Health Questions House of Commons

and his team of ministers. THE SPEAKER: Order. Order. The

questions to the Secretary of State for Health.

Question one, Mr Speaker. THE SPEAKER: The Secretary of State

for Health. As we wish each other a merry Christmas the whole House will

also this morning remember the people of Berlin as they face up to

yesterday's horrific suspected terrorist attack. Germany and its

capital Berlin, are been beacons of freedom and tolerance in modern

times and all our thoughts and prayers are with them today.

With respect to question one, evidence from all over the world

suggests that higher standards of care for patients relates directly

to the quality of clinical leadership which is why last month I

announced a number of measures to increase the number of doctors and

nurses in leadership roles in the NHS.

I thank my Right Honourable friend for his response. Clinicians in

Telford have been showing real leadership by rejecting a proposal

to close a brand-new women and children's unit and elements of our

emergency services. The quango responsible for this idea has spent

?3 million and taken three years to come up with this proposal which is

rejected by local people and local clinicians. Will my honourable

friend meet with me and my local colleagues to bring an end to this

farce and ensure that this does not continue in limbo any longer?

Thank you mrrks speaker. First of all, I do recognise the her of

campaigning on this issue in Telford and she speaks for the concerns of

many of her own constituents. As she knows, these service changes must be

locally driven and they must have the support from local GP

commissioners, but she will also know that the actual situation very

frustratingly has not led to a consensus between clinicians in

different parts of Telford and Shropshire. I agree with her that

the process has taken much too long and I'm more than happy to meet her

and try and bring the situation to a close as quickly as possible.

In a year when the Health Secretary has spent a lot of time knocking

clinicians, it is good to hear him speak so positively about them. But

can I ask him this - after four years in his own job, what

responsibility does he accept for the lack of suitably qualified

individuals, not just clinicians, who are prepared to take on the top

jobs in the NHS on a permanent basis? Well, I will tell the

honourable lady what I take responsibility for, more doctors and

more nurses and more funding than ever before in the history of the

NHS. But we know that the highest standards are often achieved when

there is strong clinical leadership. Only 54% of managers are clinicians

in this country compared to 74% in Canada and 94% in Sweden and that's

why it is right we do everything we can to encourage more clinicians

into leadership roles. Does the Secretary of State agree that the

clinical leadership involved in the getting it right first time

initiative is important, not only as it will save ?1.5 billion which

could be put back into patient care, but because patients will be in less

pain and end up having less operations and some of them will

even survive treatment which they wouldn't otherwise have done?

He is absolutely right and I want to thank him for bringing Professor Tim

Bricks to see me to explain how superb this programme is. Infection

rates for orthopaedic surgery vary between one in 20 patients in some

trusts to one in 500 in other trusts and getting this right can transform

care for patients and save money at the same time.

Can I associate myself with his comments about my one-time home,

Berlin? Will he accept that we have the best clinical leaders anywhere

in the world in this country and the challenge facing the NHS is not one

of clinical leadership or the dedicational skill of staff, it is

the chronic under funding by this Conservative Government? We do

indeed have superb clinical leaders, people like Marian in Worthing and

we have superb non clinical leaders like David Dalton in Salford's

Royal, but what I would gently say to him if he is worried about

funding why in the last election did he stand on a platform which would

have seen the NHS have ?1.3 billion less this year? Will you ensure that

clinical leaders are able to apply important techniques from other

disciplines which can drive up productivity? Absoluty right. What

is important is clinical leadership, but openness to the skills of others

industries particularly engineering skills which, of course, he is very

familiar with which can help us get processes right to improve care and

safety for patients. Thank you, Mr Speaker. Does the Secretary of State

agree that if the board of Doncaster and Bassett Law Hospital agrees to

become a teaching hospital today, it will enable the trust to train the

doctors of tomorrow so that they are more able to move into clinical

leadership roles as quickly as possible? Well, I thank her for her

question and I welcome the aspirations and the ambitions of

Doncaster Hospital. Any final decision will be a matter for the

NHS and health education England, but it is encouraging that they are

reaching for the stars like this and yes, we do need to train more

doctors and I do hope they can make a good contribution.

THE SPEAKER: The honourable gentleman's constituency was

mentioned and he came in on cue in time. Number two, sir. Evidence

based medicine is about using high quality research to achieve optimal

results. NICE plays an important role by translating research into

authoritative guidance to healthcare professionals on best practise. Is

she aware that the author said it is about integrating individual

clinical experience and the best external evidence, not just external

evidence. Is she further aware in respect of the interpretation of the

evidence based medicine, a report in the so-called Good Thinking Society

to the Charity Commission by using legal threats to force his

department and health providers to change the law on healthcare? Well,

NICE considers complementary and alternative medicines in developing

its guidance. It has been able to recommend some therapies such as

acupuncture and a range of complementary medicines for MS. We

expect healthcare professionals to take that guidance into account b,

but they must use their best understanding in treating the

individual patients in front of him. Mr Speaker, the evidence is very

clear, if you eat more sugar, it increases the risk of diabetes.

Apart from introducing the sugar tax, what further evidence based

research can be used by Government to reduce the risk of diabetes?

The honourable gentleman is a great proponent of tackling the risk of

diabetes. He knows that the Government takes tackling diabetes

seriously. That's why we have introduce the first national

diabetes programme which we have piloted and we are rolling out

across the country. This includes education programmes, but testing

and we are making sure that we use the evidence from this programme to

improve and roll out the programme in an effective way.

Mr Speaker, we are all in favour of evidence based medicine. We are also

in favour of decent resources for the National Health Service. But in

the case of the Huddersfield and Calderdale Hospital, what we want is

good management and people managing to a high quality and not GPs

promoted to a managerial position that they can't handle.

THE SPEAKER: It is in relation to evidence based medicine. The

honourable gentleman is a great advocate for evidence based

medicine, he will be pleased to hear that the national leadership

programme is one of the evidence based programmes that we are rolling

out to improve the leadership of the NHS across the country. Number

three, please, Mr Speaker. With permission, Mr Speaker, I will

answer questions three, 12, and 14 together. The UK is already a global

leader in the fight against AMR. This Government's leadership has

secured a UN declaration on AMR and a commitment from the G20 to drive

development of new anti-microbials, we will continue to deliver

international programmes to tackle AMR including the Fleming and global

AMR funds which represent ?300 million of investment over the next

five years. Thank you, Mr Speakerment one of the ten key

recommendations of the O'Neill review was to improve the data and

surveillance underlying anti-mok robial resistance. What plans does

the minister have to test all NHS patients for antibiotic resistance?

The honourable gentleman is right that improving diagnostics is

essential if we are to tackle this national threat and a routine part

of clinical management of patients showing symptoms of infections is to

take a blood sample where infection is identified, those samples are

indeed tested for resistance, but part of our AMR strategy is to

improve diagnostics and to fund innovation in this area.

Will the Government commit that part of its strategy in this area will

discourage the use of intensive farming with its over use of

antibiotics? The honourable lady is right that we must focus on this

area as well. The Government's focus is on reducing the need for

antibiotics by minimising disease risk in animals through good animal

husbandry and antibiotics do at the moment provide the only effective

means of treatment for a number of animal diseases and are therefore

essential to ensure the health and welfare of animals, but we are also

working on this in an international context with the OIE and we will

continue to drive forward this agenda.

What measures are the Government putting in place to implement

testing across the United Kingdom to reduce levels of inappropriate

antibiotic prescribing in primary care?

My honourable friend is right that we must focus on innovation and

better tests particularly bed-side testing. The Government is reviewing

the evidence in support of the use of CRP tests and their benefits.

Pilot studies in the UK are contributing to that and will be

evaluated so we can see how best to build on what is working well.

480,000 develop multidrug resist hence TB this year. Drug resistance

is combatting the outbreak of HIV and malaria. Can he outline the

steps he is taking on alternative medicines and what cooperation has

the minister had with the devolved assemblies on this matter? I'm

grateful to receive immediate promotion from the honourable

gentleman, however, we have made considerable progress in putting the

building blocks in place in our strategy, domestically, including

putting in place better data and guidance for primary care and

strengthening the framework and including introducing incentives for

the NHS, to improve prescribing of antibiotics, and this has led first

reduction of prescribing antibiotics in the last quarter which we can see

as an encouraging time. Of all of the ten recommendations in the

review into anti-micro viral resistance, and given the amount of

people dying, estimated to rise by 10 million a year by 2050 bha,

assurances can the minister give she's behind this massive global

awareness campaign. The honourable lady is right to identify the scale

of the challenge that's why we put AMR on our national risk register,

but no one country cank at thatle aLen and the UK has played a global

leadership role in this, which is why we co-sponsored the World Health

Organisation's global health plan and copiloted the Fleming fund to

help poor countries to tackle drug resistance and we'll continue to

play that global leadership role. The O'Neilll review reported some

six months ago and included recommendations for national

governments to follow. Account minister tell us what practical

progress has actually been made by this Government so far?

Well, we published our comprehensive response to the re-Neil review on

19th September. It sets out a range of actions we will take on each of

the recommendations from Lord O'Neilll but I think that the most

practical progress I can report to the House, is the fact that

prescribing of antibiotics has fallen for the first time since

records began. I think we can all be proud of that progress.

Number #4, Mr Speaker. There are currently 127,000 staff in

the EU do a vital job for patients in the NHS and social care system.

In this year of Brexit, we salute their excel et work and remain

confident we will be able to negotiate for them to continue it

going forward. Thank you, Mr Speaker. There are

over 50,000 EU nationals working as nurses and doctors out with the UK

along with 80,000 in the social care sector with the NHS facing extensive

rota gaps due to the shortage of senior and June area doctors will

the minister demand that EU nationals living here should have

the right to remain? Well that is exactly what attend to

achieve through negotiation, but we also have to remember the rights of

British citizens, including people from Scotland, who are living in the

EU at the moment and whose rights we also wish to protect. So, that's why

the Prime Minister has made a big point of saying she wishes to

negotiate this earlier, to give certainty to those people.

We are not going to leave the EU for two-and-a-half years. I want the

Secretary of State to grip GP services in Lincolnshire now and

start training more services. A surgery is closing o potentially

leaving people without a GP. And a shortage of 08 GPs, and only six out

of 30 training places taken up recently, will the Secretary of

State now grip that GP services in Lincolnshire for the sake of our

people. -- 80 GPs. The honourable gentleman has brushed aside that

part of his question that doesn't suit his purposes only to focus on

half of it. We'll let him get away with it only had on this one

occasion only, it is very cheeky. I hope I can reassure my right

honourable friend. The reality is that in the last Parliament we

increased the last number of GPs by 5%. This Parliament we are planning

to increase them by another 5,000, which will be the biggest increase

in GPs in the history of the NHS. And go with considerable extra

resources. I'll focus on the other half of the

question that the honourable gentleman missed out. The other day

I had a meeting with some constituents of mine, who said to me

they were so pleased that they were leaving the union union because now

it meant that -- the European Union, because now it meant that the extra

?350 million could be used to re-open the A department at Bishop

Auckland. I would like it ask the Secretary of State, has he found the

?350 million yet? Well, the honourable lady may have noticed

that I personally didn't talk very much about that ?350 million.

Million because whatever resources we have post-Brexit will have to be

set in the overall economic context. But, course the great thing is,

post-Brexit is that that will be a decision for this Parliament. Thank

you, Mr Speaker many members of the NHS workforce across my area come

from the EU but also many from car Ben country, the Philippines, India

and Africa. Will my right honourable friend make sure that in future

people from those countries are given equal access to work in our

NHS, just as the EU nationals. Well, I think the benefit of Brexit will

be that those kinds of decisions are what we can precisely make this in

Parliament because we will get control of our borders back. But I'm

actually very grateful to him for mentioning the very important work

done by people from outside the EU in the NHS and because I happened to

meet the Phillipine ambassador last week, I want to pay credit to the

Filipino workers in the NHS and the social care system who do an

excellent job. I would like to extend my sympathies

for the victims of the Berlin attack. Coming to the question: Much

of what we have heard today is keeping those who are already here.

BMA Scotland has said insecurity stopping EU nationals taking posts

up that need filled. This is a problem, doesn't he think it is time

to create certainty for EU nationals and avoid a self--made workforce

crisis? Well, I absolutely agree with him, which ise think it is

frustrating that the current signals from the EU are that they are

unwilling to bring forward the negotiations about the status of EU

nationals here and indeed British nationals in the EU. But no-one from

any side of the Brexit debate has ever said that post-Brexit there

will be no immigration. They have simply said that we will control

that immigration ourselves through this House and through decisions

made by the British people at general elections.

Thank you, Mr Speaker, on behalf of the Opposition can I also echo the

words said by the Secretary of State in relation to the tragic events in

Berlin and send our condolences to the people there. Mr Speaker, the

institute for employment studies has today warned Brexit meant that

nurses shortages could be made worse. This follow a Times report

that applications for nursing and midwifery were down by 20% and in

some institutions applications has halved. The decision to scrap nurse

bursaries is having the consequences every expert predicted the would.

With the uncertainty of bricts looming over our workforce, now is

not the time to take a massive gamble. In light of the evidence,

will the Secretary of State anow to scrap this disastrous policy. I say

to him, that the purpose of that policy twoos allow to us train more

nurses. ... We want the NHS to offer the

safest highest qualitier care anywhere in the world. We are

tackling unacceptable performance, in contrast to the party opposite

which ignored failures for so long. Since introducing the rigorous

special measures regime, 31 provider trusts have gone into care quality

special measures of which 15 have been turned around as a result of

the significant quality improvements. I would like to

congratulate, again, the staff of Sherwood Forest I would Valley and

Norfolk and Suffolk trust that is have all come out of special

measures in recent months. Since Medway hospital was put in special

measures it made significant improvement. Morality rates are

down. The length of stay I would like to congratulate him on

championing Medway hospital. I'm aQuire the CQC is in the process of

reexpecting head way -- I'm aware. I would like to congratulate the trust

on improvements being made thus far, which he highlighted, including, in

particular, average lengths on stay admissions wards from 11 to only

three days. Thank you, Mr Speaker, I refer to a

recent damning frorp Pennine Acute Hospital Trust referring to

maternity care, and appalling neglect, leading to the appalling

death of mothers and babies. The trusts have implemented an

improvement plan but what action will the minister take to address

the fact that when maternity services were planned in the scheme,

it was based on a predicted birth birth rate of 3,500, when reality

the trust is dealing with 10,000 a year. I'm grateful to the honourable

lady for listing some of the issues which we are aware that needs

improvement. That's why we have buddied it up with the Salford trust

next door, led by Sir David Dalton, and I will take up that issue she

raised with him. Number 7. Minister? Mr Speaker, NHS

England has a range of initiatives around waste and medicine cost

reduction. We estimate that there was up to ?150 million per annum on

waste which can be realised throughout the system. Community

pharmacists have a significant role partly by their existing duty to

review prescriptions where repeat dispensing and partly by the

commissioned medicine misuse. The minister is right community farmist

ths siss have an important role to play on 17th October he told the

House "We do not believe any community pharmacists will necessary

close as a result of my cuts." Yet the impact of the assessment,

published just two days later, by his department, describes a possible

scenario of 1,000 pharmacies closing. Oh dear Account minister

confirm today, that nobody in Britain will have to travel further

-- account minister confirm that nobody in Britain will have to

travel further to get to a chemist, as a result of his cuts. Mr Speaker,

the impact assessment set up an upper range which we do not believe

represents an accurate reflection of what will ha. The facts of the

matter are that we need our community pharmacy network to move

towards the services, Ayerza way from dispensing and paying every

community -- and away from dispensing. And saying them ?25,000

just to have an establishment is not achievable... THE SPEAKER: Order.

The honourable lady should not chunter from a sedentary position.

The honourable gentlemen should glide seamlessly above the attempted

provocation. He has finished his answer, very

well. In order to reduce the unnecessary cost and making sure the

best of community pharmacies services are provided will my

honourable friend do all he can to ensure that CCGs engage as

effectively as possible with farmist cysts preferably by getting more

people on their board to make sure the protection between it is at the

heart of what we do. Mr Speaker, as the honourable member is right. CCGs

are variable in the extent to which they commission pharmacy services

but we have set out the minor ailments scheme which by April 2018

will be rolled out nationally and which we expect every CCG to take a

part in. I have seen many examples of drugs prescribed and not used I'm

sure we all sl. Shouldn't we have renegotiated the national contract

that currently pays community pharmacies over 90% of their income

by prescribing. Surely we can do things differently.

He is quite right that we must change contract to move away from

90% of income coming from dispensing and more coming from services that

are separated commissioned. The Murray review sets out a road map

for that, and NHS England are determined to implement that. May I

pay tribute to the excellent work of pharmacies in the Peterborough area.

Look East last night demonstrated the pressure that urgent care

centres in the east are under, because of extra patient foot fall.

Can the minister give me an undertaking that he will put in

place guidelines to CCGs to encourage them to work more closely

with pharmacies to reduce that. He raises an important point and he is

quite right, we must move the community pharmacy network away from

just dispensing into services. Which will include minor ailments and

repeat prescriptions. I will encourage CCGs to do that. Community

pharmacists which were developed in Scotland, while the minister

expressed admiration for the Scottish system, does he recognise

the need to develop the full potential in community services. I

have mentioned that I think on previous occasions that Scotland has

in some respects gone frt and faster than we have - further and faster

than we have in England around community pharmacies. The ?300

million we have set aside in the integration fund for the rest of the

Parliament will be used to do just the things that the member has

mentioned. We are determined to make that happen. Thank you Mr Speaker.

Over the festive period in every town in the UK, community pharmacies

will be open to dispense emergency prescriptions to provide specialist

services and advice, does the minister appreciate this service

that not only helps the public, but takes the pressure off other parts

of NHS and will he join with me in thanking them for their work and

reconsider budge cuts and instead meet the royal pharmaceutical Royal

Pharmaceutical Society to discuss extending their role to deliver

savings to the NHS. I have met the royal college of pharmacies and they

have worked with us on the Murray review that sets out how we move the

model to services as well. I do agree there is 11,500 community

pharmacies, all of which provide excellent services and we expect

that to continue. Last year the number of access

winter deaths was 45% lower than this year and contingency planning

is under way for winter preparedness. Told me they needed to

postpone operations to get through winter. Six months later there were

?12.5 million in deficit and proposing a cancel all nonurgent

srjry. This -- surgery. When is the Government going to give local trust

the things they near. Stop passing the buck and start passing the

bucks. It is not passing the buck. There are a lot of actions being

changen in Cheshire and her diside. There is a local delivery board

doing important work and the emergency care improvement programme

is working well in his local trust. There is great pressure on emergency

services throughout Staffordshire and it will be more without the

accident and emergency centres in Stafford and Burton, but the STP

proposes to reduce one of those. Would he speak with the authors of

SDP to make clear this is the unacceptable? Well first of all, no

one fights harder and more eloquently than he does for the

needs of the people of Stafford. I always look with concern at

proposals to change emergency services, given the pressures that

exist. So I will look at the plan as he suggests. The problem is it is

not just winter precious, it is pressures all year round. The

Secretary of State will say they have decided to increase the presets

to fund it better, but that is not enough money and there is not a

strategy. Can I ask is there anybody outside his own department believes

this Government has a strategy for social care? All I would do is urge

him to listen to what the Prime Minister said last week, where she

said we recognise the short-term measures. But also we need a

long-term solution, which the Government is working hard on. Would

my honourable friend agree that one of the pressures that needs

improving for winters is with regard to inappropriate admissions to A

departments? Would he accept that the proposals by the Essex success

regime which ensure that the three hospitals concerned will maintain

their A departments, but that there will be a specialist centre

for cardiotho razzesic and burns and plastic surgery is to right way

forward to improve and enhance the care for those suffering from

accident and emergencies. He understands these matters well from

his time as a distinguished health minister. He is right, the truth is

that we want to have widespread availability of A, but it is not

the case that we serve patients best by having identical services being

offered every where. So that is why one of things we are proud of is

setting up a national network of 26 trauma centres which has had a

dramatic impact on mortality rates. I have be advised some reference to

winter in these questions is desirable. Can I associate myself

with the remarks of the Secretary of State with respect to Berlin and

wish everyone in the House a merry merry Christmas and to all those who

work in the NHS. The underfunding is so severe that hospitals have been

ordered to close operating theatres for Lechtive surgery -- for Lechtive

surgery. Is this what the Secretary of State means by a selective

naturers. Despite his rhetoric, I see Santa has been generous to him.

His local trust has 254 more nurses and 306 more doctors than in 2010

and next year will have a new emergency floor at the Leicester

Royal Infirmary. We do need to make sure there is sufficient bed

capacity in winter. But we are also doing 5,000 more elective

operations. Isn't the reality that closing operating theatres is a

short-term fix? And the truth is when this pause ends and hospitals

fill up again, above the 58% occupancy recommendations, there

will be a choose to get stuck on a waiting list, or risk going into a

hospital, when it is at full capacity, potentially unsafe and

exposed to higher infection risks. What option would the Secretary of

State choose. Could I urge him to be careful with his rhetoric. We are

not closing operating theatres for a month over Christmas. You need to be

careful what you say in this place, because people outside are

listening. But the answer is to make sure that we increase capacity in

the NHS and that is why we have 11,000 more doctors and 11,000 more

hospital nurses than six years ago and we are training 15 hundred more

doctors a year to make sure we can avoid these problems in the future.

The NHS is a national, not an international service and we clamped

down on visitors to access NHS care. The steps we have taken have meant

that income raised from visitors and migrants has risen three fold in

three years from ?97 million to ?289 million. Does he agree that in order

to recover more money from chargeable patients requires a

culture change among NHS staff and does he share my dismay that the

leader of the doctor's unions dismisses the need to address and

calls for additional investment in the NHS. I do agree with my right

honourable friend that we need increased awareness by all NHS staff

in achieving this policy. But do I also agree with one thing that was

said that sick and vulnerable patients should not be put off

seeking treatment. This has always been a key feature of our policy. To

be clear, this policy does not withhold immediately necessary or

urgent treatment, but makes sure the NHS is fairly reimbursed. As the

minister will know, the public accounts committee has looked at

this and found that the Government is woeful in collecting money from

EU citizens that use hospitals for whom the government is responsible

for getting the money. When will the Government get its act together. I

am grateful as awful for advice from the committee. There was an article

in today's Times newspaper which referred to outstanding sums. We are

taking steps to try to increase recovery rates in the here v years

o' -- in the years ahead. The sustainability plan for London sets

out how the area will implement the five year forward view and ensure

closer working across NHS bodies. Developing centres of expertise to

ensure high quality service as well as closer co-ordination with social

care providers. The St Helier trust is a high performing trust, it is

confident that it can deliver sustainable and transformed care

services, but will struggle to do so in St Helier hospital built in the

1930s. The trust has secured a commitment that funding will be

available. Will the minister confirm once the STD process is complete

they will enable it to be able to deliver services from a new

hospital. Aware of the the honourable gentleman's campaign on

this. I think it would be wrong for know pre-empt the work being done in

reviewing the SDP process and the policy priorities of NHS England.

Once those plans have been put forward to ministers be, they will

then be able to consider which we can prioritise. The SDP plans for

London include mental health needs. But there is a crisis with mental

health patients will the minister look into extra funding to increase

the number of in patient mental health beds. As my right honourable

friend is aware, given her experience, that mental health is a

priority of the Government and is of a priority of SDP process. Will take

what she says in relation to in patient beds away. It is too early

to speculate, but it will up to NHS England. My focus is on raising the

quality of the existing contract and I have been clear that the standard

of capita's work has not been acceptable and it must improve. I

meet with capita and NHS England as they work to improve the performance

of the service. Thank you. Several GP practices have reported delays in

the transfer of records and sometimes the records have

disappeared, I would like clear response from the minister around

the assurances she give that the government takes serious think safe

delivery of their confidential medical details. I'm taking these

issue very seriously and I'm personally meeting with NHS England

and capita on a fortnightly basis and ensuring there are plans in

place for each of the service delivery programmes, the improvement

should happen between January and April and rectification plans are

detailed and I shall be happy to give the honourable lady more detail

in a letter if she would like to be able to reassure people on those

issues. Will the minister advise GP

practices in my constituents who have been massively inconvenienced

by the contract, what compensation will be available to to them, for

the time and inconvenience they have been put through? At the moment, NHS

England and Capita are focussing on hard on improving the service

delivery which I think must be the top priority. We are also looking

into exactly what inconvenience and costs has been suffered by GPs, as

well as dentedists and optometrists and that will be considered and

discussed with GPs going forward. Mr Speaker, directly comparable

figures are not available, but it is clear that in the last two years,

there has been a substantial increase in delayed discharge

figures attributable to social care from the royal wolf hatch tonne

trusts which this year, amongst the worst currently being recorded

across the NHS. Sadly those do Wolverhampton.

Sadly they are no surprise bus central Government has cut

Wolverhampton city' council's budget by 7%. The pilot programme to

Wolverhampton is a redesign of services so that a signal

organisation in the hospital trust deals with patients from initial

contract through ongoing management and end of life care What steps is

the Department of Health doing to help improve this, to lesson

hospital admissions. The announcement made last week,

regarding increase funding is important. However funding alone

doesn't explain the delayed trafr in wolf hatch tonne which are five

times worse than Telford just down the road and twice as bad as

Sandwell very close and 30 times worse than the best-pour forming

councils like Newcastle, Knowsley and St Helens. In terms of the

specific point he raise about the vertically integrated pilot it is an

exciting project and I commend the people of wolf hatch tonne for doing

it. It is based in a modelled in Spain which has produced big

results. -- Wolverhampton. We'll support it, as required.

Number 15. In developing the childhood obesity

plan we considered the latest research and evidence on promotions

and advertising, including P HEs, evidence package, sugar reduction,

the evidence for action and we made no secret of the fact we considered

a range of policies before settling on a rangepolicies in the childhood

obesity plan, however we settled on the plan finally which included the

soft drinks industry level and taking 20% out of sugar in certain

projects. We concluded our plan is the right approach to secure the

future health of our children. Can I associate myself with the Secretary

of State's words of sympathy with the people of Berlin and add my

thoughts to the people of Aleppo, Yemen, Gaza and forgotten conflict

in the world. The Government's strategy has been described as a

waste approach and wasted opportunity. The Government says it

is committed to evidence-based policy but failed to acknowledge

that it is inherently flawed. Account Government get a grip and

bring a ban on advertising and price-cutting promotions on junk

food? Well I'm very happy to reassure the lady, honourable lady

that current restrictions on advertising in the UK are amongst

the toughest in the world already. There is a total ban on advertising

of less healthy food during children's television programmes and

these have shown to be effective. However we welcome action taken by

forward-thinking retailers on promotions elsewhere and in

particular Sainsbury's have committed to removing multi-buy

promotions on confestingry, biscuits and crisps on their own bands and

it'll lowering regular prices for products, and they should be

congratulated for leading the way. THE SPEAKER: We now feel

considerably better informed. The advertising industry can play a key

role ensuring adverts are appropriate? Will the minister

continue torque o working with the industry to tackle this? Yes.

Certain supermarkets persist in placing less healthy foods on

promotion near the entrances to their store, where they are

unavoidable. Would the Secretary agree it is not just at healthouting

where healthy options should be promoted but retailers should be

exercising more responsibility. I absolutely agree that putting

healthier options near checkouts and helping people make health choices

is part of people's responsibilities and the approximate enny is dropping

with retailers that it is the direction of travel and what the

public want and I think seal we see a sea change in the way in which

retailers are advertising. Let's hear the sound of Shipley. Can I

urge the minister not to go down this ridiculous nanny state route,

which one wouldn't expect from a Conservative Government, and

certainly in setting up the unhealthy food police, to go around

telling people what they should or shouldn't be eaten. No food eaten as

part of a billioned diet is particularly unhealthy and if the

Government is concerned about familiaries just about managing

would y would it contemplate increasing the costs for working

families sth The honourable gentleman flatters me by saying he

thinks I'm a nanny. It is really quite a disturbing thought. However,

what we have here is an ebeesity plan which balances both the need to

cut the sugar within young people's diets as a way it make sure they are

getting a healthy diet, and the individual choice which we know is

absolutely a Conservative ideal. Number 2, Mr Speaker.

Mr Speaker, as we enter the challenging winter period on behalf

of the whole country I want to thank the 2.7 million people working in

the health and care system, particularly those giving up all or

part of their own Christmas day to look after patients. We are in their

debt and we wish them a merry Christmas when they get the chance

it celebrate with their families The A in my area are using new

measures to cope with the staggering demand on services.

What are the doing... So resources can go where they are kneaded most.

Well, we have the Stay well... Winter campaign.

We urge the public to remember that Accident Emergency departments are

for precisely that. -- where they are needed most.

There was no new money for Government for social care in the

local government settlement, a recycling of money from the new

homes bonus for social care for 2017 only. 57 council also lose funding

due to this recycling. Salford, recently praised by the Prime

Minister for its integration of social care, will lose ?2.3 million

due to this inept settlement. Isn't it time for the Secretary of State

to accept that social care is in crisis, and that his Government

cannot just dump the issue of funding it on to councils and

council tax payers? Well, I do listen carefully to what

the honourable lady says because she has campaigned long and hard for

social care but, with respect, I would say to her, that she is

ignoring one simple fact that there is more money going into social care

now, than would have been the case if we'd followed her advice at the

last election. And what the Communities' Secretary announce the

was ?900 million of additional help over the next two years Thank you,

Mr Speaker, the Government's plan for funding social care look

indepartment because they tie care funding, which is related to need,

to council tax and deduction for the new homes bonus. Last week's

settlement was a pathetic attempt to deal with a funding gap of ?2

billion for social care by recycling ?240 million within budgets. Now,

the Chief Executive of the British Red Cross has described the social

care crisis as "a humanitarian crisis that needs urgent action."

When is the Secretary of State going to take that crisis seriously?

She talks about the council tax, but what she doesn't do is call out

Labour councils, like Hillingdon, Hounslow, Merton and Stoke, who

complain about pressures in the social care system and refuse to

introduce the social care precept that would make a difference to

their own residence. We are taking the situation seriously, more was

done this week and more will be done in the future.

As my honourable friend maybe aware, is aware, last week the Murray

report was published. Can I ask my honourable friend as to when he is

likely to actually consider that and when he will be making a statement?

I thank him, for that question, Mr Speaker, I also commend him for his

work as a pharmacy champion, them you ary review was indeed published

last week, NHS England -- the Murray review, NHS England will respond to

that in detail early in the new year. It is a very important

document. It sets out in some detail how it is that we intend to

transform the community pharmacy network into a service-base product

fegs along the lines that I know he likes. -- profession.

Last week a man with diabetes in my constituency took a fall and had to

wait almost two hours for an ambulance. I then wrote to the

Health Secretary, after it emerged not a single ambulance trust in

England met spoits response time targets in October including for the

most critical of cases. Will the Secretary of State today explain the

reason for these unacceptable ambulance delays and what he intends

to do as we approach Christmas? Well I'm aware of the case the honourable

lady refers to. I say to her in the week of the incidence London

Ambulance Service received 40,453 emergency calls be an 8% increase on

the previous week. We are trying to do something with this. We have

recruited 2,200 more paramedics since 2010 and increased the number

of training places by 60% in this year alone. London Ambulance Service

has recruited 107 more paramedics. Six since September 2015 to help

with this increasing demand. Has the public Health Minister had an

opportunity to consider the recent reports sent to her by the all-party

parliamentary group on the shocking impact on excessive dripping by

members of the public on the did excessive drinking, on the people

working in the medical services and will she meet to discuss this? I

would like to pay tribute to my honourable friend for her dogged

campaigning on this issue. She is a true champion for this issue. I

haven't had the chance to read this in detail but I have seen a number

of the recommendations. In particular, I think we are taking

action on some of them, including the pub kafgts CMO's low risk

guidelines, and a campaign which runs over Christmas and new year.

-- a it has been shown that intervention is the most effective

way of stopping problem drink. Zach, wheelchair bound, can't speak,

blind, regularly admitted on an unplanned basis it Bassetlaw

hospital children's ward. As the people of Bassetlaw are standing

with Zach and proposing the proposed overnight closure of the children's

ward, which will create chaos for his small life and that of a number

of other very poorly children like him, will democracy prevail or is

the Government going to pick a fight, with Zach, me and the people

of Bassetlaw? Well, first of all, I absolutely

commend to him for standing with his constituents and championing

individual cases. I will happily look into the proposed changes and

how they will affect people like Zach. And I want to reassure him,

that when we make these changes, it is to improve the services of people

like Zach and his constituents. That's why we are doing them.

THE SPEAKER: Alex chauk. Where is the fellow?

Despite some of the obvious challenges with the health care

service, this is a wonderful time of year, where hundreds of thousands of

children choose to quit smoking by putting down their cancer sticks and

pick up an an electronic vapour device. But does in the stiner is

share my concern with the EU directive we have to be cautious in

its implementation, if any, that it doesn't cause a barrier to people

take up vague. Well the Government is clear that vaping is less harmful

than smoking and huge numbers are using these as an effective quitting

tool. We've committed to reviewing the TPD and rewe'll fully explore

the opportunities Brexit may provied. Until exit negotiations are

concluded we remain a full member of the EU On contaminated blood, could

the Government still confirm that they plan to use a private

profit-making company such as ATOS, to administer the scheme and if so,

why? I absolutely cannot confirm. It has it not begun, therefore we are

not considering any form of companiers private or injury wise.

The health committee has published a report into preventing suicide. I

would like to thank everyone who gave evidence and the health

advisory group. We support the strategy, but the clear message we

heard was around implementation. Would the Secretary of State meet

with me and join with me in thanking all the members of Samaritans and

other groups who will be work over Christmas to support those in

crisis? I think she speaks very wisely on that. I know that

Christmas can be a lonely time for a number of people and we all commend

the work of voluntary organisations who do so well and I would be

delighted to meet her. A more than a third of my male constituents live

till over 80, but in next door over half of their residents do. In the

ten years before 2010 that gap narrowed, what is he doing to narrow

the gap in future? The best thing we can do is make sure we continue to

invest in the NHS and social care and make progress on public health,

that is often the thing that has the biggest effect on health

inequalities and that is why it is good news we have record low smoking

rates. With bed blocking at a record high, does the minister agree that

is a great pity of 40 sustainability and transformation plans, so very

few deal with step down care and in particular with community hospitals?

Well, as my honourable friend has confirmed, there are new now 44

areas working on transformation plans to look at integration between

hospital and social care to improve discharge and this is something they

have to address. Figures from the royal college of psychiatrist show

children and adolescent mental health services are underfunded,

particularly in Bristol, what is the minister doing to ensure that

children across England and the rest of the UK get the health services

they need? I think she is right to highlight this and I'm not happy

with the service we provide. It is a big area of focus with the

Government. But there is lot more to be done. My constituency has been

waiting for go ahead on a new critical treatment hospital

providing 24/7 care, for the sickest patients, the hospitals's Chief

Executive retires this month after 21 years of exceptional services,

can the Secretary of State give her a retirement present and help me

secure a decision from NHS England. I would join my honourable friend in

congratulating her Chief Executive on her commitment to the NHS. As I

said in answer to previous questions, in relation to the SDP

for her area, this is being reviewed by NHS England and I'm not in a

position to give advice of the outcome. The Secretary of State will

be aware of the case of Fiona hollings, a 19-year-old with

anorexia who has been nearly 4 hundred miles from home in a bed in

Glasgow. Her family has travelled 8,000 miles in that time to see her.

The Government commits to ending this practice, but do families

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

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

unacceptable what happened in that case. We are commissioning record

number of in patient mental health beds and it is a priority to

eliminate this problem. Constituency is using a drug using prefilled

syringes, but cannot dispose of the used needles, because they're in 2.5

litre sharp stubs. Is the minister aware of problems and are there

steps he can take to deal with it? As the member said, pharmacies are

commissioned on occasion such as this dispose of needles. I wasn't

aware of problem with the 2.5 litres tubs. I will investigate him. GP

rates are higher than in pits of Ealing than in Rwanda. Could the

Government for the O'Neil recommendation to work for a global

fund? As I have said, we are a world leader on this and have not only the

by lateral fund with China, but the ?265 million Fleming fund where we

are going to deliver by lateral national action plans with a number

of developing nations and we are committed to going further through

the global action plan with the UN. A north night ago I visited a farm

pharmacy to thank the staff. Would the minister agree it is this sort

of working that is crucially important in trying to tack winter

pressures? -- to tackle printer precious. I would agreeshgs this

year -- I would agree. The department has done more flu jabs

this year and I have had my flu jab and it is holding up well. The

average ambulance arrival time for life-threatening case has almost

doubled in and Nottingham's waiting times are the worst in a decade.

Will he apologise for his failure to fund health and social care? I would

like to add my tribute to the work of ambulance staff up and down the

country, particularly over this busy Christmas period ahead. As I have

said, we have increased funding for ambulance services. We have

increased the number of Parr -- paramedics and we have increased the

payments to paramedics to help retain and recruit more staff. We

can manage only one more. 46 years, six months after two days after his

election, I call Mr Denis Skinner. He is a mine of information ain't

he? I mean he would like to contribute really. Doesn't the

Secretary of State think it is a scandal to be shutting Bolsover

hospital with 16 valuable beds that will go forever at a time when

people are lying in trolleys in nearly every hospital in Britain,

why doesn't he give them a Christmas present at Bolsover and announce

that the Bolsover Hospital will be saved? Come on. Well I add my

congratulations to those of The Speaker for long service. I say to

him we will look carefully at all proposals to change the services

offered chl I think community hospitals have an important role in

the future of the NHS, but the services they provide will change as

more people want to be treated at home. Thank you. Order. Urgent

question. Mr Ed Miliband. To ask the Secretary of state to make a

statement on the time table and approach of Government to 21st

Century Fox's bid to take over Sky and whether it plans to refer the

bid to the competition authority. As members know, Sky PLC announced on

Friday 9th December it