, people like Marian in Worthing and

:04:46. > :04:48.we have superb non clinical leaders like David Dalton in Salford's

:04:49. > :04:52.Royal, but what I would gently say to him if he is worried about

:04:53. > :04:56.funding why in the last election did he stand on a platform which would

:04:57. > :05:04.have seen the NHS have ?1.3 billion less this year? Will you ensure that

:05:05. > :05:10.clinical leaders are able to apply important techniques from other

:05:11. > :05:15.disciplines which can drive up productivity? Absoluty right. What

:05:16. > :05:21.is important is clinical leadership, but openness to the skills of others

:05:22. > :05:25.industries particularly engineering skills which, of course, he is very

:05:26. > :05:30.familiar with which can help us get processes right to improve care and

:05:31. > :05:37.safety for patients. Thank you, Mr Speaker. Does the Secretary of State

:05:38. > :05:41.agree that if the board of Doncaster and Bassett Law Hospital agrees to

:05:42. > :05:46.become a teaching hospital today, it will enable the trust to train the

:05:47. > :05:50.doctors of tomorrow so that they are more able to move into clinical

:05:51. > :05:57.leadership roles as quickly as possible? Well, I thank her for her

:05:58. > :06:00.question and I welcome the aspirations and the ambitions of

:06:01. > :06:03.Doncaster Hospital. Any final decision will be a matter for the

:06:04. > :06:07.NHS and health education England, but it is encouraging that they are

:06:08. > :06:12.reaching for the stars like this and yes, we do need to train more

:06:13. > :06:18.doctors and I do hope they can make a good contribution.

:06:19. > :06:23.THE SPEAKER: The honourable gentleman's constituency was

:06:24. > :06:33.mentioned and he came in on cue in time. Number two, sir. Evidence

:06:34. > :06:39.based medicine is about using high quality research to achieve optimal

:06:40. > :06:44.results. NICE plays an important role by translating research into

:06:45. > :06:52.authoritative guidance to healthcare professionals on best practise. Is

:06:53. > :06:55.she aware that the author said it is about integrating individual

:06:56. > :07:01.clinical experience and the best external evidence, not just external

:07:02. > :07:06.evidence. Is she further aware in respect of the interpretation of the

:07:07. > :07:11.evidence based medicine, a report in the so-called Good Thinking Society

:07:12. > :07:14.to the Charity Commission by using legal threats to force his

:07:15. > :07:21.department and health providers to change the law on healthcare? Well,

:07:22. > :07:25.NICE considers complementary and alternative medicines in developing

:07:26. > :07:31.its guidance. It has been able to recommend some therapies such as

:07:32. > :07:37.acupuncture and a range of complementary medicines for MS. We

:07:38. > :07:42.expect healthcare professionals to take that guidance into account b,

:07:43. > :07:45.but they must use their best understanding in treating the

:07:46. > :07:49.individual patients in front of him. Mr Speaker, the evidence is very

:07:50. > :07:53.clear, if you eat more sugar, it increases the risk of diabetes.

:07:54. > :07:57.Apart from introducing the sugar tax, what further evidence based

:07:58. > :08:07.research can be used by Government to reduce the risk of diabetes?

:08:08. > :08:12.The honourable gentleman is a great proponent of tackling the risk of

:08:13. > :08:15.diabetes. He knows that the Government takes tackling diabetes

:08:16. > :08:17.seriously. That's why we have introduce the first national

:08:18. > :08:21.diabetes programme which we have piloted and we are rolling out

:08:22. > :08:26.across the country. This includes education programmes, but testing

:08:27. > :08:31.and we are making sure that we use the evidence from this programme to

:08:32. > :08:36.improve and roll out the programme in an effective way.

:08:37. > :08:40.Mr Speaker, we are all in favour of evidence based medicine. We are also

:08:41. > :08:45.in favour of decent resources for the National Health Service. But in

:08:46. > :08:49.the case of the Huddersfield and Calderdale Hospital, what we want is

:08:50. > :08:58.good management and people managing to a high quality and not GPs

:08:59. > :09:02.promoted to a managerial position that they can't handle.

:09:03. > :09:07.THE SPEAKER: It is in relation to evidence based medicine. The

:09:08. > :09:10.honourable gentleman is a great advocate for evidence based

:09:11. > :09:12.medicine, he will be pleased to hear that the national leadership

:09:13. > :09:14.programme is one of the evidence based programmes that we are rolling

:09:15. > :09:24.out to improve the leadership of the NHS across the country. Number

:09:25. > :09:28.three, please, Mr Speaker. With permission, Mr Speaker, I will

:09:29. > :09:33.answer questions three, 12, and 14 together. The UK is already a global

:09:34. > :09:38.leader in the fight against AMR. This Government's leadership has

:09:39. > :09:43.secured a UN declaration on AMR and a commitment from the G20 to drive

:09:44. > :09:48.development of new anti-microbials, we will continue to deliver

:09:49. > :09:52.international programmes to tackle AMR including the Fleming and global

:09:53. > :09:56.AMR funds which represent ?300 million of investment over the next

:09:57. > :10:00.five years. Thank you, Mr Speakerment one of the ten key

:10:01. > :10:05.recommendations of the O'Neill review was to improve the data and

:10:06. > :10:11.surveillance underlying anti-mok robial resistance. What plans does

:10:12. > :10:15.the minister have to test all NHS patients for antibiotic resistance?

:10:16. > :10:20.The honourable gentleman is right that improving diagnostics is

:10:21. > :10:23.essential if we are to tackle this national threat and a routine part

:10:24. > :10:27.of clinical management of patients showing symptoms of infections is to

:10:28. > :10:31.take a blood sample where infection is identified, those samples are

:10:32. > :10:37.indeed tested for resistance, but part of our AMR strategy is to

:10:38. > :10:41.improve diagnostics and to fund innovation in this area.

:10:42. > :10:45.Will the Government commit that part of its strategy in this area will

:10:46. > :10:53.discourage the use of intensive farming with its over use of

:10:54. > :10:56.antibiotics? The honourable lady is right that we must focus on this

:10:57. > :11:02.area as well. The Government's focus is on reducing the need for

:11:03. > :11:06.antibiotics by minimising disease risk in animals through good animal

:11:07. > :11:09.husbandry and antibiotics do at the moment provide the only effective

:11:10. > :11:13.means of treatment for a number of animal diseases and are therefore

:11:14. > :11:18.essential to ensure the health and welfare of animals, but we are also

:11:19. > :11:20.working on this in an international context with the OIE and we will

:11:21. > :11:28.continue to drive forward this agenda.

:11:29. > :11:33.What measures are the Government putting in place to implement

:11:34. > :11:36.testing across the United Kingdom to reduce levels of inappropriate

:11:37. > :11:41.antibiotic prescribing in primary care?

:11:42. > :11:47.My honourable friend is right that we must focus on innovation and

:11:48. > :11:51.better tests particularly bed-side testing. The Government is reviewing

:11:52. > :11:56.the evidence in support of the use of CRP tests and their benefits.

:11:57. > :12:02.Pilot studies in the UK are contributing to that and will be

:12:03. > :12:10.evaluated so we can see how best to build on what is working well.

:12:11. > :12:16.480,000 develop multidrug resist hence TB this year. Drug resistance

:12:17. > :12:22.is combatting the outbreak of HIV and malaria. Can he outline the

:12:23. > :12:26.steps he is taking on alternative medicines and what cooperation has

:12:27. > :12:30.the minister had with the devolved assemblies on this matter? I'm

:12:31. > :12:35.grateful to receive immediate promotion from the honourable

:12:36. > :12:39.gentleman, however, we have made considerable progress in putting the

:12:40. > :12:43.building blocks in place in our strategy, domestically, including

:12:44. > :12:49.putting in place better data and guidance for primary care and

:12:50. > :12:55.strengthening the framework and including introducing incentives for

:12:56. > :13:00.the NHS, to improve prescribing of antibiotics, and this has led first

:13:01. > :13:06.reduction of prescribing antibiotics in the last quarter which we can see

:13:07. > :13:14.as an encouraging time. Of all of the ten recommendations in the

:13:15. > :13:18.review into anti-micro viral resistance, and given the amount of

:13:19. > :13:22.people dying, estimated to rise by 10 million a year by 2050 bha,

:13:23. > :13:27.assurances can the minister give she's behind this massive global

:13:28. > :13:31.awareness campaign. The honourable lady is right to identify the scale

:13:32. > :13:35.of the challenge that's why we put AMR on our national risk register,

:13:36. > :13:41.but no one country cank at thatle aLen and the UK has played a global

:13:42. > :13:47.leadership role in this, which is why we co-sponsored the World Health

:13:48. > :13:51.Organisation's global health plan and copiloted the Fleming fund to

:13:52. > :13:56.help poor countries to tackle drug resistance and we'll continue to

:13:57. > :13:59.play that global leadership role. The O'Neilll review reported some

:14:00. > :14:01.six months ago and included recommendations for national

:14:02. > :14:04.governments to follow. Account minister tell us what practical

:14:05. > :14:10.progress has actually been made by this Government so far?

:14:11. > :14:14.Well, we published our comprehensive response to the re-Neil review on

:14:15. > :14:16.19th September. It sets out a range of actions we will take on each of

:14:17. > :14:20.the recommendations from Lord O'Neilll but I think that the most

:14:21. > :14:25.practical progress I can report to the House, is the fact that

:14:26. > :14:28.prescribing of antibiotics has fallen for the first time since

:14:29. > :14:37.records began. I think we can all be proud of that progress.

:14:38. > :14:41.Number #4, Mr Speaker. There are currently 127,000 staff in

:14:42. > :14:45.the EU do a vital job for patients in the NHS and social care system.

:14:46. > :14:48.In this year of Brexit, we salute their excel et work and remain

:14:49. > :14:51.confident we will be able to negotiate for them to continue it

:14:52. > :14:56.going forward. Thank you, Mr Speaker. There are

:14:57. > :15:00.over 50,000 EU nationals working as nurses and doctors out with the UK

:15:01. > :15:06.along with 80,000 in the social care sector with the NHS facing extensive

:15:07. > :15:10.rota gaps due to the shortage of senior and June area doctors will

:15:11. > :15:14.the minister demand that EU nationals living here should have

:15:15. > :15:18.the right to remain? Well that is exactly what attend to

:15:19. > :15:22.achieve through negotiation, but we also have to remember the rights of

:15:23. > :15:26.British citizens, including people from Scotland, who are living in the

:15:27. > :15:32.EU at the moment and whose rights we also wish to protect. So, that's why

:15:33. > :15:37.the Prime Minister has made a big point of saying she wishes to

:15:38. > :15:41.negotiate this earlier, to give certainty to those people.

:15:42. > :15:44.We are not going to leave the EU for two-and-a-half years. I want the

:15:45. > :15:49.Secretary of State to grip GP services in Lincolnshire now and

:15:50. > :15:55.start training more services. A surgery is closing o potentially

:15:56. > :15:58.leaving people without a GP. And a shortage of 08 GPs, and only six out

:15:59. > :16:03.of 30 training places taken up recently, will the Secretary of

:16:04. > :16:07.State now grip that GP services in Lincolnshire for the sake of our

:16:08. > :16:12.people. -- 80 GPs. The honourable gentleman has brushed aside that

:16:13. > :16:16.part of his question that doesn't suit his purposes only to focus on

:16:17. > :16:22.half of it. We'll let him get away with it only had on this one

:16:23. > :16:25.occasion only, it is very cheeky. I hope I can reassure my right

:16:26. > :16:28.honourable friend. The reality is that in the last Parliament we

:16:29. > :16:31.increased the last number of GPs by 5%. This Parliament we are planning

:16:32. > :16:36.to increase them by another 5,000, which will be the biggest increase

:16:37. > :16:37.in GPs in the history of the NHS. And go with considerable extra

:16:38. > :16:46.resources. I'll focus on the other half of the

:16:47. > :16:50.question that the honourable gentleman missed out. The other day

:16:51. > :16:56.I had a meeting with some constituents of mine, who said to me

:16:57. > :16:59.they were so pleased that they were leaving the union union because now

:17:00. > :17:08.it meant that -- the European Union, because now it meant that the extra

:17:09. > :17:13.?350 million could be used to re-open the A department at Bishop

:17:14. > :17:18.Auckland. I would like it ask the Secretary of State, has he found the

:17:19. > :17:24.?350 million yet? Well, the honourable lady may have noticed

:17:25. > :17:29.that I personally didn't talk very much about that ?350 million.

:17:30. > :17:34.Million because whatever resources we have post-Brexit will have to be

:17:35. > :17:39.set in the overall economic context. But, course the great thing is,

:17:40. > :17:47.post-Brexit is that that will be a decision for this Parliament. Thank

:17:48. > :17:51.you, Mr Speaker many members of the NHS workforce across my area come

:17:52. > :17:55.from the EU but also many from car Ben country, the Philippines, India

:17:56. > :17:58.and Africa. Will my right honourable friend make sure that in future

:17:59. > :18:04.people from those countries are given equal access to work in our

:18:05. > :18:08.NHS, just as the EU nationals. Well, I think the benefit of Brexit will

:18:09. > :18:11.be that those kinds of decisions are what we can precisely make this in

:18:12. > :18:16.Parliament because we will get control of our borders back. But I'm

:18:17. > :18:20.actually very grateful to him for mentioning the very important work

:18:21. > :18:26.done by people from outside the EU in the NHS and because I happened to

:18:27. > :18:41.meet the Phillipine ambassador last week, I want to pay credit to the

:18:42. > :18:43.Filipino workers in the NHS and the social care system who do an

:18:44. > :18:45.excellent job. I would like to extend my sympathies

:18:46. > :18:48.for the victims of the Berlin attack. Coming to the question: Much

:18:49. > :18:50.of what we have heard today is keeping those who are already here.

:18:51. > :18:52.BMA Scotland has said insecurity stopping EU nationals taking posts

:18:53. > :18:56.up that need filled. This is a problem, doesn't he think it is time

:18:57. > :19:01.to create certainty for EU nationals and avoid a self--made workforce

:19:02. > :19:04.crisis? Well, I absolutely agree with him, which ise think it is

:19:05. > :19:08.frustrating that the current signals from the EU are that they are

:19:09. > :19:13.unwilling to bring forward the negotiations about the status of EU

:19:14. > :19:17.nationals here and indeed British nationals in the EU. But no-one from

:19:18. > :19:21.any side of the Brexit debate has ever said that post-Brexit there

:19:22. > :19:23.will be no immigration. They have simply said that we will control

:19:24. > :19:26.that immigration ourselves through this House and through decisions

:19:27. > :19:32.made by the British people at general elections.

:19:33. > :19:36.Thank you, Mr Speaker, on behalf of the Opposition can I also echo the

:19:37. > :19:39.words said by the Secretary of State in relation to the tragic events in

:19:40. > :19:46.Berlin and send our condolences to the people there. Mr Speaker, the

:19:47. > :19:48.institute for employment studies has today warned Brexit meant that

:19:49. > :19:53.nurses shortages could be made worse. This follow a Times report

:19:54. > :19:57.that applications for nursing and midwifery were down by 20% and in

:19:58. > :20:02.some institutions applications has halved. The decision to scrap nurse

:20:03. > :20:05.bursaries is having the consequences every expert predicted the would.

:20:06. > :20:10.With the uncertainty of bricts looming over our workforce, now is

:20:11. > :20:15.not the time to take a massive gamble. In light of the evidence,

:20:16. > :20:18.will the Secretary of State anow to scrap this disastrous policy. I say

:20:19. > :20:20.to him, that the purpose of that policy twoos allow to us train more

:20:21. > :20:48.nurses. ... We want the NHS to offer the

:20:49. > :20:51.safest highest qualitier care anywhere in the world. We are

:20:52. > :20:58.tackling unacceptable performance, in contrast to the party opposite

:20:59. > :21:02.which ignored failures for so long. Since introducing the rigorous

:21:03. > :21:05.special measures regime, 31 provider trusts have gone into care quality

:21:06. > :21:08.special measures of which 15 have been turned around as a result of

:21:09. > :21:14.the significant quality improvements. I would like to

:21:15. > :21:18.congratulate, again, the staff of Sherwood Forest I would Valley and

:21:19. > :21:22.Norfolk and Suffolk trust that is have all come out of special

:21:23. > :21:25.measures in recent months. Since Medway hospital was put in special

:21:26. > :21:26.measures it made significant improvement. Morality rates are

:21:27. > :21:54.down. The length of stay I would like to congratulate him on

:21:55. > :21:59.championing Medway hospital. I'm aQuire the CQC is in the process of

:22:00. > :22:04.reexpecting head way -- I'm aware. I would like to congratulate the trust

:22:05. > :22:08.on improvements being made thus far, which he highlighted, including, in

:22:09. > :22:11.particular, average lengths on stay admissions wards from 11 to only

:22:12. > :22:17.three days. Thank you, Mr Speaker, I refer to a

:22:18. > :22:21.recent damning frorp Pennine Acute Hospital Trust referring to

:22:22. > :22:25.maternity care, and appalling neglect, leading to the appalling

:22:26. > :22:29.death of mothers and babies. The trusts have implemented an

:22:30. > :22:34.improvement plan but what action will the minister take to address

:22:35. > :22:42.the fact that when maternity services were planned in the scheme,

:22:43. > :22:46.it was based on a predicted birth birth rate of 3,500, when reality

:22:47. > :22:53.the trust is dealing with 10,000 a year. I'm grateful to the honourable

:22:54. > :22:57.lady for listing some of the issues which we are aware that needs

:22:58. > :23:02.improvement. That's why we have buddied it up with the Salford trust

:23:03. > :23:07.next door, led by Sir David Dalton, and I will take up that issue she

:23:08. > :23:14.raised with him. Number 7. Minister? Mr Speaker, NHS

:23:15. > :23:21.England has a range of initiatives around waste and medicine cost

:23:22. > :23:25.reduction. We estimate that there was up to ?150 million per annum on

:23:26. > :23:29.waste which can be realised throughout the system. Community

:23:30. > :23:36.pharmacists have a significant role partly by their existing duty to

:23:37. > :23:42.review prescriptions where repeat dispensing and partly by the

:23:43. > :23:45.commissioned medicine misuse. The minister is right community farmist

:23:46. > :23:50.ths siss have an important role to play on 17th October he told the

:23:51. > :23:54.House "We do not believe any community pharmacists will necessary

:23:55. > :23:59.close as a result of my cuts." Yet the impact of the assessment,

:24:00. > :24:02.published just two days later, by his department, describes a possible

:24:03. > :24:08.scenario of 1,000 pharmacies closing. Oh dear Account minister

:24:09. > :24:11.confirm today, that nobody in Britain will have to travel further

:24:12. > :24:16.-- account minister confirm that nobody in Britain will have to

:24:17. > :24:21.travel further to get to a chemist, as a result of his cuts. Mr Speaker,

:24:22. > :24:25.the impact assessment set up an upper range which we do not believe

:24:26. > :24:43.represents an accurate reflection of what will ha. The facts of the

:24:44. > :24:46.matter are that we need our community pharmacy network to move

:24:47. > :24:49.towards the services, Ayerza way from dispensing and paying every

:24:50. > :24:51.community -- and away from dispensing. And saying them ?25,000

:24:52. > :24:54.just to have an establishment is not achievable... THE SPEAKER: Order.

:24:55. > :24:56.The honourable lady should not chunter from a sedentary position.

:24:57. > :25:01.The honourable gentlemen should glide seamlessly above the attempted

:25:02. > :25:07.provocation. He has finished his answer, very

:25:08. > :25:10.well. In order to reduce the unnecessary cost and making sure the

:25:11. > :25:14.best of community pharmacies services are provided will my

:25:15. > :25:19.honourable friend do all he can to ensure that CCGs engage as

:25:20. > :25:26.effectively as possible with farmist cysts preferably by getting more

:25:27. > :25:31.people on their board to make sure the protection between it is at the

:25:32. > :25:35.heart of what we do. Mr Speaker, as the honourable member is right. CCGs

:25:36. > :25:39.are variable in the extent to which they commission pharmacy services

:25:40. > :25:44.but we have set out the minor ailments scheme which by April 2018

:25:45. > :25:54.will be rolled out nationally and which we expect every CCG to take a

:25:55. > :26:00.part in. I have seen many examples of drugs prescribed and not used I'm

:26:01. > :26:03.sure we all sl. Shouldn't we have renegotiated the national contract

:26:04. > :26:07.that currently pays community pharmacies over 90% of their income

:26:08. > :26:11.by prescribing. Surely we can do things differently.

:26:12. > :26:18.He is quite right that we must change contract to move away from

:26:19. > :26:25.90% of income coming from dispensing and more coming from services that

:26:26. > :26:31.are separated commissioned. The Murray review sets out a road map

:26:32. > :26:37.for that, and NHS England are determined to implement that. May I

:26:38. > :26:43.pay tribute to the excellent work of pharmacies in the Peterborough area.

:26:44. > :26:48.Look East last night demonstrated the pressure that urgent care

:26:49. > :26:54.centres in the east are under, because of extra patient foot fall.

:26:55. > :27:00.Can the minister give me an undertaking that he will put in

:27:01. > :27:05.place guidelines to CCGs to encourage them to work more closely

:27:06. > :27:09.with pharmacies to reduce that. He raises an important point and he is

:27:10. > :27:14.quite right, we must move the community pharmacy network away from

:27:15. > :27:20.just dispensing into services. Which will include minor ailments and

:27:21. > :27:29.repeat prescriptions. I will encourage CCGs to do that. Community

:27:30. > :27:34.pharmacists which were developed in Scotland, while the minister

:27:35. > :27:37.expressed admiration for the Scottish system, does he recognise

:27:38. > :27:40.the need to develop the full potential in community services. I

:27:41. > :27:45.have mentioned that I think on previous occasions that Scotland has

:27:46. > :27:48.in some respects gone frt and faster than we have - further and faster

:27:49. > :27:53.than we have in England around community pharmacies. The ?300

:27:54. > :27:57.million we have set aside in the integration fund for the rest of the

:27:58. > :28:01.Parliament will be used to do just the things that the member has

:28:02. > :28:11.mentioned. We are determined to make that happen. Thank you Mr Speaker.

:28:12. > :28:16.Over the festive period in every town in the UK, community pharmacies

:28:17. > :28:19.will be open to dispense emergency prescriptions to provide specialist

:28:20. > :28:24.services and advice, does the minister appreciate this service

:28:25. > :28:31.that not only helps the public, but takes the pressure off other parts

:28:32. > :28:37.of NHS and will he join with me in thanking them for their work and

:28:38. > :28:45.reconsider budge cuts and instead meet the royal pharmaceutical Royal

:28:46. > :28:51.Pharmaceutical Society to discuss extending their role to deliver

:28:52. > :29:00.savings to the NHS. I have met the royal college of pharmacies and they

:29:01. > :29:08.have worked with us on the Murray review that sets out how we move the

:29:09. > :29:13.model to services as well. I do agree there is 11,500 community

:29:14. > :29:14.pharmacies, all of which provide excellent services and we expect

:29:15. > :29:26.that to continue. Last year the number of access

:29:27. > :29:30.winter deaths was 45% lower than this year and contingency planning

:29:31. > :29:37.is under way for winter preparedness. Told me they needed to

:29:38. > :29:45.postpone operations to get through winter. Six months later there were

:29:46. > :29:53.?12.5 million in deficit and proposing a cancel all nonurgent

:29:54. > :30:02.srjry. This -- surgery. When is the Government going to give local trust

:30:03. > :30:11.the things they near. Stop passing the buck and start passing the

:30:12. > :30:17.bucks. It is not passing the buck. There are a lot of actions being

:30:18. > :30:21.changen in Cheshire and her diside. There is a local delivery board

:30:22. > :30:25.doing important work and the emergency care improvement programme

:30:26. > :30:30.is working well in his local trust. There is great pressure on emergency

:30:31. > :30:36.services throughout Staffordshire and it will be more without the

:30:37. > :30:43.accident and emergency centres in Stafford and Burton, but the STP

:30:44. > :30:50.proposes to reduce one of those. Would he speak with the authors of

:30:51. > :30:56.SDP to make clear this is the unacceptable? Well first of all, no

:30:57. > :31:01.one fights harder and more eloquently than he does for the

:31:02. > :31:05.needs of the people of Stafford. I always look with concern at

:31:06. > :31:09.proposals to change emergency services, given the pressures that

:31:10. > :31:15.exist. So I will look at the plan as he suggests. The problem is it is

:31:16. > :31:19.not just winter precious, it is pressures all year round. The

:31:20. > :31:25.Secretary of State will say they have decided to increase the presets

:31:26. > :31:30.to fund it better, but that is not enough money and there is not a

:31:31. > :31:33.strategy. Can I ask is there anybody outside his own department believes

:31:34. > :31:42.this Government has a strategy for social care? All I would do is urge

:31:43. > :31:49.him to listen to what the Prime Minister said last week, where she

:31:50. > :31:53.said we recognise the short-term measures. But also we need a

:31:54. > :31:59.long-term solution, which the Government is working hard on. Would

:32:00. > :32:06.my honourable friend agree that one of the pressures that needs

:32:07. > :32:10.improving for winters is with regard to inappropriate admissions to A

:32:11. > :32:15.departments? Would he accept that the proposals by the Essex success

:32:16. > :32:19.regime which ensure that the three hospitals concerned will maintain

:32:20. > :32:27.their A departments, but that there will be a specialist centre

:32:28. > :32:31.for cardiotho razzesic and burns and plastic surgery is to right way

:32:32. > :32:37.forward to improve and enhance the care for those suffering from

:32:38. > :32:40.accident and emergencies. He understands these matters well from

:32:41. > :32:47.his time as a distinguished health minister. He is right, the truth is

:32:48. > :32:52.that we want to have widespread availability of A, but it is not

:32:53. > :32:57.the case that we serve patients best by having identical services being

:32:58. > :33:03.offered every where. So that is why one of things we are proud of is

:33:04. > :33:14.setting up a national network of 26 trauma centres which has had a

:33:15. > :33:21.dramatic impact on mortality rates. I have be advised some reference to

:33:22. > :33:26.winter in these questions is desirable. Can I associate myself

:33:27. > :33:38.with the remarks of the Secretary of State with respect to Berlin and

:33:39. > :33:48.wish everyone in the House a merry merry Christmas and to all those who

:33:49. > :33:53.work in the NHS. The underfunding is so severe that hospitals have been

:33:54. > :34:01.ordered to close operating theatres for Lechtive surgery -- for Lechtive

:34:02. > :34:07.surgery. Is this what the Secretary of State means by a selective

:34:08. > :34:16.naturers. Despite his rhetoric, I see Santa has been generous to him.

:34:17. > :34:20.His local trust has 254 more nurses and 306 more doctors than in 2010

:34:21. > :34:27.and next year will have a new emergency floor at the Leicester

:34:28. > :34:38.Royal Infirmary. We do need to make sure there is sufficient bed

:34:39. > :34:43.capacity in winter. But we are also doing 5,000 more elective

:34:44. > :34:47.operations. Isn't the reality that closing operating theatres is a

:34:48. > :34:56.short-term fix? And the truth is when this pause ends and hospitals

:34:57. > :35:00.fill up again, above the 58% occupancy recommendations, there

:35:01. > :35:06.will be a choose to get stuck on a waiting list, or risk going into a

:35:07. > :35:11.hospital, when it is at full capacity, potentially unsafe and

:35:12. > :35:15.exposed to higher infection risks. What option would the Secretary of

:35:16. > :35:19.State choose. Could I urge him to be careful with his rhetoric. We are

:35:20. > :35:24.not closing operating theatres for a month over Christmas. You need to be

:35:25. > :35:27.careful what you say in this place, because people outside are

:35:28. > :35:34.listening. But the answer is to make sure that we increase capacity in

:35:35. > :35:39.the NHS and that is why we have 11,000 more doctors and 11,000 more

:35:40. > :35:44.hospital nurses than six years ago and we are training 15 hundred more

:35:45. > :35:52.doctors a year to make sure we can avoid these problems in the future.

:35:53. > :36:01.The NHS is a national, not an international service and we clamped

:36:02. > :36:07.down on visitors to access NHS care. The steps we have taken have meant

:36:08. > :36:14.that income raised from visitors and migrants has risen three fold in

:36:15. > :36:21.three years from ?97 million to ?289 million. Does he agree that in order

:36:22. > :36:25.to recover more money from chargeable patients requires a

:36:26. > :36:30.culture change among NHS staff and does he share my dismay that the

:36:31. > :36:34.leader of the doctor's unions dismisses the need to address and

:36:35. > :36:41.calls for additional investment in the NHS. I do agree with my right

:36:42. > :36:45.honourable friend that we need increased awareness by all NHS staff

:36:46. > :36:54.in achieving this policy. But do I also agree with one thing that was

:36:55. > :36:58.said that sick and vulnerable patients should not be put off

:36:59. > :37:04.seeking treatment. This has always been a key feature of our policy. To

:37:05. > :37:10.be clear, this policy does not withhold immediately necessary or

:37:11. > :37:15.urgent treatment, but makes sure the NHS is fairly reimbursed. As the

:37:16. > :37:19.minister will know, the public accounts committee has looked at

:37:20. > :37:25.this and found that the Government is woeful in collecting money from

:37:26. > :37:31.EU citizens that use hospitals for whom the government is responsible

:37:32. > :37:37.for getting the money. When will the Government get its act together. I

:37:38. > :37:42.am grateful as awful for advice from the committee. There was an article

:37:43. > :37:46.in today's Times newspaper which referred to outstanding sums. We are

:37:47. > :37:59.taking steps to try to increase recovery rates in the here v years

:38:00. > :38:06.o' -- in the years ahead. The sustainability plan for London sets

:38:07. > :38:13.out how the area will implement the five year forward view and ensure

:38:14. > :38:17.closer working across NHS bodies. Developing centres of expertise to

:38:18. > :38:23.ensure high quality service as well as closer co-ordination with social

:38:24. > :38:29.care providers. The St Helier trust is a high performing trust, it is

:38:30. > :38:33.confident that it can deliver sustainable and transformed care

:38:34. > :38:40.services, but will struggle to do so in St Helier hospital built in the

:38:41. > :38:47.1930s. The trust has secured a commitment that funding will be

:38:48. > :38:53.available. Will the minister confirm once the STD process is complete

:38:54. > :38:55.they will enable it to be able to deliver services from a new

:38:56. > :39:01.hospital. Aware of the the honourable gentleman's campaign on

:39:02. > :39:07.this. I think it would be wrong for know pre-empt the work being done in

:39:08. > :39:11.reviewing the SDP process and the policy priorities of NHS England.

:39:12. > :39:15.Once those plans have been put forward to ministers be, they will

:39:16. > :39:25.then be able to consider which we can prioritise. The SDP plans for

:39:26. > :39:30.London include mental health needs. But there is a crisis with mental

:39:31. > :39:35.health patients will the minister look into extra funding to increase

:39:36. > :39:41.the number of in patient mental health beds. As my right honourable

:39:42. > :39:46.friend is aware, given her experience, that mental health is a

:39:47. > :39:51.priority of the Government and is of a priority of SDP process. Will take

:39:52. > :40:04.what she says in relation to in patient beds away. It is too early

:40:05. > :40:08.to speculate, but it will up to NHS England. My focus is on raising the

:40:09. > :40:14.quality of the existing contract and I have been clear that the standard

:40:15. > :40:19.of capita's work has not been acceptable and it must improve. I

:40:20. > :40:29.meet with capita and NHS England as they work to improve the performance

:40:30. > :40:32.of the service. Thank you. Several GP practices have reported delays in

:40:33. > :40:37.the transfer of records and sometimes the records have

:40:38. > :40:43.disappeared, I would like clear response from the minister around

:40:44. > :40:47.the assurances she give that the government takes serious think safe

:40:48. > :40:52.delivery of their confidential medical details. I'm taking these

:40:53. > :40:58.issue very seriously and I'm personally meeting with NHS England

:40:59. > :41:05.and capita on a fortnightly basis and ensuring there are plans in

:41:06. > :41:09.place for each of the service delivery programmes, the improvement

:41:10. > :41:14.should happen between January and April and rectification plans are

:41:15. > :41:20.detailed and I shall be happy to give the honourable lady more detail

:41:21. > :41:22.in a letter if she would like to be able to reassure people on those

:41:23. > :41:37.issues. Will the minister advise GP

:41:38. > :41:40.practices in my constituents who have been massively inconvenienced

:41:41. > :41:43.by the contract, what compensation will be available to to them, for

:41:44. > :41:48.the time and inconvenience they have been put through? At the moment, NHS

:41:49. > :41:51.England and Capita are focussing on hard on improving the service

:41:52. > :41:55.delivery which I think must be the top priority. We are also looking

:41:56. > :41:59.into exactly what inconvenience and costs has been suffered by GPs, as

:42:00. > :42:09.well as dentedists and optometrists and that will be considered and

:42:10. > :42:11.discussed with GPs going forward. Mr Speaker, directly comparable

:42:12. > :42:17.figures are not available, but it is clear that in the last two years,

:42:18. > :42:20.there has been a substantial increase in delayed discharge

:42:21. > :42:25.figures attributable to social care from the royal wolf hatch tonne

:42:26. > :42:30.trusts which this year, amongst the worst currently being recorded

:42:31. > :42:38.across the NHS. Sadly those do Wolverhampton.

:42:39. > :42:43.Sadly they are no surprise bus central Government has cut

:42:44. > :42:48.Wolverhampton city' council's budget by 7%. The pilot programme to

:42:49. > :42:51.Wolverhampton is a redesign of services so that a signal

:42:52. > :42:54.organisation in the hospital trust deals with patients from initial

:42:55. > :43:03.contract through ongoing management and end of life care What steps is

:43:04. > :43:08.the Department of Health doing to help improve this, to lesson

:43:09. > :43:10.hospital admissions. The announcement made last week,

:43:11. > :43:19.regarding increase funding is important. However funding alone

:43:20. > :43:23.doesn't explain the delayed trafr in wolf hatch tonne which are five

:43:24. > :43:30.times worse than Telford just down the road and twice as bad as

:43:31. > :43:34.Sandwell very close and 30 times worse than the best-pour forming

:43:35. > :43:39.councils like Newcastle, Knowsley and St Helens. In terms of the

:43:40. > :43:43.specific point he raise about the vertically integrated pilot it is an

:43:44. > :43:47.exciting project and I commend the people of wolf hatch tonne for doing

:43:48. > :43:50.it. It is based in a modelled in Spain which has produced big

:43:51. > :43:56.results. -- Wolverhampton. We'll support it, as required.

:43:57. > :43:59.Number 15. In developing the childhood obesity

:44:00. > :44:06.plan we considered the latest research and evidence on promotions

:44:07. > :44:09.and advertising, including P HEs, evidence package, sugar reduction,

:44:10. > :44:14.the evidence for action and we made no secret of the fact we considered

:44:15. > :44:19.a range of policies before settling on a rangepolicies in the childhood

:44:20. > :44:21.obesity plan, however we settled on the plan finally which included the

:44:22. > :44:25.soft drinks industry level and taking 20% out of sugar in certain

:44:26. > :44:30.projects. We concluded our plan is the right approach to secure the

:44:31. > :44:33.future health of our children. Can I associate myself with the Secretary

:44:34. > :44:40.of State's words of sympathy with the people of Berlin and add my

:44:41. > :44:44.thoughts to the people of Aleppo, Yemen, Gaza and forgotten conflict

:44:45. > :44:47.in the world. The Government's strategy has been described as a

:44:48. > :44:54.waste approach and wasted opportunity. The Government says it

:44:55. > :45:00.is committed to evidence-based policy but failed to acknowledge

:45:01. > :45:04.that it is inherently flawed. Account Government get a grip and

:45:05. > :45:09.bring a ban on advertising and price-cutting promotions on junk

:45:10. > :45:11.food? Well I'm very happy to reassure the lady, honourable lady

:45:12. > :45:14.that current restrictions on advertising in the UK are amongst

:45:15. > :45:21.the toughest in the world already. There is a total ban on advertising

:45:22. > :45:24.of less healthy food during children's television programmes and

:45:25. > :45:29.these have shown to be effective. However we welcome action taken by

:45:30. > :45:36.forward-thinking retailers on promotions elsewhere and in

:45:37. > :45:41.particular Sainsbury's have committed to removing multi-buy

:45:42. > :45:46.promotions on confestingry, biscuits and crisps on their own bands and

:45:47. > :45:50.it'll lowering regular prices for products, and they should be

:45:51. > :45:55.congratulated for leading the way. THE SPEAKER: We now feel

:45:56. > :46:00.considerably better informed. The advertising industry can play a key

:46:01. > :46:05.role ensuring adverts are appropriate? Will the minister

:46:06. > :46:10.continue torque o working with the industry to tackle this? Yes.

:46:11. > :46:14.Certain supermarkets persist in placing less healthy foods on

:46:15. > :46:17.promotion near the entrances to their store, where they are

:46:18. > :46:22.unavoidable. Would the Secretary agree it is not just at healthouting

:46:23. > :46:27.where healthy options should be promoted but retailers should be

:46:28. > :46:36.exercising more responsibility. I absolutely agree that putting

:46:37. > :46:40.healthier options near checkouts and helping people make health choices

:46:41. > :46:42.is part of people's responsibilities and the approximate enny is dropping

:46:43. > :46:46.with retailers that it is the direction of travel and what the

:46:47. > :46:50.public want and I think seal we see a sea change in the way in which

:46:51. > :46:55.retailers are advertising. Let's hear the sound of Shipley. Can I

:46:56. > :47:01.urge the minister not to go down this ridiculous nanny state route,

:47:02. > :47:04.which one wouldn't expect from a Conservative Government, and

:47:05. > :47:07.certainly in setting up the unhealthy food police, to go around

:47:08. > :47:13.telling people what they should or shouldn't be eaten. No food eaten as

:47:14. > :47:16.part of a billioned diet is particularly unhealthy and if the

:47:17. > :47:20.Government is concerned about familiaries just about managing

:47:21. > :47:25.would y would it contemplate increasing the costs for working

:47:26. > :47:29.families sth The honourable gentleman flatters me by saying he

:47:30. > :47:35.thinks I'm a nanny. It is really quite a disturbing thought. However,

:47:36. > :47:41.what we have here is an ebeesity plan which balances both the need to

:47:42. > :47:45.cut the sugar within young people's diets as a way it make sure they are

:47:46. > :47:52.getting a healthy diet, and the individual choice which we know is

:47:53. > :47:57.absolutely a Conservative ideal. Number 2, Mr Speaker.

:47:58. > :48:01.Mr Speaker, as we enter the challenging winter period on behalf

:48:02. > :48:04.of the whole country I want to thank the 2.7 million people working in

:48:05. > :48:07.the health and care system, particularly those giving up all or

:48:08. > :48:11.part of their own Christmas day to look after patients. We are in their

:48:12. > :48:19.debt and we wish them a merry Christmas when they get the chance

:48:20. > :48:24.it celebrate with their families The A in my area are using new

:48:25. > :48:44.measures to cope with the staggering demand on services.

:48:45. > :48:47.What are the doing... So resources can go where they are kneaded most.

:48:48. > :48:49.Well, we have the Stay well... Winter campaign.

:48:50. > :48:53.We urge the public to remember that Accident Emergency departments are

:48:54. > :48:58.for precisely that. -- where they are needed most.

:48:59. > :49:02.There was no new money for Government for social care in the

:49:03. > :49:07.local government settlement, a recycling of money from the new

:49:08. > :49:12.homes bonus for social care for 2017 only. 57 council also lose funding

:49:13. > :49:16.due to this recycling. Salford, recently praised by the Prime

:49:17. > :49:19.Minister for its integration of social care, will lose ?2.3 million

:49:20. > :49:24.due to this inept settlement. Isn't it time for the Secretary of State

:49:25. > :49:27.to accept that social care is in crisis, and that his Government

:49:28. > :49:31.cannot just dump the issue of funding it on to councils and

:49:32. > :49:35.council tax payers? Well, I do listen carefully to what

:49:36. > :49:38.the honourable lady says because she has campaigned long and hard for

:49:39. > :49:42.social care but, with respect, I would say to her, that she is

:49:43. > :49:45.ignoring one simple fact that there is more money going into social care

:49:46. > :49:53.now, than would have been the case if we'd followed her advice at the

:49:54. > :49:55.last election. And what the Communities' Secretary announce the

:49:56. > :49:59.was ?900 million of additional help over the next two years Thank you,

:50:00. > :50:02.Mr Speaker, the Government's plan for funding social care look

:50:03. > :50:07.indepartment because they tie care funding, which is related to need,

:50:08. > :50:11.to council tax and deduction for the new homes bonus. Last week's

:50:12. > :50:16.settlement was a pathetic attempt to deal with a funding gap of ?2

:50:17. > :50:21.billion for social care by recycling ?240 million within budgets. Now,

:50:22. > :50:25.the Chief Executive of the British Red Cross has described the social

:50:26. > :50:28.care crisis as "a humanitarian crisis that needs urgent action."

:50:29. > :50:34.When is the Secretary of State going to take that crisis seriously?

:50:35. > :50:39.She talks about the council tax, but what she doesn't do is call out

:50:40. > :50:43.Labour councils, like Hillingdon, Hounslow, Merton and Stoke, who

:50:44. > :50:46.complain about pressures in the social care system and refuse to

:50:47. > :50:51.introduce the social care precept that would make a difference to

:50:52. > :50:54.their own residence. We are taking the situation seriously, more was

:50:55. > :50:59.done this week and more will be done in the future.

:51:00. > :51:03.As my honourable friend maybe aware, is aware, last week the Murray

:51:04. > :51:07.report was published. Can I ask my honourable friend as to when he is

:51:08. > :51:11.likely to actually consider that and when he will be making a statement?

:51:12. > :51:17.I thank him, for that question, Mr Speaker, I also commend him for his

:51:18. > :51:22.work as a pharmacy champion, them you ary review was indeed published

:51:23. > :51:25.last week, NHS England -- the Murray review, NHS England will respond to

:51:26. > :51:28.that in detail early in the new year. It is a very important

:51:29. > :51:32.document. It sets out in some detail how it is that we intend to

:51:33. > :51:37.transform the community pharmacy network into a service-base product

:51:38. > :51:42.fegs along the lines that I know he likes. -- profession.

:51:43. > :51:45.Last week a man with diabetes in my constituency took a fall and had to

:51:46. > :51:49.wait almost two hours for an ambulance. I then wrote to the

:51:50. > :51:53.Health Secretary, after it emerged not a single ambulance trust in

:51:54. > :51:57.England met spoits response time targets in October including for the

:51:58. > :52:00.most critical of cases. Will the Secretary of State today explain the

:52:01. > :52:05.reason for these unacceptable ambulance delays and what he intends

:52:06. > :52:12.to do as we approach Christmas? Well I'm aware of the case the honourable

:52:13. > :52:17.lady refers to. I say to her in the week of the incidence London

:52:18. > :52:21.Ambulance Service received 40,453 emergency calls be an 8% increase on

:52:22. > :52:27.the previous week. We are trying to do something with this. We have

:52:28. > :52:31.recruited 2,200 more paramedics since 2010 and increased the number

:52:32. > :52:36.of training places by 60% in this year alone. London Ambulance Service

:52:37. > :52:40.has recruited 107 more paramedics. Six since September 2015 to help

:52:41. > :52:43.with this increasing demand. Has the public Health Minister had an

:52:44. > :52:49.opportunity to consider the recent reports sent to her by the all-party

:52:50. > :52:54.parliamentary group on the shocking impact on excessive dripping by

:52:55. > :52:57.members of the public on the did excessive drinking, on the people

:52:58. > :53:01.working in the medical services and will she meet to discuss this? I

:53:02. > :53:04.would like to pay tribute to my honourable friend for her dogged

:53:05. > :53:08.campaigning on this issue. She is a true champion for this issue. I

:53:09. > :53:10.haven't had the chance to read this in detail but I have seen a number

:53:11. > :53:15.of the recommendations. In particular, I think we are taking

:53:16. > :53:20.action on some of them, including the pub kafgts CMO's low risk

:53:21. > :53:31.guidelines, and a campaign which runs over Christmas and new year.

:53:32. > :53:41.-- a it has been shown that intervention is the most effective

:53:42. > :53:46.way of stopping problem drink. Zach, wheelchair bound, can't speak,

:53:47. > :53:51.blind, regularly admitted on an unplanned basis it Bassetlaw

:53:52. > :53:54.hospital children's ward. As the people of Bassetlaw are standing

:53:55. > :53:59.with Zach and proposing the proposed overnight closure of the children's

:54:00. > :54:06.ward, which will create chaos for his small life and that of a number

:54:07. > :54:09.of other very poorly children like him, will democracy prevail or is

:54:10. > :54:14.the Government going to pick a fight, with Zach, me and the people

:54:15. > :54:19.of Bassetlaw? Well, first of all, I absolutely

:54:20. > :54:22.commend to him for standing with his constituents and championing

:54:23. > :54:25.individual cases. I will happily look into the proposed changes and

:54:26. > :54:30.how they will affect people like Zach. And I want to reassure him,

:54:31. > :54:34.that when we make these changes, it is to improve the services of people

:54:35. > :54:39.like Zach and his constituents. That's why we are doing them.

:54:40. > :54:43.THE SPEAKER: Alex chauk. Where is the fellow?

:54:44. > :54:47.Despite some of the obvious challenges with the health care

:54:48. > :54:51.service, this is a wonderful time of year, where hundreds of thousands of

:54:52. > :54:56.children choose to quit smoking by putting down their cancer sticks and

:54:57. > :55:01.pick up an an electronic vapour device. But does in the stiner is

:55:02. > :55:06.share my concern with the EU directive we have to be cautious in

:55:07. > :55:13.its implementation, if any, that it doesn't cause a barrier to people

:55:14. > :55:20.take up vague. Well the Government is clear that vaping is less harmful

:55:21. > :55:27.than smoking and huge numbers are using these as an effective quitting

:55:28. > :55:31.tool. We've committed to reviewing the TPD and rewe'll fully explore

:55:32. > :55:35.the opportunities Brexit may provied. Until exit negotiations are

:55:36. > :55:39.concluded we remain a full member of the EU On contaminated blood, could

:55:40. > :55:47.the Government still confirm that they plan to use a private

:55:48. > :55:53.profit-making company such as ATOS, to administer the scheme and if so,

:55:54. > :55:57.why? I absolutely cannot confirm. It has it not begun, therefore we are

:55:58. > :56:01.not considering any form of companiers private or injury wise.

:56:02. > :56:08.The health committee has published a report into preventing suicide. I

:56:09. > :56:12.would like to thank everyone who gave evidence and the health

:56:13. > :56:19.advisory group. We support the strategy, but the clear message we

:56:20. > :56:23.heard was around implementation. Would the Secretary of State meet

:56:24. > :56:28.with me and join with me in thanking all the members of Samaritans and

:56:29. > :56:34.other groups who will be work over Christmas to support those in

:56:35. > :56:39.crisis? I think she speaks very wisely on that. I know that

:56:40. > :56:44.Christmas can be a lonely time for a number of people and we all commend

:56:45. > :56:49.the work of voluntary organisations who do so well and I would be

:56:50. > :56:57.delighted to meet her. A more than a third of my male constituents live

:56:58. > :57:04.till over 80, but in next door over half of their residents do. In the

:57:05. > :57:09.ten years before 2010 that gap narrowed, what is he doing to narrow

:57:10. > :57:15.the gap in future? The best thing we can do is make sure we continue to

:57:16. > :57:20.invest in the NHS and social care and make progress on public health,

:57:21. > :57:23.that is often the thing that has the biggest effect on health

:57:24. > :57:29.inequalities and that is why it is good news we have record low smoking

:57:30. > :57:37.rates. With bed blocking at a record high, does the minister agree that

:57:38. > :57:42.is a great pity of 40 sustainability and transformation plans, so very

:57:43. > :57:48.few deal with step down care and in particular with community hospitals?

:57:49. > :58:00.Well, as my honourable friend has confirmed, there are new now 44

:58:01. > :58:06.areas working on transformation plans to look at integration between

:58:07. > :58:13.hospital and social care to improve discharge and this is something they

:58:14. > :58:18.have to address. Figures from the royal college of psychiatrist show

:58:19. > :58:23.children and adolescent mental health services are underfunded,

:58:24. > :58:27.particularly in Bristol, what is the minister doing to ensure that

:58:28. > :58:34.children across England and the rest of the UK get the health services

:58:35. > :58:39.they need? I think she is right to highlight this and I'm not happy

:58:40. > :58:43.with the service we provide. It is a big area of focus with the

:58:44. > :58:49.Government. But there is lot more to be done. My constituency has been

:58:50. > :58:54.waiting for go ahead on a new critical treatment hospital

:58:55. > :58:57.providing 24/7 care, for the sickest patients, the hospitals's Chief

:58:58. > :59:03.Executive retires this month after 21 years of exceptional services,

:59:04. > :59:07.can the Secretary of State give her a retirement present and help me

:59:08. > :59:09.secure a decision from NHS England. I would join my honourable friend in

:59:10. > :59:15.congratulating her Chief Executive on her commitment to the NHS. As I

:59:16. > :59:19.said in answer to previous questions, in relation to the SDP

:59:20. > :59:25.for her area, this is being reviewed by NHS England and I'm not in a

:59:26. > :59:32.position to give advice of the outcome. The Secretary of State will

:59:33. > :59:37.be aware of the case of Fiona hollings, a 19-year-old with

:59:38. > :59:42.anorexia who has been nearly 4 hundred miles from home in a bed in

:59:43. > :59:47.Glasgow. Her family has travelled 8,000 miles in that time to see her.

:59:48. > :59:51.The Government commits to ending this practice, but do families

:59:52. > :59:59.really have to put up with it until then. How would he feel if it was

:00:00. > :00:03.his child involved? ? I say we are taking action on this. I agree it is

:00:04. > :00:09.unacceptable what happened in that case. We are commissioning record

:00:10. > :00:16.number of in patient mental health beds and it is a priority to

:00:17. > :00:23.eliminate this problem. Constituency is using a drug using prefilled

:00:24. > :00:28.syringes, but cannot dispose of the used needles, because they're in 2.5

:00:29. > :00:34.litre sharp stubs. Is the minister aware of problems and are there

:00:35. > :00:42.steps he can take to deal with it? As the member said, pharmacies are

:00:43. > :00:48.commissioned on occasion such as this dispose of needles. I wasn't

:00:49. > :01:03.aware of problem with the 2.5 litres tubs. I will investigate him. GP

:01:04. > :01:07.rates are higher than in pits of Ealing than in Rwanda. Could the

:01:08. > :01:15.Government for the O'Neil recommendation to work for a global

:01:16. > :01:22.fund? As I have said, we are a world leader on this and have not only the

:01:23. > :01:27.by lateral fund with China, but the ?265 million Fleming fund where we

:01:28. > :01:31.are going to deliver by lateral national action plans with a number

:01:32. > :01:38.of developing nations and we are committed to going further through

:01:39. > :01:47.the global action plan with the UN. A north night ago I visited a farm

:01:48. > :01:50.pharmacy to thank the staff. Would the minister agree it is this sort

:01:51. > :01:55.of working that is crucially important in trying to tack winter

:01:56. > :02:06.pressures? -- to tackle printer precious. I would agreeshgs this

:02:07. > :02:11.year -- I would agree. The department has done more flu jabs

:02:12. > :02:22.this year and I have had my flu jab and it is holding up well. The

:02:23. > :02:26.average ambulance arrival time for life-threatening case has almost

:02:27. > :02:35.doubled in and Nottingham's waiting times are the worst in a decade.

:02:36. > :02:41.Will he apologise for his failure to fund health and social care? I would

:02:42. > :02:47.like to add my tribute to the work of ambulance staff up and down the

:02:48. > :02:51.country, particularly over this busy Christmas period ahead. As I have

:02:52. > :02:59.said, we have increased funding for ambulance services. We have

:03:00. > :03:06.increased the number of Parr -- paramedics and we have increased the

:03:07. > :03:14.payments to paramedics to help retain and recruit more staff. We

:03:15. > :03:21.can manage only one more. 46 years, six months after two days after his

:03:22. > :03:28.election, I call Mr Denis Skinner. He is a mine of information ain't

:03:29. > :03:35.he? I mean he would like to contribute really. Doesn't the

:03:36. > :03:42.Secretary of State think it is a scandal to be shutting Bolsover

:03:43. > :03:48.hospital with 16 valuable beds that will go forever at a time when

:03:49. > :03:52.people are lying in trolleys in nearly every hospital in Britain,

:03:53. > :03:57.why doesn't he give them a Christmas present at Bolsover and announce

:03:58. > :04:07.that the Bolsover Hospital will be saved? Come on. Well I add my

:04:08. > :04:12.congratulations to those of The Speaker for long service. I say to

:04:13. > :04:16.him we will look carefully at all proposals to change the services

:04:17. > :04:19.offered chl I think community hospitals have an important role in

:04:20. > :04:23.the future of the NHS, but the services they provide will change as

:04:24. > :04:33.more people want to be treated at home. Thank you. Order. Urgent

:04:34. > :04:41.question. Mr Ed Miliband. To ask the Secretary of state to make a

:04:42. > :04:46.statement on the time table and approach of Government to 21st

:04:47. > :04:55.Century Fox's bid to take over Sky and whether it plans to refer the

:04:56. > :05:00.bid to the competition authority. As members know, Sky PLC announced on

:05:01. > :05:01.Friday 9th December it