:00:00. > :00:00.being read for the third time. Objection taken. What today?
:00:07. > :00:24.Tuesday, 21st of February. Thank you. Order! Order! Under this
:00:25. > :00:38.Government, yesterday I announced that we are going further with
:00:39. > :00:46.upfront ID checks for elective care. We wish to recharge the cost of
:00:47. > :00:50.their home country. We welcome this crackdown on the abuse of our
:00:51. > :00:57.National Health Service, but at this time we are struggling to find money
:00:58. > :01:05.for care elderly people. We cannot afford to provide a free national
:01:06. > :01:11.health service. It's a national not an international health service and
:01:12. > :01:17.I was this appointed as the comments from the opposition, saying that the
:01:18. > :01:24.money this would raise is a drop in the ocean. 500 million pounds,
:01:25. > :01:31.enough to finance 5000 GPs enough for everyone's constituents in this
:01:32. > :01:42.House. Whenever there are disastrous figures, isn't it a coincidence when
:01:43. > :01:46.the Government renounces away as cracking down on health tourism. It
:01:47. > :01:51.is chronically underfunded and this Government is doing nothing about
:01:52. > :01:58.it. I'll tell you what we're doing about underfunding. We are raising
:01:59. > :02:04.three times more than he was a health Minister of through
:02:05. > :02:11.international visitors. Mr Speaker, given the Government's stated
:02:12. > :02:18.objectives, could be Secretary of State set out for those who have
:02:19. > :02:21.severe injury mental illness and who are homeless, who are unlikely to
:02:22. > :02:31.have the required documentation, how is the Secretary of states going to
:02:32. > :02:36.implement this to them? We have good evidence from hospitals like the one
:02:37. > :02:40.in Peterborough where they introduced ID checks for elective
:02:41. > :02:49.care and they have seen no evidence that people who need care are being
:02:50. > :02:55.denied it. It's making sure that we abide with the fundamental principle
:02:56. > :03:09.of fairness that people who don't have a NHS through their taxes
:03:10. > :03:16.should be providing. We've just heard that the CC G is changing its
:03:17. > :03:24.constitution, excluding GPs, changing the nature of it. This is
:03:25. > :03:44.under resourced, and are stressed and asking to do something else like
:03:45. > :03:55.this, it won't cope. I had the extra money we raise from international
:03:56. > :04:02.visitors -- I hope that. We'll continue to fund the NHS. See if you
:04:03. > :04:06.travel to America, you have to have medical insurance, won't that be one
:04:07. > :04:12.of the requirements for people coming into the country to have
:04:13. > :04:20.medical insurance? We did look at this extremely carefully and what we
:04:21. > :04:24.concluded was that you don't have to have medical insurance if you go to
:04:25. > :04:30.countries like America, and we don't insist on it because of our tourist
:04:31. > :04:36.industry head. We decided it would be better for people who are getting
:04:37. > :04:43.visas here to pay a surcharge. It's raising several hundred million
:04:44. > :04:47.pounds for our NHS. I have always supported a view that we aren't
:04:48. > :04:53.running an international health service, but could be Secretary of
:04:54. > :05:01.State direct his energies stopping the wastage going on elsewhere in
:05:02. > :05:04.the NHS when highly skilled surgeons and teams have to wait to operate
:05:05. > :05:09.because there isn't a bed for their patients. How much is that wasting
:05:10. > :05:19.because of the chronic underfunding this Government has produced? These
:05:20. > :05:24.accusations would have a little bit more credibility if Labour were
:05:25. > :05:37.promising any extra money for an NHS, however they were committing to
:05:38. > :05:46.?5.5 billion less. My Hons friends will be when polio was eradicated in
:05:47. > :06:05.the 1980s, however 85% of sufferers can develop post polio syndrome.
:06:06. > :06:14.This involves increased referrals. 93% of people are unaware of PPS. A
:06:15. > :06:20.low awareness in the NHS and among GPs leaves patients waiting up to
:06:21. > :06:26.six years for a diagnosis. Will the Government agreed to fund a campaign
:06:27. > :06:33.for this? I congratulate him for the work he does for the British Polio
:06:34. > :06:36.Charity and I agree it's difficult to diagnose as there is no
:06:37. > :06:44.definitive test and symptoms are vague. There are guidelines from the
:06:45. > :06:55.Fellowship to make is aware of these conditions. Having noted there is no
:06:56. > :07:00.tests, can the Minister outline what information is available to medical
:07:01. > :07:08.professionals to make sure that the symptoms are collectively collated?
:07:09. > :07:12.As I said, the symptoms are vague and the fact is there is no
:07:13. > :07:16.definitive test but as my honourable friend pointed out, the awareness
:07:17. > :07:25.amongst GPs isn't as high as it might be. We need is guidelines plus
:07:26. > :07:33.the help of the British Polio Fellowship for better education. I
:07:34. > :07:39.will answer three and ten together. In the last four years, 31 trusts
:07:40. > :07:45.have been put into special measures, one in ten are NHS Trust. Out of
:07:46. > :07:49.those, 16 have come out and I bank those from Addenbrooke's hospital
:07:50. > :08:05.which came out last month. A safer and more caring NHS for the
:08:06. > :08:13.3 million patients and the staff there can be streamed it proud of
:08:14. > :08:18.what they have achieved. Bolton hospital has also come out after
:08:19. > :08:23.extreme hard work, so there is now a surplus which is being reinvested
:08:24. > :08:30.into patients, so will my right honourable friend joining in when I
:08:31. > :08:36.thank staff for their hard work. It's a fantastic example of what is
:08:37. > :08:43.possible in very challenging circumstances, and I feel that staff
:08:44. > :08:51.should be proud. On average, staff go on to recruit new doctors and
:08:52. > :08:58.nurses and see improvement. The Secretary of State is right to
:08:59. > :09:05.congratulate those hospitals, but we still need to reduce the pressure is
:09:06. > :09:14.on A E. That could be through increasing care in rural hubs. The
:09:15. > :09:22.money spent in Ely, minor injuries unit is money well spent, will he
:09:23. > :09:27.agreed? I know that my honourable friend campaigns and cares for her
:09:28. > :09:33.local health services. We know how important that is at Ely, and they
:09:34. > :09:38.are setting up some public engagement meetings. I want to
:09:39. > :09:45.reassure her that there will be a formal consultation if there are any
:09:46. > :09:49.changes. The self congratulatory tone of the Health Secretary is
:09:50. > :09:54.astonishing. In the last year, the numbers of people waiting longer
:09:55. > :10:01.than four hours in A E has gone up by 63%. The numbers waiting on
:10:02. > :10:06.trolleys have gone up by percent, and the number of discharges has
:10:07. > :10:12.gone up. While we won hospitals in special measures to be improving,
:10:13. > :10:21.what are the answers to these urgent problems affecting the NHS across
:10:22. > :10:29.the board? I will tell her. 130 more people starting cancer treatment
:10:30. > :10:33.every single day. 2.5 thousand being seen in accident and emergency
:10:34. > :10:38.within four hours. 5000 more operations every single day. None of
:10:39. > :10:44.which would be possible if we cut the
:10:45. > :10:50.The trust has been taken out of special measures in spite of the
:10:51. > :10:54.growth of people with mental health problems dying from things like
:10:55. > :11:00.suicide, avoidable deaths. Panorama has shown in 33 trusts, the number
:11:01. > :11:05.of avoidable deaths has doubled in the last three years, with a real
:11:06. > :11:10.terms cut of ?150 million. What specific measures is he taking to
:11:11. > :11:19.tackle the problem of avoidable deaths? We have committed, the Prime
:11:20. > :11:25.Minister affirmed this commitment last month, to spend ?1 billion more
:11:26. > :11:29.every year on mental health services but we recognise it is not just
:11:30. > :11:33.about money, it is about having proper suicide prevention plans and
:11:34. > :11:37.we have updated that and making sure we properly across the NHS
:11:38. > :11:40.investigate avoidable deaths and learn from them and that is why
:11:41. > :11:44.following the tragedy of what happened with Southern health we
:11:45. > :11:48.have started a new programme, the first of its kind, whereby every
:11:49. > :11:54.trust will publish on a quarterly basis its number of deaths. A year
:11:55. > :11:58.ago in East Sussex the trust was rated inadequate. Thanks to the hard
:11:59. > :12:04.work of the staff, the hospitals are now good in many measures albeit
:12:05. > :12:09.further improvements are needed. Can he thank the staff and would he
:12:10. > :12:13.agree we need to talk up our successes as well as recognising
:12:14. > :12:18.challenges? I absolutely will join him in doing that and I think it is
:12:19. > :12:21.really important, contrary to what the former Shadow Health Secretary
:12:22. > :12:27.says, that we praise NHS staff. There is a lot of pressure
:12:28. > :12:31.everywhere in the NHS and praising NHS staff is not being self
:12:32. > :12:38.congratulatory, it is recognising when a good job is being done.
:12:39. > :12:42.Further to the very important questions, members might have seen
:12:43. > :12:45.that Panorama programme and it was shocking and disgusting and I'm
:12:46. > :12:51.ashamed to live in a country where in past year there has been 1000
:12:52. > :12:56.more unexpected deaths. That is not a reflection of a country that cares
:12:57. > :12:59.equally about mental health as physical health. In spite of what he
:13:00. > :13:04.just told us, the money he talks about is not getting to where it is
:13:05. > :13:11.needed. What will you do to insure that no person in our country should
:13:12. > :13:15.lose their life because they have a mental health condition which is not
:13:16. > :13:18.treated properly? I agree, there is a huge amount we need to do to
:13:19. > :13:26.improve mental health provision. Let me also say a huge amount has been
:13:27. > :13:29.done and is being done. We are now seeing 1400 more people every day
:13:30. > :13:32.with mental health conditions, we are committing huge amounts of extra
:13:33. > :13:39.money into mental health provision and we are becoming a global leader.
:13:40. > :13:43.Certainly according to the person who is in charge of the Royal
:13:44. > :13:46.College of psychiatrists. We have to support the efforts happening in the
:13:47. > :13:56.NHS because we are one of the best in the world. Last month the Prime
:13:57. > :14:01.Minister made a major speech in which she made it clear in proving
:14:02. > :14:05.children and young people's mental health is a major priority for this
:14:06. > :14:08.government. My department will work with the Department for Education to
:14:09. > :14:18.publish an ambitious green paper outlining the plans before the end
:14:19. > :14:22.of the year. I am grateful. Would my right honourable friend agree that
:14:23. > :14:27.as well as providing mental health support in schools and colleges,
:14:28. > :14:30.community hospitals because of their locality, status and scale could
:14:31. > :14:37.often provide a very useful forum for providing these vital services?
:14:38. > :14:41.I am pleased he raises that point because when we discuss mental
:14:42. > :14:45.health, we talk about the services provided by mental health trusts and
:14:46. > :14:48.we do not give enough credit to the work done in primary care in
:14:49. > :14:53.community hospitals and by GPs who have a very important role as the
:14:54. > :14:59.first point of contact. He is absolutely right to make that point.
:15:00. > :15:05.Will the green paper look at the role educational psychologists could
:15:06. > :15:10.play, not only in providing support and assistance to young people with
:15:11. > :15:14.mental health problems, but also looking at preventative work? Cuts
:15:15. > :15:18.in local authority budgets have meant the service has become quite
:15:19. > :15:23.fragmented but it should be practical ways in which it could be
:15:24. > :15:27.improved to help young people with mental health problems. She is
:15:28. > :15:33.absolutely right. As we have looked into this issue, we have realised
:15:34. > :15:37.that there are two issues when it comes to improving children and
:15:38. > :15:40.young people's mental health, improving access to specialist care
:15:41. > :15:44.for people who need it and prevention. It is the work that can
:15:45. > :15:48.be done by teachers within schools, training people in mental health
:15:49. > :15:54.first aid, making a huge difference and we want to make sure we do them
:15:55. > :15:57.both. I welcome the Secretary of State's focus on child and
:15:58. > :16:03.adolescent mental health gap but what is he going to do about out of
:16:04. > :16:08.area transfers which too often sees children in beds due and red, 300
:16:09. > :16:19.miles away from their home? -- mental health care. I thank him for
:16:20. > :16:23.his continuing campaigning on mental health issues and he is right it is
:16:24. > :16:27.completely unacceptable, not least because if we want a child to get
:16:28. > :16:30.better quickly, the more visits from friends and family they can have,
:16:31. > :16:38.the better. The faster they will recuperate. We have commissioned 56
:16:39. > :16:44.more beds. The total number is a record 1142. We are determined to
:16:45. > :16:47.end out of area treatments by the end of the parliament. No one will
:16:48. > :16:54.disagree with what he has said but it is not going to help people in
:16:55. > :16:59.Dudley at a house which faces closure this year for the want of
:17:00. > :17:04.what is quite a small amount of money. Will he look at this
:17:05. > :17:06.personally and do everything he can to help this really valuable
:17:07. > :17:17.facility open? It is closing because... Dudley is losing 20% of
:17:18. > :17:23.its funding compared with just 1% in Surrey which he represents. Dudley
:17:24. > :17:27.CCG has seen its funding go up and on top of that we are asking all
:17:28. > :17:33.CCGs to increase the proportion they spend on mental health. I'm happy
:17:34. > :17:36.look into the situation. I would be very disappointed if within Dudley
:17:37. > :17:41.we're not seeing increasing resources going into mental health
:17:42. > :17:45.provision. Could he say a little more about how children's mental
:17:46. > :17:48.health services can work more closely with schools and the
:17:49. > :17:55.education system war broadly? Absolutely, very happy to do that --
:17:56. > :17:59.more broadly. Very interesting innovation going on in many parts of
:18:00. > :18:06.the country. I visited a school where there is a worker based
:18:07. > :18:08.full-time in the school and it had a transformational effect, the
:18:09. > :18:11.teachers always had someone they knew they could talk to, their
:18:12. > :18:19.understanding of mental health improved, this is what we want to
:18:20. > :18:21.encourage. Further to that, what persuasiveness is the Minister
:18:22. > :18:25.bringing to bear in the education system, particularly in primary
:18:26. > :18:30.schools, where on occasions very young people have had such a
:18:31. > :18:35.diagnosis and problems have been created within the school
:18:36. > :18:39.environment? This is a very important issue because as he knows,
:18:40. > :18:45.half of all mental health conditions are diagnosed before or become
:18:46. > :18:49.established before people of 14 and the sooner we catch them, the better
:18:50. > :18:54.the chance of giving someone a full cure. We need to find a way whereby
:18:55. > :18:57.there is some mental health expertise in every primary school so
:18:58. > :19:10.that we can head off some of these terrible problems. Last night the
:19:11. > :19:15.Panorama programme showed mental health is not funded properly. Cuts
:19:16. > :19:19.led to amenity teams being disbanded, loss of staff and loss of
:19:20. > :19:23.inpatient psychiatry beds. Most disturbing of all, parents talking
:19:24. > :19:28.of what happens to their children when they are denied support in a
:19:29. > :19:33.crisis, self harming or suicidal, no inpatient beds. One parent called it
:19:34. > :19:39.a living nightmare. We do not need warm words, we need action to make
:19:40. > :19:44.sure mental health services are properly funded and staffed. Let me
:19:45. > :19:50.tell her what action is happening this year. The proportion of CCG
:19:51. > :19:58.budgets being assigned to mental health is increasing from 12.5% up
:19:59. > :20:03.to 13.1% which is an increase of ?342 million. It is action happening
:20:04. > :20:12.today because this covenant is funding our NHS. Number five, Mr
:20:13. > :20:15.Speaker. The Government recognises the value of surrogacy in helping
:20:16. > :20:19.people who cannot have children create a family. Legislation is now
:20:20. > :20:24.over 30 years old and in view of changes in society it is time for an
:20:25. > :20:28.independent review. We have asked the Law Commission to include a
:20:29. > :20:36.project on surrogacy for 2017 to 2019. The Minister will be aware of
:20:37. > :20:39.the work by my constituent who I pay tribute to today. I welcome the
:20:40. > :20:43.Minister's answer but I wonder whether I could ask very
:20:44. > :20:46.specifically about the remedial order for the situation on single
:20:47. > :20:52.parents which my constituent is waiting for? My honourable friend
:20:53. > :20:56.has raised this very difficult case with me and my sympathies go to his
:20:57. > :21:01.constituent. He is right that High Court has made a judgment about the
:21:02. > :21:05.current provisions and the Government is obliged to act within
:21:06. > :21:08.a reasonable timescale so we will be bringing forward irremediable order
:21:09. > :21:11.this spring. I am pressing for this to happen but I'm in the hands of
:21:12. > :21:22.the business managers and I will keep the House updated. And my
:21:23. > :21:27.honourable friend. Number six. The Robert Naylor's report on the NHS
:21:28. > :21:30.will be published shortly. In developing his recommendations, he
:21:31. > :21:34.has worked with leaders across the NHS and this will ensure his
:21:35. > :21:40.recommendations are informed by the salability and transformational
:21:41. > :21:43.plans and will help support successful delivery --
:21:44. > :21:47.sustainability. I look forward to the report. It has been shortly for
:21:48. > :21:54.a while. My constituency is exactly the sort of community-based model we
:21:55. > :21:58.should promote. Promoting good health and assisting recovery after
:21:59. > :22:04.medical treatment. NHS property services mean it has a threefold
:22:05. > :22:08.increase in its bill, what assurances can the Government give
:22:09. > :22:11.that the report will ensure cooperation on estates planning so
:22:12. > :22:17.that my constituents who rely on the health part's contribution can face
:22:18. > :22:22.the future with confidence? We have accepted one of the recommendations
:22:23. > :22:26.from Robert Naylor ahead of the report publication which is looking
:22:27. > :22:30.to bring together NHS property services with other estate services
:22:31. > :22:35.and with regard to allocations being given to the CCG, I can tell the
:22:36. > :22:46.honourable lady the Department of Health has provided ?127 million of
:22:47. > :22:49.funding to CCGs. In looking at the estate plan and the transformation
:22:50. > :22:52.plan, will the Minister in short travel arrangements between
:22:53. > :22:57.different sites are taken into account? -- ensure. For health care
:22:58. > :23:05.professionals, patients and visitors. I am grateful to my
:23:06. > :23:09.honourable friend who has consistently shown concern about
:23:10. > :23:14.arrangements in Essex went as we look at potential reconfiguration of
:23:15. > :23:20.urgent and emergency care arrangements and ensuring good
:23:21. > :23:26.access to AMD macro is vital as it is everywhere of -- AMD macro. In
:23:27. > :23:31.Leicester the CCG is proposing to close a walk-in centre and moving it
:23:32. > :23:37.to another part in Leicester. It then becomes a drive-in centre. Does
:23:38. > :23:46.he agree it is important local people are consulted fully on these
:23:47. > :23:49.proposals? Of course as he knows, service reconfiguration requires
:23:50. > :23:53.public consultation. I'm not sure whether the walk-in centre qualifies
:23:54. > :23:56.but I am happy to look at it. A number were established under the
:23:57. > :24:01.previous government in a random way and they need to be located more
:24:02. > :24:08.appropriately for the local people. Would my noble friend agree with me
:24:09. > :24:13.that the driving force of SDPs is to improve and enhance patient care for
:24:14. > :24:23.our constituents? -- my honourable friend. With regard to the mid-Essex
:24:24. > :24:29.SDP, no proposal put forward involves any closure of accident and
:24:30. > :24:38.emergency and far from downgrading the existing AMD macro it is about
:24:39. > :24:44.upgrading the quality of care for my constituents? -- accident and
:24:45. > :24:48.emergency departments. The success regime for mid-Essex is looking at
:24:49. > :24:54.the configurations of the three existing accident and emergencys
:24:55. > :25:01.each of whom may develop their own speciality and none will close.
:25:02. > :25:04.Analysis of the SDPs this week found that a substantial number of
:25:05. > :25:11.departments across the country could be closed or downgraded over the
:25:12. > :25:14.next four years, and approached the royal college described as alarming.
:25:15. > :25:16.We have seen the images over the last month of departments
:25:17. > :25:20.overflowing and stretched to the limits so surely now is not the time
:25:21. > :25:24.to get rid of them. Can he pledged today that the numbers of accident
:25:25. > :25:32.and emergency beds will not reduce below the current level? He is right
:25:33. > :25:35.to point out that the SDPs are looking at providing more integrated
:25:36. > :25:40.care across localities. And there are a number of indicative proposals
:25:41. > :25:45.which will have to be worked through. NHS England at the moment
:25:46. > :25:49.are reviewing each of the SDPs and they will be presented to the
:25:50. > :25:54.department for their consideration in the coming weeks and months.
:25:55. > :25:57.Regarding bed closures, I gently remind the honourable gentleman that
:25:58. > :26:01.in the last six years of the previous Labour government, over
:26:02. > :26:06.25,000 beds were closed across the NHS in the first six years since
:26:07. > :26:14.2010, fewer than were closed by discovered than its predecessor.
:26:15. > :26:25.Minister moment. With permission, I will answer questions seven and 15
:26:26. > :26:29.together. The relationship between health and social care budget is
:26:30. > :26:34.complex. Recent study by the University of Kent shows that for
:26:35. > :26:40.every pound spent, hospital closure falls by 30 to 35%. We will be aware
:26:41. > :26:45.that there is an increasing delays over transfers of care over the last
:26:46. > :26:51.two years. This has meant more hospital beds are unavailable. Our
:26:52. > :27:00.best estimate is around 0.7% of total NHS bed capacity due to the
:27:01. > :27:04.increase in social care delays. It's quite amazing that the Minister
:27:05. > :27:16.stands up and accept that there is a crisis in the NHS caused by social
:27:17. > :27:21.care. It has been reduced to washing, feeding and toileting our
:27:22. > :27:28.elderly people. Crisis in social care, where people are being left
:27:29. > :27:43.with the most complex care because of staffing levels... Order! We must
:27:44. > :27:58.have one question. No comfort for our elderly people. I say to them
:27:59. > :28:21.it's not too late. Can you bring forward the ?700 million... Order!
:28:22. > :28:35.Order!. I say to the lady we have a lot to get through. Leadership Grid
:28:36. > :28:42.and best practice are important. Social care delays occurred in 24
:28:43. > :28:50.local authorities. Many others have burst virtually none. I visited
:28:51. > :28:54.Saint Helens, the honourable lady's own constituencies. They have
:28:55. > :29:03.achieved some of the best outcomes in the country. I'm sure she will
:29:04. > :29:10.agree with me in congratulating those in charge. There had been cuts
:29:11. > :29:16.in Rochdale, piling the pressure onto our social budget. The 2%
:29:17. > :29:24.preset loanee raise 4.2 million which is a drop in the ocean of the
:29:25. > :29:31.deficit of ?80 million. There's a increase in delayed discharges. I
:29:32. > :29:38.call upon the Minister to bring in the better care of so that our
:29:39. > :29:48.social care services can cope now. As a direct answer, it will be
:29:49. > :29:53.allocated in a way so that it will address real need which is what we
:29:54. > :29:57.will be doing for the remainder of this Parliament, starting from
:29:58. > :30:03.April. What I would say is that we spend in this country more on adult
:30:04. > :30:09.social care and Germany, Canada and Italy. It's very important that we
:30:10. > :30:18.also spend it well. It's very good to hear my honourable friend's
:30:19. > :30:24.research from Kent earlier. NHS and Social Services are working closer
:30:25. > :30:29.together than ever before but there is still further to go. Does my
:30:30. > :30:33.honourable friend agree with me that's important to overcome the
:30:34. > :30:37.barriers between Social Services and NHS so that they function more as
:30:38. > :30:46.one system so that patients get the sort of they need in the right
:30:47. > :30:50.place. Minister. She raises a good point about the vanguard in Kent,
:30:51. > :30:56.and I visited that care home vanguard in Sutton where they've
:30:57. > :31:06.achieved a 20% reduction in A E admissions, with better integration.
:31:07. > :31:12.If the Minister sought BBC News last night he may have seen the pressure
:31:13. > :31:20.in the Blackburn emergency department. It's down to Burnley's
:31:21. > :31:30.other hospital being closed down. What else can we do to reduce the
:31:31. > :31:38.pressure? Two thirds of all delayed transfers of care are as a
:31:39. > :31:44.consequence of internal NHS issues, and not that and councils. I think
:31:45. > :31:55.the relationship with Blackburn and Burnley is part of that. Recent
:31:56. > :32:01.figures in South words has 150 out of 184 delayed discharges. Sir David
:32:02. > :32:06.Alton has said hospital overcrowding at Salford Royal is a cousin the
:32:07. > :32:11.hospital's inability to transfer patients to and alternative care
:32:12. > :32:17.setting and changes to social care are urgently required. We've had
:32:18. > :32:23.cuts of 40% to our budget in local council since 2010, but Salford
:32:24. > :32:30.Royal is now providing social care rather than the council. I know that
:32:31. > :32:37.the help secretary respects Sir David, does he accept his view about
:32:38. > :32:45.funding changes will he continue to find reasons to blame for his
:32:46. > :32:52.Government's cuts? We respect Sir David Dalton and might I remind the
:32:53. > :32:59.honourable lady that she stood for Parliament under the slogan Not A
:33:00. > :33:02.Penny More. What I will say is in Manchester that there is an
:33:03. > :33:12.opportunity through the devolution deal to integrate social care and
:33:13. > :33:29.the NHS and I expect them to do so. Best trend data comes from the GP -
:33:30. > :33:37.patient survey which collates feedback of over 2 million patients
:33:38. > :33:40.I annually. 92% of patients found their appointments to be convenient,
:33:41. > :33:51.a slight increase from previous results. 86% rated their experience
:33:52. > :33:57.with a GP surgery as good. There was a 30% rise in waiting times in 2016.
:33:58. > :34:03.One of the key concerns raised by constituents, when I speak to local
:34:04. > :34:07.GPs, one of the key pressures they are facing is the failing social
:34:08. > :34:14.care system. So he knows those answers he gave a minute ago don't
:34:15. > :34:22.address them. Will he commit to something meaningful? Those answers
:34:23. > :34:26.are from a GP patient survey, but I do accept, and the Government
:34:27. > :34:33.accepts that we need more GPs in this country. They are important in
:34:34. > :34:38.the NHS and by 2020 we have plans to have a further 5000 doctors working
:34:39. > :34:43.in primary care. We also intend to add to that pharmacist, clinical
:34:44. > :34:49.pharmacists and mental health therapist and that will be part of
:34:50. > :34:55.the solution. It's not just the need for GPs, but surely what is required
:34:56. > :34:59.is for GPs should work at weekends and they should be included in their
:35:00. > :35:08.assessments for demand, working together in groups. The Government
:35:09. > :35:18.is committed to having seven-day appointments with GPs eight AM- 8pm.
:35:19. > :35:24.We want to roll that out in London. The other plan is to have GPs
:35:25. > :35:30.working smarter in hubs which labels them to spread and include services
:35:31. > :35:38.such as pharmacy, physios and social care in that integrated hub. In a
:35:39. > :35:43.survey I conducted in Enfield North, 58% agree it is difficult to get an
:35:44. > :35:52.appointment. Now the Royal College of GPs has calculated that Enfield
:35:53. > :36:02.need 84 more GPs by 2020, but in fact, between now and 2014, we've
:36:03. > :36:11.lost for GPs. What is he going to do that if these 5000 GPs appear by
:36:12. > :36:17.2020 that Enfield will get those GPs that it needs? As I said earlier, we
:36:18. > :36:25.will have 5000 doctors working in 2020, a chunk of those will be able
:36:26. > :36:30.to work across the country, and Enfield will see its share. The
:36:31. > :36:40.point is that the Honourable Lady makes our correct. Collaboration is
:36:41. > :36:44.also important. How far have we got spending the billion pounds
:36:45. > :36:58.earmarked by the Chancellor for this surgery is and does he share our
:36:59. > :37:02.vision of more polyclinics. There is more spend in the community and as a
:37:03. > :37:09.proportion, an increase in the amount of money the NHS has going
:37:10. > :37:15.into primary care. Part of that will be polyclinics and state clinics
:37:16. > :37:21.generally. What you find with the vanguard is when you put together
:37:22. > :37:26.groups of 50,000 patients in a GP hubs, the quality of care increases
:37:27. > :37:36.dramatically and we are going to excel rate that. The challenges
:37:37. > :37:42.facing our health system are grave so we need to uptake technologies
:37:43. > :37:47.for patient outcomes that meets those challenges, so by capitalising
:37:48. > :37:53.on advances in genomic, data, digital health and Informatics,
:37:54. > :38:01.there should be access to cost-effective, new products. It's
:38:02. > :38:05.vital that we endeavour to ensure the NHS gets better value for money
:38:06. > :38:11.for the drugs bill so we can get more innovative products to patients
:38:12. > :38:18.more quickly. De she also agree that there is much more work to be done
:38:19. > :38:21.alongside the accelerated access review and the forthcoming life
:38:22. > :38:29.sciences strategy to achieve this objective? I completely agree with
:38:30. > :38:34.my friends. Medicines is one of the highest spendings, and it's
:38:35. > :38:39.important that NHS gets best value. I was glad to have supported our
:38:40. > :38:45.recent ill on medicine and medicine supplies. This means we can prevent
:38:46. > :38:54.unjustified price rises from brand medicines. Ensuring cost effective
:38:55. > :39:01.prescribing behaviour. When will this be published and will it
:39:02. > :39:04.include how to improve patient access to molecular diagnostics? We
:39:05. > :39:16.are working hard on that exact point. As the Health Secretary is
:39:17. > :39:21.aware, my constituents Abby Longfellow is suffering from a rare
:39:22. > :39:32.disease. What was Government do to ensure access for people with
:39:33. > :39:38.ultra-rare diseases such as Abbey? We are trying to do with
:39:39. > :39:42.technologies for rare diseases, and the implementations which has 51
:39:43. > :39:47.commitments to be implemented by 2024 improving the lives of
:39:48. > :40:16.constituents exactly like my honourable friend's. Cheap
:40:17. > :40:32.it is cheap feeding awareness week. -- tube.
:40:33. > :40:38.Scientists are warning for the first time that resistance to malaria may
:40:39. > :40:45.be increasing, can the Minister outlined what further steps have
:40:46. > :40:57.been taken to deal with and he microbe I'll resistance in the next
:40:58. > :40:58.few years. We are trying to work with international partners to deal
:40:59. > :41:14.with a range of Question 11, Mr Speaker. We are
:41:15. > :41:20.determined we will improve access to cost-effective innovative medicines
:41:21. > :41:26.including breast cancer drugs which is why we introduced the Cancer
:41:27. > :41:34.Drugs Fund. She will know that cost-effective is not an easy thing
:41:35. > :41:38.to decide and many women will not get access to the breast cancer
:41:39. > :41:44.drugs they need unless there is a review of how we assess cost
:41:45. > :41:47.effectiveness or how Nice assess it. Will she support an independent
:41:48. > :41:54.review of those processors and will she have something to say about
:41:55. > :41:58.off-take and cancer drugs? -- off patent. We have debated this in the
:41:59. > :42:03.House and it is worth looking at our record. The Cancer Drugs Fund has
:42:04. > :42:09.helped 95,000 people access drugs and Nice has approved three breast
:42:10. > :42:14.cancer drugs, while there are others it has not yet. It is important
:42:15. > :42:21.politicians do not intervene in this debate as these are very difficult
:42:22. > :42:27.decisions which will always find challenging issues in the situation
:42:28. > :42:37.where the NHS has a finite budget. If the member was standing, I would
:42:38. > :42:43.call him, but if he isn't, I went. He is, so I will. I'm delighted to
:42:44. > :42:46.stand. Thank you. Even there is no General Hospital in my constituency
:42:47. > :42:51.and a large number of my constituents have to travel many
:42:52. > :42:53.miles for cancer treatment, what discussions has my right honourable
:42:54. > :42:58.friend had with the Welsh Government to persuade them to fund mobile
:42:59. > :43:02.cancer treatments? We have continual discussions with the Welsh
:43:03. > :43:05.Government to make sure these issues are under review and I will
:43:06. > :43:08.definitely write to the honourable gentleman about this issue and I
:43:09. > :43:14.will also be happy to meet with him about this, if you would like to
:43:15. > :43:19.discuss it further. Would the Minister agree that there is no one
:43:20. > :43:23.subject we have discussed here today that would not be improved by the
:43:24. > :43:26.better transfer of patient data and could she tell me how the department
:43:27. > :43:34.is working towards linking social care with the GPs, mental health,
:43:35. > :43:37.innovation, cancer drugs in order to understand where we can best target
:43:38. > :43:43.patient outcomes and spend our resources? My honourable friend is
:43:44. > :43:48.very well aware because of her leading role with the Private
:43:49. > :43:51.Members' Bill which she is bringing forward that we are working very
:43:52. > :43:57.hard to improve the connection of patient data and in particular
:43:58. > :44:00.through the role of the national data guardian and the safeguarding
:44:01. > :44:05.rules which will make sure we not only protect patient data more
:44:06. > :44:09.effectively but we are able going forward to share it in an effective
:44:10. > :44:14.way which improves patient care. I would like to make further progress
:44:15. > :44:21.with questions from backbenchers. Question number 12. Developing a
:44:22. > :44:24.variety of routes into nursing is a priority to reflect the local
:44:25. > :44:30.population served by nurses. That is why we have developed the new
:44:31. > :44:34.nursing associate role and nursing degree apprenticeships which are
:44:35. > :44:37.opening up routes into the profession for thousands of people
:44:38. > :44:41.from all backgrounds and allowing employers to grow their own
:44:42. > :44:45.workforce locally. Will the Minister inform the House if there are plans
:44:46. > :44:50.to roll out the associate role to include Wiltshire and enable new
:44:51. > :44:52.nursing degree apprentice schemes to be offered in larger further
:44:53. > :44:57.education colleges so that counties like Wiltshire which have no
:44:58. > :45:06.university can provide them? We have announced the first 1000 nursing
:45:07. > :45:09.associates. I visited in Romford the hospital with the first very
:45:10. > :45:14.enthusiastic group of nursing associates. We have announced a
:45:15. > :45:19.second wave of 2000 associate roles. I regret Wiltshire I do believe has
:45:20. > :45:27.any of those. They can bid for more in the future. When the Secretary of
:45:28. > :45:30.State scrapped the nursing bursary, he claimed his reforms would lead to
:45:31. > :45:34.an increase in nursing applications will stop last week figures from
:45:35. > :45:38.Ucas showed there has been a drop in nursing applications of 23%. A
:45:39. > :45:44.worrying trend when the demands of Brexit will need we need more
:45:45. > :45:49.home-grown nurses. Will he scrapped this disastrous policy or give
:45:50. > :45:53.Greater Manchester ability to opt out and reinstate the nursing
:45:54. > :46:00.bursary? I would urge the right honourable member not to indulge in
:46:01. > :46:05.scaremongering about the number of nurses... There are people applying
:46:06. > :46:09.to become nurses. That on more than two applications from individuals
:46:10. > :46:14.for the nursing places on offer to start next August. The number of
:46:15. > :46:18.applications from EU nationals which has gone down significantly, he
:46:19. > :46:21.needs to be careful in interpreting these figures this early, it
:46:22. > :46:29.coincided with the introduction of the language tests for EU nationals.
:46:30. > :46:32.Surely with the reduction of 23% in applications are English and nursing
:46:33. > :46:38.schools, the minister might want to actually look again at the policy.
:46:39. > :46:44.There has been a significant drop, 90% drop, in EU nationals. With one
:46:45. > :46:47.in ten nursing vacancies in NHS England and a cap on agency, who
:46:48. > :46:53.exactly does the Minister think should staff the NHS? I gently say
:46:54. > :46:57.to the honourable lady there are 51,000 nurses in training at present
:46:58. > :47:03.and the number of applications through Ucas bus far suggests there
:47:04. > :47:08.will be more than two applicants for each place and as I have just said,
:47:09. > :47:12.the reduction in application forms requested by EU nationals has come
:47:13. > :47:20.down coinciding with the introduction of a language test.
:47:21. > :47:24.Language test applications was over 3500 last January, so the reduction
:47:25. > :47:29.after language tests was from that to 1300. In December, there were
:47:30. > :47:33.only 101 applications. This cannot all be blamed on the language test.
:47:34. > :47:42.What is he going to do to protect nursing numbers? There are over
:47:43. > :47:45.13,000 more nurses working in the NHS today than in May, 2010. The
:47:46. > :47:52.introduction of the language test came into effect from July of last
:47:53. > :47:56.year and since then, the applicants have been somewhat steady. It is
:47:57. > :47:59.down very significantly but that is because frankly we have had
:48:00. > :48:05.applications from nurses from EU countries that have not been able to
:48:06. > :48:10.prosper language test. The national standard is to be expected 85% of
:48:11. > :48:16.cancer referrals to receive initial treatment within two months of
:48:17. > :48:20.urgent referrals. For cancer overall, most recent data indicates
:48:21. > :48:26.we achieved 82%. For prostate cancer, 78%. The lower figure for
:48:27. > :48:31.prostate cancer is because of the pathways being more complex than
:48:32. > :48:34.average. I'm disappointed in the figures but at least they are
:48:35. > :48:38.available. When I asked this last month, the information was not
:48:39. > :48:44.available. Nor was it available about the number of vacancies for
:48:45. > :48:47.prostate cancer surgeons, no information about training,
:48:48. > :48:52.equipment used, because this information is not collected
:48:53. > :48:54.centrally, I am told. When will the department collect adequate
:48:55. > :49:05.information to run a health service properly? There is more information
:49:06. > :49:10.published on cancer I CCG since the back end of last year than at any
:49:11. > :49:15.time in the history of the NHS. He is right to say that prostate cancer
:49:16. > :49:22.is grouped with other cancers in general and that is the type of
:49:23. > :49:24.surgeons employed, the facts are this government is incredibly
:49:25. > :49:31.transparent in terms of information published on cancer. Last Saturday
:49:32. > :49:36.was world cancer day and the theme was unity and I am still wearing my
:49:37. > :49:40.band with pride. We must do all we can to beat cancer yet the
:49:41. > :49:46.Government is coming to the three-year anniversary of not
:49:47. > :49:50.meeting the 62 day waiting target. Treatment quickly after diagnosis is
:49:51. > :49:54.crucial for all cancers. Will the Minister outlined what he is doing
:49:55. > :50:00.to ensure this target is once again met so that patients received timely
:50:01. > :50:04.treatment? The volume has increased greatly, something like 2000 more
:50:05. > :50:09.being diagnosed every day. She is right, of the eight cancer standards
:50:10. > :50:16.we judge ourselves against, we meet seven under 62 day one has not been
:50:17. > :50:19.met. The cancer strategy put out a pathway and we have invested in the
:50:20. > :50:27.early diagnosis component of that and 200 million in terms of early
:50:28. > :50:30.diagnosis and 31-day or clear or being referred for treatment. That
:50:31. > :50:38.is the pathway to meeting the 62 days. It is an important indicator
:50:39. > :50:42.and we need to do better. We know that a strong primary care system is
:50:43. > :50:46.the bedrock of the NHS which is why I'm pleased to announce today NHS
:50:47. > :50:51.England will publish the new GP contract agreed by the Government,
:50:52. > :50:57.NHS England and the BMA which will see almost ?240 million extra
:50:58. > :51:02.invested in GP services, require GPs to establish whether overseas
:51:03. > :51:06.visitors are eligible for free care and improve access for patients by
:51:07. > :51:11.removing extra funding if GPs readily close for afternoons in the
:51:12. > :51:19.working week. Would the Secretary of State consider putting a GP in every
:51:20. > :51:22.A department so that they could triage patients not so ill and
:51:23. > :51:27.advise them to go home and see their own GP on another occasion? She is
:51:28. > :51:34.right to say that it is the proxy that all A is space available
:51:35. > :51:39.should do that -- the policy. The hospitals that do it are the most
:51:40. > :51:47.successful results wise, not least the one that pioneered that model.
:51:48. > :51:52.We have seen 4000 people with urgent operations cancelled, 18,000 people
:51:53. > :51:57.a week in January waiting on trolleys in corridors, nine out of
:51:58. > :52:03.ten hospitals overcrowded and unsafe levels. Even in the local paper, I
:52:04. > :52:07.read his local hospital had to put patients in the gym overnight. Does
:52:08. > :52:15.he agree with the Prime Minister that the crisis facing our NHS is to
:52:16. > :52:19.a small number of incidents? The NHS is under pressure but we never get
:52:20. > :52:25.from the honourable gentleman any solutions. Our solution is 600 more
:52:26. > :52:32.A consultants since 2010, 2000 more paramedics, 2500 more people
:52:33. > :52:35.being seen within four hours everyday. His solution at the last
:52:36. > :52:41.election was to cut the NHS budget by 1.3 billion. His solution has
:52:42. > :52:46.been to blame everybody else but never take responsibility himself.
:52:47. > :52:50.Can I ask the Secretary of State what he is going to do about the
:52:51. > :52:55.crisis we are facing in staffing? Last week we learned half of junior
:52:56. > :52:58.doctors are abandoning specialist training, we have heard already
:52:59. > :53:05.applications for nursing degrees are down by a quarter following the
:53:06. > :53:09.axing of the student bursary, shortage of midwives. I know he has
:53:10. > :53:16.been in US and he will try to give us alternative facts, but when will
:53:17. > :53:21.he deal with the staffing crisis? Let us look at the reality instead
:53:22. > :53:28.of his rhetoric. In his own trust in Leicester, there are 246 more nurses
:53:29. > :53:35.than in 2010 and 330 more doctors. 185 more patients seen in A
:53:36. > :53:38.everyday. Next year a new emergency floor will open at the Leicester
:53:39. > :53:44.while infirmary because we are backing the NHS instead of cutting
:53:45. > :53:52.its budget -- Royal Infirmary. The recently produced council survival
:53:53. > :53:58.rate indicator is a beacon of light. What will come the Government do to
:53:59. > :54:02.hold underperforming CCGs to account for this outcome indicator given
:54:03. > :54:08.that we are still failing to catch up with international averages when
:54:09. > :54:12.it comes to survival rates? He is right to say that we now published
:54:13. > :54:17.one year survival rates for every CCG in the country and I agree with
:54:18. > :54:22.him that it is a beacon of light and a transformative step. It shows
:54:23. > :54:26.differences between the best and the worst of over 10% which is
:54:27. > :54:30.unacceptable. The transparency itself will bring improvements but
:54:31. > :54:35.we have also recently established 16 cancer alliances whose job it is to
:54:36. > :54:44.roll out best practice and investigate poor performance. Can
:54:45. > :54:52.the Minister update the House about NHS litigation costs which rocketed
:54:53. > :54:57.last year? Are they under control? It is a very big concern and the
:54:58. > :55:01.only way in the long run to reduce the litigation costs is to have
:55:02. > :55:04.safer care and that is why this covenant has prioritised safety in
:55:05. > :55:11.everything we do. -- this government. If a patient in the eyes
:55:12. > :55:19.suffers a stroke, they have a far better chance of recovery if they
:55:20. > :55:24.get quick treatment. -- in Cornwall. What is the Government doing to
:55:25. > :55:30.ensure that there will be a national stroke strategy? The current stroke
:55:31. > :55:40.strategy was produced in 2007 and our priority is to implement it
:55:41. > :55:43.fully. I would prefer to have detailed implementation plans and
:55:44. > :55:48.not more strategies. The issue he refers to is there are a great deal
:55:49. > :55:52.of differences in performance across the country, in particular access to
:55:53. > :56:02.speech and language therapy and we need to achieve better. My
:56:03. > :56:11.constituents, they have been through lengthy processes for Beth Allen to
:56:12. > :56:15.access treatment for muscular dystrophy and thankfully he is now
:56:16. > :56:20.receiving the treatment. What action is the Government taking to increase
:56:21. > :56:28.the capacity of the medicines and health care products as the result
:56:29. > :56:33.of the UK leaving the EU and most importantly, will the Secretary of
:56:34. > :56:38.State agreed to meet with muscular dystrophy UK?
:56:39. > :56:45.I would like to pay tribute to the work of the charity the art
:56:46. > :56:51.honourable gentleman mentioned. It does important work and I have
:56:52. > :56:57.sympathy for the KC mentioned. The UK rare diseases strategy has 51
:56:58. > :57:03.recommendations which are being driven through the NHS and improving
:57:04. > :57:13.life chances that patients with rare diseases, and our genomics
:57:14. > :57:19.department is bringing improvements so that people with rare diseases
:57:20. > :57:23.can receive treatment quicker. People in Lancashire will be pleased
:57:24. > :57:35.that the emergency services in Shirley in Chorley had been
:57:36. > :57:42.reopened. I recognise there's a lot that's gone in to reopening that in
:57:43. > :57:47.Chorley and I'm delighted ID work done by the Deputy Speaker and the
:57:48. > :57:52.honourable member for South Rebel. Last year, hospital trusts were
:57:53. > :57:58.advised to raise bed budget to revive resources funding. Does he
:57:59. > :58:03.think this is a good idea what advice is he giving officials
:58:04. > :58:09.issued? It's not a sustainable position to have to do that. They
:58:10. > :58:18.were pressures on the front line and that had to happen, but I recognise
:58:19. > :58:20.that budget Capitals are important. Young people with anxiety can find
:58:21. > :58:28.themselves out of school and sidelined. Are there any ways to
:58:29. > :58:35.reach out to these young people's futures that we mustn't give up on?
:58:36. > :58:40.3% of schoolchildren had severe anxiety, but we also know that if we
:58:41. > :58:44.treat them quickly we can often cure the condition and it doesn't come
:58:45. > :58:51.back, so he is right, we have to be as imagine it as possible. I have
:58:52. > :58:58.two report back to a constituent awaiting treatment is that the
:58:59. > :59:10.waiting time for his clinic is to use. People with mental ill-health
:59:11. > :59:21.have the right to access to treatment. Why can't this be dealt
:59:22. > :59:29.with by the honourable gentleman? We are spending at least ?1 billion
:59:30. > :59:35.more per year then his Government. This year we will be implementing
:59:36. > :59:41.maximum times for eating disorders, but we are also trying to put
:59:42. > :59:51.pathways to all illnesses and I agree that that waiting time is
:59:52. > :59:54.matched to long. Some GP practices across Lancashire have started
:59:55. > :00:04.publishing benumbed bar of missed appointments. When will he look at
:00:05. > :00:08.giving GPs the powers to charge those who missed their GP
:00:09. > :00:12.appointments in Lancashire? I have sympathy for those who are
:00:13. > :00:17.frustrated about that. I've said before my objection to that is not
:00:18. > :00:21.one of principle but whether it's practical to do it. Perhaps it's
:00:22. > :00:29.something that GPs can decide at a local level. The Health Secretary
:00:30. > :00:35.there was a small number of NHS during this winter. I would like to
:00:36. > :00:40.know what he calls small. There are a large number in my constituency
:00:41. > :00:43.alone. I would like him to visit my local hospital and see for himself
:00:44. > :00:55.as the Shadow Health Secretary will do later this week. I don't think
:00:56. > :01:00.our debates helped by her taking my comments out of context. I was
:01:01. > :01:05.talking about eight specific week when we talked about a small number
:01:06. > :01:11.of incidents that the pressure is recognised across the NHS which is
:01:12. > :01:18.why this Government is backing NHS with record funding. Slow payments
:01:19. > :01:25.for relatively small sums by NHS providers has caused a health clinic
:01:26. > :01:33.to close in my area. Will he impose strict guidelines for timely
:01:34. > :01:51.Caymans? My honourable friend will be aware there is a 30 day advisory
:01:52. > :02:00.strategy for NHS departments -- NHS providers to pay within 30 days.
:02:01. > :02:08.Adolescent mental training -- health training positions are unfilled. How
:02:09. > :02:16.does the Government plan on dealing with these recruitment issues? We
:02:17. > :02:31.have said we will recruit the brightest and the best. I have a
:02:32. > :02:42.constituent who has breast cancer and cannot access drugs. I will meet
:02:43. > :02:47.with my friend on a difficult case. What's has been done about
:02:48. > :02:57.increasing nurses' pay? Many of them have expertise and qualifications?
:02:58. > :03:00.As the honourable lady will be aware, relevant bodies are due to
:03:01. > :03:17.make their recommendations this week and we will look at those closely.
:03:18. > :03:22.North Hampshire, what's reassuring scan the Minister give that GP
:03:23. > :03:28.services will keep up with housing growth happening in the area? I can
:03:29. > :03:34.reassure him we take that into account when we give out funding for
:03:35. > :03:37.private care, but it depends on a strong economy and this is something
:03:38. > :03:44.that the Government will always do the NHS. These secretary for state
:03:45. > :03:45.of communities and