Health Questions House of Commons

Hello, welcome to BBC Parliament's

live coverage of the House of

Commons. In an hour we will have an

emergency debate called by Labour MP

Dame Margaret Hodge on tax

avoidance. This follows the release

of the so-called Paradise Papers, a

Ligue two of financial documents

which have shown the offshore

financial dealings of

multinationals, celebrities and

public figures. The main business of

the day will be the first day of the

committee stage of the European

Union Withdrawal Bill. Brexit

Secretary David Davis announced

yesterday Parliament will have a

vote on the final document. First,

questions to the Health Secretary,

Jeremy Hunt, and his team of

ministers.

Minister of state, Mr Philip Dunne.

Local NHS organisations are

responsible for deciding the most

appropriate structures needed to

deliver to their patients.

Commissioners and regulators are

responsible to ensure that NHS

providers act in the interest of

patients and taxpayers. A theme in

review undertaken by Lord Carter

sought to drive efficiency through

sharing administrative functions

across NHS bodies in an area. A

number of trusts are creating the

right structures to do so. NHS

improvement is aware of 39

subsidiaries.

Does the Minister share my concern

that NHS trusts in Yorkshire are now

lining up to follow the example of

Airedale Hospital trust, which

recently, behind closed doors as

part of a VAT scam, said up

subsidiary company to run many of

its activities, which will not only

cost the Treasury but also mean that

new staff such as hospital porters

will no longer be unable -- NHS

terms and conditions?

I can reassure

the honourable gentleman that we

have no interest in allowing NHS

trusts to avoid their tax

responsibilities, and guidance was

sent to all trusts in September to

ensure that any to be transfers of

staff would continue to be subject

to NHS pension rules. It should not

be done for tax avoidance purposes.

What role does the Minister Sever

the private and voluntary sector in

the provision of services and

delivery in the future?

There have

been a continuing involvement of

private provision of health services

since the origins of the NHS when GP

partnerships came in to provide as

business -- Private businesses,

their services. The introduction of

competitive tendering to NHS

contract was introduced by the Last

Leg government, and the rate of

private provision under that

government grew more rapidly than

under this comment. -- the last

Labour government.

If the NHS providers said up

wholly-owned subsidiary, would the

minister expects to see all of those

papers in the public domain?

As I

said in answer to the honourable

gentleman, the trust which would

consolidate any subsidiaries in its

accounts would publish the accounts

of subsidiaries as part of their

consolidated accounts each year.

Mr

Speaker, on Sunday the Secretary of

State said good public services or

part of the capitalist economy, yet

trusts are so strapped for cash they

are providing... Several parts of

the NHS are subsidising these

trusts. There are also members of

staff who find they no longer work

for the NHS. This is another step

towards privatisation. What

protections are in place to prevent

any these companies from being sold

off to the highest bidder in the

future?

I'm afraid the honourable

gentleman, for whom I have

considerable respect, is trying once

again the tired old weaponising on

the NHS by alleging privatisation,

seeing privatisation ferries were

there aren't any. This is about

responding to Lord Carter... I may

remind him this is about responding

to the review into efficiency, which

I know he supports, and finding the

right structures to allow, for

example, back offices of different

NHS bodies in an area to be

combined. That requires a scripture.

And a number of trusts are providing

those services to each other through

subsidiaries.

The NHS needs more doctors, which is

why last year we announced one of

the biggest ever increases in

medical school places, 25% increase,

500 additional students will start

next year and a further thousand the

year after.

I'm pleased to hear the

department is working on addressing

these issues. Can we also look at

other difficulties specifically

facing rural areas? Local patient

transport is one of these. With

rural boss Max links thin on the

ground and struggling, will adequate

provision be made to ensure patients

will always access services they

need?

He is right to raise the

question. I visited Thornbury on

Friday and was discussing some of

these issues. The NHS has an

obligation to make sure that people

can access it services and indeed in

certain circumstances people are

entitled to funding to help them do

that. I thank him for raising the

issue and I know he will continue to

fight hard on that.

All four

witnesses who gave evidence to the

health committee enquiry last week

described the current situation as

unprecedented. Janet Davies, the

head of the royal corals -- the

Royal College of Nursing, said of

Brexit happens it would be

devastating. Does he accepted there

is no deal next month on the future

of EU nationals, the current stream

of workers in the NHS will become a

flood?

With respect, I don't think

it helps to reassure the brilliant

NHS professionals from the EU

working in the system when he asks

question like that. The reality is

they are staying in the NHS. And at

every opportunity I make sure that

they feel welcome, I try to stress

how important they are, how the NHS

would fall over without them, and

the government continues to make

every effort possible to secure a

deal for their future, which we are

confident we will achieve.

A&E is important to my constituency

and those of my neighbour. It is

also very important to me, having

saved my husband's life on two

occasions. Last August, it was close

overnight because there weren't

enough doctors to safely staff it.

There are enough doctors to safely

staff it. Unfortunately, NHS

improvement has interfered to stop

the reopening by at least one month.

Should Grantham Hospital be reopened

in December?

I am completely clear,

Leo said to her, I think in this

House, but I certainly said to her

colleague, who I'm delighted to see

in his place after an incredibly

brave battle against cancer, that

this was a temporary closure based

on difficulties in recruiting

doctors. I will take that issue and

look at it carefully.

Last winter,

we saw patients languishing on

trolleys and A&E first 12 hours. We

had the Red Cross called in. We had

people leaving A&E before their

treatment. Does the Secretary of

State accept this is absolutely

unacceptable this winter, and what

steps is he taking Miss Winter to

ensure this does not happen?

With

respect, we didn't have the Red

Cross called in, we contract with

the Red Cross throughout the year,

as she well knows as a senior

doctor. What happened last year was

not acceptable. We have done a huge

number of things. Perhaps the most

important thing is putting Annex £1

billion into the social care budget

for this year and a further billion

for next year. That is where

particular pressures war. We have

also helped improve A&E facilities.

A shortage of nurses has led to the

closure of the inpatient ward at

Shepton Mallet community Hospital

this winter. Can the Secretary of

State say something about what the

government has done to increase the

number of nurses Imrul areas, and

also encourage the Somerset

political commissioning group to

recommit itself to the future of

Shepton Mallet community hospital?

I

congratulate him for the close

interest he shows in his local

community hospital, because this

matters so much, not just to his

constituency, but to the NHS,

because this is where we discharged

a lot of people from busy district

General hospitals. He is right,

there has been a shortage of

nursing, and that is why we have

decided to increase the number of

nurse training places by 25%, the

biggest increase in the history of

the NHS.

Would the Secretary of

State consider bringing in a bursary

scheme by which young doctors would

have their student debt wiped after

five years in areas which have a

shortage of doctors?

Well, we have

introduced something similar, so

where there are areas that I found

it difficult to recruit GP trainees

for three years or more, we have

introduced a £20,000 salary

supplement to attract people. It has

been very successful. We have

expanded it to 200 places this year.

They have undertaken a consultation

to close the surgery on my

constituency against the wishes of

the local committee. Does my right

honourable friend agree that CCGs

have responsibilities to support

rural practices and should do all

they can to recruit GPs into rural

areas?

I do agree with her, and I

also know that in areas like

Wealden, despite the fact they are

useful areas to live, it can be

difficult to recruit people,

particularly to become new partners

in GP practices. And this is an area

we are concerned about. Nationally,

we have a plan to recruit 5000 more

doctors working in general practice

by 2020, 2021. But we need to make

sure they go to rural areas like

hers.

The Secretary of State will no there

are huge vacancies across the NHS,

particularly in nursing, partly

driven by pay restraint. He has said

the pay cap will be scrapped. Does

he agree with Simon Stevens, who

said it would be an goal not to

fully fund the scrapping of that pay

cap next week in the budget and

expected to be paid for productivity

gains?

I have been very clear. The

government is willing to be flexible

in terms of funding additional pay

beyond the 1% for nurses. But we do

want some important reforms to the

contracts they operate under. And if

those negotiations go well, and at

the moment we have been having very

constructive discussions with the

RCN, I'm hopeful we can get a deal

will

Can I ask about Simon Stevens

comments last week? He said waiting

list would rise to 5 million if this

continues, the cancer list would

deteriorate, the mental health

pledge will not be met, the 18 weeks

target will be permanently abandoned

and is it not the case in the budget

next week, if the Chancellor does

not allocate at least a nectar £6

billion per year for the NHS, he

will have failed in his

responsibility as secretary of

state? -- extra £6 billion.

What we

all noticed is when he came up with

his plan in 2014, Labour did not

back it. In the 2015 election they

did not agree to fund it, to the

June £5 billion more we were

prepared to put in and his refused.

He is quoting Simon Stevens and when

the British economy sneezes, the NHS

catches a cold and it would be far

worse than that for the NHS if we

had Labour's run on the pound. This

government has changed policy so

that all NHS patients will be able

to book routine GP appointments in

the evenings and weekends. We think

that is very important for NHS

patients. But also to relieve

pressure on accident and emergency

departments.

In September Jubilee

surgery, starving to medical

practice and Highlands practice

launched a same day access scheme

based at Fareham community Hospital

which welcomed the Secretary of

State on a visit last year.

Clinician led and supported by the

task force. Will he join me in

congratulating the GPs, including

Doctor Tom Bertram, leading this

scheme and the CCG and explain how

patients will gain access to a GP in

Fareham?

I was honoured to meet

them. I think Richard and his team

have done a fantastic job in

transforming services in a way

reducing pressure on local hospitals

and also really improving services

for local people. There was a real

buzz and I noticed in neighbouring

Gosport they have made changes

improving patient satisfaction to

90%, with 60% of issues dealt with

on the same day. Really exciting

things happening.

Pointon has fewer

queue -- full time GPs than 2010

despite a growth in population and

many GPs have quit the service

because of the pressure on them.

What will he do not only to attract

more people into the GP service, but

to keep those already there?

Very

important questions. I had an

excellent visit to Warrington

Hospital towards the end of the

summer and there are fantastic bits

of work I have seen here,

particularly on sepsis prevention.

The issues are firstly about getting

more medical school graduates to go

into general practice. This year we

think we will get 3019 medical

school graduates to go into general

practice, a record, it has never

been that high. It is also about

retention and looking at some of the

things frustrating GPs, including

the cost of indemnity, that

insurance policy. We have announced

we will move to a national scheme to

help control those costs.

One

village medical practice in my

constituency in Slade Byrne was

threatened some years ago and was

fortunately saved. It does

tremendous service for the local

community. Without it elderly

patients would tap to travel more

than 40 minutes to Clitheroe and is

no capacity. What will he do to make

sure places like Slade Byrne have a

future?

It is essential in rural

constituencies like his own we

continue to have active GP

practices. I noticed those practices

sometimes give the best care in the

whole of the NHS because they know

the people, their families and is

continuity of care and they are very

broad for the local community. I

congratulate him on what he did to

say that practice.

Is it right

constituency in Stroud had to wait

weeks to get an ordinary appointment

with their GP? Given the

sustainability and transformation

plans are now saying they will be an

acute sorted job GPs, what does he

intend to do about that?

-- shortage

of GPs. Nobody should have to wait

weeks for an appointment in Stroud

or anywhere else. We have a lack of

capacity in general practice, which

is why we decided to embark on a

plan for 5000 more doctors working

in general practice. One of the

biggest ever increases. I am afraid

it will take time to feed through

the system. But we are comfortable

we will deliver it.

Number four, Mr

Speaker.

Every week we have four

claims against the NHS for a brain

injured baby. There is still far too

much avoidable harm hand -- when it

comes to maternity services which is

why I launched an ambition to halve

the neonatal injury, and

stillbirths.

The Secretary of State

rightly focuses on the importance of

reducing infant mortality. With the

police investigating the unusually

high number of baby deaths in

Chester Hospital, can he update my

constituents with the progress of

the investigation and the measures

taken to make sure safety at the

Countess of Chester, which serves

the northern part of my

constituency?

First of all I thank

her for her campaign which I think

is something that has engendered

huge respect on all sides of the

House. With respect to that

particular investigation she will

understand I cannot comment on a

police investigation. Nonetheless,

immediately after the issues were

surfaced, safety measures were taken

so the hospital does not now provide

care for babies born before 32 weeks

and they are implementing 24

recommendations from the Royal

College of paediatrics and

childcare.

The shortfall in midwives

and the financial crisis in the NHS

threatens the safety, quality and

sustainability of midwifery

services. The words of the Royal

College of Midwives. How will he

with store -- restore the confidence

in the RCM and professional bodies?

He is right we need more midwives.

We have 6000 in training and 2000

more than we had in 2010. It is also

important to recognise the progress

they made. Stillbirth rates are down

14% over the first, between 2010 and

2015. Neonatal death down 10%. There

is important progress happening.

Will my honourable friend join with

me in congratulating my constituents

support group and the Royal College

of obstetricians and gynaecologists

on the update to the green top

clinical guidelines? I'm sure he

will agree they are a significant

step forward in preventing a wicked

and wholly unnecessary neonatal

infection will stop I am very happy

to offer my congratulations.

--. I

am very happy to. We have done very

well on this but we do have other

infections like group B macro which

are higher than they need to be and

I am in fact speaking on a

conference this afternoon and I am

happy to pass on my congratulations.

Only 57 set of maternity units in

England have accreditation compared

to 100% in Scotland and Northern

Ireland and 79% in Wales. What plans

does he had to increase

accreditation for all hospital

units?

Despite the rivalry which

sometimes happens between our

nations I have a lot of respect for

the patient safety initiatives in

Scotland and we will bad. We have

what we think is the most ambitious

plan to improve maternity safety

anywhere. -- and we will look at

that. It is one area where the

countries should work together.

Number five, Mr Speaker.

Very last

one from me, Mr Speaker. On mental

health, as you know, we have one of

the most ambitious plans to expand

mental health provision in Europe.

That means we need to recruit for an

extra 21,000 posts in the next three

years and plans are in place to do

that.

I thank the Secretary of State

for his encouraging answer. But can

I ask what that means specifically

for mental health provision and

mental health funding in the London

Borough of Croydon?

He is right to

challenge me on that. Because we are

asking all CCGs to increase funding

in real terms going into mental

health year in and year out. 85% of

CCGs are doing that and last year we

had an extra half £1 billion

reaching the front line for mental

health. Regrettably Croydon is not

among the 85%. Having listened to

his question I will take it away and

find out what happened.

How does the

Secretary of State expect to achieve

these plans to increase the mental

health workforce when only last week

the head of NHS England Simon

Stevens said, quite, on the current

outlook, it will be increasingly

hard to expand mental health

services? -- and I quote.

It is hard

because of the financial pressure on

the NHS to expand mental health

services in the last seven years but

we have succeeded. We have 4300 more

people working in mental health

trust. 1.4 billion more being spent

on mental health than three years

ago. We have a plan, it is a good

one and we will make sure it does

happen.

Thank you, Mr Speaker. I am

sure he would welcome the fact

cancer survival rates are at a

record high. Can he explain how the

Government will fund the latest

technology so we can continue to

stay ahead of this terrible disease?

I am grateful for the question from

my friend from Hitchin and

Harpenden. Compared to 2010, 150

more people are starting cancer

treatment every single day. That is

why there are 7000 people alive

today who would not have been if we

have the survival rates of five

years ago. But we are still behind

the Western European average. We

want to do something about this. A

big investment in capital equipment

is something we are prioritising

therefore.

Constituents in York have

experienced sexual trauma without a

clinical pathway in which to have

their psychological support address.

Therefore will be Secretary of State

take action in making sure we have a

national framework to support

particularly women as well has star

to provide that service?

These are

issues that have focused people's

minds at the moment. I will take

that away and come back with some

thoughts when I have looked into it

carefully.

Thank you, Mr Speaker.

Further to the response to my

honourable friend for Liverpool with

a tree I feel the Secretary of State

has not been clear with the House.

Will we get more money in the budget

Simon Stevens has asked for or not?

I'm afraid she will have to wait

until the Chancellor delivers his

budget. There are large financial

pressures on the NHS. What I would

say is if you look at the record of

this government, we inherited a

financial recession, but unlike her

party, we reviewed to cut spending

on the NHS. Now we are increasing

it.

Number six, Mr Speaker.

Me now on, Mr Speaker. Improving

Claire -- care for people with lung

disease is crucial and we want

continued action to increment the

existing plans, including the NHS

have come framework, detailing

extra-plural Sierras and including

reducing respiratory deaths as a key

indicator. That includes implement

in polity standards on fibrosis,

asthma and chronic disease and a

pilot to improve care of

breathlessness.

I think Rob Lee more

needs to be done. Last month I

launched the foundation report into

pulmonary fibrosis. -- probably more

needs to be done. It is still

commonplace for people with IPF. As

it is for people with other

conditions. Will he meet with myself

and the British Lung foundation, who

will lead a task force for long

health and establish what more can

be done to address the issue?

I

thank her for that. He speaks with

passion about this. I know she has

tragic special -- she speaks with

passion about this and I know she

has tragic personal experience. One

of the priority areas as I said is

set out in the outcome framework,

reducing early death from

respiratory disease such as IPF. I

understand the cases have risen in

recent years and it is rightly a

cause for concern. She is right to

raise it and I look forward to

meeting with her.

I have long

supported COPD related groups in my

constituency in Northern Ireland.

What help is he offering voluntary

groups and families? Especially for

the tens of thousands of young

children diagnosed as asthmatic in

terms of offering help and

assistance with their condition?

stop respiratory illness affects one

in five people in the UK. It is

responsible for a million hospital

admissions annually. It is in our

interest to implement the outcomes

framework. I look forward to further

discussions with him and very happy

to meet with him if he wishes.

Does

the Minister, who I know cares

deeply, share my concern that when

lung capacity is damaged in

childhood it can often never

recover? Isn't that a powerful

reason we need to make significant

progress on air quality issues?

Absolutely. I have just returned

from the G7 health ministers

meeting. One of the subject under

discussion was environmental factors

and climate change and its impact on

public health. There were many areas

in which we have challenging

discussions, but the air quality and

its impact on respiratory disease

was not one of them.

I gather it was

in Rome, is that correct?

Milan.

Sharon Hodgson.

Under this

government we have seen lung disease

admissions to A&E double, rise at

double the rate of general

admissions. This is more concerning

when the bulk of admissions happen

over the winter months, when A&E

department are under significant

pressure. Will the Minister

committed today, now, to introduce a

long disease strategy, and ensure

that we can reverse -- reverse these

worrying trends and the pressure on

people's lives and the NHS?

Indeed

Milan but we don't mention football

any more. I hear it is a touchy

subject. Very topical. There is no

new plan for any National strategy

on this but we work closely with

charities like the British Lung

foundation, and we have to remain

committed to implementing the

outcomes framework. We are better

prepared for a winter than we have

been before. She's right to raise

this.

Question seven.

With

permission I will take question

seven and 20 together. We are fully

engaged with the highest level of

government work on Brexit. The

Secretary of State is a member of

the Cabinet committee on Brexit and

is engaged on all areas where Brexit

may impact health and social care.

We are actively considering

implications on the workforce,

medicine, equipment regulation, life

sciences, public health, research

and data.

I thank the Minister for

his reply. Is he aware of the latest

figures released this month from the

nursery and midwifery Council which

confronts a clear trend? The number

of nurses and midwives leaving the

register alongside a drop of those

coming to work from Europe. Does he

agree these dramatic figures should

set alarm bells ringing in Whitehall

and every UK health Department?

It

is the case that we have been

reliant for much of the increase in

this country, both doctors and

nurses, on doctors and nurses coming

from the EU. A reduction in that

increase is something we are

watching carefully. I gently say to

the honourable gentleman that the

last figures we had at the end of

June, there were three South -- 3000

more technicians working in the NHS

in England than in the gym before.

Brexit may well result in the loss

of both rights for people with

disabilities. Wembley release the

funds into the health and social

care sector? -- when will the

Minister release?

The honourable

gentleman is looking for answers

about the social care. My honourable

friend, the Minister for social

care, has made it clear they will be

a paper published in due course. I'm

afraid he will have to be more

patient.

My right honourable friend, the

Secretary of State, Eddie made a

welcome statement about the

contribution of EU citizens to the

health and social care sector. Could

the Minister kindly advise us what

is being done at a trust level to

support overseas workers from the EU

and elsewhere to ensure they feel

welcome, and that they are

encouraged to stay here as long as

possible?

I am very grateful to my

honourable friend forgiving me the

opportunity to reaffirm the

commitment of the NHS from the

centre right through every

organisation for whom EU citizens

are working, but they are welcome

here, my right honourable friend,

the member for Holden price

yesterday made it clear that we are

looking to have a simple,

straightforward and cheap means for

those who are here at the point of

departure to be able to register to

stay here. We want to encourage all

those working for the NHS to

continue to do so, wherever they

come from.

A visit to the hospital

in April to Kettering Hospital

confirmed that... Isn't it the case

and it has always been the case the

NHS has recruited from outside the

EU and will continue to do so after

Brexit?

My honourable friend is

quite right. There has been a

long-standing tradition of this

country welcoming professionals from

outside through various waves of

migration that go back over several

decades. It is important to point

out to my honourable friend that the

Secretary of State announced one

year ago a 25% increase in doctors

in training in this country, and

earlier this autumn a 25% increase

in nurses to be trained in this

country come so that we become less

reliant on overseas clinicians at a

time of some 2 million shortage

worldwide.

Being a member of the

European medicines agency has

allowed early access for UK patients

to new drugs. It also plays a

crucial role in quality control and

safety monitoring. So what solution

has the department come up with to

ensure timely access to new drugs

after Brexit? But also, that any

convocations are spotted early?

As I

indicated in my answer to the first

question earlier, finding an

appropriate relationship with the

DMA pulsed Brexit is one of the core

strands of work the Department is

doing. On Monday of next week the

other EU nations will vote to decide

which country will host the new EEM

eight. We have made clear we are

looking for mutual recognition.

With

the World Trade Organisation not

having updated its drug lists since

2010, all new drugs developed in the

last seven years could incur

tariffs. What contingencies have

been made to avoid shortages and

increase costs in the event of a no

deal Brexit?

We are looking for a

relationship with the EU to ensure

we have tariff free access to the

single market, including for drugs

and medicines, because that is such

a critical element of our economy

and the life sciences industry.

There are contingencies being put in

place in the event of no deal. She

will have to wait, as will the rest

of us, to see of that eventuality

happens. We don't want that to

occur. It is not our intent.

Adult

smoking prevalence is now 15.5%, the

lowest ever. In July, we published a

tobacco control plan for England

which sets out conditions to reduce

smoking still further and commits us

to a series of actions to deliver

those ambitions. Our end goal is a

smoke-free generation.

I thank my

honourable friend for that answer.

One of the most effective ways of

helping people to give up smoking is

the provision of smoking cessation

services. In Harrow, where the local

unit actually managed to help 4000

people attempt to give up smoking,

of which more than 50% did so, the

answer to that has been to close the

unit, which I think is very

ineffective. Will you take action to

ensure that doesn't happen across

the country?

He's right to raise it.

Local authorities are best placed to

take local spending decisions, not

ministers in Whitehall. But they

must be accountable for their

decisions. That is why we publish

information at local authority

level, so local decision-makers can

be held to account. We offered

expert support from Public Health

England. In holding Harrow to

account, I have a strong feeling he

will continue to do that.

I am a

reformed smoker. It was quite a

battle to do it. I wonder what

proposals Her Majesty's government

have to enlist people to help to

kick the weed. We know how to do it.

What an honourable gentleman he is.

What an offer! Plans in all areas

are two draw up local plans across

the NHS, including the public health

prevention agenda. I suggest he

volunteered his services and I

suspect they will take his hand off.

Jackie Doyle-Price.

On November the

3rd we published our response to the

accelerated access review. We set

out to give patients quicker access

to life-saving treatments. We are

delighted that Sir Andrew witty will

chair the group, which will

fast-track products each year.

The technologies used at the new

Natal unit are now considered

essential by my constituents

Invergordon. It serves 500,000

people within 90 minutes of

Aberdeen. What assessment has the

Minister made of the importance of

proximity to local communities?

I'm

pleased to hear that. It is good to

know we are on track to achieve our

ambition to reduce the rates of

stillbirth, neonatal and maternal

deaths, as well as perinatal 20% by

2020. Innovations like Aberdeen have

contributed to this. It is important

that our regional committees have

access to specialist care of the

kind he describes.

Is the Minister

aware that over 60% of health

innovation research funding goes to

the Golden Triangle, and less than

13% goes to the North? Given that

Manchester and the north-west has

got a life sciences hub and we have

got an evolution of health, isn't it

about time we got our fair share to

ensure we can close the gap with

some of those health outcomes?

I

can't disagree with the point of the

honourable lady makes. One of the

reasons that we have said up this

accelerated access review and

Patrick is to make sure we do invest

where innovation is taking place,

and there is no reason why

Manchester cannot be a part of this.

Mr Speaker... It goes back a long

way. Mr Speaker... One of the

innovative treatments being offered

in my own constituency, which

concerns me, is that of puberty

blockers and hormone replacement

therapy for children identifying

themselves as transgender. Does the

Minister agree that an improvement

would mean restricting these two

under 18s? --?.

At the risk of

prolonging the hilarity, my

honourable friend does in fact

raises serious point. Health is a

devolved matter in Wales. The NHS in

England has strict guidelines

regarding the restrictions on

puberty blockers and hormone

replacement therapy. They may only

be prescribed by a multidisciplinary

team and careful assessment of the

individual, and we keep a watching

eye on these matters.

Liberal

Democrat competition.

Jo Swinson.

Thank you, Mr Speaker. A strong UK

pharmaceuticals industry is

important for ensuring the NHS can

access innovative treatments, but

there is uncertainty over whether UK

qualified persons, people who

certified medical products and

devices as safe, would be able to

continue to do so for European

countries post Brexit Allsup I would

ask the Minister will when will

there be clarity about the future

European relationships regarding

medical advice approval?

I can

confirm we have actual offered

mutual recognition but she is right

to raise this very important

subject. It is central to this that

we maintain safety across the NHS

and access to pharmaceuticals is

part of this.

Ministers have had no such

discussions. The procurement of

local health services by means of

competitive tendering is a matter

for the local clinical commissioning

group. Greenwich clinical

commissioning group is an

independent statutory organisation

responsible for commissioning

services from local people. To

ensure the best outcomes...

That is an incredibly complacent

response from the Minister. This has

gone up by 14% in six months, the

cost of this contract allocated to a

private divider. They claimed that

the Greenwich scrutiny committee was

due to a 14% increase in the tariff

costs of health services. My local

health care trust says that is 0.6%.

How does he explain that increase

and why isn't the department looking

into these private companies that

are naming their price when they

have won the contract?

It is a factual answer and I think

it is an important one to make.

Actually it increases in tariff and

it would have applied any provider

and not just circle. I'm Sapporo --

I am sorry he does not support this.

I understand previous services were

delivered by a number of providers.

And different patient experience. I

think it is a step forward.

Question

11, Mr Speaker.

After the Prime

Minister announced an independent

enquiry into the effects of blood,

the department consulted on that

enquiry and the Cabinet office

updated the House on the 3rd of

November and said it would be a

statutory enquiry under the 2005 act

and the Cabinet office would be the

sponsoring department. The business

service authority started

administering the new blood payment

support scheme on the 1st of

November.

Mike Amesbury.

From April

next year those affected by

contaminated blood, including people

in my constituency, could face

considerable cuts in discretion of

support as the business service

authorities could not reveal this.

Will the Minister give a guarantee

that absolutely nobody will be left

worse off as part of this review?

I

can give the honourable gentleman

that assurance and that will form

part of the statement I gave on the

response to the consultation we

undertook earlier.

Discretionary

payments will be maintained. The

Minister will be aware the integrity

of blood products is underpinned by

a common European agreement on

standards. Can she assure the House

she has spoken to other ministers

across Europe to make sure whether

or not there is a deal that

standards will be fully maintained

subsequent to Brexit?

I can confirm

that is very much part of the

discussions we are having. In truth,

the common standards are shared

across Europe in any case and we

will continue.

Question number tell

world, Mr Speaker. -- number 12.

The

response of the expert working group

on hormone pregnancy tests will be

published tomorrow. There will be a

ministerial statement with a copy of

the report. It follows a review of

all available data by a panel with

expertise in science and health

care.

I will come the minister's

statement. But there are some

questions about the opaque nature of

the enquiry and many constituents of

mine have had lives blighted as have

many others by the hormone pregnancy

drug. Will he appeared before the

select committee and look at the way

that enquiry was conducted? Will he

consider a public enquiry so

families can get truth and justice

about how they had been affected by

this drug?

I thank her for that. I

think it would be premature to

consider issues of liability before

considering the strength of evidence

and seeing the report which we will

study carefully. The report will

conclude whether there is a casual

association and if it had adverse

outcomes to pregnancy and we look

forward to seeing its outcomes and

recommendations.

Number 13, Mr

Speaker.

There is no fixed timetable

for STPs to become accountable care

systems. Evolution into one or more

is dependent on an STP demonstrating

it is working in a locally

integrated health system.

Commissioners and providers in

partnership with local authorities

would need to choose, to assume

collective responsibility, for

resource and public health and the

criteria will be set out in the NHS

England next steps forward review.

Last week NHS doctors set out to

account for a judicial review

against plans to use secondary

legislation to enable private

companies to run large parts of the

ACOs. The county care organisations.

I think the Government understands

that doctors, nurses, patients and

the public would like an NHS run for

the public by the public, using

public funding. Ultimately will you

make sure we have time in this place

for members to discuss and

scrutinise the ACOs which are a

drastic change to our NHS?

I think

the best thing he can do in getting

to understand what STPs are really

about is to talk to the recently

appointed chair of the Norfolk and

Waverley STP covering his local

area. It will find the former Labour

Secretary of State can give him very

good advice, Patricia Hewitt.

Number

14, Mr Speaker.

Thank you again, Mr

Speaker. NHS England has a duty to

commission dental services to meet

local needs, including for the most

deprived groups. Nationally access

continues growing with 1.9 million

more patients seen between 2010 and

2016. The starting well programme,

I'm sure she is aware of, will help

children under five and in 13, high

need areas, the programme is also

working to improve access and oral

health.

In my constituency seven

people per day are going into

accident and emergency because of

toothache. The poorest among stars

are twice as likely to be

hospitalised for dental care. Yet

there is no mention of dental care

in the five-year forward planning

and funding has fallen by 15% since

2010. Why is the minister leaving my

constituents in pain and burdening

accident and emergency by neglecting

dental care?

I am interested to hear

the honourable lady say that.

According to the survey the January-

March 2017 survey, they were

published in July this year those

trying to get a dental appointment

in Newcastle and Gateshead, 97% were

successful compared to 95% England

average.

Topical questions, Stuart C

McDonald.

As well as congratulating

the Minister for Public health for

being an excellent ambassador for

the United Kingdom happy health

Summit in Milan, I would also like

to congratulate Colchester NHS

foundation trust for exiting special

measures. They are the 23rd trust to

do so. They were in special mazes

longer than any other trust and the

fact they got a good rating for

compassion and the effectiveness of

their care and leadership is a huge

tribute to the hard-working staff.

Back in July ministers said they

would make sure patient access to

innovative medicine was protected

through strong regulatory framework

and sharing data. Can he confirm the

UK will definitely sign up to the

clinical trial regulation system so

we do not have to seek

pharmaceutical companies moving

trials overseas?

That is absolutely

our intention. We have signalled to

the European Union and European

countries we want the closest

possible relationship after Brexit.

We have made the big and generous

offer and we hope it will be

accepted.

Thank you, Mr Officer

Dibble Speaker. In my constituency

we had the outstanding rated wording

hospital and practices and also the

Sussex and Surrey STP, rated in

category four, needs most

improvement. Part of the problem is

it is too big and does not follow a

natural footprint. Will he bought a

local call for it to be withdrawn

and make it fit for purpose and

sustainable? -- will he support a

local call.

STP footprints were as a

result of discussion with NHS

England and reflect patient flow,

the location of different

organisations in the health economy

and natural geography. We stayed at

the next steps that it was open to

discussion between ourselves and NHS

England about adjusting boundaries

where there was a collective request

by local organisations and we mean

that.

Thank you, Mr Speaker. Last

month there was a closure of 190

community pharmacies. It was clear

that this action was a result of

pharmacy budgets. Does the Minister

had any idea how many community

pharmacies are at risk of closure

because of government cuts? What

assessment has he made of the likely

impact of a closure on the patience

and wider NHS? Will he joining me in

asking the Chancellor to adequately

fund this vital service? -- will he

be joining me.

She will have to wait

for the budget as everybody else. We

monitor the market carefully in the

community pharmacy sector. Access to

pharmaceutical services is very good

in England, with 88% of people

falling within a 20 minute walk of a

community pharmacy. For areas with

fewer pharmacies, the access scheme

continues to provide more protection

and a growing number of Internet

pharmacies offer greater choice.

Pharmacies are a critical part of

the primary care infrastructure in

the country.

Thank you, Mr Speaker.

Months ago a hospital came out

special measures with improvements

to patient safety being among the

most notable highlights in the

report. Given the success in my

local area can my honourable friend

and former house of progress E is

making to boost patient safety

across the rest of the country?

I am

happy to do that. I had a very good

visit to Medway recently. Leslie

Dwyer and her team are doing a

fantastic job. They had real

challenge is to turn the trust

around but succeeded and the staff

did amazingly well. In truth we

still have far too high levels of

avoidable harm across the NHS. I

want us to be the safest in the

world and that is why the next few

months we will have campaigns to

improve maternity safety, deal with

medication error and improve the

transparency when there are

avoidable deaths.

Can I raise the

issue of mesh implants? It has been

great with me by constituents. A

report in the United States

indicates associated pain, headaches

and aching pains and joints, can I

ask if he is looking at this issue

and incident giving the announcer

saying it is a matter for the

devolved administration, it would be

instructive if I could get an answer

because it would help inform the

Scottish government, Aggie.

He

raises an issue which is of concern

to many women up and down the

country. -- thank you. Nobody could

not be moved by the injuries they

are experiencing. We now have 18

centres of specialist care which can

treat those women. The advice we

still receive is within narrow cases

are stressing, mesh remains the best

possible string that. It will be

kept under review and I know my

honourable friend is meeting the

all-party group to consider this in

greater detail.

The James Paget

Hospital at Gholston are doing great

work under great pressure and have

highlighted the Clinical

Commissioning Group have got two

different regulators. Does my

honourable friend agree it would be

sensible to have one body overseeing

both organisations, to avoid

duplication and redirect funding to

the front line?

He makes a very

important point. We have no plans

for legislative change. But we do

want closer working between NHS

improvement and NHS England on the

ground so people working in

constituencies in areas such as his

are only getting one set of

instructions and we are making good

progress.

I have repeatedly asked

and yet again I ask the Secretary of

State if he will visit my area to

see for himself the damaging impact

the downgrades and closure of local

hospital services in Dewsbury and

Huddersfield will have on my

constituents will stop I'm very

happy to -- --.

I'm happy to accept

our invitation to visit her area and

I will do. What I know I will see

when I go there is the right 8300

more people being treated within

four hours at her local hospital.

There are 42 more doctors and 56

more nurses than 2010.

Thank you.

Can I thank the Secretary of State

for the help he gave for my hospital

in my constituency? One problem is

Somerset pays the lowest amount of

money to keep people in homes in the

peninsular. That is putting more

people into the hospital. Can he

offer advice on how we can get round

this issue?

I am happy to do that.

It is very straightforward. We

listened hard when local authority

said they needed more support for

the social care budget and put an X

to £2 billion into this year's

budget. -- extra £2 billion. Expect

all local authorities to play their

part in reducing pressure on

hospitals.

If the health secretary

does visit Huddersfield and

Dewsbury, can I join the party? I

know he wants... I will not spoil

his visit but I would remind him I

would liken to meet our local Vice

Chancellor, at the teaching hospital

in Huddersfield, they would be

interested if the money was

available to start one up. Will he

meet my Vice Chancellor when he

comes you Dewsbury and Huddersfield?

I met him on June the 24th last

year. He is a splendid chap.

I would

be delighted to meet his Vice

Chancellor in principle but the

decision of where the medical

schools will be based will be

independent of me, because I have a

constituency interest in that issue,

as well.

Rural communities and towns

like new without an accident and

emergency desperately need a high

performing ambulance service.

Midlands ambulance services across

the country are generally missing

their targets. It is not a new

problem. It began when Labour's

disastrous regionalisation of Andy

Lynch and services was put in place.

But it needs to end an improvement

is replied. -- required. -- of

ambulance services was put in place.

I am aware the performance of east

Midlands ambulances is not what we

would like at present. The strategy

being adopted is to introduce the

new and villains response programme

and at present there is a

consultation with staff going on to

introduce new working models to

bring that into effect. -- the new

facilities response programme.

Does

he share my concern that Lloyds

pharmacy is announced 190 branch

closures across England because of

funding cuts, exacerbated by rising

drug costs and cash row problems --

flow problems? And why is it 30% of

pharmacies in one constituency can

get the access scheme but only 1.3%

in Hull can do the same?

It is a rural constituency. She

asked me about the Lloyds pharmacy

announcement. When I first heard

that news my thought was not to play

politics but for the staff affected.

As I said at the all-party group,

Lloyds have made a commercial

decision. We don't yet know which

pharmacies will close. We do know

that 40% of promises within a timid

walk -- ten minute walk of two or

others.

There were GPs who prescribe

homoeopathy and acupuncture and the

system we have is that we allow GPs

to decide whatever they think is in

the clinical interest of their

patients. Is that still his position

and is he aware of the Parliamentary

petition in favour of homoeopathy?

Consistency personified. It is the

responsibility of local NHS

organisations to make decisions on

the commissioning and funding of any

health care treatments for NHS

patients, including homoeopathy.

Alternative medicine can in

principle feature in a range of

services offered including those by

GPs.

What safeguards will be

Secretary of State put in place to

ensure that NHS trusts do not

finance the lifting of the pay cap

by making staff cuts, downgrading

roles are reducing terms and

conditions under the guise of

reforms?

NHS trusts are under

pressure to make very ambitious

efficiency savings anyway. We have

listened carefully to the case that

they would not be able to make

further efficiency savings to

finance an increase in pay beyond

the 1%.

Congratulations for noticing

it is actually me behind this

extremely impressive facial growth

for Alzheimer, which is extremely

serious Bremain's mental health.

Three out of four suicides... Willie

Minister commit to renew this

government's relentless pursuit of

parity in mental health and physical

health?

Yes, indeed. The moustache

is impressive. I am a big supporter

of the cause because I think it has

a positive mindset. It is very

honest. One in eight men in the UK

have experienced mental health

problems, three adults four suicides

are men. We welcome the which

focuses on prostate cancer,

testicular cancer and the

partnerships they build with mental

health services in the NHS and

across the charity sector. I wish my

honourable friend well with his

growth.

Wildie department urgently

review waiting times targets for

children to access mental health

services? Even if cams in my

constituency wrist -- achieves its

targets, more than 100 children need

to make more than nine weeks for

their first appointment.

She is

absolutely right. That is totally

unacceptable for anybody who is a

parent. It is far too long. That is

why we decided to have a Green paper

on children's mental health and we

hope to publish it soon.

In their

annual State of care report, the

Care Quality Commission have

highlighted there are 4000 fewer

nursing home beds in England than in

2015. What plans does the Secretary

of State have to address the

workforce and funding issues that

lie behind this? Will he meet with

me to discuss the situation in my

own constituency and nationally?

I

would like to congratulate her on

becoming chair of the liaison

committee. I am always happy to meet

her. That is a very important issue.

Our figures show the number of

nursing home beds as distinct from

the number of nursing homes is

broadly stable. But there is real

pressure, there are real issues

around market failing.

The South

Cumbria area is one of the few

places in England where patients

needing the least complex

radiotherapy must travel longer than

the maximum 45 minutes recommended

by the advisory group. In the

consultation, which will close on

the 18th of December, will you make

sure that access to radiotherapy

within 45 minutes is a Greek

criteria in allocating resources? --

a key criteria.

I'm grateful to the

honourable gentleman for raising

this point. I would just say to him

that we are absolutely aware of the

need for more radiographers and

stenographers are available to

support facilities right across the

country. We currently have some 200

radiographers in training and I

would like him to write to me so we

can flag up the specific point he

raises.

Local A&E serving my

constituents in Kent now have 24-7

mental health services thanks to

this government's determination to

improve mental health care. Can my

right honourable friend assure me

that the government will fulfil its

commitment to increase mental health

spending by at least 1 billion by

2020?

We are absolutely committed to

that. We're spending 1.4 alien more

than three years ago. There is more

we need to invest. -- 1.4 million.

For people who believe in parity of

esteem, being able to get help

quickly in a mental health crisis as

quickly as you can go to A&E for a

physical health crisis, is one of

the big gaps we have to fill.

I know

the Secretary of State will be

impressed and will eventually...

However, I am very, very proud of

the collaboration going on between

Saint St Helens Council and the CCG

and the hospitals. What is needed is

additional resources. You will see

the good news that is made of it.

But they cannot deliver everything

required without the additional

resources. Will you help us, please?

I recognise the picture. I did have

an excellent visit to the hospital.

They are doing some fantastic work

on patient safety. Collaboration is

better than it has been before

between the partners and the local

health economy but there are

financial pressures. We will have a

million more over 75s in ten years

in this country, that is why we have

committed to increase resources

going into the NHS and the social

care system.

The NHS STP review in my region

recently recommended all acute

services be maintained at North

Devon Hospital, a welcome decision

and a victory for the community.

With the minister work with me and

local NHS managers to ensure the

clinical need identified can be

fully delivered?

I share the

ambition of the honourable

gentleman. I much enjoyed visiting

his hospital in Barnstable during

the summer. I have been impressed by

the way in which the four trust? In

Devon providing acute services have

decided to come together and provide

a collaborative tool of their ED

staff to ensure each hospital is

adequately covered. That is a model

we can adopt.

The health committee

heard attaining a diagnosis of

autistic spectrum disorder can often

be a postcode lottery. Wildie

department now seek to publish data

to ensure we know where trained

clinicians are positioned across NHS

England, to ensure that workforce

planning is undertaken

appropriately?

I can give the

honourable lady and assurance we

will be publishing that data in the

New Year. It is very important that

we work hard to make sure that

people can get a timely diagnosis.

That means we are working to get

referrals seen more promptly, but

recognising that actually the time

taken to give a full diagnosis will

take some time.

Recruitment and

retention is just one reason why my

hospital trust is currently going

through the special measures

process. With the Secretary of State

pay tribute to the staff in

Lincolnshire, and will you agree

that part of the challenge they face

on recruitment and retention will be

solved via medical School in

Lincolnshire?

If I may say, that

question was absolutely beautifully

put! I have met the staff at Lincoln

Hospital, having been to all the

hospitals in the trust. Very nice to

see the lady in her place! But

indeed, one of the key priorities,

wherever the new medical schools