09/01/2017 House of Commons

system that provides security and dignity in old age. Order. Urgent

question, Mr Peter Kyle. I would like to ask the Secretary of State

for Justice to make a statement on the emergency review to determine

how to ban perpetrators of domestic violence from directly

cross-examining their victims within the family court? Mr Speaker, can I

start by saying how grateful I am to the honourable member for the chance

to update the House of what is an important issue. To put this in

context, the issues at stake in family proceedings are always

sensitive and often complex. The decisions of the court can have far

reaching implications for the individuals concerned. The presence

of domestic abuse only exacerbate an already traumatic situation. The

government has taken steps to make sure victims in the family justice

system have support and protection. Protected legal aid for individuals

seeking protection from abusers. We continue to invest in the court

estate to improve the physical security of family courts and the

emotional support available for users. We have placed particular

emphasis on training for those who work in the family justice system,

making sure they understand the nature and impact of domestic abuse

and they act appropriately when they come across it. We know there is

more to do. As my colleague, the Minister for victims, made clear

when this was debated in Parliament on the 15th of September, the

government is determined to improve the family justice response to

domestic abuse and we have been working closely with judges and

others to consider what additional protection may be necessary. We are

particularly concerned about the fact that unrepresented, alleged

perpetrators can cross examine their alleged victims in family

proceedings. I want to make family court processes safer for victims so

they can advocate effectively for themselves and for the safety of

their children. This cannot happen while a significant number of

domestic abuse victims face cross-examination by their abusers.

The Lord Chancellor has requested urgent advice on how to put an end

to this practice. This sort of cross examination is illegal in the

criminal courts and I am determined to see it banned in family courts

also. We are considering the most comprehensive and efficient way of

making that happen. That will help family courts to concentrate on the

key concerns for the family and always put the children's interests

first, which is what they are supposed to do. This work, which is

being fast tracked within the Department, is looking in particular

at the provisions in the criminal law which presents alleged

perpetrators from cross-examining their alleged victims in criminal

proceedings, and we are considering how we might apply similar

provisions in the slightly different circumstances of family proceedings.

Members will appreciate such a proposal does require thought, but

we want to resolve it as soon as possible. We will be making further

details available shortly once the work is complete. I would like to

thank the president of the family division who has argued passionately

that this practice should be outlawed for good. This is an issue

that has been wreaking untold devastation on victims of domestic

violence. I have spoken to numerous survivors of abuse his accounts of

torment under cross-examination, often by convicted rapist in the

family Court, are devastating to hear but impossible for most of us

to imagine. I have spoken to woman who was cross-examined by a man who

was in jail for numerous counts of rape and abuse that left her

unconscious and hospitalised. As a result of the family court process,

this vulnerable woman needed weeks of medication and months of

counselling to recover. She has now suffered this ordeal three times. I

have spoken to the sister of a woman who was abuse egregiously it

resulted in her death. The convicted murderer then sued the custody of

their child from prison where he was serving a life sentence for murder.

He directly cross-examined the sister of the woman he murdered.

Even having the grotesque nerve to ask, what makes you think you can be

a parent to my child? Abuse is being continued, perpetuated right under

the noses of judges and police. The very institutions that should be

protecting the vulnerable with every sinew of state power. On September

the 15th last year in response to speeches from members from both

sides of the House, the Parliamentary under Secretary of

State for Justice said this was a scourge which blights our society.

Yet he made no commitment to review or to change policy. Sadly, it took

the excellent coverage of the Guardian over the Christmas break

for that to emerge from the Justice Department. However, the source was

anonymous. Can the Minister give clarity in the following areas...

Lord Justice Mumby, the president of the family court division supports

members to outlaw the cross-examination of victims by

perpetrators. He said this would require primary legislation. Does

the Minister agree with this assessment? If so, would he

prioritise the drafting and the deduction of any such legislation as

a priority? The anonymous source told the Guardian, this was a matter

of urgency for the Secretary of State. Can he tell the House, when

this review was started, and more importantly, when it will be

completed? Victims of abuse need to have precision and clarity at this

moment of great importance for them. Speed is of the essence, but so is

consultation. We need to get this right. Can the Minister tell us what

process is underway to enable victims and campaigners and support

organisations to feeding their essential experiences and views in

order that this review will at all times, be carried out with and not

done too, survivors of domestic abuse. And finally, as I told the

House back in September, it is a source of shame to me personally, I

got the age I am today without being aware such barbarism is being

practised within our own legal system. In addition to my lack of

inquisitiveness, which I regret profoundly, the secrecy imposed by

law on the family court process allowed this to continue without

journalistic oversight. Will he consider longer term assessment of

the wider operational activity of the family court system? This should

look in a considered and detailed way of the overall operation of the

family courts with a view to making sure, where appropriate, the greater

transparency and oversight of the family court process is introduced?

Order. Just before we proceed, let me just say this, the honourable

gentleman has raised an extremely serious matter and he has done so on

the back of considerable knowledge and research. He has aired the issue

in this House with great sensitivity. I did not wish to

interrupting, not least for that obvious reason. But perhaps I can

announce to the House New Year's resolution and that is, we must,

from now on, we must, without fail, stick to the established time limits

for urgent questions. The honourable gentleman was notified of the two

minute limit and he took over three minutes. The second point, the brief

this preamble of description is fine, but an urgent question is

supposed to be that, not a speech, not a contribution to debate, but a

series of questions. I know the honourable gentleman well and I know

he will not take offence because he has raised important matters, but in

future it must be done in accordance with the proper form and to time.

The Minister of April. Can I start by agreeing with the

honourable gentleman on many of the points he has made. Judges have

always had discretion to try to get to the truth of the matter and to

protect families and so on and judges have discretion to ask

questions themselves to avoid situations arising which are against

the interests of justice. But over recent years the judges have come

more concerned about situations, as the honourable gentleman has said,

where the abuse is being perpetrated through the proceedings and that is

why Sir James Mumby has spoken out and why the department is treating

this as something that should be dealt with as a matter of urgency.

Is it necessary to change the law? The answer is it is. In order to ban

cross-examination it would be necessary for primary legislation

and there are ancillary matters relating to this which would require

legislation. Is work being done? Yes, it is being done at great pains

to ensure that all these matters are dealt with in a comprehensive and

effective way and so the urgency is there. This is something I became

the minister dealing with these matters in October. I chaired the

family Justice board and we have become very concerned over that

period about this issue and the Lord Chancellor shares that concern,

which is why we are moving at speed to try and tackle this. The extent

to which consultation is necessary is something I will consider in the

light of the honourable gentleman's comments and will discuss it with

him in private. But it is pretty straightforward what is required, a

band and then the ancillary measures which are necessary to allow

cross-examination without the perpetrator doing it. The extent to

which a wide consultation is needed I will question. Finally, in terms

of transparency in the cause, journalists are now able to attend

court and report proceedings but there are obvious restrictions to

protect children and the like. The Minister is to be congratulated on

moving promptly on this matter and the family division is to be

congratulated. Would my right honourable friend accept the simple

solution would be probably to adopt the criminal procedures under the

1991 legislation lock stock and barrel and use the format to put

that into primary lock and accept the very modest public expenditure

of a court appointed to do the cross-examination where justice

requires would be a drop in the ocean compared to the benefits and

the interest of justice to individuals who are victims of

abuse? I am very grateful to the chairman of the Select Committee for

those comments. I agree with a good deal of it. There are some

differences from criminal proceedings. For example in a case

where an injunction is being sought whether it is not a criminal charge

or a case where perhaps money is being considered, but there is a

background of abuse. In fact for legal aid in cases of domestic abuse

that is a wider list than is available in terms of criminal

proceedings, but the basic point he makes is right. As to the bill, I am

not able to give a commitment on that, it would depend on how quickly

the work was concluded and that is something I am working on very fast.

I thank the honourable member for hope for asking this urgent question

and that the Minister for asking this response. This issue really

unite the House. Questioning victims in court has been repeatedly raised

in this house and in the media. Many members on both sides of the House

have constituents who have been left devastated by the experience so that

the government is doing something to no end this practice is welcome. But

this is a clear admission that the legal aid cuts have caused this

situation. Victims of domestic violence struggled to provide

evidence of their abuse because frequently they are not believed. In

some cases medical evidence is difficult to obtain and their

experience is made worse still because the abuser is also unable to

get representation and is allowed to question them. Even in a situation

where they are prevented from contacting that situation and so the

abuse continues. But it need not be that way. In the criminal cause the

cross-examination of a member accused of domestic violence is not

allowed. Is the Ministry counting the numbers of litigants in person

in the family courts? How many of those are victims of domestic

violence? How many are convicted or alleged to have committed domestic

violence? Will the Minister look to the practice in criminal cause and

alongside prohibiting cross examination introduce greater use of

more sensitive procedures? When will the review finally begin? At the

honourable lady knows on her final point the review has to be concluded

by the 18th of April, sorry by April, 2018, so it is not overdue

yet, but it is something the government has very much in mind and

which we will have to start fairly shortly. In terms of the other

points, legal aid is available in cases of domestic abuse, that is why

the government concentrated its efforts in legal aid on areas where

people's lives liberties were at stake and in areas such as domestic

abuse and housing were homes were at risk, so that is not an issue. But I

accept the evidence criteria are important and that is why the

government has allowed a longer period and a wider range of evidence

to be used for that. I think that is something that has been welcome.

Cross-examination by litigants in person takes place too much and she

asked what the exact number is. It is not clear, but it is a

considerable number, which is why the government considers this to be

an important issue to tackle. Can I congratulate my honourable friend

and welcome everything he says about the government's attitude to this

long-standing problem. Could I urge him to look at the rules in relation

to legal aid because there is strong anecdotal evidence from former

colleagues of mine at the family bar and a judiciary that there is a

direct consequence and link between the rise in litigants in person and

the changes to legal aid actually begun under the last Labour

government and it is this link between litigants in person that is

causing so many of these problems and would he at least look at it and

it may provide some of the solutions. As my honourable friend

has rightly said, this is a long-standing issue, but it is one

which has become particularly urgent and where the cries for help from

the judges and others have become more urgent and that is why the

government is tackling this issue. As regards litigants in person, it

is necessary to find a way of stopping them using proceedings to

continue the abuse. That is what we are aiming to do. May I welcome the

Justice Secretary's emergency review and stress how important it is that

we all focus across the UK on how to prevent the perpetrators of domestic

abuse from using the processes of the justice system. In Scotland the

government is engaged in a significant overhaul of the justice

system ahead of the introduction of new legislation to introduce an all

encompassing offence of domestic abuse to include all forms of

coercive behaviour. In Scotland legal aid is widely available in

both criminal and civil cases. In England and Wales are cuts to legal

aid mean 80% of family cases seek at least one party without a lawyer and

60% of cases in the family courts and neither partner has a lawyer.

Victims of domestic abuse can only access legal aid if they cross a

threshold test which has already been found to be too restrictive in

the judicial review case. What we really need in addition to this

review is a review of the criteria for access to legal aid for victims

and survivors of domestic abuse. When will the government commit to

that sort of review? The honourable and learned lady segued into a

question just in time! I thank the honourable lady for that and for her

news from Scotland. In terms of legal aid in England and Wales it

was deliberately decided by my right honourable friend to concentrate the

effort on the cases where people's' life, liberty and their homes or

where there have been domestic abuses. Give it was a period of

austerity and decisions had to be made, he got that judgment right. In

terms of the criteria for legal aid and the evidence that needs to be

provided, it is not as though the government has said it is set in

stone. When criticisms have been made we have changed the rules to

make a system which tackles those criticisms. My overall point would

be that the government is responding when it should. Can I welcome a

right honourable friend's announcements today and the work he

is doing with the Lord Chancellor. But can I also draw his attention to

a report published in April of this year which I published with my

honourable friend the member for Birmingham Yardley, which not only

picked upon this issue of cross examination, but look at the issues

of special measures in court to make sure it is easier for some of the

most vulnerable victims to give their evidence so they do not feel

intimidated in that process? Can I pay tribute to my right honourable

friend's work in this area which is important. I know the government and

the ministerial committee that looks and violence against women and girls

takes a particular note of it. As regards special measures, the family

courts have always had a wider set of tools available to them than the

criminal cause and the judges have a wide discretion. Measures such as

taking cross-examination on a video basis, the section 28 in the

criminal courts, you can do that in family cases. You can take evidence

in a wide variety of ways, so there is a lot of protection there. We are

going further with this and so measures to deal with the court,

like ensuring there are separate waiting rooms, screens and those

sorts of physical aspects, they are being covered. So is the training of

the staff which is very important as well. I want to thank the Minister

for highlighting the discretion already available. Could he say what

steps he is taking now to remind the judiciary of the discretion that

they have and how they can apply it? The honourable lady makes an

important point and there are practice directions in the family

division and one is being prepared at the moment and so I will make

sure her comments are taken well on board in that direction, although we

do not make the practice directions, but we can pass that on. I have been

struck in my constituency surgeon sees surgeries, and one of my

constituents complaining about this was a former police officer. Can I

urge the Minister to use every tool possible to get this matter resolved

as soon as possible? We have all had examples and I am glad my honourable

friend was able to get that on the record. We have all had examples of

cases were in a way and abuse has occurred in the court. That is

something that is unconscionable and needs to stop and we need to tackle

this very urgently. The question of who should be

involved and consulted in this review, will the Minister Bear in

mind party litigants cross-examining their victims is actually just one

species of the controlling behaviour that lies at the heart of domestic

abuse. It is for that reason there is a real and important role for

organisations such as women's aid to have their voices heard in this

process? The honourable gentleman makes an important point and of

course the department does listen to what is said. The only point I make

is this is a discrete issue. It is an issue about banning

cross-examination by alleged perpetrators and making arrangements

to ensure cross-examination can take place in a suitable way. I wouldn't

want to sacrifice speed in tackling that for anything. Last week the

country were shocked and saddened by the death of my constituent, Gill

savoured, who campaigned for victims of sexual violence. She was

instrumental in changing the law which stopped rapist cross-examining

victims. Will my right honourable friend join me in paying tribute to

Jill, expressing our sincere condolences to her family does he

agree it is absolutely right the law is extended to the victims of

domestic violence? I certainly think it is important to pay

tribute to Jill Saward and she was someone who showed to the rest of

her life what a wonderful person she was. Campaigning and doing charity

work. She was a model and someone who was the example of good. I would

like to pass the law which applies in criminal cases on into family so

we can tackle the abuse described. I declare my interest as a member of

Wilberforce chambers in Hull, although not currently practising. I

welcome the Justice Secretary's position to bring forward a review

of this issue. It clearly is an issue. But the Minister will no that

this was created as a result of the legal aid sentencing and punishment

of offenders act in 2012, because the truth is this, the very vast of

what people now are refused legal representation in family

proceedings, unless they can prove domestic violence, which is

virtually impossible to prove. So maybe the government should be

bringing forward a review, it isn't working, do something about it. I

don't agree with him, but can I just say there will be a review, it is

something we have promised. The date by which it has to be completed is

in April 2018 and three are committed to doing that. In terms of

the family proceedings, I think it is right that in many cases families

can come together and reach agreements and we don't have the

problem he outlined. But in some cases, and there are a significant

number of individuals where abuse is present. In those cases, it is

important the individual who is the victim shouldn't be cross examined

by the alleged perpetrator and that is what we want to solve. Earlier we

heard a cherry, now we can hear a Berry. Mr Jake Berry. Thank you Mr

Speaker. Can I congratulate the Minister as to the taking this on.

In his statement he has referred this as urgent. Will he commit when

this review is complete, to bring this through as emergency

legislation? I think it would forward support from all sides of

the House and we could do with this legislation in one day in ensuring

this could be changed as quickly as possible. Can I save the importance

of this is accepted across the House. Whether it is the appropriate

way of dealing with it or not, one thing is clear it should be dealt

with as a matter of urgency and that is what I am committed to do. They

should have said in the case of the point Laspo. On several occasions,

the Minister has said he's dealing with it urgently. When will we the

result? Of course the answer you get from the dispatch box is shortly,

which is what I have said, but that doesn't mean shortly. The

government's reforms around the family courts were designed to keep

some of these antagonistic cases out of court altogether but the changes

to legal aid had met there are more litigants in person in these very

sensitive cases. Does he acknowledge the being caused by litigants in

person on court resources, spinning out the times cases often take with

constant advice legal procedures needed by the judge himself. We need

to do something about this because it is messing up the family courts.

I do accept how litigants are helped with court proceedings is important

and the government spending ?3.5 million helping them. The point I

make, it is not every case that needs to be decided in court and I

am a strong supporter of mediation. I would like to see more of that.

This is a welcome review, but cross-examination is not the only

way which perpetrators exploit family core processors to perpetuate

their abuse. Can I ask the Minister if the emergency review will look at

the other ways in which abusers can, string out judicial process in the

family courts to continue abusing former partners and their children?

I will be happy to discuss the issue with the honourable lady and

certainly in due course about the matter. But, this is a discrete

area. It is an important one and I would like to see it tackle swiftly.

I am not looking to widen what we are doing at the moment. I want to

get on with this. Women's Aid have raised this issue and a number of

occasions, including most recently where they found 25% of women they

interviewed had been cross-examined on including one woman who had been

raped, beaten and abused over six years, had been cross-examined for

three hours. Notwithstanding the need to get it right, can I ask my

honourable friend, when he does get it right in terms of review, we move

to bring legislation as soon as possible to make sure this can never

happen again? My honourable friend highlights an important case. He

highlights the work of Women's Aid and I think he is right to say this

is a matter that needs to be tackled urgently. The need for training of

the judiciary goes beyond the family Court. I constituent of mine came to

see me because her ex-partner talk a case in the civil courts about the

management of family property. The judge said it was irrelevant that he

was in prison for raping her daughter. This cannot be right, they

need to be trained as well. Of course, that would not have been a

family Justice case, it would have been a civil case. I agree with the

honourable lady, that is also an important consideration. It is

something I will look into. I very much welcome what the Minister has

said today in his commitment to legislate. But in the meantime will

he ensure the best possible support is in place to support these very

vulnerable people, these victims, before, during and after these

proceedings? Yes, as I mentioned in my response to the urgent question,

a lot of effort has gone into training both court staff and others

to provide emotional support that is needed. While I think we all welcome

the tone of what the Minister has said today, this is supposed to be

an urgent review. Many women are going through these cases right now

so can we have some clarity that at least by Easter this review will be

concluded and we will look to see improvements in our courts? Yes, I

agree with that. I welcome the tone of the Minister's remarks. Will he

agree with me the point about legal aid misses the fact some of these

perpetrators are using the ability to cross examined as a tactic in the

courts, motivating what they are doing and it is more important is

plugged in the law is made to stop this practice from continuing? What

is being put forward by a number of colleagues and my honourable friend

has made the same point, it is a form of abuse in itself to be cross

examining the victim in these circumstances. I agree with that,

which is why we are keen to conclude this review on a short timetable, as

I said to the honourable lady. I am grateful to the Minister for the

terms in which he has replied to the urgent question. He has talked about

the urgency of this issue. He has accepted the words of the chairman,

the president of the family court that primary legislation would be

needed. What commitment can he give to those survivors of domestic

violence and abuse that change will be brought forward urgently? I can

make the assurances I have made, we are tackling this as a matter of

urgency. There is a busy legislative timetable with all sorts of matters

to do with Europe and the like and we will have to see what can be

achieved in terms of the legislative timetable, but I want to tackle this

urgently. On behalf of of my constituent, Claire, whose children

were murdered by her ex-husband, I welcome this review. But in the

debate in September which I co-sponsored, the minister at his

side made a clear commitment to overhauling the culture of the

family courts, and in particular our review our practice direction 12. Is

the government still committed to the broader set of changes we so

urgently need to see? Can I just beat to the to the work the

honourable lady has done on this issue. The family justice board

which I'd share with another minister, the honourable member for

Crewe and Nantwich. We are committed to improving the overall in which

way the courts work and we are in the process of having a new practice

direction in the area of victims. But it is certainly a point we are

very much alive too. Everyone who has spoken today has said how urgent

the situation is, including the minister himself. In view of this

and in view of the fact he has said primary legislation will be needed,

is there any reason why he could not present this in three or four

months? As I have said to her colleague, we are keen to complete

this review as a matter of urgency. Legislative programme is a complex

matter at the moment, for reasons which I have already hinted that so

we will have to see what is possible. But we would like to

tackle it urgently. The questions has been on domestic violence, but

can he confirm he is also seeking to implement this protection for

victims of emotional, financial control and other forms of

nonviolence abuse, which the government has, to its great credit,

sought to criminalise in recent months? As he will know, there is a

cross governmental approach to abuse which has its own definitions and so

on. If he looks at the areas covered for abuse when it comes to

applications for legal aid, he will see it is far wider than just

physical violence, it includes sex abuse cases and the like. We are

well alive to the need to cover a wider area than simply violence.

Whilst I appreciate the urgency and scope of the investigation, can he

give consideration to cases where the DWP are sharing the victims of

domestic abuse's information with the perpetrators of the crime when

making their decisions about benefits claims and giving, in the

case of my constituent, her anonymity being taken away from her

and it was passed on by the DWP? I am sure the honourable lady is

making an important point. If she wanted to write to me speak to me

about it I would be happy to look at it. But it is not what we are doing

in this particular exercise by looking at the cross-examination of

alleged perpetrators, it is a discreet, narrow area which we are

tackling and we wanted tackle urgently. It is a different matter,

but her point is important. Survivors of domestic abuse tell us

they feel read Victor Mize and re-traumatised by their experience

in the family Court. Could the minister give us more clarity on how

the voices and views of survivors of domestic abuse will be considered in

this emergency review? Well, my view of this is that it is

now though issued to ban perpetrators, or alleged

perpetrators from cross examining victims. I think this is something

we all agree on. The sort of arrangement that there need to be

put in place to tackle the issue of cross-examination are things that

are being tried in the criminal courts. If she has any particular

ideas or concerns about that I would obviously be happy to discuss it

with her, but I don't think it is a complicated matter, but a simple one

that needs urgent action. Thank you, whilst I'm aware that this debate

focuses on the adult victims of domestic abuse, research shows that

an estimated hundred and 30,000 children in the UK live in

households with high risk of domestic abuse where there is a

significant risk of harm or death and thousands more live with other

levels of domestic abuse every single day. Can the Minister please

clarify that as recommended by Women's Aid, there must not be an

assumption of shared parenting in cases where domestic abuse is a

feature? Well, I mean it is an important point and clearly the

courts are very alive to this, but I think we do have to give some

discretion, because the family cases are very wide and have the range of

factors in them. I think the judges do a good job and I would just like

to put on record that these aren't easy cases and judges do have to

have an area of discretion. Although she makes a good point I would like

to insure that remains the case. Thank you. Constituent came to meet

extremely distressed she was having her husband repeatably take a back

to the family court over access issues, so not only was she having

the cross-examination she was also being driven into poverty by having

to fund her own defence and her own case. Will the Minister also look at

how courts can look at fixation is, repeated requests over access which

are actually behind a lot of this POS of behaviour? -- a lot of this

coercive behaviour. I think she makes a very important point, I am

more than happy to raise this in the family Justice board and to look at

it, but it's not part of the important work we're doing at the

moment to try and do something urgently the issue of

cross-examination. It is appointed that bears on it but it is not the

absolute focus on what we're doing at the moment. But it is and we will

look forward to -- we will look into. Statement the Secretary of

State secretary Jeremy Hunt. With the mission I would like to

make a statement about mental health and NHS performance. This government

is committed to a shared society in which public services work to the

highest standards for everyone. This includes plans announced by the

Prime Minister this morning and mental health. I am proud that under

this government 1400 more people are accessing mental health services

every day compared to 2010. We are investing more in mental health than

ever before, with plans for a million more people with mental

health conditions to access services by 2020. But, we

recognise there is more to do and so we will proceed with plans to

further improve mental health provision including formally

accepting the recommendations of the independent task force on mental

health which will see mental health spending increase by ?1 billion a

year by the end of parliament. A green paper on children and young

People's mental health to be published by the end of the year,

enabling every secondary school to train someone in mental health first

aid. A new partnership with employers to support mental health

in the workplace, at ?250 million extra invested in places of safety

for those in crisis following the highly successful start to this

programme in the last Parliament. An ambitious expansion of digital

mental health provision and an updated and more comprehensive

suicide prevention strategy, further details of these plans are contained

in the written ministerial statement. However, telling the

winter, as are most precious public surface the NHS has been under

sustained pressure for a number of years. In just six years the number

of people over 80 has risen by 340,000. And life expectancy has

risen by 12 months. As a result demand is unprecedented. The Tuesday

after Christmas was the busiest day in the history of the NHS. Some

hospitals are reporting that Amy attendances are up to 30% higher

compared to last year. -- A attendances. I therefore hope to set

out how we intend to sustain it for the future. First I would like to

pay tribute to staff on the front line. 1.3 million NHS staff,

alongside another 1.4 million in the social care system, do an incredible

job which is frankly humbling for all abuzz in this House. An

estimated hundred and 50,000 medical staff and many non-medical staff

worked on Christmas Day and New Year's Day, they have never worked

harder to keep patients save and whole countries in their debt. With

respect to this winter, the NHS has made more extensive preparations

than ever before. We started the run-up to the winter period with

over 600 more doctors and 3000 more nurses. Then just a year ago.

Bringing the total increase since 2010 to 11,400 more doctors, and

11,200 more hospital nurses. The NHS allocated ?400 million to local

health systems for winter preparedness, it is nationally

assured the winter plans of every trust, it launched the largest ever

flu vaccination programme with over 30 million people already

vaccinated, it also bolsters support outside a unease with 12,000

additional GP sessions -- A The result has been that this winter has

already seen days where a unease have treated an extra number of

people within four hours. -- a record number of people. As head of

NHS providers said, "Although there have been serious problems at some

trust, the system as a whole is doing slightly better than last

year." However, there are indeed a number of trusts where the situation

has been extremely fragile, all of last week's a neat guy that happened

at 19 trusts of which four are in special measurements. The most

recent stats show that three quarters of the folly weight

occurred in three trusts. In Worcestershire there has been a

number of unexpectedly long trolley waits. We are also aware of ongoing

problems in North Midlands with extremely high numbers of 12 hour

trolley waits. Nationally the NHS has taken urgent action to... As of

this week and there are some signs that that pressure is using both in

the most distressed trusts and across the system. However, with a

further cold weather and the way a spike in respiratory infections and

a rise in blue will bring further challenges ahead. So, NHS England

and NHS improvements will also consider further measures which May

be taken in particularly distressed systems on a temporary basis at the

discretion of local clinical leaders. They may include temporary

release in time for GPs to support urgent care word, clinically

triaging non-urgent calls to the Ambulance Service before they are

taken to hospital, continuing to suspend collective care including

where appropriate suspension of non-urgent outpatient appointing is,

working on rapid reinspection when this has potential to reopen at

capacity, working with community trusts and community nursing teams

to speed up discharge. Taking together these actions will give the

NHS the flexibility to take further measures as and when appropriate at

a local level. However, looking to the future, it is clear we need have

an honest discussion with the public about the purpose of A

departments, there is nowhere outside the UK that commits to all

patients that we will also out any health need within four hours, only

four other countries New Zealand, Sweden, Australia and have similar

national standards which are generally less stringent than ours.

This government is committed to maintaining and delivering that

vital for our commitment to patients, but since it was announced

in 2000 there are nearly 9 million more visits to our a unease, up to

30% of whom NHS England estimates do not need to be there and the tide is

continuing to rise. So, if we are continuing to respect this for our

standard we to be clear it is for urgent health problems not all

health problems however minor. As the NHS England's medical director

for acute care has said, "No country in the world has a standard for all

health problems however small, and if we are to protect services for

the most honourable neither can we." So we will continue to explore ways

to ensure that at least some of the patients who do not need to be in

A This way we will be able to improve the patient experience for

those with more minor conditions who are currently not seen within four

hours as well as protect the four hour promised for those who actually

need it. Mr Speaker, taken together what I have announced today are

plans to support the NHS in a difficult period, but also plans for

a government that is ambitious for our NHS, quite simply to offer the

safest, highest quality care available anywhere for both mental

and physical health. But they will take time to come to fruition and in

the meantime all our thoughts are with NHS and social care staff who

were working extremely hard over the winter and throughout the year both

inside and outside our hospitals and I commend the statement of the

House. I'm grateful to the Secretary of State for advance copy of his

statement and I begin by playing tribute to all the NHS staff who are

working day in day out to provide the highest possible care to

patients at the Spivey period. Of course, we welcome measures to

improve mental health services. -- this busy period. We welcome and

such announcements 12 months ago when the then Prime Minister made

these announcements. But do you not agree that if you want to shine a

light on mental health position you should aim had taught and... A

reduction in mental health head, 400 fewer doctors working in mental

health and perhaps most disgracefully of all the raiding of

children's local mental health budgets in order to plug funding

gaps in the widening NHS. Why were you unable to compare that the money

the mental health would be ring fenced? We would welcome support on

measures to improve mental health in schools, would the government offer

more resources to local authority psychologists, and what provision

would be in place to give teachers suitable training? Tending to the

winter crisis, this morning the Secretary of State said that things

have only been, "Falling over in a couple of places." Let's look at the

facts, a third of hospitals declared last month they needed help to deal

with patients coming through the doors, 15 hospitals ran out of bed

in one day in December, several hospitals have warned they can't

offer comprehensive care, elderly patients have been left languishing

on hospital trolleys in corridors sometimes but over 24-hour 's and he

says care is only falling over in eight couple of places. I know Lala

land did well at the globes last night, I didn't realise the

Secretary of State was living there, perhaps that's where he was all

weekend. Can he confirm that the NHS is facing a winter crisis and the

blame for this lies at the door of number ten Downing St? Does the

Secretary of State agree it was an error to ignore the pleas for extra

funds for social care in the Autumn Statement? Willy now bring forward

extra money allocated the social care's and Willie edge the

Chancellor and the Prime Minister... And with respect to the four hour a

any target he has just announced can repressive however, is he now really

telling patients that rather then trying to hit back for our target,

the government is now free writing and down grading it? If so, does NHS

England support this move and what guidance has he taken from the Royal

College of emergency medicine is that this is an appropriate change?

This Secretary of State has made patient safety a priority in that he

has our support, will he agree that one of the most upsetting reports to

come out of hospitals last week was the death of two patients at

Worcestershire wall and hospital trolleys. Can I ask the Secretary of

State whether he will lead an enquiry into these deaths? Does he

know whether these were isolated incidences and when does the trust

it intend to report back and will he undertake to keep the House updated

on these matters? In conclusion, there is no doubt that this current

crisis could have been averted, hospital bottoms, council leaders,

patient groups, MPs, urged the council to give the NHS and social

care extra money in the Autumn Statement, those requests fell on

deaf ears and we are now seeing the dismal consequences. NHS staff

deserve better, patients deserve better, the government needs to do

better can I I am happy to respond to his

comments and the Commons of all on rebel members. But I say this about

the tone of what he said. He speaks as if the NHS never had any problems

over the winter when Labour was in power. Let me say to him very

simply, the one thing NHS staff don't want right now is for any

party to start weaponised in the NHS for party political purposes. Let me

remind him when his party runs the NHS, double the number of people are

on waiting lists for treatment, people wait twice as long to have

their hips replaced. Whatever the problems are in the NHS, Labour is

not the solution. He talked about mental health. Let me tell him what

is happening on mental health. Thanks to the efforts of this

government and the Conservative led coalition, we have some of the

highest dementia diagnosis rates in the world. Talking therapies

programme, which is one of the most popular programmes for the treatment

of depression and anxiety, is treating 750,000 more people every

year and is being copied by people in Sweden. We are treating, every

day, 1400 more people for mental health conditions. We have record

numbers of psychiatrist. He mentioned mental health nurses, we

are training 8000 more, 22% increase. This is backed up by what

we are confirming today, which hasn't been done before, the

government is accepting the report of the independent task force review

led by the Chief Executive of Mind which commits us to spending ?1

billion more on mental health by the end of this Parliament. That would

not be possible with the spending commitments Labour was prepared to

make NHS in the last Parliament. It is because of this government's

funding we can make this commitment on mental health. Now, he talked

about the NHS and he gave completely the wrong impression of what I said

this morning. I was completely clear that all NHS hospitals are operating

under greater pressure than they have ever operated under. But, he

should perhaps listen to independent voices like Chris Hobson, no friend

of the government when it comes to NHS policy, who is very clear that

in the vast majority of trusts, people are coping slightly better

but we have serious problems in a few trusts, including Worcestershire

and a number of others. I can commit to him we will follow closely, the

reports and investigations into the two reported deaths at

Worcestershire and keep the House updated. He talked about social

care, social care last year 's spending went up by around ?600

million. He stood on a platform at the last election of not a penny

more to local authorities for social care. Not a penny more. To stand

here as a defender of social care is frankly an insult to vulnerable

people up and down the people, but particularly people living under

Labour councils like Hounslow, Merton and Ealing, where they are

refusing to raise social care but complaining about social care

funding. He also talked more generally about NHS funding. I'd

just say this... In the last Parliament it wasn't the

conservatives who put funding for the NHS, it was his party who put

funding for the NHS. It wasn't the Conservatives who said funding the

five-year forward view was impossible, it was his party. They

said the cheque would bounce. It hasn't bounced and we are putting

that money in. Tough as it is on the NHS front line, I do say he was

right to raise this issue in this House, but wrong to raise it in the

way he did. The NHS as record doctors, record nurses, record

funding, care, despite the pressures of winter is safer, high-quality and

reaching more people than ever before and it is time to support

those on the front line not try to use them for party political points.

I welcomed the Secretary of State's statement and the Prime Minister's

focus on mental health. She spoke of holding the NHS leadership to

account for the extra billion that will be investing in mental health.

Could the Secretary of State set out in further detail how CCG 's will be

held accountable so we can deliver progress and parity? I can

absolutely do that. We have had a patchy record in the NHS of making

sure money promised for mental health actually reaches the front

line. The way we intend to address this is by independently compiled

Ofsted style ratings for every CCG in the country that actually

highlights where mental health provision is inadequate. Those

ratings are decided by an independent committee chaired by the

same Paul Farmer, who is responsible for the independent task force

report. I am confident we can shine a light on those areas that are not

delivering. After the recent enquiry the Health Select Committee did into

suicide, I absolutely welcome the extra funding to mental health and

I'm sure the Secretary of State remembers some of the discussions we

had in that room. I also pay tribute to the staff and obviously with my

background, I know what it is like when A is swamped when you don't

have anywhere to put people. I don't think the staff across NHS England

are afraid of us discussing this topic and weaponised and yet, they

are in tears, they are exhausted, they are demoralised, they have

never experienced a winter like this. Perhaps the secretary of State

can explain why his figures suggest 19 diverts and only two trusts in

serious problems. Where as what we're hearing from the Nuffield

trust, it is 40 or 50 trusts diverging, which it is absurd. That

means it is widespread. Talking about, and I people going to A who

don't need to be there, but they are not the people three deep on

trolleys waiting for a bed for 36 hours. Those are people who need a

bed and they are ill. We have discussed sustainability on several

occasions and the concern people have is because they don't have the

money to redesign, they are starting with A closures and bed cuts. I

would hope this incident would show that simply isn't possible. It is

not possible for the UK and particularly NHS England to lose any

more beds. In Scotland we face the same problem of increased demand and

shortage of doctors. A 49% of our patients were seen within four hours

in Christmas week. And it is estimated in areas of England, it is

within 50 and 60%. The difference is how it is organised, it is the

fragmentation, the lack of integration. There are things to be

done, use community pharmacies and GPs and try and bring the NHS back

together. I hope the honourable lady won't take offence if I say her

questions must be judged to be rhetorical questions. Secretary of

State. I was handy at-bats, but that was

then! This is now, that was when I was a badly behaved backbencher,

like the honourable gentleman. Secretary of State. I will try to

interpret the questions in what she said. If he is saying are the

problems in England similar to Scotland, I think we share problems,

particularly across the busy winter period and she has observed in

Scotland they are failing to meet targets in Scotland. But she is

right to say bed capacity is an absolutely critical issue. It is an

issue which we have not always got right in England. Beds have been

decommissioned and actually the alternative provision that was

promised has not been made and it has had knock-on effects. When it

comes to what happens in Scotland and England, Scotland has gone

further than England in terms of use of community pharmacy and that is

something to be commended. But England has gone further in our

plans for reforming and increasing investment into general practice,

which is what the president of the Royal College of GPs was talking

about over Christmas, and she is keen for Scotland to match the

package we have done in England. I commend my right honourable friend

for his statement. All of us know the work done in our local areas and

those working for the NHS at such a difficult time. In relation to

mental health, would he confirmed the Prime Minister's welcome speech

this morning emphasised Perrinelle -- Perry mental health but also

emphasise the point of transparency to make sure we know what it is CCGs

are doing and assist members of parliament in the work, not only

when we call for extra resource, but to make sure we play our part in

making sure locally, our area does the best they can in compared with

other areas rather make a general point and resources, which is the

easiest one to make? As my colleague in the Department of Health who did

a huge amount of good work on mental health, and on perinatal mental

health, 20% of mothers suffer some form of postnatal depression and

that has a huge impact on the child, costing around ?10,000 for every

birth in the country caused by lack of proper mental health provision.

This plan today means we can treat an extra 30,000 women, which we

think is the number of women that need to be treated better. On

transparency, he makes an important point. I would put it like this.

Funding matters, but when it comes to mental health, we have some of

the best mental health provision in the world, but it is inconsistent.

The only way we can get it consistent is by shining a light on

the different parts of the country, so we can bring all areas up to the

standards of the best. Mr Dennis Skinner. Is the Minister aware, when

he says there are 9 million more patient visits now, as opposed to

the year 2000, it makes no sense at all that in that climate, shutting

hospitals like the Community Hospital in Bolsover, and the

Secretary of State turns a blind eye to it, will he look at this question

because when you shut those hospitals, the beds are gone for

ever. Get stuck in. I actually think he does make an important point. It

isn't just about decisions to downgrade or close A when there

isn't alternative provision, but it is community hospitals, which are

important places for A and hospitals to step people down to. He

is right, I am getting comments, but this is a process that has been

going on in the NHS for decades and we have not always got it right

under both parties. But he is right is said we need to make sure when

there are changes in provision and community hospitals, we have good,

alternative plans. Order. In wishing two members of the best in the weeks

and months ahead, I Andrea Jenkins. First of all I would like to echo

some of the points the Secretary of State has made. Regarding the

support the mental health for expectant mothers. As one myself,

the midwife has been fantastic right from the very first appointments, at

grassroots level. We are feeling it on the ground.

while 50 young people in Yorkshire received care the mental health, how

would this new approach address the concerns of young people and their

parents and what measures are in to reduce the waiting list? I would

like to add my very good wishes and my confidence that she would get

superb care from the NHS and thank her for her campaigning and

patients' safety. She will be pleased to hear... In numbers, the

plan that we are outlining will mean that we are treating a million more

people a year with mental health conditions when it comes to young

people an additional 70,000 people will get treatment every single year

and that will I hope bring down the Camhs waiting times. But, we also

want to do work in schools to stop people getting on this waiting list

in the first place. The young mind survey before Christmas showed that

in 50% of clinical commissioning group areas there is a failure to

spend the full amount of investment allocated to children and young

people's mental health. Which is scandalous. I noted his point about

Ofsted like ratings, but doesn't he need instant use a system that

guarantees that the money for children's mental health is spent as

intended? He is writes to want to make sure that we live up to those

promises that matter he is right. He was a minister when some of them

were made and they are important promises. But I would say to him

that we are delivering what he wants, we are on track this year to

spending over a billion more compared to when he was Minister for

mental health. It has taken time for the NHS to get their message on

mental health but is getting through loud and clear. As a frequent user

of the Red Cross myself, and admirer of it I regard their claims of being

over the top. I'd join with the Minister in his tribute to the

front-line staff of the NHS. Would he agree with me that these

pressures are not in the go away and there must be a continuing drive for

reform and to do these things better? And what will he tell the

House, what are the impediments in the NHS to the sharing of best

practice and secondly what steps is he creating, is he taking to create

a more experienced and better trained leadership who are more

prepared for the exceptional medical and management challenges the NHS

now faces? Well, my right honourable is friend speaks extremely wisely

and I think we have to be careful about the language we use in these

situations, because many honourable people can be frightened if you get

the tone wrong and the vast majority of NHS services are performing

extremely well. His point and leadership is important, and one I

have given a lot of thought to come at the heart of it the problem is

that in this country, we don't have enough hospitals being run by

doctors and nurses. Alain 56% of our managers have a clinical at ground,

-- around 56%. Which compares to 96% in Sweden, to put it bluntly doctors

like to be given instructions by other doctors. If you are an

exceptional person, non-clinical background you can do it, but it is

hard because doctors are highly experienced people, so I have put in

place measures to try and make it easier for more clinicians to become

an managers of the future. In wishing the honourable member for

Liverpool way victory... In her speech to date the Prime Minister

made a number of many hard-hitting observations, she said "There is no

excluding the fact that people with mental health problems are not

treated the same as if they had a physical ailment." She told us about

the shocking reality that an average 13 people take their life every

single day in England. Given that the Conservative Party has been in

government for almost seven years and the Secretary of State has been

Health Secretary for almost four of those years, he does he think is

responsible for the PowerBook failures highlighted by the pie

minister today? -- I think that is a totally inappropriate question. With

great respect to her, and she campaigned tirelessly on mental

health and deserves great credit and that is, that is the same as saying

that the last Labour government should have sorted out every single

problem in mental health by 2010, and another stunning him and saying

that because the truth is that we have made good progress. If she

thinks it's trivial but we are treating 400 people every day... She

should go inspectors some of her constituencies who are getting

access to mental health... We have made big strides but there is much

more to do and we are determined to do what it takes. Recognising that a

supply of extra resources for the NHS will be a rifle and continuing

issue, isn't my right honourable friend right when he says that equal

attention needs to be given to controlling demand so that people

don't instinctively make calls an GP services in any department which

doctors themselves believe are avoidable and can be dealt with in

other ways? I think my right honourable friend 's beak is

extremely wisely and at the heart of it, we have a good commitment,

before our commitment. -- speaks extremely wisely. I think it is one

of the best thing the NHS does, the problem that it you are ill we will

do something about it in four hours. However, if you have a situation

which NHS England describes as of the 30% of people don't taxi need to

be there, then you risk not being able to deliver that promised the

people that axiom do need it. Looking at control of demand for

people who don't need to be in Amy 's, and -- Amy Makros. He seems to

believe blaming the public for... He well knows that the reason the

public go to Amy is because they can't get their GP and social care

is in crisis. Will he confirm that he has announced a significant

watering down of the four hour commitment and what is he personally

doing to address the chronic long-term underperformance of

hospitals like that of Worcester where two people died and trolleys.

And Plymouth who wear one of the hospitals that had to call in the

Red Cross. I think probably because of the fall and that we are in now

he is misinterpreting what I have said, but it needs to be put right.

-- because of the fall. I have not watered down the four our target I

have recommitted the government to. Maybe he wasn't listening but I just

said that I thought it was one of the best things about the NHS. But,

the public will go to the place where it is easier to get in front

of a doctor quickly and if we don't recognise that there is an issue

with the fact that people who don't need to go to Amy Makros are going

there we won't make their needs better by his constituencies and

mind. If he asked what are we doing to in difficulty, we have introduced

a new chief inspector of hospitals, which his party tried to write down.

Mr Speaker can I welcome the Prime Minister's announcement and the

Secretary of State's confirmation about the extra support the mental

health and particularly welcomed the review to be led by Lord Stevenson,

as they carry out that review into improving businesses ability to

support people with mental health problems can they look at how we can

help smaller businesses, those that don't have the human resource

expertise that larger businesses may have, to make sure that people with

mental health and stay in work and are able to get back into work when

they fall out of work. They are the biggest single category of disabled

people not currently working and we could make a huge difference. He

will know that from his distinguished time as a minister in

the blue WP -- in the DWP. We are trying to address the fact that if

someone stops going to work, is signed off because of severe

depression, that is ad for the individual and for the business.

But, too often what happens is then it becomes entirely the NHS's

responsibility to get that person after work. And the business think

it's not their responsibility not any more. But with help from the

business we could get that has them back to work much more quickly,

which would mean they would recover more quickly and the business

wouldn't lose so much money. We will never solve the challenges facing

the NHS and social care until there is a long-term settlement for

funding both. Does the Secretary of State understand that the social

care preset is completely inadequate to filling in the gap and will

increase inequalities because the areas that most need probably bonded

pair will be least able to raise that money? Will he speak to the

Chancellor and this the energy secretary to look again at this

issue and get the funding social care desperately needs? I do agree

with hair that there are serious funding pressures and social care

and we need a long-term solution to this and we are doing important work

on that. I think the preset is part of the solution the local government

settlement has been adjusted to take account of the different spending

powers or revenue raising powers of wealthier counties and local

authority areas compared to other areas. We have to take into account

the equality issue. But, issue saying how we sold the whole

problem, the answer is no there was more work to do. Can I welcome the

statement that could I pay a huge tribute to everyone working at

Nottingham University trust especially inanely and especially in

the nine days between Christmas and January the 2nd -- especially in the

nine days. There are hundred and 80 people in the Amy Department seeking

treatment, 395 more admissions then discharges in that nine-day period.

So, we'll huge tribute to everyone. Could I get an assurance that he

will continue to work with our hospital trusts as they bring

forward plans to change schemes, it's not just simply about money,

and do everything he can to support them? I am happy to do that and I

will echo her praise for this staff at Nottingham University trust, who

I know where particularly pressured over Christmas, and two I know made

particular efforts to improve patient safety at the recent years.

But, she's absolutely right and I will continue to work closely with

her trust. At 930 this morning I received an e-mail from a

constituent in Coventry who asked me to bring it to the Secretary of

State's attention and I'm late to do so. She writes as fied "I'm an nice

with 26 years experience who is always worked full-time -- I'm an

nice. But I have gladly served and given 100% to do it. Unfortunately,

my 18-year-old daughter has recently become and were mentally and

attempted suicide twice in a three-week period. I'm sad to say,

this comes in nursery 26 years experience. The care she has been

given is appalling. I expect that as a family who gave so much to society

and still do, when it is our time in need we can expect a service that

meets our needs. " Could you arrange... She continues that she

has been waiting six months without any mental health assessment or

support from the NHS, six months for a daughter of 18 years of age. Will

he agreed to meet her so it's just not more hollow words? I am more

than happy to meet her, but I would rather, what I would like to do

ahead of that is to look at the particular issue as to why she has

to wait so long. He puts it very eloquently, and she puts eloquently,

we Of thank you. The House of, is

library calculated the real terms increase in health related spending

between 2010 and 2016 in England was 9.4%. But it was zero in Wales. Not

only are A waiting times longer in Wales than in England but routine

procedures can take two and a half times longer in Wales. I regularly

see constituents in tears waiting well in excess of the year for hip

operations. Would the secretary of state agreed that the party opposite

must start acknowledging the challenges that the NHS Wales and

responsibility for them? I think his constituents in Wales would be

appalled by the reaction we have just had then. They stand on their

high horse complaining about NHS care in England but when he brings

up poor NHS care in Wales they make noises as if they don't want to hear

it. If they care about NHS patients, they should care about them through

the whole of the United Kingdom. NHS care in Wales is worse and they need

to do something about it. Avec Cooper. I have been contacted by

several constituents who spent 14 hours in A waiting for a bed. We

have been hampered by social care cuts, by a shortage of A doctors.

Some think the health department was warned would become a growing

problem over five years ago. And the Health Select Committee warned about

again last year. When will this shortage of A doctors be ended by

the government, by the summer? By next year, the following year? He

has had seven years. When will he deal with the shortage of A

doctors? The number of A doctors have gone up since 2010 by 1002 and

that, over 50% increase. The number of A consultants has gone up by

20%. We have recruited 2000 more paramedics and as a result of those

changes, are a emergency departments are seeing, within the four hour

target, 2500 people more every single day, compared to 2010. It is

not to minimise the pressures in the NHS over winter and that doesn't say

there isn't more that needs to be done, which is why I outlined a

number of things in my statement. The Secretary of State came to see

the plans of the emergency room at Worthing hospital. I hope next time

he comes he can look at the Community Hospital and the mental

health services as well. Can I put to him on the child mental health

care, we have 700,000 teenagers going through each year, each stage

and a quarter of them will have bumps and need resilience. The

parents and teachers need help, can he make sure the Green paper covers

advice to parents and teachers so they know what's in the normal range

of behaviours and what is outside them? Can I commend the right

honourable gentleman for his one-man campaign against the misinformation

put out by 38 degrees, which I continue to admire on many

occasions. Also thank the staff at Worthing hospital for their

fantastic work over the busy period. He puts his finger on a very

important issue, which is, as we seek to raise the profile of mental

health treatment for children and young people, what we mustn't do is

medicalise every single moments of stress, worries before exams, those

are not a cause to talk to an NHS psychiatrist. A lot of our work on

the green paper will be how we can promote self health, support schools

to help people but when they do need NHL 's help, they get it quickly. It

is great to see the Secretary of State here in the chamber after

enjoying his Christmas recess. While he was away, stuff on the NHS front

line had to work double shifts. The London Ambulance Service computer

system crashed. And we also found the Red Cross needed to be drafted

into our hospitals. Can the Secretary of State tell us today,

which hospitals he personally visited during the Christmas recess?

Let me just say, I was in touch with what was happening in the NHS every

day throughout the Christmas recess. But as someone who has worked in a

hospital herself, she might perhaps think about whether it is

particularly helpful for NHS hospitals to have visits by

high-profile politicians right at their busiest period. But I have

been very closely in touch. She talked about the problems at London

Ambulance Service, which was a problem, which staff had been

trained to deal with. I just say to her, her own hospital, the staff

worked extremely well. What they don't welcome is the attempts, I

think she is making this afternoon, to try to politicise the the NHS

faces. In connection with the changes to the four hour stand of

the Secretary of State has heralded, what does he think can be done to

incentivise and upscale GPs, who may wish to a closer interest in minor

and moderate illnesses, including the use of nurse led minor injury

units? These have a very important role and I think if we look at some

of the most successful and best performing trusts in the country

like Luton and Dunstable for example, what they do is they have a

very good streaming process at the front door with good alternatives

for people who are not appropriate to go into an A department. Nurse

led units can be important, GP led units can make a difference as well.

It won't be the same everywhere, for reasons of space and nothing else,

but there is a solution everyone can adopt. We have seen in the last few

weeks, pressures in the NHS, but what is surprising to me, given we

are not in the midst of a desperate cold spell yaps, we're not in the

throes of a flu epidemic, how can the secretary of state come here

today and I think in place in league, suggest he has a grip on the

services in the NHS. I'd like to know why he wasn't on top of those

trusts he knew for a week and potentially under threat if any

pressure occurred. What will he do when we hit the cold snap and people

are suffering from flu in large numbers? I reject that suggestion

and if you want to know what we have been doing over the course of the

year, as I said in my statement, we have 1600 more doctors than a year

ago. Over 3000 more nurses. We have the biggest flu vaccination in our

history, we have additional GP sessions booked over the festive

period. There was a huge amount of work being done and the particular

focus on distressed areas. Many of those distressed areas did cope

extremely well, not all of them, which is why there is more work to

do. The health committee in the last parliament luck that children's

mental health services and one of the main concerns was distances

travelled by patients, sometimes halfway across the country to get

treatment. Can you expand on his plans, and is it a new form of

gatekeeper and can he keep drunks out of A? Rather than the phrase

gatekeeper, I would use the word streaming and make sure we have

alternative offers for people who don't need to be in A departments.

That is not safe for A departments to have people there for six or

eight hours, it is distracting for staff and harder for them to do with

people who have more immediate needs. In terms of the distances

travelling, it is an acceptable for people to go 400 miles for a mental

health bed. What is the solution? We are commissioning more beds, but the

solution is to intervene earlier, so people don't get to the stage in

treatment where they need inpatient care. We know if we intervene

earlier, in many cases, we can head off that need and help people get

better quickly. This afternoon, the patients in Nottingham are waiting

for more than four hours. In the last month, figures are available,

3500 people who had to wait for more than four hours in the emergency

department. We cannot go on like this. Will he agree to fast-track

the capital we need to increase capacity at Nottingham's emergency

department? I will happily take a look at that and when it comes to

the allocation of capital, we do prioritise any project that will

help improve the situation in any department and reduce stresses. The

Secretary of State has acknowledged there is a shortage of acute mental

health beds and there's arises from a decision by many health trusts to

close beds and favour putting resources into services in the

community. One effect of this, people approaching and mental health

crisis find it harder to know where to turn for help. Will he explain

more about the crisis provision in which we are now investing this

extra ?50 million, and in particular is there a common way of knowing how

one can easily access these vital services? I am happy to supply more

details. The ?50 million is for places of safety that is

specifically focused on support for the police service, so we can make

sure we live up to what will be our legal commitment from this year, not

to send young people into police cells, when actually what they need

is a mental health support. But more broadly, he is right, there is a

policy change, which I think most people think is the right thing,

which is to treat more people in the community where we possibly can.

What I think is not working is the system which divides people up into

40 years. Sometimes we say to people, we cannot treat you because

we are in TF three and you are not sick enough. That is not acceptable

and that is why we are doing this Green paper and we want to look at a

way forward. Does the Secretary of State accept it is not solely down

just to an ageing society in the crisis and deepening crisis of the

NHS and the failure to provide sufficient funding is the key to

this crisis and therefore it is possible to address and what will he

do about it? If she is worried about funding, she might explain why

funding for the NHS in England went up by double the rate than funding

in Scotland over the last Parliament. But she is right... I

will get heard the figures on Northern Ireland. I say that by way

of reference. But let me agree with her, as well as apologising for my

earlier error, let me agree with her, it isn't just about the ageing

society. It is also about changing consumer expectations, people want

access to health care 20 47 today in a way that wasn't the case ten or 20

years ago and that is a cause of a lot of the additional pressure. I

welcome this announcement on mental health and it is clear the

government is serious about improving mental health treatment

and prevention. The challenge is to translate ambitions into action. Can

my right honourable friend assure me he will put in place mechanisms to

make sure these proposals and those in the five-year forward view for

mental health become reality? And specifically, would he look that one

step is to make sure that no STD is signed off without clear plans of

funding for improving mental health care. -- STP. It is happening and

one of the key metrics by which we will be junked judging STPs. She is

right ambitions need to be turned into action. But because of the

Commons that she and many other members have made over the last few

years, she will find there is much more understanding in the NHS that

this is a big priority. We need to stop resources constantly being

sucked into the acute sector, as has happened over many years. The

Secretary of State announced the government were pressing ahead with

significant cuts to community pharmacy budget in the Department of

Health, in the face of huge opposition from members of both

sides of hours, members of the public and health care

professionals. Given evidence one in five people, who would normally see

a pharmacist for medical advice, say they will make a GP appointment if

the local pharmacist is closed and in areas of high deprivation I moan,

it is four in five. Many of these people will turn about the local

hospital in desperation. Isn't the government in danger of making an

appalling crisis in the NHS even worse? We are having to ask the

pharmacy sector to make efficiency savings, just as we are asking all

part of the NHS make efficiency savings. 40% of pharmacies are

clustered in groups of three or more. Does make sense for the to

continue to subsidise pharmacies that are very close to river

pharmacies, so this is to ensure that where there is only one local

pharmacy, that pharmacies protected. Does my right honourable friend

acknowledge the damaging effect that loneliness can have on mental

health, and will he join me in welcoming the Jo Cox loneliness

commission later this month? I am happy to do that and to acknowledge

the importance of this issue, when it comes to older people per latest

figures I have seen is that 5 million older people say that their

main form of company if the television. That is not acceptable

and we all have the responsibility to do better in that the spec. Not

just from moral point of view but from a practical point of view, this

leads to people more likely to need hospital treatment which is

expensive and challenging for the NHS. Thank you Mr Speaker. The

secretary of this date has talked a great deal about preventing people

getting to A by intervening much earlier, yet surely he has to do

recognise that the cuts that have been made to local authorities, in

social care make it much more likely that people will not be picked up

earlier in the progress of any illness and will go and have to

resort to the health service in a much more difficult situation. Can't

he now have a discussion with his colleagues on the front bench and

tell them, particularly the Chancellor, that they have got this

wrong, we have to do invest in preventative services, we funding

authorities not cutting. It means investing in proper social care, not

the ?5 billion of cuts that we have seen in social persons 2020,

otherwise the pressure on our NHS will discontinue. Actually, I agree

with her broad points about the importance of the social care system

and its interconnectedness with the NHS and we faced in 2010 as you well

knows, because her party's manifesting the fact that this is

well, we faced a very challenging economic situation in which both

parties recognised the need for cuts to be made in public spending, but

what teams in 2015 at least in our party 's manifesto was the

recognition that actually when it came to social care we need to make

sure we increased funding into the social care. And all local

authorities are now able to increase funding for social care in real

terms and I hope we can start turning things around. Thank you

very much, with the recent educational select committee report

on children in care in mind I certainly welcome the Prime

Minister's be focused on mental health and the Secretary of State's

continued support of action to be taken, but what steps does he has in

mind to deliver actual practical steps given that we found that local

integration, effective relationships and the teaching of PSA cheeks all

helped to produce good outcomes. I think he's absolutely right and

obviously his role in the select committee will give him a particular

insight into this. But, we don't want to rush to come to a solution

on this which is why we will simply do a green paper before the end of

the year because it is complex. As the other honourable members have

alluded to the risk of metallising problems when we know that all young

people at school have periods of stress and anxiety and worry that an

diagnosable mental health conditions and we wouldn't want to make them as

such. So, this is about thinking through a smart way to improve

self-help and also to educate school so that they are able to spot when

this is just a temporary period, in the run-up to exams or whatever, or

whether it could be something a lot more serious like OCD or an eating

disorder or something that needs more immediate help. That is

something went to date we have started a big education programmes

with schools ball and go further. Q. I would like to welcome the extra

investment if it turns out to be extra investment in mental health. I

wanted to push the Secretary of State and the question around

educational psychology and how that is going to work in, I speak as a

mother of a child with SEN issues who has relied on clinical and

educational psychology in schools and the school where my children

currently goes to is increasing the class sizes and 30 to 33 and

reducing the teaching staff specifically those who engage in SEN

children, because of changes to educational funding. I wondered the

Secretary of State and tell me how he thinks that will affect the

children's mental health in my children's school? I think she

raises an important issue and I know that I have had constituents and I'm

sure she has as well, where they found access to educational

psychologists difficult and couldn't get a plan approved that they needed

to. This is what we will be considering in the build-up to the

green paper and I would encourage her to participate in the process.

Thank you, will the Health Secretary please get the message out there

loud and clear to health bosses up and down the country that we need

more capacity in our A so that when people come forward to NHS

England with the request for money for their appalling plan to

downgrade my local A, all those Huddersfield Royal Infirmary replace

it with a small unit with smaller bets, that that money would be

better spent on front line a need care. I of course take seriously

everything he says and I will say this, the NHS doesn't always get

these things right. I led a campaign against an A closure in my own

constituency when as a backbencher. And the party apps it was empower

and they were about to take a wholly mistaken decision. Bass macro Dub

party opposite was in power. So we will look carefully, and I do

think that the broader point he makes is that we have to understand

that the pasty matters. I would say that in the long run we are not

going to solve this problem simply by the increasing capacity in a any.

Because we need alternative forms of provision. Bass macro capacity in

the A We need to find ways of... That is what we are exploring. I

declare an interest as my husband is an A consultant. If the Secretary

of State would speak to him he would tell him that the extra pressure on

A, as we have had, because of the disappearance of preventative power

of social care, and of other services. It's not individuals

arriving at a any who should and it is other services with varying

people to A when they shouldn't. -- referring people. Would the

Secretary of State take responsibility for his government's

decisions over eight years that have panned out to be false economies of

cutting services back to the bone. With respect, I agree with the broad

principle that preventative care is absolutely vital, I disagree with

the suggestion that this has been cut to the bone. We had an increase

of 5% more and peas Tuohy GPs last parliament. -- and increase of 5%

more GPs. Both at the last election and the one before, the party

promising the most resources for the NHS was on this side and not on her

side. Everyone knows the Secretary of State has an impossible job which

he does with humanity and energy, but the two tier system that we had

depending on where you live, in the North Lincolnshire you can wait

three weeks to see a doctor or two hours for an ambulance to come, on

top of lack of investment. Two hours people of weighted lying in the

street waiting for an ambulance. This is not acceptable. -- people

have waited. I just wonder whether we don't need to start an honest

discussion with the people about how we're going to devote more resources

to help in this country, perhaps social in Shawlands models or

leaving, God forbid, charging people who don't turn up to appointment. --

social in Shawlands models. I don't agree with moving to a social in

Shawlands model, but the broader issue is something that I do have

some sympathy with. We have to recognise that if we're going to

have a million more over 65 is, over the decades ahead we will have to

find a way to continue to invest more in our health and social care

systems. This year we are doing that women extra 3.8 billion, over the

decades ahead governments will continue to need to do. He had led

rightly a specific problem, which I don't have the solution to. But I

understand the problem that in ball areas the book away too long for

ambulances. This system of targets that we have in sensor size

Ambulance Services... That is something that I will look at. The

Secretary of State houses he has a strategy, so I issue me must be on

top of these facts. Can I ask him, as the latest count this week how

many beds where being locked in hospitals by people that could be

discharged but there went the facilities in the community? More

than a third of A attendances at peak times are caused by jewel in

this, which is unacceptable and irresponsible, what more can we do

the hugely reduced that proportion by this time next year? -- caused by

the slump in this. I think the issue he raises is one about public

responsibility, these are our National Health Service is and we

need to treat them in a responsible way and it is selfish to behave in

an irresponsible way and create pressure on an A which means that

somebody else who needs the help might not be able to get it. Is the

Secretary of State accusing the Red Cross of weapon I think the National

Health Service, and secondly can I say when the NHS is making courts

the services that supper time and time again are the so-called

Cinderella services ie mental health services. The only way to prevent

that is to ring fence that funding. Finally, the other thing that

happens is when you cut local authority services to the bone is

that they can only provide strategy services. What is stopping the

Secretary of State commissioning and all parties group to look at the

sustainable long-term funding model for social care? The Prime Minister

has said that we need to find a long-term solution to the funding of

social care and that is work that is ongoing and we recognise the urgency

of the situation. But, I would simply say, the evidence about

whether or not services for mental health are reaching the front line

is whether actually more money is being spent on mental health

provision then in previous years and it is about ability of pounds more

being spent 20 years ago. Thank you. The AA in me at Worcester and

Alexandra Hospital in Redditch have been under huge pressure. -- be a

any macro. Can he reassure patients that all is being done to help

alleviate the situation now, and also what we really need at odd

trust is a capital bid of 29 million to be agreed to increase capacity to

alleviate this problem. I totally recognise that and I want to thank

her for her interest on behalf of her own constituents in what has

been happening. Subject to staffing there will be a new ward opening at

the trust next week. We have a new Chief Executive arriving at the

trust in the spring. We recognised the need for capital spending to

increase capacity of both the Alex and the Royal and we will look

sympathetically at that. He couldn't resist his customary political

attack on the Wells NHS, I had cause to visit my local hospital to go to

a new macro with a family member. And there was a speedy and expect

service. -- go to my Amy macro. Can I invite him to congratulate the

Welsh Labour government and not having to call in the Red Cross and

to congratulate them on their long standing emphasis on mental health

meaning we spend more per capita in Wales than in England or indeed any

part of the UK notwithstanding the ?2 billion cut he has made to the

Welsh budget in the last six years? What he wasn't prepared to say

people wait twice as long very hip replacement in Wales, more than

double the proportion of the double the proportion of the

population are on a waiting list for NHS care, that's one in seven people

in Wales compared to one in one in 15 in England and you are 40 times

more likely to be waiting for a diagnostic test result waiting too

long for a test result in Wales compared to England. Thank you, Mr

Speaker. The Secretary of State will be aware that our hospitals have

been under pressure due to be demographics and ageing population.

Will he agree that it's encouraging Will he agree that it's encouraging

to hear work being done on Friday to make sure doctors can be available

to those who need them and that people are sent away to specialists

who can help them like a physiotherapist rather than taking

up vital GP appointments? Indeed. I congratulate all the NHS and social

care staff in Derby doing a fantastic job. Also on the

pioneering work we have done, which I know has made a huge difference to

his constituents. Over the New Year, East Midlands Ambulance Service saw

life-threatening calls up 42% on life-threatening calls up 42% on

last year. Beauty of Nottingham last year. Beauty of Nottingham

University Hospital trust described the emergency department as pushed

to the limit. The honourable member has already said almost double the

normal number of hospital admissions. Clearly these were

necessary attendances but surely many of them could have been

prevented. He has already acknowledged the connection between

inadequate social care and this is inadequate social care and this is

entirely foreseeable prices. I ask again, will he commit his Government

to properly fund it? I just find these questions about funding

curious coming from a party that had we followed their plans would be

spending ?1.3 billion less on the NHS this year compared to what the

NHS is actually getting. I just say to them the reason that we are able

to spend that extra money on the NHS is because we know how to run the

economy. It's all too often been the case that mental health patients

have wondered if this issue actually has another leadership. I'm pleased

to see the Prime Minister made one of her earlier speeches on this

particular issue. While no one in this house would oppose an extra 1.4