0:00:25 > 0:00:29Hello, welcome to BBC Parliament's live coverage of the House of
0:00:29 > 0:00:36Commons. In an hour we will have an emergency debate called by Labour MP
0:00:36 > 0:00:39Dame Margaret Hodge on tax avoidance. This follows the release
0:00:39 > 0:00:43of the so-called Paradise Papers, a Ligue two of financial documents
0:00:43 > 0:00:48which have shown the offshore financial dealings of
0:00:48 > 0:00:51multinationals, celebrities and public figures. The main business of
0:00:51 > 0:00:55the day will be the first day of the committee stage of the European
0:00:55 > 0:00:59Union Withdrawal Bill. Brexit Secretary David Davis announced
0:00:59 > 0:01:10yesterday Parliament will have a vote on the final document. First,
0:01:10 > 0:01:13questions to the Health Secretary, Jeremy Hunt, and his team of
0:01:13 > 0:01:20ministers. Minister of state, Mr Philip Dunne.
0:01:20 > 0:01:22Local NHS organisations are responsible for deciding the most
0:01:22 > 0:01:28appropriate structures needed to deliver to their patients.
0:01:28 > 0:01:30Commissioners and regulators are responsible to ensure that NHS
0:01:30 > 0:01:39providers act in the interest of patients and taxpayers. A theme in
0:01:39 > 0:01:45review undertaken by Lord Carter sought to drive efficiency through
0:01:45 > 0:01:49sharing administrative functions across NHS bodies in an area. A
0:01:49 > 0:01:54number of trusts are creating the right structures to do so. NHS
0:01:54 > 0:02:02improvement is aware of 39 subsidiaries.
0:02:02 > 0:02:07Does the Minister share my concern that NHS trusts in Yorkshire are now
0:02:07 > 0:02:12lining up to follow the example of Airedale Hospital trust, which
0:02:12 > 0:02:17recently, behind closed doors as part of a VAT scam, said up
0:02:17 > 0:02:21subsidiary company to run many of its activities, which will not only
0:02:21 > 0:02:26cost the Treasury but also mean that new staff such as hospital porters
0:02:26 > 0:02:32will no longer be unable -- NHS terms and conditions?I can reassure
0:02:32 > 0:02:37the honourable gentleman that we have no interest in allowing NHS
0:02:37 > 0:02:40trusts to avoid their tax responsibilities, and guidance was
0:02:40 > 0:02:46sent to all trusts in September to ensure that any to be transfers of
0:02:46 > 0:02:51staff would continue to be subject to NHS pension rules. It should not
0:02:51 > 0:02:57be done for tax avoidance purposes. What role does the Minister Sever
0:02:57 > 0:03:01the private and voluntary sector in the provision of services and
0:03:01 > 0:03:10delivery in the future?There have been a continuing involvement of
0:03:10 > 0:03:16private provision of health services since the origins of the NHS when GP
0:03:16 > 0:03:21partnerships came in to provide as business -- Private businesses,
0:03:21 > 0:03:26their services. The introduction of competitive tendering to NHS
0:03:26 > 0:03:29contract was introduced by the Last Leg government, and the rate of
0:03:29 > 0:03:35private provision under that government grew more rapidly than
0:03:35 > 0:03:47under this comment. -- the last Labour government.
0:03:47 > 0:03:51If the NHS providers said up wholly-owned subsidiary, would the
0:03:51 > 0:03:56minister expects to see all of those papers in the public domain?As I
0:03:56 > 0:04:01said in answer to the honourable gentleman, the trust which would
0:04:01 > 0:04:05consolidate any subsidiaries in its accounts would publish the accounts
0:04:05 > 0:04:14of subsidiaries as part of their consolidated accounts each year.Mr
0:04:14 > 0:04:18Speaker, on Sunday the Secretary of State said good public services or
0:04:18 > 0:04:21part of the capitalist economy, yet trusts are so strapped for cash they
0:04:21 > 0:04:30are providing... Several parts of the NHS are subsidising these
0:04:30 > 0:04:36trusts. There are also members of staff who find they no longer work
0:04:36 > 0:04:39for the NHS. This is another step towards privatisation. What
0:04:39 > 0:04:44protections are in place to prevent any these companies from being sold
0:04:44 > 0:04:49off to the highest bidder in the future?I'm afraid the honourable
0:04:49 > 0:04:52gentleman, for whom I have considerable respect, is trying once
0:04:52 > 0:04:59again the tired old weaponising on the NHS by alleging privatisation,
0:04:59 > 0:05:01seeing privatisation ferries were there aren't any. This is about
0:05:01 > 0:05:09responding to Lord Carter... I may remind him this is about responding
0:05:09 > 0:05:12to the review into efficiency, which I know he supports, and finding the
0:05:12 > 0:05:16right structures to allow, for example, back offices of different
0:05:16 > 0:05:20NHS bodies in an area to be combined. That requires a scripture.
0:05:20 > 0:05:24And a number of trusts are providing those services to each other through
0:05:24 > 0:05:31subsidiaries. The NHS needs more doctors, which is
0:05:31 > 0:05:35why last year we announced one of the biggest ever increases in
0:05:35 > 0:05:41medical school places, 25% increase, 500 additional students will start
0:05:41 > 0:05:47next year and a further thousand the year after.I'm pleased to hear the
0:05:47 > 0:05:53department is working on addressing these issues. Can we also look at
0:05:53 > 0:05:56other difficulties specifically facing rural areas? Local patient
0:05:56 > 0:06:01transport is one of these. With rural boss Max links thin on the
0:06:01 > 0:06:05ground and struggling, will adequate provision be made to ensure patients
0:06:05 > 0:06:10will always access services they need?He is right to raise the
0:06:10 > 0:06:14question. I visited Thornbury on Friday and was discussing some of
0:06:14 > 0:06:19these issues. The NHS has an obligation to make sure that people
0:06:19 > 0:06:23can access it services and indeed in certain circumstances people are
0:06:23 > 0:06:27entitled to funding to help them do that. I thank him for raising the
0:06:27 > 0:06:32issue and I know he will continue to fight hard on that.All four
0:06:32 > 0:06:38witnesses who gave evidence to the health committee enquiry last week
0:06:38 > 0:06:41described the current situation as unprecedented. Janet Davies, the
0:06:41 > 0:06:45head of the royal corals -- the Royal College of Nursing, said of
0:06:45 > 0:06:48Brexit happens it would be devastating. Does he accepted there
0:06:48 > 0:06:55is no deal next month on the future of EU nationals, the current stream
0:06:55 > 0:06:59of workers in the NHS will become a flood?With respect, I don't think
0:06:59 > 0:07:04it helps to reassure the brilliant NHS professionals from the EU
0:07:04 > 0:07:08working in the system when he asks question like that. The reality is
0:07:08 > 0:07:15they are staying in the NHS. And at every opportunity I make sure that
0:07:15 > 0:07:18they feel welcome, I try to stress how important they are, how the NHS
0:07:18 > 0:07:23would fall over without them, and the government continues to make
0:07:23 > 0:07:26every effort possible to secure a deal for their future, which we are
0:07:26 > 0:07:36confident we will achieve. A&E is important to my constituency
0:07:36 > 0:07:40and those of my neighbour. It is also very important to me, having
0:07:40 > 0:07:45saved my husband's life on two occasions. Last August, it was close
0:07:45 > 0:07:51overnight because there weren't enough doctors to safely staff it.
0:07:51 > 0:07:54There are enough doctors to safely staff it. Unfortunately, NHS
0:07:54 > 0:08:03improvement has interfered to stop the reopening by at least one month.
0:08:03 > 0:08:08Should Grantham Hospital be reopened in December?I am completely clear,
0:08:08 > 0:08:12Leo said to her, I think in this House, but I certainly said to her
0:08:12 > 0:08:18colleague, who I'm delighted to see in his place after an incredibly
0:08:18 > 0:08:23brave battle against cancer, that this was a temporary closure based
0:08:23 > 0:08:26on difficulties in recruiting doctors. I will take that issue and
0:08:26 > 0:08:33look at it carefully.Last winter, we saw patients languishing on
0:08:33 > 0:08:38trolleys and A&E first 12 hours. We had the Red Cross called in. We had
0:08:38 > 0:08:41people leaving A&E before their treatment. Does the Secretary of
0:08:41 > 0:08:44State accept this is absolutely unacceptable this winter, and what
0:08:44 > 0:08:49steps is he taking Miss Winter to ensure this does not happen?With
0:08:49 > 0:08:54respect, we didn't have the Red Cross called in, we contract with
0:08:54 > 0:08:59the Red Cross throughout the year, as she well knows as a senior
0:08:59 > 0:09:04doctor. What happened last year was not acceptable. We have done a huge
0:09:04 > 0:09:08number of things. Perhaps the most important thing is putting Annex £1
0:09:08 > 0:09:10billion into the social care budget for this year and a further billion
0:09:10 > 0:09:17for next year. That is where particular pressures war. We have
0:09:17 > 0:09:24also helped improve A&E facilities. A shortage of nurses has led to the
0:09:24 > 0:09:29closure of the inpatient ward at Shepton Mallet community Hospital
0:09:29 > 0:09:32this winter. Can the Secretary of State say something about what the
0:09:32 > 0:09:35government has done to increase the number of nurses Imrul areas, and
0:09:35 > 0:09:39also encourage the Somerset political commissioning group to
0:09:39 > 0:09:46recommit itself to the future of Shepton Mallet community hospital?I
0:09:46 > 0:09:48congratulate him for the close interest he shows in his local
0:09:48 > 0:09:53community hospital, because this matters so much, not just to his
0:09:53 > 0:09:56constituency, but to the NHS, because this is where we discharged
0:09:56 > 0:10:00a lot of people from busy district General hospitals. He is right,
0:10:00 > 0:10:03there has been a shortage of nursing, and that is why we have
0:10:03 > 0:10:08decided to increase the number of nurse training places by 25%, the
0:10:08 > 0:10:15biggest increase in the history of the NHS.Would the Secretary of
0:10:15 > 0:10:19State consider bringing in a bursary scheme by which young doctors would
0:10:19 > 0:10:24have their student debt wiped after five years in areas which have a
0:10:24 > 0:10:32shortage of doctors?Well, we have introduced something similar, so
0:10:32 > 0:10:36where there are areas that I found it difficult to recruit GP trainees
0:10:36 > 0:10:41for three years or more, we have introduced a £20,000 salary
0:10:41 > 0:10:44supplement to attract people. It has been very successful. We have
0:10:44 > 0:10:55expanded it to 200 places this year.
0:10:55 > 0:11:01They have undertaken a consultation to close the surgery on my
0:11:01 > 0:11:03constituency against the wishes of the local committee. Does my right
0:11:03 > 0:11:09honourable friend agree that CCGs have responsibilities to support
0:11:09 > 0:11:14rural practices and should do all they can to recruit GPs into rural
0:11:14 > 0:11:20areas?I do agree with her, and I also know that in areas like
0:11:20 > 0:11:24Wealden, despite the fact they are useful areas to live, it can be
0:11:24 > 0:11:28difficult to recruit people, particularly to become new partners
0:11:28 > 0:11:32in GP practices. And this is an area we are concerned about. Nationally,
0:11:32 > 0:11:39we have a plan to recruit 5000 more doctors working in general practice
0:11:39 > 0:11:42by 2020, 2021. But we need to make sure they go to rural areas like
0:11:42 > 0:11:48hers. The Secretary of State will no there
0:11:48 > 0:11:52are huge vacancies across the NHS, particularly in nursing, partly
0:11:52 > 0:11:56driven by pay restraint. He has said the pay cap will be scrapped. Does
0:11:56 > 0:12:01he agree with Simon Stevens, who said it would be an goal not to
0:12:01 > 0:12:05fully fund the scrapping of that pay cap next week in the budget and
0:12:05 > 0:12:12expected to be paid for productivity gains?I have been very clear. The
0:12:12 > 0:12:15government is willing to be flexible in terms of funding additional pay
0:12:15 > 0:12:21beyond the 1% for nurses. But we do want some important reforms to the
0:12:21 > 0:12:26contracts they operate under. And if those negotiations go well, and at
0:12:26 > 0:12:29the moment we have been having very constructive discussions with the
0:12:29 > 0:12:37RCN, I'm hopeful we can get a deal will
0:12:38 > 0:12:41Can I ask about Simon Stevens comments last week? He said waiting
0:12:41 > 0:12:48list would rise to 5 million if this continues, the cancer list would
0:12:48 > 0:12:52deteriorate, the mental health pledge will not be met, the 18 weeks
0:12:52 > 0:12:56target will be permanently abandoned and is it not the case in the budget
0:12:56 > 0:13:01next week, if the Chancellor does not allocate at least a nectar £6
0:13:01 > 0:13:05billion per year for the NHS, he will have failed in his
0:13:05 > 0:13:12responsibility as secretary of state? -- extra £6 billion.What we
0:13:12 > 0:13:16all noticed is when he came up with his plan in 2014, Labour did not
0:13:16 > 0:13:25back it. In the 2015 election they did not agree to fund it, to the
0:13:25 > 0:13:29June £5 billion more we were prepared to put in and his refused.
0:13:29 > 0:13:33He is quoting Simon Stevens and when the British economy sneezes, the NHS
0:13:33 > 0:13:40catches a cold and it would be far worse than that for the NHS if we
0:13:40 > 0:13:49had Labour's run on the pound. This government has changed policy so
0:13:49 > 0:13:54that all NHS patients will be able to book routine GP appointments in
0:13:54 > 0:13:59the evenings and weekends. We think that is very important for NHS
0:13:59 > 0:14:01patients. But also to relieve pressure on accident and emergency
0:14:01 > 0:14:09departments.In September Jubilee surgery, starving to medical
0:14:09 > 0:14:13practice and Highlands practice launched a same day access scheme
0:14:13 > 0:14:15based at Fareham community Hospital which welcomed the Secretary of
0:14:15 > 0:14:19State on a visit last year. Clinician led and supported by the
0:14:19 > 0:14:24task force. Will he join me in congratulating the GPs, including
0:14:24 > 0:14:30Doctor Tom Bertram, leading this scheme and the CCG and explain how
0:14:30 > 0:14:37patients will gain access to a GP in Fareham?I was honoured to meet
0:14:37 > 0:14:41them. I think Richard and his team have done a fantastic job in
0:14:41 > 0:14:45transforming services in a way reducing pressure on local hospitals
0:14:45 > 0:14:50and also really improving services for local people. There was a real
0:14:50 > 0:14:54buzz and I noticed in neighbouring Gosport they have made changes
0:14:54 > 0:14:58improving patient satisfaction to 90%, with 60% of issues dealt with
0:14:58 > 0:15:03on the same day. Really exciting things happening.Pointon has fewer
0:15:03 > 0:15:11queue -- full time GPs than 2010 despite a growth in population and
0:15:11 > 0:15:15many GPs have quit the service because of the pressure on them.
0:15:15 > 0:15:20What will he do not only to attract more people into the GP service, but
0:15:20 > 0:15:26to keep those already there?Very important questions. I had an
0:15:26 > 0:15:29excellent visit to Warrington Hospital towards the end of the
0:15:29 > 0:15:34summer and there are fantastic bits of work I have seen here,
0:15:34 > 0:15:39particularly on sepsis prevention. The issues are firstly about getting
0:15:39 > 0:15:44more medical school graduates to go into general practice. This year we
0:15:44 > 0:15:48think we will get 3019 medical school graduates to go into general
0:15:48 > 0:15:53practice, a record, it has never been that high. It is also about
0:15:53 > 0:15:56retention and looking at some of the things frustrating GPs, including
0:15:56 > 0:16:01the cost of indemnity, that insurance policy. We have announced
0:16:01 > 0:16:08we will move to a national scheme to help control those costs.One
0:16:08 > 0:16:11village medical practice in my constituency in Slade Byrne was
0:16:11 > 0:16:16threatened some years ago and was fortunately saved. It does
0:16:16 > 0:16:19tremendous service for the local community. Without it elderly
0:16:19 > 0:16:23patients would tap to travel more than 40 minutes to Clitheroe and is
0:16:23 > 0:16:29no capacity. What will he do to make sure places like Slade Byrne have a
0:16:29 > 0:16:36future?It is essential in rural constituencies like his own we
0:16:36 > 0:16:40continue to have active GP practices. I noticed those practices
0:16:40 > 0:16:44sometimes give the best care in the whole of the NHS because they know
0:16:44 > 0:16:47the people, their families and is continuity of care and they are very
0:16:47 > 0:16:51broad for the local community. I congratulate him on what he did to
0:16:51 > 0:16:57say that practice.Is it right constituency in Stroud had to wait
0:16:57 > 0:17:01weeks to get an ordinary appointment with their GP? Given the
0:17:01 > 0:17:05sustainability and transformation plans are now saying they will be an
0:17:05 > 0:17:10acute sorted job GPs, what does he intend to do about that?-- shortage
0:17:10 > 0:17:15of GPs. Nobody should have to wait weeks for an appointment in Stroud
0:17:15 > 0:17:21or anywhere else. We have a lack of capacity in general practice, which
0:17:21 > 0:17:25is why we decided to embark on a plan for 5000 more doctors working
0:17:25 > 0:17:30in general practice. One of the biggest ever increases. I am afraid
0:17:30 > 0:17:33it will take time to feed through the system. But we are comfortable
0:17:33 > 0:17:43we will deliver it.Number four, Mr Speaker.Every week we have four
0:17:43 > 0:17:50claims against the NHS for a brain injured baby. There is still far too
0:17:50 > 0:17:54much avoidable harm hand -- when it comes to maternity services which is
0:17:54 > 0:18:02why I launched an ambition to halve the neonatal injury, and
0:18:02 > 0:18:08stillbirths.The Secretary of State rightly focuses on the importance of
0:18:08 > 0:18:13reducing infant mortality. With the police investigating the unusually
0:18:13 > 0:18:19high number of baby deaths in Chester Hospital, can he update my
0:18:19 > 0:18:22constituents with the progress of the investigation and the measures
0:18:22 > 0:18:28taken to make sure safety at the Countess of Chester, which serves
0:18:28 > 0:18:32the northern part of my constituency?First of all I thank
0:18:32 > 0:18:38her for her campaign which I think is something that has engendered
0:18:38 > 0:18:43huge respect on all sides of the House. With respect to that
0:18:43 > 0:18:46particular investigation she will understand I cannot comment on a
0:18:46 > 0:18:53police investigation. Nonetheless, immediately after the issues were
0:18:53 > 0:18:57surfaced, safety measures were taken so the hospital does not now provide
0:18:57 > 0:19:03care for babies born before 32 weeks and they are implementing 24
0:19:03 > 0:19:05recommendations from the Royal College of paediatrics and
0:19:05 > 0:19:11childcare.The shortfall in midwives and the financial crisis in the NHS
0:19:11 > 0:19:16threatens the safety, quality and sustainability of midwifery
0:19:16 > 0:19:18services. The words of the Royal College of Midwives. How will he
0:19:18 > 0:19:27with store -- restore the confidence in the RCM and professional bodies?
0:19:27 > 0:19:32He is right we need more midwives. We have 6000 in training and 2000
0:19:32 > 0:19:39more than we had in 2010. It is also important to recognise the progress
0:19:39 > 0:19:44they made. Stillbirth rates are down 14% over the first, between 2010 and
0:19:44 > 0:19:522015. Neonatal death down 10%. There is important progress happening.
0:19:52 > 0:19:55Will my honourable friend join with me in congratulating my constituents
0:19:55 > 0:20:01support group and the Royal College of obstetricians and gynaecologists
0:20:01 > 0:20:07on the update to the green top clinical guidelines? I'm sure he
0:20:07 > 0:20:12will agree they are a significant step forward in preventing a wicked
0:20:12 > 0:20:18and wholly unnecessary neonatal infection will stop I am very happy
0:20:18 > 0:20:25to offer my congratulations.--. I am very happy to. We have done very
0:20:25 > 0:20:32well on this but we do have other infections like group B macro which
0:20:32 > 0:20:36are higher than they need to be and I am in fact speaking on a
0:20:36 > 0:20:43conference this afternoon and I am happy to pass on my congratulations.
0:20:43 > 0:20:50Only 57 set of maternity units in England have accreditation compared
0:20:50 > 0:20:55to 100% in Scotland and Northern Ireland and 79% in Wales. What plans
0:20:55 > 0:20:58does he had to increase accreditation for all hospital
0:20:58 > 0:21:03units?Despite the rivalry which sometimes happens between our
0:21:03 > 0:21:07nations I have a lot of respect for the patient safety initiatives in
0:21:07 > 0:21:13Scotland and we will bad. We have what we think is the most ambitious
0:21:13 > 0:21:18plan to improve maternity safety anywhere. -- and we will look at
0:21:18 > 0:21:23that. It is one area where the countries should work together.
0:21:23 > 0:21:30Number five, Mr Speaker.Very last one from me, Mr Speaker. On mental
0:21:30 > 0:21:35health, as you know, we have one of the most ambitious plans to expand
0:21:35 > 0:21:40mental health provision in Europe. That means we need to recruit for an
0:21:40 > 0:21:45extra 21,000 posts in the next three years and plans are in place to do
0:21:45 > 0:21:52that.I thank the Secretary of State for his encouraging answer. But can
0:21:52 > 0:21:54I ask what that means specifically for mental health provision and
0:21:54 > 0:22:03mental health funding in the London Borough of Croydon?He is right to
0:22:03 > 0:22:10challenge me on that. Because we are asking all CCGs to increase funding
0:22:10 > 0:22:16in real terms going into mental health year in and year out. 85% of
0:22:16 > 0:22:20CCGs are doing that and last year we had an extra half £1 billion
0:22:20 > 0:22:24reaching the front line for mental health. Regrettably Croydon is not
0:22:24 > 0:22:28among the 85%. Having listened to his question I will take it away and
0:22:28 > 0:22:34find out what happened.How does the Secretary of State expect to achieve
0:22:34 > 0:22:38these plans to increase the mental health workforce when only last week
0:22:38 > 0:22:43the head of NHS England Simon Stevens said, quite, on the current
0:22:43 > 0:22:46outlook, it will be increasingly hard to expand mental health
0:22:46 > 0:22:55services? -- and I quote.It is hard because of the financial pressure on
0:22:55 > 0:22:58the NHS to expand mental health services in the last seven years but
0:22:58 > 0:23:03we have succeeded. We have 4300 more people working in mental health
0:23:03 > 0:23:07trust. 1.4 billion more being spent on mental health than three years
0:23:07 > 0:23:11ago. We have a plan, it is a good one and we will make sure it does
0:23:11 > 0:23:16happen.Thank you, Mr Speaker. I am sure he would welcome the fact
0:23:16 > 0:23:21cancer survival rates are at a record high. Can he explain how the
0:23:21 > 0:23:24Government will fund the latest technology so we can continue to
0:23:24 > 0:23:34stay ahead of this terrible disease? I am grateful for the question from
0:23:34 > 0:23:40my friend from Hitchin and Harpenden. Compared to 2010, 150
0:23:40 > 0:23:44more people are starting cancer treatment every single day. That is
0:23:44 > 0:23:48why there are 7000 people alive today who would not have been if we
0:23:48 > 0:23:52have the survival rates of five years ago. But we are still behind
0:23:52 > 0:23:57the Western European average. We want to do something about this. A
0:23:57 > 0:23:59big investment in capital equipment is something we are prioritising
0:23:59 > 0:24:05therefore.Constituents in York have experienced sexual trauma without a
0:24:05 > 0:24:10clinical pathway in which to have their psychological support address.
0:24:10 > 0:24:14Therefore will be Secretary of State take action in making sure we have a
0:24:14 > 0:24:18national framework to support particularly women as well has star
0:24:18 > 0:24:26to provide that service?These are issues that have focused people's
0:24:26 > 0:24:30minds at the moment. I will take that away and come back with some
0:24:30 > 0:24:36thoughts when I have looked into it carefully.Thank you, Mr Speaker.
0:24:36 > 0:24:42Further to the response to my honourable friend for Liverpool with
0:24:42 > 0:24:46a tree I feel the Secretary of State has not been clear with the House.
0:24:46 > 0:24:53Will we get more money in the budget Simon Stevens has asked for or not?
0:24:53 > 0:24:56I'm afraid she will have to wait until the Chancellor delivers his
0:24:56 > 0:25:03budget. There are large financial pressures on the NHS. What I would
0:25:03 > 0:25:08say is if you look at the record of this government, we inherited a
0:25:08 > 0:25:16financial recession, but unlike her party, we reviewed to cut spending
0:25:16 > 0:25:21on the NHS. Now we are increasing it.Number six, Mr Speaker.
0:25:26 > 0:25:30Me now on, Mr Speaker. Improving Claire -- care for people with lung
0:25:30 > 0:25:36disease is crucial and we want continued action to increment the
0:25:36 > 0:25:39existing plans, including the NHS have come framework, detailing
0:25:39 > 0:25:44extra-plural Sierras and including reducing respiratory deaths as a key
0:25:44 > 0:25:51indicator. That includes implement in polity standards on fibrosis,
0:25:51 > 0:25:54asthma and chronic disease and a pilot to improve care of
0:25:54 > 0:26:00breathlessness.I think Rob Lee more needs to be done. Last month I
0:26:00 > 0:26:05launched the foundation report into pulmonary fibrosis. -- probably more
0:26:05 > 0:26:12needs to be done. It is still commonplace for people with IPF. As
0:26:12 > 0:26:16it is for people with other conditions. Will he meet with myself
0:26:16 > 0:26:20and the British Lung foundation, who will lead a task force for long
0:26:20 > 0:26:24health and establish what more can be done to address the issue?I
0:26:24 > 0:26:30thank her for that. He speaks with passion about this. I know she has
0:26:30 > 0:26:34tragic special -- she speaks with passion about this and I know she
0:26:34 > 0:26:40has tragic personal experience. One of the priority areas as I said is
0:26:40 > 0:26:44set out in the outcome framework, reducing early death from
0:26:44 > 0:26:49respiratory disease such as IPF. I understand the cases have risen in
0:26:49 > 0:26:52recent years and it is rightly a cause for concern. She is right to
0:26:52 > 0:26:56raise it and I look forward to meeting with her.I have long
0:26:56 > 0:27:01supported COPD related groups in my constituency in Northern Ireland.
0:27:01 > 0:27:07What help is he offering voluntary groups and families? Especially for
0:27:07 > 0:27:11the tens of thousands of young children diagnosed as asthmatic in
0:27:11 > 0:27:17terms of offering help and assistance with their condition?
0:27:17 > 0:27:23stop respiratory illness affects one in five people in the UK. It is
0:27:23 > 0:27:27responsible for a million hospital admissions annually. It is in our
0:27:27 > 0:27:32interest to implement the outcomes framework. I look forward to further
0:27:32 > 0:27:39discussions with him and very happy to meet with him if he wishes.Does
0:27:39 > 0:27:42the Minister, who I know cares deeply, share my concern that when
0:27:42 > 0:27:46lung capacity is damaged in childhood it can often never
0:27:46 > 0:27:50recover? Isn't that a powerful reason we need to make significant
0:27:50 > 0:27:56progress on air quality issues? Absolutely. I have just returned
0:27:56 > 0:27:59from the G7 health ministers meeting. One of the subject under
0:27:59 > 0:28:04discussion was environmental factors and climate change and its impact on
0:28:04 > 0:28:08public health. There were many areas in which we have challenging
0:28:08 > 0:28:12discussions, but the air quality and its impact on respiratory disease
0:28:12 > 0:28:22was not one of them.I gather it was in Rome, is that correct?Milan.
0:28:22 > 0:28:28Sharon Hodgson.Under this government we have seen lung disease
0:28:28 > 0:28:35admissions to A&E double, rise at double the rate of general
0:28:35 > 0:28:39admissions. This is more concerning when the bulk of admissions happen
0:28:39 > 0:28:43over the winter months, when A&E department are under significant
0:28:43 > 0:28:46pressure. Will the Minister committed today, now, to introduce a
0:28:46 > 0:28:52long disease strategy, and ensure that we can reverse -- reverse these
0:28:52 > 0:29:00worrying trends and the pressure on people's lives and the NHS?Indeed
0:29:00 > 0:29:04Milan but we don't mention football any more. I hear it is a touchy
0:29:04 > 0:29:11subject. Very topical. There is no new plan for any National strategy
0:29:11 > 0:29:15on this but we work closely with charities like the British Lung
0:29:15 > 0:29:20foundation, and we have to remain committed to implementing the
0:29:20 > 0:29:23outcomes framework. We are better prepared for a winter than we have
0:29:23 > 0:29:33been before. She's right to raise this.Question seven.With
0:29:33 > 0:29:37permission I will take question seven and 20 together. We are fully
0:29:37 > 0:29:43engaged with the highest level of government work on Brexit. The
0:29:43 > 0:29:46Secretary of State is a member of the Cabinet committee on Brexit and
0:29:46 > 0:29:51is engaged on all areas where Brexit may impact health and social care.
0:29:51 > 0:29:56We are actively considering implications on the workforce,
0:29:56 > 0:30:01medicine, equipment regulation, life sciences, public health, research
0:30:01 > 0:30:08and data.I thank the Minister for his reply. Is he aware of the latest
0:30:08 > 0:30:13figures released this month from the nursery and midwifery Council which
0:30:13 > 0:30:19confronts a clear trend? The number of nurses and midwives leaving the
0:30:19 > 0:30:24register alongside a drop of those coming to work from Europe. Does he
0:30:24 > 0:30:28agree these dramatic figures should set alarm bells ringing in Whitehall
0:30:28 > 0:30:34and every UK health Department?It is the case that we have been
0:30:34 > 0:30:39reliant for much of the increase in this country, both doctors and
0:30:39 > 0:30:45nurses, on doctors and nurses coming from the EU. A reduction in that
0:30:45 > 0:30:48increase is something we are watching carefully. I gently say to
0:30:48 > 0:30:55the honourable gentleman that the last figures we had at the end of
0:30:55 > 0:30:59June, there were three South -- 3000 more technicians working in the NHS
0:30:59 > 0:31:04in England than in the gym before. Brexit may well result in the loss
0:31:04 > 0:31:12of both rights for people with disabilities. Wembley release the
0:31:12 > 0:31:20funds into the health and social care sector? -- when will the
0:31:20 > 0:31:22Minister release?The honourable gentleman is looking for answers
0:31:22 > 0:31:26about the social care. My honourable friend, the Minister for social
0:31:26 > 0:31:30care, has made it clear they will be a paper published in due course. I'm
0:31:30 > 0:31:36afraid he will have to be more patient.
0:31:36 > 0:31:38My right honourable friend, the Secretary of State, Eddie made a
0:31:38 > 0:31:41welcome statement about the contribution of EU citizens to the
0:31:41 > 0:31:46health and social care sector. Could the Minister kindly advise us what
0:31:46 > 0:31:50is being done at a trust level to support overseas workers from the EU
0:31:50 > 0:31:54and elsewhere to ensure they feel welcome, and that they are
0:31:54 > 0:32:00encouraged to stay here as long as possible?I am very grateful to my
0:32:00 > 0:32:02honourable friend forgiving me the opportunity to reaffirm the
0:32:02 > 0:32:06commitment of the NHS from the centre right through every
0:32:06 > 0:32:10organisation for whom EU citizens are working, but they are welcome
0:32:10 > 0:32:15here, my right honourable friend, the member for Holden price
0:32:15 > 0:32:20yesterday made it clear that we are looking to have a simple,
0:32:20 > 0:32:23straightforward and cheap means for those who are here at the point of
0:32:23 > 0:32:27departure to be able to register to stay here. We want to encourage all
0:32:27 > 0:32:31those working for the NHS to continue to do so, wherever they
0:32:31 > 0:32:43come from.A visit to the hospital in April to Kettering Hospital
0:32:43 > 0:32:47confirmed that... Isn't it the case and it has always been the case the
0:32:47 > 0:32:50NHS has recruited from outside the EU and will continue to do so after
0:32:50 > 0:32:57Brexit?My honourable friend is quite right. There has been a
0:32:57 > 0:33:03long-standing tradition of this country welcoming professionals from
0:33:03 > 0:33:05outside through various waves of migration that go back over several
0:33:05 > 0:33:13decades. It is important to point out to my honourable friend that the
0:33:13 > 0:33:16Secretary of State announced one year ago a 25% increase in doctors
0:33:16 > 0:33:21in training in this country, and earlier this autumn a 25% increase
0:33:21 > 0:33:25in nurses to be trained in this country come so that we become less
0:33:25 > 0:33:29reliant on overseas clinicians at a time of some 2 million shortage
0:33:29 > 0:33:35worldwide.Being a member of the European medicines agency has
0:33:35 > 0:33:42allowed early access for UK patients to new drugs. It also plays a
0:33:42 > 0:33:47crucial role in quality control and safety monitoring. So what solution
0:33:47 > 0:33:52has the department come up with to ensure timely access to new drugs
0:33:52 > 0:33:58after Brexit? But also, that any convocations are spotted early?As I
0:33:58 > 0:34:03indicated in my answer to the first question earlier, finding an
0:34:03 > 0:34:09appropriate relationship with the DMA pulsed Brexit is one of the core
0:34:09 > 0:34:14strands of work the Department is doing. On Monday of next week the
0:34:14 > 0:34:19other EU nations will vote to decide which country will host the new EEM
0:34:19 > 0:34:27eight. We have made clear we are looking for mutual recognition.With
0:34:27 > 0:34:32the World Trade Organisation not having updated its drug lists since
0:34:32 > 0:34:362010, all new drugs developed in the last seven years could incur
0:34:36 > 0:34:41tariffs. What contingencies have been made to avoid shortages and
0:34:41 > 0:34:50increase costs in the event of a no deal Brexit?We are looking for a
0:34:50 > 0:34:55relationship with the EU to ensure we have tariff free access to the
0:34:55 > 0:34:58single market, including for drugs and medicines, because that is such
0:34:58 > 0:35:05a critical element of our economy and the life sciences industry.
0:35:05 > 0:35:08There are contingencies being put in place in the event of no deal. She
0:35:08 > 0:35:14will have to wait, as will the rest of us, to see of that eventuality
0:35:14 > 0:35:20happens. We don't want that to occur. It is not our intent.Adult
0:35:20 > 0:35:27smoking prevalence is now 15.5%, the lowest ever. In July, we published a
0:35:27 > 0:35:31tobacco control plan for England which sets out conditions to reduce
0:35:31 > 0:35:34smoking still further and commits us to a series of actions to deliver
0:35:34 > 0:35:41those ambitions. Our end goal is a smoke-free generation.I thank my
0:35:41 > 0:35:44honourable friend for that answer. One of the most effective ways of
0:35:44 > 0:35:48helping people to give up smoking is the provision of smoking cessation
0:35:48 > 0:35:55services. In Harrow, where the local unit actually managed to help 4000
0:35:55 > 0:36:00people attempt to give up smoking, of which more than 50% did so, the
0:36:00 > 0:36:05answer to that has been to close the unit, which I think is very
0:36:05 > 0:36:08ineffective. Will you take action to ensure that doesn't happen across
0:36:08 > 0:36:14the country?He's right to raise it. Local authorities are best placed to
0:36:14 > 0:36:18take local spending decisions, not ministers in Whitehall. But they
0:36:18 > 0:36:23must be accountable for their decisions. That is why we publish
0:36:23 > 0:36:26information at local authority level, so local decision-makers can
0:36:26 > 0:36:29be held to account. We offered expert support from Public Health
0:36:29 > 0:36:33England. In holding Harrow to account, I have a strong feeling he
0:36:33 > 0:36:40will continue to do that.I am a reformed smoker. It was quite a
0:36:40 > 0:36:44battle to do it. I wonder what proposals Her Majesty's government
0:36:44 > 0:36:54have to enlist people to help to kick the weed. We know how to do it.
0:36:54 > 0:37:02What an honourable gentleman he is. What an offer! Plans in all areas
0:37:02 > 0:37:07are two draw up local plans across the NHS, including the public health
0:37:07 > 0:37:10prevention agenda. I suggest he volunteered his services and I
0:37:10 > 0:37:21suspect they will take his hand off. Jackie Doyle-Price.On November the
0:37:21 > 0:37:243rd we published our response to the accelerated access review. We set
0:37:24 > 0:37:31out to give patients quicker access to life-saving treatments. We are
0:37:31 > 0:37:39delighted that Sir Andrew witty will chair the group, which will
0:37:39 > 0:37:45fast-track products each year. The technologies used at the new
0:37:45 > 0:37:51Natal unit are now considered essential by my constituents
0:37:51 > 0:37:55Invergordon. It serves 500,000 people within 90 minutes of
0:37:55 > 0:37:59Aberdeen. What assessment has the Minister made of the importance of
0:37:59 > 0:38:06proximity to local communities?I'm pleased to hear that. It is good to
0:38:06 > 0:38:10know we are on track to achieve our ambition to reduce the rates of
0:38:10 > 0:38:16stillbirth, neonatal and maternal deaths, as well as perinatal 20% by
0:38:16 > 0:38:202020. Innovations like Aberdeen have contributed to this. It is important
0:38:20 > 0:38:24that our regional committees have access to specialist care of the
0:38:24 > 0:38:35kind he describes.Is the Minister aware that over 60% of health
0:38:35 > 0:38:39innovation research funding goes to the Golden Triangle, and less than
0:38:39 > 0:38:4413% goes to the North? Given that Manchester and the north-west has
0:38:44 > 0:38:51got a life sciences hub and we have got an evolution of health, isn't it
0:38:51 > 0:38:54about time we got our fair share to ensure we can close the gap with
0:38:54 > 0:39:00some of those health outcomes?I can't disagree with the point of the
0:39:00 > 0:39:04honourable lady makes. One of the reasons that we have said up this
0:39:04 > 0:39:08accelerated access review and Patrick is to make sure we do invest
0:39:08 > 0:39:12where innovation is taking place, and there is no reason why
0:39:12 > 0:39:23Manchester cannot be a part of this. Mr Speaker... It goes back a long
0:39:23 > 0:39:36way. Mr Speaker... One of the innovative treatments being offered
0:39:36 > 0:39:41in my own constituency, which concerns me, is that of puberty
0:39:41 > 0:39:45blockers and hormone replacement therapy for children identifying
0:39:45 > 0:39:49themselves as transgender. Does the Minister agree that an improvement
0:39:49 > 0:39:59would mean restricting these two under 18s? --?.At the risk of
0:39:59 > 0:40:03prolonging the hilarity, my honourable friend does in fact
0:40:03 > 0:40:09raises serious point. Health is a devolved matter in Wales. The NHS in
0:40:09 > 0:40:13England has strict guidelines regarding the restrictions on
0:40:13 > 0:40:15puberty blockers and hormone replacement therapy. They may only
0:40:15 > 0:40:21be prescribed by a multidisciplinary team and careful assessment of the
0:40:21 > 0:40:25individual, and we keep a watching eye on these matters.Liberal
0:40:25 > 0:40:37Democrat competition.Jo Swinson. Thank you, Mr Speaker. A strong UK
0:40:37 > 0:40:41pharmaceuticals industry is important for ensuring the NHS can
0:40:41 > 0:40:44access innovative treatments, but there is uncertainty over whether UK
0:40:44 > 0:40:48qualified persons, people who certified medical products and
0:40:48 > 0:40:51devices as safe, would be able to continue to do so for European
0:40:51 > 0:40:57countries post Brexit Allsup I would ask the Minister will when will
0:40:57 > 0:41:01there be clarity about the future European relationships regarding
0:41:01 > 0:41:06medical advice approval?I can confirm we have actual offered
0:41:06 > 0:41:09mutual recognition but she is right to raise this very important
0:41:09 > 0:41:16subject. It is central to this that we maintain safety across the NHS
0:41:16 > 0:41:20and access to pharmaceuticals is part of this.
0:41:20 > 0:41:23Ministers have had no such discussions. The procurement of
0:41:23 > 0:41:28local health services by means of competitive tendering is a matter
0:41:28 > 0:41:32for the local clinical commissioning group. Greenwich clinical
0:41:32 > 0:41:34commissioning group is an independent statutory organisation
0:41:34 > 0:41:38responsible for commissioning services from local people. To
0:41:38 > 0:41:49ensure the best outcomes... That is an incredibly complacent
0:41:49 > 0:41:53response from the Minister. This has gone up by 14% in six months, the
0:41:53 > 0:41:59cost of this contract allocated to a private divider. They claimed that
0:41:59 > 0:42:03the Greenwich scrutiny committee was due to a 14% increase in the tariff
0:42:03 > 0:42:08costs of health services. My local health care trust says that is 0.6%.
0:42:08 > 0:42:11How does he explain that increase and why isn't the department looking
0:42:11 > 0:42:15into these private companies that are naming their price when they
0:42:15 > 0:42:21have won the contract?
0:42:21 > 0:42:28It is a factual answer and I think it is an important one to make.
0:42:28 > 0:42:31Actually it increases in tariff and it would have applied any provider
0:42:31 > 0:42:36and not just circle. I'm Sapporo -- I am sorry he does not support this.
0:42:36 > 0:42:44I understand previous services were delivered by a number of providers.
0:42:44 > 0:42:49And different patient experience. I think it is a step forward.Question
0:42:49 > 0:42:5611, Mr Speaker.After the Prime Minister announced an independent
0:42:56 > 0:43:01enquiry into the effects of blood, the department consulted on that
0:43:01 > 0:43:04enquiry and the Cabinet office updated the House on the 3rd of
0:43:04 > 0:43:08November and said it would be a statutory enquiry under the 2005 act
0:43:08 > 0:43:12and the Cabinet office would be the sponsoring department. The business
0:43:12 > 0:43:16service authority started administering the new blood payment
0:43:16 > 0:43:24support scheme on the 1st of November.Mike Amesbury.From April
0:43:24 > 0:43:31next year those affected by contaminated blood, including people
0:43:31 > 0:43:35in my constituency, could face considerable cuts in discretion of
0:43:35 > 0:43:39support as the business service authorities could not reveal this.
0:43:39 > 0:43:43Will the Minister give a guarantee that absolutely nobody will be left
0:43:43 > 0:43:49worse off as part of this review?I can give the honourable gentleman
0:43:49 > 0:43:53that assurance and that will form part of the statement I gave on the
0:43:53 > 0:43:57response to the consultation we undertook earlier.Discretionary
0:43:57 > 0:44:02payments will be maintained. The Minister will be aware the integrity
0:44:02 > 0:44:05of blood products is underpinned by a common European agreement on
0:44:05 > 0:44:09standards. Can she assure the House she has spoken to other ministers
0:44:09 > 0:44:13across Europe to make sure whether or not there is a deal that
0:44:13 > 0:44:19standards will be fully maintained subsequent to Brexit?I can confirm
0:44:19 > 0:44:24that is very much part of the discussions we are having. In truth,
0:44:24 > 0:44:27the common standards are shared across Europe in any case and we
0:44:27 > 0:44:37will continue.Question number tell world, Mr Speaker. -- number 12.The
0:44:37 > 0:44:41response of the expert working group on hormone pregnancy tests will be
0:44:41 > 0:44:44published tomorrow. There will be a ministerial statement with a copy of
0:44:44 > 0:44:50the report. It follows a review of all available data by a panel with
0:44:50 > 0:44:57expertise in science and health care.I will come the minister's
0:44:57 > 0:45:00statement. But there are some questions about the opaque nature of
0:45:00 > 0:45:07the enquiry and many constituents of mine have had lives blighted as have
0:45:07 > 0:45:11many others by the hormone pregnancy drug. Will he appeared before the
0:45:11 > 0:45:16select committee and look at the way that enquiry was conducted? Will he
0:45:16 > 0:45:20consider a public enquiry so families can get truth and justice
0:45:20 > 0:45:28about how they had been affected by this drug?I thank her for that. I
0:45:28 > 0:45:32think it would be premature to consider issues of liability before
0:45:32 > 0:45:35considering the strength of evidence and seeing the report which we will
0:45:35 > 0:45:42study carefully. The report will conclude whether there is a casual
0:45:42 > 0:45:46association and if it had adverse outcomes to pregnancy and we look
0:45:46 > 0:45:49forward to seeing its outcomes and recommendations.Number 13, Mr
0:45:49 > 0:45:56Speaker.There is no fixed timetable for STPs to become accountable care
0:45:56 > 0:46:03systems. Evolution into one or more is dependent on an STP demonstrating
0:46:03 > 0:46:07it is working in a locally integrated health system.
0:46:07 > 0:46:09Commissioners and providers in partnership with local authorities
0:46:09 > 0:46:14would need to choose, to assume collective responsibility, for
0:46:14 > 0:46:19resource and public health and the criteria will be set out in the NHS
0:46:19 > 0:46:26England next steps forward review. Last week NHS doctors set out to
0:46:26 > 0:46:28account for a judicial review against plans to use secondary
0:46:28 > 0:46:35legislation to enable private companies to run large parts of the
0:46:35 > 0:46:41ACOs. The county care organisations. I think the Government understands
0:46:41 > 0:46:44that doctors, nurses, patients and the public would like an NHS run for
0:46:44 > 0:46:49the public by the public, using public funding. Ultimately will you
0:46:49 > 0:46:56make sure we have time in this place for members to discuss and
0:46:56 > 0:47:00scrutinise the ACOs which are a drastic change to our NHS?I think
0:47:00 > 0:47:06the best thing he can do in getting to understand what STPs are really
0:47:06 > 0:47:10about is to talk to the recently appointed chair of the Norfolk and
0:47:10 > 0:47:14Waverley STP covering his local area. It will find the former Labour
0:47:14 > 0:47:19Secretary of State can give him very good advice, Patricia Hewitt.Number
0:47:19 > 0:47:2714, Mr Speaker.Thank you again, Mr Speaker. NHS England has a duty to
0:47:27 > 0:47:30commission dental services to meet local needs, including for the most
0:47:30 > 0:47:34deprived groups. Nationally access continues growing with 1.9 million
0:47:34 > 0:47:39more patients seen between 2010 and 2016. The starting well programme,
0:47:39 > 0:47:44I'm sure she is aware of, will help children under five and in 13, high
0:47:44 > 0:47:47need areas, the programme is also working to improve access and oral
0:47:47 > 0:47:54health.In my constituency seven people per day are going into
0:47:54 > 0:47:58accident and emergency because of toothache. The poorest among stars
0:47:58 > 0:48:03are twice as likely to be hospitalised for dental care. Yet
0:48:03 > 0:48:06there is no mention of dental care in the five-year forward planning
0:48:06 > 0:48:13and funding has fallen by 15% since 2010. Why is the minister leaving my
0:48:13 > 0:48:18constituents in pain and burdening accident and emergency by neglecting
0:48:18 > 0:48:24dental care?I am interested to hear the honourable lady say that.
0:48:24 > 0:48:29According to the survey the January- March 2017 survey, they were
0:48:29 > 0:48:33published in July this year those trying to get a dental appointment
0:48:33 > 0:48:36in Newcastle and Gateshead, 97% were successful compared to 95% England
0:48:36 > 0:48:46average.Topical questions, Stuart C McDonald.As well as congratulating
0:48:46 > 0:48:49the Minister for Public health for being an excellent ambassador for
0:48:49 > 0:48:52the United Kingdom happy health Summit in Milan, I would also like
0:48:52 > 0:48:59to congratulate Colchester NHS foundation trust for exiting special
0:48:59 > 0:49:03measures. They are the 23rd trust to do so. They were in special mazes
0:49:03 > 0:49:08longer than any other trust and the fact they got a good rating for
0:49:08 > 0:49:11compassion and the effectiveness of their care and leadership is a huge
0:49:11 > 0:49:16tribute to the hard-working staff. Back in July ministers said they
0:49:16 > 0:49:20would make sure patient access to innovative medicine was protected
0:49:20 > 0:49:23through strong regulatory framework and sharing data. Can he confirm the
0:49:23 > 0:49:27UK will definitely sign up to the clinical trial regulation system so
0:49:27 > 0:49:30we do not have to seek pharmaceutical companies moving
0:49:30 > 0:49:37trials overseas?That is absolutely our intention. We have signalled to
0:49:37 > 0:49:39the European Union and European countries we want the closest
0:49:39 > 0:49:43possible relationship after Brexit. We have made the big and generous
0:49:43 > 0:49:50offer and we hope it will be accepted.Thank you, Mr Officer
0:49:50 > 0:49:55Dibble Speaker. In my constituency we had the outstanding rated wording
0:49:55 > 0:50:00hospital and practices and also the Sussex and Surrey STP, rated in
0:50:00 > 0:50:04category four, needs most improvement. Part of the problem is
0:50:04 > 0:50:08it is too big and does not follow a natural footprint. Will he bought a
0:50:08 > 0:50:12local call for it to be withdrawn and make it fit for purpose and
0:50:12 > 0:50:18sustainable? -- will he support a local call.STP footprints were as a
0:50:18 > 0:50:24result of discussion with NHS England and reflect patient flow,
0:50:24 > 0:50:26the location of different organisations in the health economy
0:50:26 > 0:50:31and natural geography. We stayed at the next steps that it was open to
0:50:31 > 0:50:34discussion between ourselves and NHS England about adjusting boundaries
0:50:34 > 0:50:37where there was a collective request by local organisations and we mean
0:50:37 > 0:50:47that.Thank you, Mr Speaker. Last month there was a closure of 190
0:50:47 > 0:50:53community pharmacies. It was clear that this action was a result of
0:50:53 > 0:50:56pharmacy budgets. Does the Minister had any idea how many community
0:50:56 > 0:51:01pharmacies are at risk of closure because of government cuts? What
0:51:01 > 0:51:04assessment has he made of the likely impact of a closure on the patience
0:51:04 > 0:51:09and wider NHS? Will he joining me in asking the Chancellor to adequately
0:51:09 > 0:51:16fund this vital service? -- will he be joining me.She will have to wait
0:51:16 > 0:51:19for the budget as everybody else. We monitor the market carefully in the
0:51:19 > 0:51:24community pharmacy sector. Access to pharmaceutical services is very good
0:51:24 > 0:51:28in England, with 88% of people falling within a 20 minute walk of a
0:51:28 > 0:51:32community pharmacy. For areas with fewer pharmacies, the access scheme
0:51:32 > 0:51:37continues to provide more protection and a growing number of Internet
0:51:37 > 0:51:41pharmacies offer greater choice. Pharmacies are a critical part of
0:51:41 > 0:51:45the primary care infrastructure in the country.Thank you, Mr Speaker.
0:51:45 > 0:51:49Months ago a hospital came out special measures with improvements
0:51:49 > 0:51:51to patient safety being among the most notable highlights in the
0:51:51 > 0:51:56report. Given the success in my local area can my honourable friend
0:51:56 > 0:51:59and former house of progress E is making to boost patient safety
0:51:59 > 0:52:05across the rest of the country?I am happy to do that. I had a very good
0:52:05 > 0:52:09visit to Medway recently. Leslie Dwyer and her team are doing a
0:52:09 > 0:52:14fantastic job. They had real challenge is to turn the trust
0:52:14 > 0:52:18around but succeeded and the staff did amazingly well. In truth we
0:52:18 > 0:52:24still have far too high levels of avoidable harm across the NHS. I
0:52:24 > 0:52:28want us to be the safest in the world and that is why the next few
0:52:28 > 0:52:30months we will have campaigns to improve maternity safety, deal with
0:52:30 > 0:52:35medication error and improve the transparency when there are
0:52:35 > 0:52:43avoidable deaths.Can I raise the issue of mesh implants? It has been
0:52:43 > 0:52:48great with me by constituents. A report in the United States
0:52:48 > 0:52:51indicates associated pain, headaches and aching pains and joints, can I
0:52:51 > 0:52:54ask if he is looking at this issue and incident giving the announcer
0:52:54 > 0:52:58saying it is a matter for the devolved administration, it would be
0:52:58 > 0:53:00instructive if I could get an answer because it would help inform the
0:53:00 > 0:53:06Scottish government, Aggie.He raises an issue which is of concern
0:53:06 > 0:53:10to many women up and down the country. -- thank you. Nobody could
0:53:10 > 0:53:16not be moved by the injuries they are experiencing. We now have 18
0:53:16 > 0:53:20centres of specialist care which can treat those women. The advice we
0:53:20 > 0:53:28still receive is within narrow cases are stressing, mesh remains the best
0:53:28 > 0:53:31possible string that. It will be kept under review and I know my
0:53:31 > 0:53:35honourable friend is meeting the all-party group to consider this in
0:53:35 > 0:53:40greater detail.The James Paget Hospital at Gholston are doing great
0:53:40 > 0:53:44work under great pressure and have highlighted the Clinical
0:53:44 > 0:53:47Commissioning Group have got two different regulators. Does my
0:53:47 > 0:53:50honourable friend agree it would be sensible to have one body overseeing
0:53:50 > 0:53:54both organisations, to avoid duplication and redirect funding to
0:53:54 > 0:54:00the front line?He makes a very important point. We have no plans
0:54:00 > 0:54:06for legislative change. But we do want closer working between NHS
0:54:06 > 0:54:11improvement and NHS England on the ground so people working in
0:54:11 > 0:54:14constituencies in areas such as his are only getting one set of
0:54:14 > 0:54:20instructions and we are making good progress.I have repeatedly asked
0:54:20 > 0:54:24and yet again I ask the Secretary of State if he will visit my area to
0:54:24 > 0:54:29see for himself the damaging impact the downgrades and closure of local
0:54:29 > 0:54:31hospital services in Dewsbury and Huddersfield will have on my
0:54:31 > 0:54:40constituents will stop I'm very happy to -- --.I'm happy to accept
0:54:40 > 0:54:45our invitation to visit her area and I will do. What I know I will see
0:54:45 > 0:54:49when I go there is the right 8300 more people being treated within
0:54:49 > 0:54:54four hours at her local hospital. There are 42 more doctors and 56
0:54:54 > 0:55:01more nurses than 2010.Thank you. Can I thank the Secretary of State
0:55:01 > 0:55:07for the help he gave for my hospital in my constituency? One problem is
0:55:07 > 0:55:10Somerset pays the lowest amount of money to keep people in homes in the
0:55:10 > 0:55:15peninsular. That is putting more people into the hospital. Can he
0:55:15 > 0:55:20offer advice on how we can get round this issue?I am happy to do that.
0:55:20 > 0:55:24It is very straightforward. We listened hard when local authority
0:55:24 > 0:55:29said they needed more support for the social care budget and put an X
0:55:29 > 0:55:34to £2 billion into this year's budget. -- extra £2 billion. Expect
0:55:34 > 0:55:37all local authorities to play their part in reducing pressure on
0:55:37 > 0:55:43hospitals.If the health secretary does visit Huddersfield and
0:55:43 > 0:55:52Dewsbury, can I join the party? I know he wants... I will not spoil
0:55:52 > 0:55:58his visit but I would remind him I would liken to meet our local Vice
0:55:58 > 0:56:01Chancellor, at the teaching hospital in Huddersfield, they would be
0:56:01 > 0:56:05interested if the money was available to start one up. Will he
0:56:05 > 0:56:09meet my Vice Chancellor when he comes you Dewsbury and Huddersfield?
0:56:09 > 0:56:14I met him on June the 24th last year. He is a splendid chap.I would
0:56:14 > 0:56:19be delighted to meet his Vice Chancellor in principle but the
0:56:19 > 0:56:22decision of where the medical schools will be based will be
0:56:22 > 0:56:26independent of me, because I have a constituency interest in that issue,
0:56:26 > 0:56:33as well.Rural communities and towns like new without an accident and
0:56:33 > 0:56:36emergency desperately need a high performing ambulance service.
0:56:36 > 0:56:40Midlands ambulance services across the country are generally missing
0:56:40 > 0:56:45their targets. It is not a new problem. It began when Labour's
0:56:45 > 0:56:48disastrous regionalisation of Andy Lynch and services was put in place.
0:56:48 > 0:56:55But it needs to end an improvement is replied. -- required. -- of
0:56:55 > 0:57:01ambulance services was put in place. I am aware the performance of east
0:57:01 > 0:57:05Midlands ambulances is not what we would like at present. The strategy
0:57:05 > 0:57:10being adopted is to introduce the new and villains response programme
0:57:10 > 0:57:15and at present there is a consultation with staff going on to
0:57:15 > 0:57:20introduce new working models to bring that into effect. -- the new
0:57:20 > 0:57:26facilities response programme.Does he share my concern that Lloyds
0:57:26 > 0:57:29pharmacy is announced 190 branch closures across England because of
0:57:29 > 0:57:37funding cuts, exacerbated by rising drug costs and cash row problems --
0:57:37 > 0:57:44flow problems? And why is it 30% of pharmacies in one constituency can
0:57:44 > 0:57:53get the access scheme but only 1.3% in Hull can do the same?
0:57:53 > 0:57:57It is a rural constituency. She asked me about the Lloyds pharmacy
0:57:57 > 0:58:03announcement. When I first heard that news my thought was not to play
0:58:03 > 0:58:08politics but for the staff affected. As I said at the all-party group,
0:58:08 > 0:58:13Lloyds have made a commercial decision. We don't yet know which
0:58:13 > 0:58:19pharmacies will close. We do know that 40% of promises within a timid
0:58:19 > 0:58:24walk -- ten minute walk of two or others.
0:58:24 > 0:58:28There were GPs who prescribe homoeopathy and acupuncture and the
0:58:28 > 0:58:32system we have is that we allow GPs to decide whatever they think is in
0:58:32 > 0:58:36the clinical interest of their patients. Is that still his position
0:58:36 > 0:58:44and is he aware of the Parliamentary petition in favour of homoeopathy?
0:58:44 > 0:58:47Consistency personified. It is the responsibility of local NHS
0:58:47 > 0:58:51organisations to make decisions on the commissioning and funding of any
0:58:51 > 0:58:56health care treatments for NHS patients, including homoeopathy.
0:58:56 > 0:58:59Alternative medicine can in principle feature in a range of
0:58:59 > 0:59:06services offered including those by GPs.What safeguards will be
0:59:06 > 0:59:09Secretary of State put in place to ensure that NHS trusts do not
0:59:09 > 0:59:16finance the lifting of the pay cap by making staff cuts, downgrading
0:59:16 > 0:59:18roles are reducing terms and conditions under the guise of
0:59:18 > 0:59:24reforms?NHS trusts are under pressure to make very ambitious
0:59:24 > 0:59:30efficiency savings anyway. We have listened carefully to the case that
0:59:30 > 0:59:33they would not be able to make further efficiency savings to
0:59:33 > 0:59:39finance an increase in pay beyond the 1%.Congratulations for noticing
0:59:39 > 0:59:46it is actually me behind this extremely impressive facial growth
0:59:46 > 0:59:51for Alzheimer, which is extremely serious Bremain's mental health.
0:59:51 > 0:59:58Three out of four suicides... Willie Minister commit to renew this
0:59:58 > 1:00:02government's relentless pursuit of parity in mental health and physical
1:00:02 > 1:00:09health?Yes, indeed. The moustache is impressive. I am a big supporter
1:00:09 > 1:00:13of the cause because I think it has a positive mindset. It is very
1:00:13 > 1:00:17honest. One in eight men in the UK have experienced mental health
1:00:17 > 1:00:23problems, three adults four suicides are men. We welcome the which
1:00:23 > 1:00:29focuses on prostate cancer, testicular cancer and the
1:00:29 > 1:00:32partnerships they build with mental health services in the NHS and
1:00:32 > 1:00:35across the charity sector. I wish my honourable friend well with his
1:00:35 > 1:00:45growth.Wildie department urgently review waiting times targets for
1:00:45 > 1:00:53children to access mental health services? Even if cams in my
1:00:53 > 1:00:56constituency wrist -- achieves its targets, more than 100 children need
1:00:56 > 1:01:01to make more than nine weeks for their first appointment.She is
1:01:01 > 1:01:06absolutely right. That is totally unacceptable for anybody who is a
1:01:06 > 1:01:12parent. It is far too long. That is why we decided to have a Green paper
1:01:12 > 1:01:18on children's mental health and we hope to publish it soon.In their
1:01:18 > 1:01:21annual State of care report, the Care Quality Commission have
1:01:21 > 1:01:26highlighted there are 4000 fewer nursing home beds in England than in
1:01:26 > 1:01:302015. What plans does the Secretary of State have to address the
1:01:30 > 1:01:34workforce and funding issues that lie behind this? Will he meet with
1:01:34 > 1:01:39me to discuss the situation in my own constituency and nationally?I
1:01:39 > 1:01:42would like to congratulate her on becoming chair of the liaison
1:01:42 > 1:01:47committee. I am always happy to meet her. That is a very important issue.
1:01:47 > 1:01:51Our figures show the number of nursing home beds as distinct from
1:01:51 > 1:01:56the number of nursing homes is broadly stable. But there is real
1:01:56 > 1:02:03pressure, there are real issues around market failing.The South
1:02:03 > 1:02:09Cumbria area is one of the few places in England where patients
1:02:09 > 1:02:11needing the least complex radiotherapy must travel longer than
1:02:11 > 1:02:18the maximum 45 minutes recommended by the advisory group. In the
1:02:18 > 1:02:22consultation, which will close on the 18th of December, will you make
1:02:22 > 1:02:25sure that access to radiotherapy within 45 minutes is a Greek
1:02:25 > 1:02:33criteria in allocating resources? -- a key criteria.I'm grateful to the
1:02:33 > 1:02:36honourable gentleman for raising this point. I would just say to him
1:02:36 > 1:02:41that we are absolutely aware of the need for more radiographers and
1:02:41 > 1:02:43stenographers are available to support facilities right across the
1:02:43 > 1:02:49country. We currently have some 200 radiographers in training and I
1:02:49 > 1:02:54would like him to write to me so we can flag up the specific point he
1:02:54 > 1:03:04raises.Local A&E serving my constituents in Kent now have 24-7
1:03:04 > 1:03:07mental health services thanks to this government's determination to
1:03:07 > 1:03:11improve mental health care. Can my right honourable friend assure me
1:03:11 > 1:03:14that the government will fulfil its commitment to increase mental health
1:03:14 > 1:03:21spending by at least 1 billion by 2020?We are absolutely committed to
1:03:21 > 1:03:25that. We're spending 1.4 alien more than three years ago. There is more
1:03:25 > 1:03:31we need to invest. -- 1.4 million. For people who believe in parity of
1:03:31 > 1:03:34esteem, being able to get help quickly in a mental health crisis as
1:03:34 > 1:03:39quickly as you can go to A&E for a physical health crisis, is one of
1:03:39 > 1:03:45the big gaps we have to fill.I know the Secretary of State will be
1:03:45 > 1:03:52impressed and will eventually... However, I am very, very proud of
1:03:52 > 1:03:58the collaboration going on between Saint St Helens Council and the CCG
1:03:58 > 1:04:02and the hospitals. What is needed is additional resources. You will see
1:04:02 > 1:04:06the good news that is made of it. But they cannot deliver everything
1:04:06 > 1:04:13required without the additional resources. Will you help us, please?
1:04:13 > 1:04:18I recognise the picture. I did have an excellent visit to the hospital.
1:04:18 > 1:04:21They are doing some fantastic work on patient safety. Collaboration is
1:04:21 > 1:04:24better than it has been before between the partners and the local
1:04:24 > 1:04:27health economy but there are financial pressures. We will have a
1:04:27 > 1:04:33million more over 75s in ten years in this country, that is why we have
1:04:33 > 1:04:35committed to increase resources going into the NHS and the social
1:04:35 > 1:04:45care system. The NHS STP review in my region
1:04:45 > 1:04:49recently recommended all acute services be maintained at North
1:04:49 > 1:04:52Devon Hospital, a welcome decision and a victory for the community.
1:04:52 > 1:04:56With the minister work with me and local NHS managers to ensure the
1:04:56 > 1:05:04clinical need identified can be fully delivered?I share the
1:05:04 > 1:05:08ambition of the honourable gentleman. I much enjoyed visiting
1:05:08 > 1:05:11his hospital in Barnstable during the summer. I have been impressed by
1:05:11 > 1:05:17the way in which the four trust? In Devon providing acute services have
1:05:17 > 1:05:23decided to come together and provide a collaborative tool of their ED
1:05:23 > 1:05:28staff to ensure each hospital is adequately covered. That is a model
1:05:28 > 1:05:38we can adopt.The health committee heard attaining a diagnosis of
1:05:38 > 1:05:41autistic spectrum disorder can often be a postcode lottery. Wildie
1:05:41 > 1:05:49department now seek to publish data to ensure we know where trained
1:05:49 > 1:05:53clinicians are positioned across NHS England, to ensure that workforce
1:05:53 > 1:05:58planning is undertaken appropriately?I can give the
1:05:58 > 1:06:01honourable lady and assurance we will be publishing that data in the
1:06:01 > 1:06:06New Year. It is very important that we work hard to make sure that
1:06:06 > 1:06:11people can get a timely diagnosis. That means we are working to get
1:06:11 > 1:06:14referrals seen more promptly, but recognising that actually the time
1:06:14 > 1:06:20taken to give a full diagnosis will take some time.Recruitment and
1:06:20 > 1:06:26retention is just one reason why my hospital trust is currently going
1:06:26 > 1:06:31through the special measures process. With the Secretary of State
1:06:31 > 1:06:33pay tribute to the staff in Lincolnshire, and will you agree
1:06:33 > 1:06:37that part of the challenge they face on recruitment and retention will be
1:06:37 > 1:06:43solved via medical School in Lincolnshire?If I may say, that
1:06:43 > 1:06:49question was absolutely beautifully put! I have met the staff at Lincoln
1:06:49 > 1:06:54Hospital, having been to all the hospitals in the trust. Very nice to
1:06:54 > 1:07:01see the lady in her place! But indeed, one of the key priorities,
1:07:01 > 1:07:04wherever the new medical schools