Health Questions House of Commons

Don't forget to join me for a round-up of the day at 11pm tonight.

First, questions to the Health Secretary.

The 150,000 EU nationals working in our health and care services do a

brilliant job and we want them to continue doing it. I am in regular

talks to inform them of domestic workforce plans and negotiations

with the EU. I thank him for that answer. He will be aware that

represents something in excess of 5% of the total workforce within the

NHS. This is something which is done to have to be addressed, engaging

with the recruitment sector, the employment sector and indeed the

devolved administrations. Is that the way the Minister will handle

this? We absolutely will be taking a UK wide approach cost of the actual

numbers are slightly higher than the numbers he talks about for England,

we are about 9% of doctors are EU nationals and about 19% of nurses

are EU nationals. But we are still seeing doctors and nurses coming to

the UK and we need to do everything on all sides of this House to

reassure them that we see them as having a bright and vital future in

the NHS. If students with four a grades at A-level continue to find

it difficult to get into a medical degree in this country, is it any

wonder we have to import them from Europe? Well, he makes a very

important point, and that is precisely why last year we increased

the number of medical school places by I think the second biggest hike

in the history of the NHS, a 25% increase. Because we absolutely do

believe that this country should be training all the doctors and nurses

that we need. The truth is, EU staff no longer want to come here. Doctors

and nurses are leaving in their droves. Thanks to the abolition of

the NHS bursary, our nurses of tomorrow are going to have to pay to

train. When is the Secretary of State going to understand that this

staffing crisis has not materialised out of thin air, it is directly

attributable to his actions and the actions of his government over the

last century? -- the last seven years. She may have noticed a little

thing called Brexit that happened last year, which is actually... Is

actually because of understandable concern. But if she looks at the how

many doctors came from the EU to the NHS in the year ending this March,

in other words, post-Brexit? 2200. And how many nurses? 4000 nurses

joined the NHS from the EU in the year ending March. One of the

consequences of free movement from the EU is that proportionately we

take in rather fewer doctors, particularly, but also nurses from

the Indian subcontinent and other places. What assessment at the

Secretary of State made of the capacity to revisit the strong

relationship we did have with those workforces in the immediate post-war

years? Well, he makes an important point, and I think that what we want

to do is to attract the brightest and best into the NHS from all over

the world, wherever they come from, if there is a need. The only caveat

is that I think there are a number of doctors that we have imported

from very, very poor countries that actually do need those skills back

home, and I think we do have to recognise we have not in national

responsibility to make sure we train the number of doctors and nurses we

need ourselves. -- we have a national responsibility. It is also

costing a lot more in Nottingham and elsewhere because of luck cost

agency costs, isn't it clear that if we stop restricting access from the

EU for staffing purposes, it will cost the NHS an absolute fortune

more? Let me reassure him, there is no intention to restrict access for

vital professions such as the clinical professions in the NHS

post-Brexit. We have said many times we will have a pregnant -- pragmatic

immigration policy. But the long-term solution is not having to

import doctors and nurses from anywhere because the W H O says

there is a worldwide shortage of about 2 million clinical

professionals because we are not the only nation facing the challenge of

an ageing population. I welcome his words and the deeds he is doing in

terms of recruiting more doctors and nurses. Hospitals like mine in

Basingstoke rely on the best and the brightest from around the world.

What can he do to make sure that when we need to recruit nurses in

particular, we have the travel permits are available and work

permits are available for them to be able to move in swiftly rather than

having to wait for long periods of time whiz-mac She is absolutely

right to make that point and in fact nurses are on the Home Office tear

to shortage occupation shortage list and they will remain so for as long

as we need them to be. But the bigger issue here is that for a long

time, we have relied on being able to import as many doctors and nurses

from the EU as we need to, so we have not trained enough people

ourselves. That is not only bad for EU countries but also bad for our

own young people. I will take questions two and 12 together. Last

year the stud-mac announced one of the biggest expansions of medical

training places -- this Government, involving 1500 additional medical

school doses of the year, of which 500 staff this September and reforms

that will enable universities to offer up to 10,000 additional nurse

training places every year. In Swindon, funding for a video

campaign to recruit additional GPs to fill vacancies in our local

community, will the Secretary of State committed to exploring further

innovative ways to match newly qualified staff to vacancies that

they may not have previously considered? I think he makes a

really important point, and there are parts of the country where there

are GP shortages that have been very successfully addressed as the CCG

has done in Swindon. An overall part of this is persuading people who go

into medicine that going into general practice is one of the most

exciting and rapidly changing parts of medicine today, and we have seen

a 9% increase in the number of medical students choosing to go into

general practice since 2015. Further to the previous question, could I

ask the Secretary of State what he is doing to ensure that there is

enough doctors and nurses recruited, retained and developed at my local

hostel dubbed hospital? I heard a lot about his hospital when I went

to visit last year. I had the privilege of visiting them recently

after the horrific terrorist attacks, and I want to commend the

blade work done in that hospital, stepping Hill, in the wake of that

bomb. They have done a very good job of recruiting, I think they got 93

more doctors and nearly 300 more nurses since 2010. But we are having

a national programme to help all trusts Britain the nursing staff. It

has been launched by NHS Improvement in the last week. Thank you, Mr

Speaker. In this country, we are short of approximately 40,000 nurses

and applications were nurse faces have gone down by nearly 23%. Can

the Secretary of State tell us why he and his Government think that is

the case? Well, she happens to work in an NHS hospital that has had a

big increase in the number of nurses and in fact across the country, the

actual picture is that we have 13,000 more nurses working in our

wards since 2010. But she is right, we do need more nurses and that is

why we are expanding the number of nurse associates. This year we are

for the first time opening up a route into nursing through the

apprenticeship route, which means that people from nontraditional

backgrounds, particularly banned three health care assistants, will

find it easier to get into nursing, and that is how we will stand on it.

The latest NHS indicators published last week says that the number of

GPs in the past 12 months is estimated to have fallen. Again it

is expected to have fallen by March 20 17. Why is that? What we have had

is a big increase in the number of medical students choosing to go into

general practice, but we have also had an increase in the number of GPs

retiring early, and that is a problem we are urgently addressing.

May I congratulate my right honourable friend serving as Health

Secretary in three parliaments, and say to him that the sides doctors

and nurses, he should be looking to increase the use of properly

regulated acupuncturists, herbalists, wholemeal parts,

chiropractors and osteopaths, who would reduce the burden on doctors

and nurses of the Health Service. Over those three parliaments, I have

learned to expect questions in a similar vein from my honourable

friend, and I do commend his persistence in championing that

cause. As he knows, I think the most important thing in all of these

issues is to follow the scientific advice. Thank you very much. When

the Government removed the nursing bursary and introduced tuition fees,

the Secretary of State said that this was, as he has repeated this

morning, to fund 10,000 extra student nurse places. Yet the

universities are saying that no extra bases have been commissioned

so when will we see an expansion of student nurse training?

I always well, the interest she shows but given Scotland has seen a

fall in life expectancy in 100 years, she might want to think about

her own constituents. With respect to the number of nurses, we have now

over 50,000 nurses in training and we are confident we will deliver an

increase in the supply of nurses to the NHS. We still have a nursing

bursary and no tuition charges. The Secretary of State might want to

explain why the university 's claim that are no additional places. In

addition, we are losing almost half of junior doctors at the end of the

foundation years. What action as the Secretary of State taking to find

out why? I think the heart of this is that we need to open up avenues

for flexible working, more flexible working for both doctors and nurses.

I think if she followed what we have done in England, where we have

actually pioneered the reduced agency spend by 19% in the year,

while it is going up in Scotland, she might find they have more money

to spend on their own constituents. At the Secretary of State confirm

what specific actions she is taking to help trusts such as the Acute

Hospital trust that runs on the Alex Hospital in my constituency of

Redditch, that is in special measures. These types of trust fees

special measures in retaining and recruiting staff. Can I welcome the

first question I have received from my honourable friend and say to her

that I am very aware of the issues faced by the Worcester search acute

trust. I have been to visit it after the difficult period they have come

through. We have a new leadership team who I think I've made a very

promising start. We have found, because of the experience of other

hospitals that have been through difficult patches, it was never

about the commitment of staff, it is about getting the right leadership

in place. I can assure her I did see outstanding commitment from the

staff. The number of nurses has fallen for the first time in one

decade. That is why we need fear pay now. I read in the newspapers that

the Health Secretary now supports the Labour Party policy of scrapping

the cup, although he did not put with us last week. When you set the

remit soon, will he tell them to scrap the cap and will he published

his instructions before the summer recess? I did not vote for his

amendment because as usual libra taught us how they want to spend the

money without the faintest idea how they know where it will come from --

Labour taught us. I think he is ignoring the elephant in the room,

if we followed the spending plans he campaigned for, the NHS would have

2.6 billion less every year. That is the equivalent of 85,000 fewer

nurses. I want to talk about the spending plans of 2017, were he can

find 1 billion for Ireland but nothing for nurses in England. --

Northern Ireland. Do not go ahead with further cuts to Corporation tax

and put that money into giving our doctors and nurses a fair pay rise?

Let me tell him what extra money is going into the NHS. Three years ago,

1.8 billion, not asked for by Labour. 3.8 billion two years ago,

nearly 1 billion more than they were promising and this year ?1.3

billion. That is a lot of extra money. Why is it going and's we have

more than 3 million jobs, that is strong economy that is improving the

NHS. Question number three, Mr Speaker. Health education England is

responsible for meeting workforce requirements for the NHS. The number

of dermatologists and the NHS continues to grow, with 18% more

consultants and 13% more doctors in training since 2010. In the latest

workforce plan, 2% increase in training places for dermatologists

over the previous year. It is a popular choice for doctors and it

enjoys equal hundred percent rate. I am pleased to see that through a

combined approach between hospitals it has been possible to prevent the

long-term closure of the dermatology department and have fun in place

with the full service reopening in 2018 but given the seriousness of

the conditions, which include skin cancer, which is growing, with my

right honourable friend give further insurances of how we're going to

ensure sufficient supply of specialists in this area? Well, I

know my honourable friend has campaigned actively to the

dermatology services at the hospital in her constituency have been

retained following consultant retirements, which I think prompted

the temporary arrangements. I am pleased since the beginning of

April, we have successfully commissioned dermatology clinics at

Musgrove Park, using specialists from Bristol, with a view of

restoring a full service by next April. We do recognise the

importance of dermatology and are committed to encouraging the

speciality in Somerset and nationally. Dermatology is one of

those specialisms that this does boot determined on -- that is

determined on EQ nationals. The extreme hard Brexit being pursued by

the Prime Minister 's disastrous for our NHS. What is he and the

Secretary of State doing to pool our Prime Minister back from this

damaging cause? In relation to dermatologists, I think is what he

had in mind. Mr Speaker, I cannot tell the honourable gentleman how

many of the dermatologists come from the EU. What I can tell him is that

since the referendum, 560 29 UK EU doctors have come to work in the

NHS. The Secretary of State recently met the Chief Executive of St Helier

University Hospital trust and was impressed by the fantastic work

staff were doing, despite the surroundings and facilities which

are clearly in need of improvement, as he has been campaigning for. Any

significant service chains must be based on conical evidence, consider

patient choice and has the support of GP commissioners. I thank him for

that response. The Secretary of State did visit the hospital on the

first day of the election campaign, nothing suspicious about the timing.

He will have heard that 43% of the whole estate is unsuitable for the

delivery of modern health care. Yet, thanks to the hard work of staff at

St Helier Hospital, it is one of the few hospitals that managed to keep

on top of the waiting time targets, would you like to be the beer of

good news I confirm that the Government is going to reinstate the

?290 million the Secretary of State cancelled to allow the new hospital

to be built? As the honourable gentleman knows, the Southwest

London area is in the process of turning the proposals into plans

with public consultation when appropriate. It has yet to make any

recommendation and, as he knows, they have set up for local

transformation boards to consider how best to transform services,

including at and Holly hospital and Epsom. -- St Helier Hospital. It

would be wrong for me to prejudge those conclusion. Is it better than

having emptied vertical campaigns, I wonder if my right honourable

friend, my honourable friend, would have a sympathetic ear to having an

alternative plan to health care that works clinically, financially and

listens to all residents? A well thought out plan. My honourable

friend is quite right that we do need to look to be proposals coming

out of the commissioned on the ground who are responsible for

running acute services for the whole south-west London. They have made it

very clear that the intent to consult with the public once they

have made their own recommendations transparent. The intent to retain

all five hospitals, but to look at the configurations of services, that

needs to be led by clinicians. Thank you. As I asked my first health

question, can I thank the cardiac team in London where my

father-in-law just retired. We did everything they could last week and

showed the very best of the NHS. -- they did everything they could. We

have committed to an extra 5000 doctors in general practice by 2020.

NHS England and health education England are working together with

the profession to increase the GP workforce. We believe this is an

essential part of creating a strong general practice and NHS for the

future. In recent years, the number of family doctors in Sunderland has

plummeted. All of the evidence shows doctors are more likely to stay in

the areas they have trained. Does the Secretary of State by the

Minister accept that new medical school places should be created in

places such as Sunderland reveals the greatest need to recruit and

retain. I'm thank her for that. Since 2016, Sunderland's GP start

scheme has created new GPs over the next three years. You understand

that point about medical school provision. Through a partnership

between Newcastle and Durham, there are currently 25 medical schools in

England offering just over 6000 Government funded medical school

places, we finding 1500 additional places each year and 500 have

already been allocated, 24 of these two Newcastle. Recruiting more GPs

in Cheltenham is vital to help the workload. Rising costs, and act as a

disincentive. Does he agree with me that this is something that must

meet addressed decisively? We recognise the role they play in the

care and following the review, additional money was included in the

contract last year to... We said we would ensure appropriate funding for

GPs to meet the cost in the short term and work with the industry to

create a longer term solution. Thank you, Mr Speaker. As numbers of GPs

go down, there is increasing pressure on the time they have

patience. One of the areas that has been missed as the area of suicide

and self harm. We now know that there is an increased risk of

suicidal behaviour for those on unstable, a regular zero-hour

contracts and also those are likely to take their own life. I know the

honourable lady does a huge amount of work in this area and chairs the

whole tv-mac all-party group. 85% of respondents rated their GP care is

good. ?13 million of taxpayer money, which we hope will increase the time

GPs can spend with patients. I am very happy to meet with her. GPs are

the first line of defence against antibiotic resistance, which has the

potential to be an uncontrollable global new Black Death. With the

Minister confirm that the UK will retain its position as world leader

on this when the global fund will open applications and when the pilot

while for drug development will begin operating? I thank him for

that. We have committed ?50 million assistance towards setting up the

innovation fund. I will say that quickly. We are one of the world

leaders in that subject. I am meeting with him and the honourable

member for Stafford and you're shortly you can take that forward. I

spoke to one GP last week you told me that because he has been unable

to recruit help, he has only been able to take one weeks leave in

three years. This is not sustainable. The morale of GPs is at

an all-time low, the number continues to fall, surgeries are

closing and patience are finding it harder and harder to get an

appointment. He has promised annex 5000 GPs bike 2020. Given it will

take ten years to train a GP. Can you tell the House how he was going

to deliver this promise? I look forward to our engagement. It is a

landmark document published in April last year and sets out extra

investment that people have been calling for four years of ?2.5

billion per year for practice services. Investment is rising. More

people are coming into general practice, that is the good news and

we want to encourage that. We have to take action to prevent the early

retirements and to bring people back to general practice and we are

indeed doing that. Developing new routes into nursing is a priority

for the Government. That is why we launched both the new nursing

associate role and the nursing degree apprenticeship earlier this

year, as the Secretary of State said earlier this afternoon. This will

open new routes into the nursing profession for thousands of people

from all backgrounds and will also allow employers to grow their own

workforce from the local communities. My constituents welcome

the manifesto commitment to expand the number of clinical staff in

mental health. What more can I right honourable friend say about plans

for mental health nurse training and have people will benefit? The

workforce plan for England indicated a 3% increase in the number of

mental health nursing training places. The current level is the

highest of any nursing branch as a percentage of the workforce that

serves, which sued allow for 22%, over 8000 full-time equivalent

members of staff, growing in the mental health nursing workforce by

2020. The fact is, when the Government chose to charge students

record levels of student fees, the Secretary of State and his Ministers

were warned that would lead to fall in applications. Applications for

nursing degrees has fallen by 23%. Given he has already acknowledged

that we can no longer rely on EU staff as a result of Brexit, when

will Ministers understand the biggest challenge facing nursing

recruitment is not our policy towards the EU, it is the

I think he is right to draw attention to the fact that we

continue to have a surplus of applicants for nursing degree

courses in this country. The level of that surplus has come down

somewhat as a result of the change in funding structures. We will have

to see where it ends up because at the moment, universities are

directly recruiting outside the UK system and we are confident there

will be what in places this applicants year, some 2-1. Would the

Minister agree there is opportunity for more mature students to be able

to access courses easily and more must be done with adult learning

institutions to provide courses that provide direct access? I think he is

quite right to point out that the more mature workforce and in

particular for people perhaps coming back into careers later in life or

after, for women, after they have children, for example, is an

important source of experience for professionals and we need to do more

to encourage people to come back into the workforce later in life.

Number seven. Last year, our A saw 1800 more people every day within

the four hour target compared to 2010. We have also nearly 1500 more

emergency care doctors and a verse 600 more emergency care consultants.

I thank him for that answer. A handy departments -- in the departments at

district hospitals are a critical part of the regional emergency

infrastructure and ensure that the larger city departments can do with

major trauma as well as day-to-day emergencies. Will he ensure that

this vital emergency infrastructure is protected, enhanced and funded? I

do absolutely agree with him that having an emergency care network

that works well for his constituents is absolutely essential, and that

will mean relying on a network of hospitals, as he fully understands.

I do recognise the concern that his own hospital, which he campaigns for

extremely vigorously, and I want to assure him I will be watching very

carefully what happens there. Would he now confirm what the Minister

said that it was scaremongering to talk of the closure of Huddersfield

A, and will he now confirm that we should have a real plan with a gold

standard university to have a new medical school in Huddersfield so we

can attract talent and that would do a great deal for morale, which would

recruit good doctors and nurses everywhere? Well, I do think he is

right to say that it is time we had more medical schools, given that

health and social care will be one of the fastest expanding areas of

the economy over the coming years. And I do think that the Prime

Minister was absolutely right to say there should be no scaremongering

about important local plans that will improve services for patients.

Mr Speaker, can the Secretary of State reassure my constituents that

the component parts of the NHS can communicate with each other

sufficiently so that decisions of for example a medical deed to remove

accreditation for anaesthetic training will not lead to the

closure of a handy departments in places such as the court in general,

where my father was treated so well last Friday? -- Horton General. He

is a splendid fellow and he is now in another place! I am referring to

another house of Parliament! I was concerned about the general

laughter, Mr Speaker, but that comment! But I am delighted that my

honourable friend was my father was treated so well. I enjoyed my visit

to the hospital recently. And she is right that where there are changes

in the patterns of training, we need to be very careful to make sure that

they do not interrupt the way local services are delivered in a

disadvantageous way. The boundaries of the sustainability and

transformation partnerships is bound to cause concern about the future of

a handy and other acute departments. Given the nature of them. My area,

South Korea, relatively sparsely populated and rural, is lumped in

with Lancashire, largely urban. Will he confirm that the voices of rural

communities will not be dwarfed by those of the larger urban ones, and

this week as we celebrate the 25th anniversary of Westmorland General

Hospital, will he guarantees that were going to the hospital will not

be close and not receive any downgrading? The hospital has a very

important future in the NHS. I am happy to give him that assurance. I

do not think that he should be concerned about STP footprints

covering both rural and urban areas. However, I think where there is an

issue in his constituency and many others is in the response times for

ambulance is in the most remote areas. That is something we are

looking at. Thank you, Mr Speaker. Another threat to A units is the

capped expenditure process which will mean hundreds of million pounds

cut from NHS budgets, sneak out during the election, so far we have

had nothing but silence from this Government. It is time we had the

truth. When did the Secretary of State sign of the plans and when

will he publish them? The capped expenditure process is an NHS

England initiative to meet its statutory duty to live in its budget

and I do support the principle that in a period where real expenditure

on the NHS is going up by ?5 billion, the benefits should be

spread fairly amongst patients in all parts of the country. Number

eight, Mr Speaker. Thank you, Mr Speaker. In July 2016, the

Government published our commitment to end of life care. This set out

what everyone should expect from their care at the end of life and

the actions we are taking to make high-quality end of life care a

reality for everyone. By 2020 we want to significantly improve

pavement -- patient choice including an increasing the number of people

able to die in the pace of their choice, at home. I thank her for her

reply and it is welcome news that there is such a focus on and of life

care. Would she agree to meet with me to discuss the bill that was

presented in the other place to look at the way at how we can improve

access to palliative care across the UK? I would be delighted to meet

with my honourable friend, who is a very committed and passionate

campaigner in this area. I am very keen to explore anything which

improves care and choice for all patients at the end of their care.

Croydon's NHS including end of life care has been funded below the

London average every year since the Conservatives first came into

government. That is leading to service closures in Croydon which

are available elsewhere and longer waiting times for GPs or the A and

Croydon. When will Croydon's funding be brought up to the London average?

Well, the amount of resource dedicated locally is a matter for

CCG is and we continue to make sure that funding is fair. As I suggest

he takes it up with his CCG. Number nine. Clinical commissioning groups

as statutory organisations have a duty to deliver the best possible

services within the financial allocation. NHS England supports

them in this by providing several sets of guidance, as do NICE and

other arm's-length bodies. He will know that the clinically driven

process in Shropshire could lead to hundreds of millions of pounds of

investment in our local hospital. That is being jeopardised by Telford

CCG and Telford cancelled. When there is this gridlock in between

two local CCGs, what more can the Government do to break this

deadlock? I am aware that he has been concerned about this for a long

time. An independent review is taking place and people know that

Professor Simon brick has been appointed as the independent chair

of the joint committee of CCGs agreed between them both, the review

will report in July and be considered by the local CCGs before

next steps, including public consultation. Clear rules apply to

any significant reconfigurations and I expect these to be followed in

Shropshire as in anywhere else. Patients at the MRI in Manchester

with serious congenital heart problems found out last week that

the services will now no longer be provided in Manchester or in fact

anywhere in the North West. Due to a government review of services,

meaning that staff cannot be retained and recruited. What does

the Minister had to say to those patients who now have to go to Leeds

or Newcastle to get the lifelong surgery a need? -- life prolonging.

I understand this is an independent review of services and it was -- it

will report in due course. When political activists mislead and

misinform my constituents about the future of our Princess Royal

hospital, does my right honourable friend agree that the CCG could

communicate directly and clearly with residents so they can be

reassured that our A and our women and Children's Services are safe?

Yes, I do. I think CCGs should communicate directly with patients

and should do it clinically led. As I said, there are very clear

guidelines set out that they must follow in order to do that. There

are five tests that must be met before any reconfigurations are

brought forward and that should be the same in our area is in anywhere

else. Our community Hospital is a treasured asset and is try to find

savings of ?176 million. The local commissioning group is launching a

consultation into its future imminently. May I seek reassurance

that the hospital will not close and further that as part of this

consultation, their voices will be not just heard but also acted upon?

Clinical commissioning groups have a statutory responsibility to consult

the public and MPs have a key role and that to make sure that members

of the public engage with those consultations, and I will be

following her instances closely and she is more than welcome to come and

see me about it. Number Ten, Mr Speaker. The UK is a world leader in

tobacco control, we will publish a new tobacco control plan shortly,

building on our success, that panel set out new national ambitions to

further reduce smoking prevalence, particularly among disadvantaged

groups. Mr Speaker, I need to declare an interest in Southwark --

as Southwark County Council. Given the responsible it is of local

government, can Peter Aldous House what more can be done to do with the

situation where actuarial advice to local government and other public

sector pension schemes is that they are not at liberty to disinvest from

tobacco stocks? I will have to look into the exact point he raises, but

can I first welcomed into his pace? I watch closely with his

predecessor. When we published the tobacco control plan, there will be

clear local tobacco plans that will be part of that, and there is no

point did us in government, we need to recognise what is needed in each

local area Andy he knows -- and he has specific needs in his area. Does

he agree with me that it is vital that all those people that are

affected by smoking-related diseases and approach the NHS are pointed to

smoking cessation services, and it is vital that local authorities

continue to run these services? Yes, absolutely. Local authorities have

an obligation to do so. But as I said to the member for Ipswich, it

is important that local plans come forward alongside the national plan

because the local solutions needed in different areas and it will be

the same in his borough as in my area of Hampshire. Thank you very

much, Mr Speaker. Last week marked the tenth anniversary of the smoking

ban across the UK. Sadly, this celebration was dampened by the fact

we have yet to see the Government's new tobacco control plan. It was

promised back in December 20 15. The previous two shadow Health Minister

is repeatedly said we would see it shortly, but we failed to set out an

updated strategy to work towards a smoke-free society. I know the

Minister is new in his post and I welcome him to his post. We have

worked well together in the past on the best cancer all party group. So

I hope that he will, I know he has not given us a date yet, but if he

can give us an indication, will it be before Christmas? I am grateful

to the honourable lady. We have worked closely in the past, I am a

new minister in the post, I have been through the plan but it is me

who has to defend it and I want to be sure it is right and that I am

happy with it as much as anybody else in government. My intention is

that it be published before summer recess. Within East Sussex, that are

the highest number of smoking-related deaths and I welcome

the update on the tobacco control plan but how will he raise awareness

and provide equal access to rural communities? Well, rural communities

are as important as any other and it will be up to East Sussex County

Council to come forward with a local tobacco control plan, and they know

she will be taking a close interest in that, as she does with all

matters relating to her constituents. Question number nine,

Mr Speaker. Public Health England leads a wide ranging programme to

improve children's oral health and that oral health strategy published

last year showed a marked improvement across the country in

proportion of children with no obvious tooth decay, which rose from

six to 9% in 2008, 2/70 5% in 2015. -- 69%. NHS in England are

publishing plans for a starting well programme which will target high

needs errors to improve oral health of children under the age of five.

Prevention in early intervention is absolutely crucial. We have five

times the national average level of tooth decay. I have asked for help

for this over two years and absolutely nothing has been done.

Why is the dental health of children in Dewsbury so unimportant to this

government? NHS England do recognise there are significant challenges

with dentistry in Yorkshire. They had a pilot scheme from January that

closed last week to improve access to primary care dentistry in and

around Bradford. This pilot will inform wider work the NHS is

considering across Yorkshire. I declare an interest which is

probably fairly well-known. The answer is the Minister will be

aware, early year prevention. There is a huge campaign going on that's

been led by the Chief dental officer, for whom I have

considerable admiration. Would he be prepared to meet me with the Chief

dental officer to discuss progress. Would he look at the possibility of

funding, additional funding, from the dental claw-back that happens

annually? The honourable gentleman is a dentist. I believe he's the

only dentist in the house, and he's practising occasionally. I would be

delighted to meet my honourable and experienced friends to discuss the

issues on dentistry. In 2016, NT 5% of patients -- 85% of patients

across England reported satisfactory service. In Newcastle it was higher,

88%. Newcastle has fantastic GPs, but many of my poorest constituents

suffer from GP on availability and constantly change suppliers because

of the requirement to read tender every couple of years to a market

that quite frankly doesn't want them. They are poor or marginalised

to a point where they cannot be made money from. How can we make sure we

get quality and consistency of GP services -- they deserve. My

constituencies have had to do without a GP surgery over the last

two years because it was closed. Proposals are in place for a new one

to be opened next summer. Will the time in set out by NHS England be

met? I will ask NHS England, but if that is what they told the

honourable member, then that's what will happen. We are investing a

record 1.4 billion in children's mental health services. We know

transition from children to adult services can cause distress. NHS

England has prioritise conditions to offer financial incentives and we

will look at that the forthcoming paper. There is a growing crisis in

young people's mental health in Plymouth and the far south-west.

Despite 75% of mental health problems starting before the age of

18, only 8% of funding is allocated to young people. Will the Minister

consider ring fencing young people's mental health funding? The

honourable gentleman raises a very good point. We have to to balance

the need to give CCGs the need to prioritise and allocate in our own

way. The safeguards for physical health are more rigorous than mental

health, we need to keep that under review, but we have additional

targets that are being met. Can I commend the government for its work

on mental health over the last few years, but when the government comes

to publish its Green paper jointly with the Department for Education

and Department of Health, can I urge the Minister to focus on the

evidence of what works for young people and children, which is early

intervention, rigorous early intervention, often with enduring

psychotherapeutic interventions. Can she reassure me that they will look

at the evidence of what actually works for young people? I can give

my honourable friend that assurance and the CQC are undertaking thematic

reviews to see what works. He's right to identify early intervention

as key, but also the need to highlight transition as well. The

honourable member for Norfolk North wasn't exactly standing, he was

perched like a panther about to pounce. Mr Norman Lamb. Thank you

for the encouragement. I have been alerted to an online posting on the

social network next door yesterday, from the father of a teenager who

suffered awful trauma, witnessing the horror at Grenfell Tower. He was

after therapy for his daughter. Clearly there is an absolute need to

ensure everyone who might be in need knows how to get it. What is the

government doing to ensure that the case, and what is the government

also doing to make sure there is sufficient funding locally for

mental health services to provide ongoing needs that will clearly be

there. I thank the honourable gentleman for his intervention and

will be grateful to receive more details so we make sure that support

going where it's needed. I can advise him that in the event of the

very recent and too frequent disasters we have had recently, we

have been relying on more intervention on the ground, and Ella

worked in mental health first aid, we are prioritising those areas. NHS

improvement offers tailored support to organisations that they oversee,

particularly those that have gone into special measures as a result of

the CQC review. And then the department has responsibility for

holding NHS improvement to account. It does that threw me. North

ligature and cool foundation trust are in special measures for quality

and foundation reasons. The support to date has been neither timely nor

effective. What will the government do about it? We are clearly

disappointed that it has gone into special measures again. It's one of

the small number that have emerged and then reverted. It's something we

are taking a lot of interest in. NHS improvement has appointed an

improvement director and also arranged for nearby trusts, is in

the process of arranging for a nearby trusts to provide support. I

can assure him it is receiving weekly updates into the Department

stubbly topical questions. Yesterday I updated the house. Since February

there has been an increase in delay on discharges,. Yesterday we set out

further measures including specific reductions required in all local

areas, and immediate CQC reviews and all the worst performing areas. The

latest figures from the BMA show a huge rise in the number of patients

with mental health conditions being sent hundreds of miles away from

home for treatment. Isn't any talk of parity of esteem meaningless

unless and until patients can access the support they need close to home?

I agree that it's a very important issue. It's particularly important

because people with mental health conditions need regular visits from

friends and family to help them get over a crisis and their chances of

getting discharged and being able to go home are higher when they are

closer to home. She will be aware we have a commitment to eliminate all

out of area placements for children by 2020 and we're making progress

with adults as well. United with local people, patients and medical

professionals in opposition to NHS England's badly thought out and

wrong proposals to close Glenville hospitals heart unit. Will he ensure

that the eventual decision reflects the responses they received to the

consultation? My honourable friend with other Leicestershire MPs have

made their views very clear to me. I hosted a number of Leicestershire

members from both sides of the house on this issue. He's also aware the

public consultation on congenital heart disease services continues

until the 17th of July and we will obviously take all comments made

into account in to conclusions from that report. Today is the sixth

anniversary of the publication of the Dilnot commission's report on

the funding of social care. In those six years ministers have legislated

for a cap and then abandon those measures. In their manifesto they

brought forward disastrous measures on the so-called The Minch attacks.

Can ministers confirm those policies have been abandoned, and when he

expects to have new proposals for reform? I have great respect for the

honourable lady who campaigns consistently on this issue. I don't

think that's a fair reflection on what has happened. In the last year

of the last Labour government, 45,000 people had to sell their

homes to pay for care costs. Under this government we have made it the

law that nobody has to sell their home. There is more work to do but

we have made important progress and will continue to do so. Nothing is

more important than people being able to access a GP when they need

one. With that in mind will the Minister join me in welcoming the

move taken by South Tees CCG so there are 19,000 more appointments

for people in Middlesbrough, Redcar and Cleveland by making sure there

are appointments available on evenings, weekends and bank holidays

and. I welcome that. The access improvements have been put in place.

Patients can now benefit from accessing GP appointments at a time

convenient for them seven days a week, exactly as should be. Will the

Scottish Government is now committing to a soft opt out system

for organ donation, a system implemented in Wales in 2015, isn't

it time the UK Government followed the Wales and Scottish Government 's

lead and introduce a similar system south of the border? I think there

is a lot of merit in the opt out systems that have been developed for

some time in Wales and is now happening in Scotland. We are

looking closely at the evidence but we do have a lot of sympathy. If it

leads to an increasing organ donations, it's something we would

want to pursue. One-year cancer survival rates are now at a record

high of 70%. Does the Minister agree with me that we should and can go

further by improving early diagnosis and screening? Yes, progress is

really encouraging and I'm sure members across the house will be

encouraged to seek the progress report today from the Chief Medical

Officer. The age of position is here. The NHS has always been at the

forefront of new technology. So it must be with this. Will a minister

be willing to meet with the all-party Parliamentary group on

blood donation after it reconvenes next week. Can it provide an update

on the safety of blood tissues and organs to lift or appease the

referral period for gay men who want to give blood. I would be happy to

agree to such a meeting. I know it's an issue that has support on all

sides of the house and I would be happy to have that meeting. Last

week I met with doctors and nurses is an excellent small hospital

serving a rural publishing spread over 1000 square miles. Will my

right honourable friend urged the South Tees trust to do everything it

can to ensure continued provision of services at this vital local

hospital? I'm aware the honourable gentleman has taken a strong

interest in the number of consultants and anaesthetists

available at the hospital. I would be happy to meet him with his

concerns in person. At the height of the recent election campaign NHS

England took forward plans to effectively merge six South London

CCG 's including Greenwich under one senior chief officer. Wouldn't this

be a retrograde step at a time when primary care has been devolved

downwards and all the emphasis is his on integration of the local

borough level? I think the answer is it varies from area to area. The

CCGs grew up organically following the 2012 act. There are areas where

they can in addition to the welcome focus on mental health first aid, we

can have equal focus on mental health keep fit, so we can all keep

a mental health in good condition? I think every child should leave

school is knowledgeable about how to main mentally resilient as they do

as to how to be physically healthy. A recent assessment, what recent

assessment has he make of the financial sustainability of

commentary and rugby CCG? I think our view is that like all CCGs, it

is under a great deal of pressure, but given increases in funding we

have seen recently, it should be entirely possible for it to be

sustainable. Could I return to the issues facing the Northern

Lincolnshire and cool trust? It is clearly of concern to my

constituents that both Grimsby and Scunthorpe hospitals are in Special

Measures for the second time in as many years. Will he meet with me and

neighbouring MPs to discuss the situation? I am more than happy to

meet my honourable friend but he should be confident that we have put

a substantial support package in place, including a budding

relationship with another trust and special teams from NHS Improvement

to turn things around. Well the Secretary of State say what action

he intends to take to address the link between suicide and socio-

economic depression, highlighted in the report from the Samaritans, as

he seeks to reduce suicide by 10% by 2020? We will look very carefully at

what the Samaritans report say and we always do look very carefully at

what they say but I think this is an area where the signs are that our

policies are having an impact and we are seeing significant in reduction

in suicide rates, but it is still the biggest call Villard cause of

death in men under 50. Funding and international Health Service open to

the world is another thing. Does he have any other indication whether

the advance charging of nonemergency treatment for overseas patients is

putting more money into our NHS? He has been a great campaigner to

ensure that those who come to visit this country should contribute for

health care received here if they are not resident. We have put in

place a number of measures to increase the appropriate charging

structures. We will increase the funding received by the NHS from ?89

million to ?289 million and we will be getting the results of similar

action which we would expect to see further increase shortly. -- we

increased the funding. NHS property services have just signed a new ?1

million lease on a Central London location. Could I suggest other

properties are available? Would you like me to enquire into my own

constituency where NHS property services increased mental threefold?

Better value to the taxpayer is available. I am happy to look into

those issues if she sends me the details. I know the Secretary of

State and Minister of State share my passion for ensuring we have a

bereavement Sweet attached to every maternity unit in the country.

Pretty currently set at what steps he can take to make this reality?

Once again, I congratulate my honourable friend for the dedicated

work he has made in this area. The Government does understand the

importance for bereaved parents to have a dedicated base to be, where

bereaved parents cannot hear other babies crying. We have funded such

spaces in nearly 40 hospitals and continue to work to see what more we

can do to improve their position. The honourable member has parabola

to come on side of the chamber to another! But she has here and I

suppose we should hear her. Did she have a question on the paper? Your

opportunity is now, get in there! Thank you, Mr Speaker.

Mr Speaker during the election, a lady in my constituency told me that

she had waited nearly four hours for an ambulance to come to her home to

pick off the floor. I was wanting to ask the Secretary of State if you

have the confidence in the handle and sewers, both in London and

elsewhere, we have seen targets consistently missed, and whether he

would now look at extra resources for the Ambulance Service across the

country so urgently needed by all of our constituents? If I may say, that

was a brilliant recovery! And she is absolutely right to focus our

attention on the performance of ambulance services. They are under

pressure, they are heading around 71% for the category A calls and the

target is to hit 75%. But there are some bigger issues with the way

those targets work, which we are looking at, and in the days of her

Ambulance Service it has just had a CQC inspection. As a result of the

capped expenditure process, the wider Devon STP is being asked to

make ?78 million of savings at short notice within the next nine months.

Does the Secretary of State share my concern about this and the impact on

patients, the short time frame and also the undermining of already

agreed savings by the STB? Will he meet with me to discuss this and the

wider CEP? Are more than happy to meet with her. I think the principle

behind the capped expenditure process is that we should have

fairness between patients in different parts of the country and

we should not see patients in one part disadvantage because in the

neighbouring area the NHS has overspent. But the way we implement

it must be sensitive and fair and many to make sure we get that right.

Thank you, Mr Speaker. What advice would the Secretary of State give my

constituents who received urgent care from Virgin care, who are told

that wounds should only be dressed once and they should purchase

further dressings from the local chemist, free at the point of

delivery? What I would suggest is that she gets in touch with the

details, but I would say that where the care is not satisfactory,

whether it is delivered by both the public sector or the independent

sector, that is why we have an independent inspection regime to

root out those problems. I am delighted to hear the Minister

answer the member from Boston with a positive move forward. On a recent

visitor Nottingham University I saw similar techniques applied to

Alzheimer's Research UK will he back that as well as cancer diagnosis and

treatment? The chief medical officer has reported today and it is fear

that this is an exciting new innovation in medicine. Wibble

tackle cancer first but there is real potential for rare diseases and

every other that she mentions. Low-mac order, we must now move on.

Urgent question, Angela